When we think of postpartum depression (PPD), we often picture new mothers struggling with mood changes, exhaustion, and feelings of being overwhelmed. But did you know that up to 10% of fathers globally experience postpartum depression too? (Cameron et al., 2016; Rao et al., 2020). This hidden struggle is even more common in low- and middle-income countries (LMICs), where financial stress, limited healthcare access, low education and lack of social support can exacerbate the issue (Husain et al., 2011).
For many dads, PPD does not always look like sadness. It can show up as anxiety, obsessive thoughts, irritability, or even physical symptoms such as headaches or stomach issues (Matthey et al., 2003; Zelkowitz & Milet, 2001). These struggles can make it harder for fathers to bond with their infant, support their partner, or feel present in their new role as a parent (Zelkowitz & Milet, 2001). Sadly, when PPD goes unnoticed, it can also affect children, increasing their risk of developmental and emotional challenges, such as developmental delays, behavioural issues, and a heightened risk of mental health problems. Despite the serious impact, male PPD remains under-researched and rarely talked about. Many dads do not seek help because they feel pressure to “stay strong” or do not realise that what they are experiencing is depression (Pedersen et al., 2021). But mental health matters for both parents.
In Pakistan, as many as 1 in 4 dads (23.5%) struggle with PPD (Pedersen et al., 2021; Atif et al., 2022), yet it remains a neglected clinical and research area. While many parenting programmes focus on teaching fathers how to care for their children, very few address the paternal psychological well-being or parental relationship quality.
To bridge this gap, a new clinical trial published in JAMA Psychiatry examined whether Learning Through Play Plus Dads (LTP + Dads), a group-based parenting intervention could help fathers experiencing postpartum depression, when delivered by community health workers. An initial feasibility study in Karachi showed that the programme helped dads feel less depressed, more confident as parents, and more positive about their child’s development (Husain et al., 2021). However, a second study was necessary to rigorously evaluate the programme’s effectiveness on a larger scale. While the feasibility study demonstrated that the intervention was practical and promising, further research was needed to confirm its impact through a more robust study design, ensuring the findings were reliable and generalisable.
Postpartum depression affects fathers too, yet remains overlooked. A new study in Pakistan explores how a community-based parenting intervention can support dads’ mental health.
Methods
What this study was about?
This study assessed the effectiveness of Learning Through Play Plus Dads (LTP + Dads), a psychosocial intervention delivered by non-specialists, in reducing paternal postpartum depression.
How was it done and who took part?
Researchers ran a cluster randomised clinical trial (CRCT) in Karachi (2018–2019), where they randomly assigned dads to different groups without telling the assessors who was in which group. They focused on fathers who were 18 or older, had been diagnosed with major depression (based on DSM-5 criteria), and had a child under 30 months old.
Out of 1,582 dads who were asked to join, 357 were randomly placed into groups (half in the program, half not), and 328 were included in the final analysis. Dads were not included if they had serious physical or mental health issues, struggled with substance use, or had specific plans to harm themselves.
What’s LTP + Dads?
LTP + Dads is a group program that helps dads support their child’s early development while also improving their own well-being. It includes:
- Learning Through Play (LTP) – A visual guide showing how kids grow from birth to age 3, with pictures of parent-child bonding.
- Cognitive Behavioural Therapy (CBT) – Group sessions to help dads manage depression.
- Focus on Fathers – Training on parenting, stress management, budgeting, healthcare, and more.
The program ran for 12 sessions over 4 months. Community health workers led the sessions, but they were not involved in the usual treatment groups to keep results unbiased. Randomisation was done by a neutral statistician, and the researchers assessing the results did not know which dads were in which group.
What outcomes did the researchers measure?
- The primary outcome was depression score change, using the clinician-rated 17-item Hamilton Depression Rating Scale (HDRS-17).
- The secondary outcomes included anxiety, parenting stress, violence, disability and functioning, quality of life, and child health.
- Assessments occurred at baseline, 4 months (end of intervention), and 6 months (2 months postintervention).
Results
What the study found
- The study included 357 dads, with an average age of 31.4 years. The dads in the LTP + Dads group had much better results than those in the usual treatment group (TAU) in several areas, like depression, anxiety, social support, quality of life, and relationship satisfaction.
