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Randomized Controlled Trial
. 2025 Jan 1;82(1):22-30.
doi: 10.1001/jamapsychiatry.2024.2752.

A Group Parenting Intervention for Male Postpartum Depression: A Cluster Randomized Clinical Trial

M Ishrat Husain  1   2 , Tayyeba Kiran  3 , Rabia Sattar  3 , Ameer B Khoso  3   4 , Ming Wai Wan  5 , Daisy R Singla  1   2   6 , Madeha Umer  1   7 , Rabdino Mangrio  3 , Paul Bassett  8 , Imran B Chaudhry  5   9 , Shehla N Zafar  10 , Farhat A Jafri  11 , Nasim Chaudhry  3   5 , Nusrat Husain  1   5
Affiliations
Randomized Controlled Trial

A Group Parenting Intervention for Male Postpartum Depression: A Cluster Randomized Clinical Trial

M Ishrat Husain et al. JAMA Psychiatry. .

Abstract

Importance: Male postpartum depression is prevalent across populations; however, there is limited evidence on strategies to address it, particularly in low-income settings.

Objective: To evaluate the effectiveness of Learning Through Play Plus Dads (LTP + Dads), a nonspecialist-delivered psychosocial intervention, in improving symptoms of male postpartum depression compared to treatment as usual.

Design, setting, and participants: This cluster randomized clinical trial was conducted in Karachi, Pakistan, between June 2018 and November 2019. Assessors were blind to treatment allocation. Participants were recruited from 2 large towns in the city of Karachi via basic health units. Fathers aged 18 years and older with a DSM-5 diagnosis of major depressive episode and a child younger than 30 months were recruited. Of 1582 fathers approached, 1527 were screened and 357 were randomized in a 1:1 ratio to either the intervention or treatment as usual; 328 were included in the final analysis. Data were analyzed from April to June 2022.

Interventions: LTP + Dads is a manualized intervention combining parenting skills training, play therapy, and cognitive behavior therapy. The intervention was delivered by community health workers via 12 group sessions over 4 months.

Main outcomes and measures: The primary outcome was change in 17-item Hamilton Depression Rating Scale score at 4 months. Secondary outcomes included anxiety symptoms; parenting stress; intimate partner violence; functioning; quality of life; and child social, emotional, and physical health outcomes. Assessments were completed at baseline and 4 and 6 months postrandomization.

Results: Of the 357 fathers included (mean [SD] age, 31.44 [7.24] years), 171 were randomized to the intervention and 186 to treatment as usual. Participants randomized to the intervention demonstrated significantly greater improvements in depression (group difference ratio [GDR], 0.66; 95% CI, 0.47 to 0.91; P < .001), anxiety (GDR, 0.62; 95% CI, 0.48 to 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 to 1.00; P = .05), disability (GDR, 0.77; 95% CI, 0.61 to 0.97; P = .03), and health-related quality of life (GDR, 12.7; 95% CI, 0.17 to 0.34; P < .001) at 4 months. The difference in depression and parenting stress was sustained at 6 months. Children of fathers randomized to the parenting intervention had significantly greater improvements in social-emotional development scores (mean difference, -20.8; 95% CI, -28.8 to -12.9; P < .001) at 6 months.

Conclusions and relevance: The psychosocial parenting intervention in this study has the potential to improve paternal mental health and child development in Pakistan. Further studies in other populations and with longer follow-up are warranted.

Trial registration: ClinicalTrials.gov Identifier: NCT03564847.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr M. Husain reported grants from COMPASS Pathfinder Limited, other from Mindset Pharma Inc (stock options), and personal fees from Wake Network Inc outside the submitted work; and previously served as trustee for the Pakistan Institute of Living and Learning. Dr N. Chaudhry reported grants from the Pakistan Institute of Living and Learning (principal investigator of the award by Grand Challenges Canada) during the conduct of the study and is the chief executive officer of Pakistan Institute of Living and Learning; Dr N. Chaudhry has also received travel grants from Lundbeck and Pfizer to attend 1 national and 1 international academic meeting and conference in the last 3 years; she is a chief investigator and coinvestigator for several research projects funded by various grant bodies, including the Medical Research Council, Wellcome Trust, National Institute for Health and Care Research, and Global Challenges Research Fund. Dr N. Husain previously served as trustee of the Pakistan Institute of Living and Learning, Abaseen Foundation UK, Lancashire Mind UK, and Manchester Global Foundation; he is an executive member of the Academic Faculty at the Royal College of Psychiatrists, London; he is a National Institute for Health and Care Research senior investigator; and he reports funding from the Mental Health Research for Innovation Centre and the National Institute for Health and Care Research Manchester Biomedical Research Center. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. CONSORT Flow Diagram
LTP + Dads indicates Learning Through Play Plus Dads; PHQ-9, 9-item Patient Health Questionnaire; SCID-5, Structured Clinical Interview for DSM-5.
Figure 2.
Figure 2.. Trajectory of 17-Item Hamilton Depression Rating Scores in Treatment Clusters (HDRS-17)
LTP + Dads indicates Learning Through Play Plus Dads.
See this image and copyright information in PMC

References

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