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From the Journals

Fathers' Mental Health Improves with Group Therapy: Study

A cluster randomized trial found that a group parenting intervention for fathers with postpartum depression led to significant improvements in paternal mental health and child social-emotional development, with 75% of participants attending 10 or more of the 12 sessions.

Conexiant

A cluster randomized clinical trial conducted in Karachi, Pakistan found that a nonspecialist-delivered psychosocial intervention may improve symptoms of male postpartum depression compared with treatment as usual.

In the study, published in JAMA Psychiatry, researchers evaluated the effectiveness of Learning Through Play Plus Dads (LTP + Dads), an integrated parenting skills intervention for depressed Pakistani fathers.

The trial included 357 fathers with a DSM-5 diagnosis of major depressive episode and a child younger than 30 months. The participants were randomly assigned to undergo either LTP + Dads (n = 171) or treatment as usual (n = 186). The primary outcome was change in 17-item Hamilton Depression Rating Scale (HDRS-17) score at 4 months.

The study was conducted between June 2018 and November 2019 in two large towns in Karachi. Participants were recruited from basic health units and randomized in a 1:1 ratio to either LTP + Dads or treatment as usual. The intervention consisted of 12 group sessions delivered by community health workers over 4 months, combining parenting skills training, play therapy, and cognitive behavior therapy.

Assessments were completed at baseline, 4 months, and 6 months postrandomization. Secondary outcomes included anxiety symptoms; parenting stress; intimate partner violence; functioning; quality of life; and child social, emotional, and physical health outcomes.

Among the key findings were:

  • Fathers in the intervention group showed significantly greater improvements in HDRS-17 scores at 4 months (group difference ratio [GDR] = 0.66, 95% confidence interval [CI] = 0.47–0.91, P < .001) and 6 months (GDR = 0.67, 95% CI = 0.48–0.93, P < .001) compared with fathers in the control group.
  • Remission rates (HDRS-17 score ≤ 7) were significantly higher in the intervention group at both time points.
  • The intervention group demonstrated improvements in anxiety symptoms, parenting stress, intimate partner violence, disability, and health-related quality of life at 4 months.
  • Children of fathers in the intervention group showed improved social-emotional development scores at 6 months (mean difference = –20.8, 95% CI = –28.8 to –12.9, P < .001).

At 4 months, the intervention group showed significant improvements compared to the control group in:

  • Anxiety symptoms (GDR = 0.62, 95% CI = 0.48–0.81, P < .001)
  • Parenting stress (GDR = –12.5, 95% CI = –19.1 to –6.0, P < .001)
  • Intimate partner violence (GDR = 0.89, 95% CI = 0.80–1.00, P = .05)
  • Disability (GDR = 0.77, 95% CI = 0.61–0.97, P = .03)
  • Health-related quality of life (GDR = 12.7, 95% CI = 0.17–0.34, P < .001).

Improvements in depression and parenting stress were sustained at 6 months. The intervention group also showed greater improvements in parental knowledge and attitudes at 4 months (mean difference = 2.3, 95% CI = 1.3–3.4, P < .001) and dyadic adjustment scores (GDR = 10.8, 95% CI = 5.8–15.8, P < .001).

Fathers in the intervention group completed a mean of 10.3 (standard deviation = 2.6) of the 12 sessions, with 75% attending 10 or more sessions.

The findings provided evidence for the effectiveness of a nonspecialist-delivered psychosocial intervention in improving paternal mental health and child development outcomes in a low-resource setting. The integrated approach of LTP + Dads, combining parenting skills, play therapy, and cognitive behavior therapy, may offer a comprehensive solution to address male postpartum depression (PPD) and its associated impacts on family well-being.

Limitations of the study included the short follow-up period, potential social desirability bias caused by self-reported measures, and limited generalizability to rural settings or higher socioeconomic populations in Pakistan.

The researchers suggested that future research should include partner-inclusive studies, longer follow-up periods, and exploration of digital delivery methods to enhance scalability in low- and middle-income countries.

In conclusion, this cluster randomized clinical trial demonstrated the potential of LTP + Dads to improve paternal mental health and child development outcomes in Pakistan, offering a promising approach to address the high rates of male PPD in low-resource settings.

Conflict of interest disclosures can be found in the study.