Key findings
- Depression: The LTP + Dads group showed greater improvement in their depression scores (HDRS-17: score ≤7) compared to those in the usual treatment group at:
- 4 months (HDRS-17: Group Difference Ration (GDR) = 0.66, 95% CI, 0.47 to 0.91, p
- 6 months (GDR = 0.67, 95% CI, 0.48 to 0.93, p
- Social Support & Quality of Life: Fathers in the intervention group reported higher social support (p = .03) and quality of life (p
- Anxiety & Partner Violence: Anxiety symptoms significantly decreased (p p = .05).
- Relationship Satisfaction: Improved in the intervention group at 4 months (GDR = 10.8, 95% CI, 5.8 to 15.8, p
- Self-Esteem: No real difference between groups.
- Parenting Participation: Dads in LTP + Dads attended more sessions—75% completed at least 10 out of 12 sessions.
Child-Related Outcomes
- Emotional Development: Kids of dads in LTP + Dads had better emotional outcomes at 6 months (lower ASQ:SE-2: MD = −20.8, 95% CI, −28.8 to −12.9, p
- General Development: No major differences between groups (ASQ-3 scores).
- Home Environment: Improved at 4 months (higher HOME scale scores: MD = 4.0, 95% CI, 1.6– to 6.4, p = .001), but did not last to 6 months.
- Child Illnesses: No big differences in how often kids got sick.
- Parenting Knowledge & Stress: Dads in the program scored higher on parenting knowledge at 4 months (KAP scale: Mean Difference (MD) = 2.3, 95% CI, 1.3 to 3.4, p p p = .001).
The LTP + Dads programme had benefits for fathers’ mental health and child development, especially in the early months.
Conclusions
The authors concluded that integrated psychosocial interventions, delivered by non-specialised providers, can improve paternal mental health, well-being, and knowledge of child development in low-resource settings like Pakistan.
Further trials of LTP + Dads in diverse settings with detailed neuropsychological assessments and long-term follow-ups will form evidence on the sustainable benefits of the intervention for fathers with PPD and their children.
The authors also suggest that turning the programme into a mobile app could help spread it widely. In the future, involving both parents in the programme could provide even greater benefits for family health and child development.
Community-based interventions can improve paternal mental health in low-resource settings, while future research should explore long-term impacts and digital expansion for wider accessibility.
Strengths and limitations
The study design had several strengths that helped ensure reliable results. To prevent mixing up the groups, community health workers running the intervention were not involved in the usual treatment groups, keeping things clear and separate. An independent statistician used computer-generated randomisation to assign participants, which kept the process fair and unbiased. Furthermore, outcome assessors, as well as the researchers and statisticians analysing the results, were blinded to group allocations, enhancing objectivity and minimising potential bias.
The assessments were conducted by trained research assistants using validated tools, and the data analysis followed an intent-to-treat approach, meaning all participants were included in the results, even if they dropped out, ensuring the results were not skewed. The sample size was carefully planned based on pilot data, factoring in potential dropout rates.
One of the most promising parts of this study was the involvement of community health workers to deliver the intervention. This shows that LTP+ could work well in low-resource areas, and the low dropout rate suggests that it could be expanded in the future. Scaling it up across Pakistan with a larger study would be a good next step.
Overall, the researchers should be commended for conducting this study, which is one of the first randomised controlled trials on paternal postnatal depression; a field that is generally ignored.
However, there were some limitations. The study did not provide much information on how missing data was handled, and it is unclear if participants knew which group they were assigned to, which could have influenced their responses. Additionally, the study was done in semi-urban areas with lower income, where access to healthcare might be limited. The group getting the intervention had extra mental health support, which could have made the results stand out more. However, since they did not collect data on how the usual treatment changed, we cannot fully rule out other treatments that might have affected the results.
Apart from these, the study used self-reported measures, which could lead to social desirability bias (where they report things they think the researchers want to hear or that are more socially acceptable). Future studies could use alternative treatments for comparison to get a better understanding of how LTP+ compares.
A strength was the sample size, which included participants from two large towns in Karachi. However, these results may not apply to fathers in rural areas or those from higher socioeconomic backgrounds. Also, since the study did not follow up for very long, we do not know how long the benefits might last, so more research is needed.
Since the study did not follow up for very long (6 months), we do not know how long the benefits might last, so more research is needed.
