Male mental health is an under-explored area. In a new approach, the program, “Learning Through Play Plus Dads”, provides a group-based parenting intervention. Results show a significant reduction in male postpartum depression, with over 70% of participants experiencing complete remission of symptoms. The protocol also improved child development and strengthened relationships within families. This innovative approach shows that fathers’ well-being is crucial to family dynamics and the emotional growth of children.
Male postpartum depression is an under-reported issue, although its prevalence is beginning to gain attention in the scientific literature. Traditionally, postpartum depression has been associated more with mothers, but there is growing evidence that fathers are also affected, albeit in different ways.
Studies on the prevalence of postpartum depression in men vary, with estimates suggesting that between 4% and 25% of new fathers may experience depressive symptoms within the first year after the birth of their child. The variation in prevalence is due to differences in study methodologies, definitions of postpartum depression, and the cultures in which the studies were conducted.
Symptoms in men may differ from those of mothers. While women tend to report sadness, frequent crying, and anxiety, men may be more irritable, angry, impulsive, or emotionally withdrawn. Stress, changes in family dynamics, financial pressure, and lack of sleep are all factors that can contribute to the onset of depression.
The causes of postpartum depression in men are multifactorial. Hormonal changes, such as a decrease in testosterone levels, may be a factor, as well as increased responsibilities and social pressure to be a “provider” or “support” for the family.
Men with a history of depression or whose spouses/partners are also suffering from postpartum depression are at greater risk of developing the disorder.
Some known risk factors for postpartum depression in men include:
A history of depression or mood disorders.
Unstable or strained marital relationships.
Difficulty coping with new parenting responsibilities.
Financial or work-related stress.
Lack of social support.
Unfortunately, many fathers with postpartum depression do not seek treatment, either because of social stigma, lack of knowledge, or difficulty recognizing symptoms. Treatment may include cognitive behavioral therapy (CBT), psychotherapy, and, in some cases, antidepressant medications. It is also crucial to have adequate support, both emotional and practical, within the family and society.
A study published in JAMA Psychiatry investigated the impact of a psychosocial intervention aimed at postpartum depression in men, comparing the results with usual care. The protocol called Learning Through Play Plus Dads (LTP+Dads), was tested in a randomized clinical trial conducted in Karachi, Pakistan, between June 2018 and November 2019.
The intervention combined parenting skills training, playful play, and cognitive behavioral therapy. The sessions, led by community health workers, took place in groups over 12 meetings spread over 4 months.
The researchers recruited 357 fathers diagnosed with major depressive episodes who had children under 30 months of age. They were randomized into two groups: 171 received the intervention and 186 received usual care.
The primary objective was to measure changes in depression scores after 4 months using the Hamilton Depression Rating Scale. Other factors, such as anxiety, parenting stress, domestic violence, quality of life, and child socioemotional development, were also analyzed.
The results showed that fathers who participated in the LTP+Dads intervention had significant improvements in symptoms of depression, anxiety, parenting stress, and quality of life, with 70% of these fathers showing improvements compared to the group who received usual care. These improvements were maintained after 6 months.
In addition, the children of fathers who received the intervention also showed improvements in socioemotional development.
The psychosocial parenting intervention in this study has the potential to improve paternal mental health and child development. Additional studies in other populations and with longer follow-ups are needed.
Although postpartum depression in men has traditionally been overlooked, there is growing recognition of its importance. Raising awareness is essential to ensure that new fathers receive the emotional and psychological support they need to cope with the complexities of fatherhood.
READ MORE:
A Group Parenting Intervention for Male Postpartum Depression
A Cluster Randomized Clinical Trial
M. Ishrat Husain; Tayyeba Kiran; Rabia Sattar; et al.
JAMA Psychiatry. 2024. doi:10.1001/jamapsychiatry.2024.2752
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.
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