Implications for practice
The results suggest that the parenting programme tested in this study could help improve dads’ mental health and child development in LMICs with settings similar to those in this study: two large towns in Karachi, Pakistan.
The study shows that non-specialists can effectively deliver programmes to help dads with postpartum depression, especially in LMICs. Since dads in the program reported better social support, future programmes should focus on building peer support networks, which are key for mental well-being and preventing depression.
The intervention not only helped with depression, but also boosted parenting knowledge, relationship satisfaction, and reduced partner violence. These results suggest that similar programmes could benefit the whole family.
The programme also helped improve kids’ emotional development, showing how important it is for dads to be involved in early childhood. Programmes aimed at fathers should be promoted to improve kids’ growth and development.
Unlike past studies with mothers, this intervention did not show much of an impact on kids’ physical health, which suggests that other strategies might be needed to get dads more involved in areas like hygiene, nutrition, and infection control.
Overall, the success of this intervention shows its potential to be used in other LMICs. Policymakers and program developers should think about adding similar interventions to national mental health and parenting programs. Many dads do not seek help because they feel pressure to “stay strong” or do not realise that what they are experiencing is depression. But mental health matters for both parents, and receiving support is not a sign of weakness—it’s a step toward a healthier, happier family!
The intervention not only helped with depression but also boosted parenting knowledge, relationship satisfaction, and reduced partner violence.
Statement of interests
Author declares no conflict of interests.
Links
Primary paper
Husain, M. I., Kiran, T., Sattar, R., Khoso, A. B., Wan, M. W., Singla, D. R., … & Husain, N. (2025). A Group Parenting Intervention for Male Postpartum Depression: A Cluster Randomized Clinical Trial. JAMA Psychiatry, 82(1), 22-30. https://dx.doi.org/10.1001/jamapsychiatry.2024.2752
Other references
- Cameron, E. E., Sedov, I. D., & Tomfohr-Madsen, L. M. (2016). Prevalence of paternal depression in pregnancy and the postpartum: an updated meta-analysis. Journal of affective disorders, 206, 189-203. https://dx.doi.org/10.1016/j.jad.2016.07.044
- 2. Rao, W. W., Zhu, X. M., Zong, Q. Q., Zhang, Q., Hall, B. J., Ungvari, G. S., & Xiang, Y. T. (2020). Prevalence of prenatal and postpartum depression in fathers: a comprehensive meta-analysis of observational surveys. Journal of affective disorders, 263, 491-499. https://dx.doi.org/10.1016/j.jad.2019.10.030
- Husain, N., Chaudhry, N., Tomenson, B., Jackson, J., Gater, R., & Creed, F. (2011). Depressive disorder and social stress in Pakistan compared to people of Pakistani origin in the UK. Social psychiatry and psychiatric epidemiology, 46, 1153-1159. https://doi.org/10.1007/s00127-010-0279-y
- Matthey, S., Barnett, B., Howie, P., & Kavanagh, D. J. (2003). Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety?. Journal of affective disorders, 74(2), 139-147. https://doi.org/10.1016/S0165-0327(02)00012-5
- Zelkowitz, P., & Milet, T. H. (2001). The course of postpartum psychiatric disorders in women and their partners. The Journal of nervous and mental disease, 189(9), 575-582. doi:10.1097/ 00005053-200109000-00002
- Pedersen, S. C., Maindal, H. T., & Ryom, K. (2021). “I wanted to be there as a father, but I couldn’t”: A qualitative study of fathers’ experiences of postpartum depression and their help-seeking behavior. American journal of men’s health, 15(3), 15579883211024375. https://doi.org/10.1177/15579883211024375
- Atif, M., Halaki, M., Chow, C. M., & Raynes‐Greenow, C. (2022). Risk factors of paternal postnatal depression in Pakistan: findings from an urban sample. Nursing & health sciences, 24(3), 618-624. https://doi.org/10.1111/nhs.12954
- Husain, M. I., Chaudhry, I. B., Khoso, A. B., Wan, M. W., Kiran, T., Shiri, T., … & Husain, N. (2021). A group parenting intervention for depressed fathers (LTP+ Dads): a feasibility study from Pakistan. Children, 8(1), 26. https://doi.org/10.3390/children8010026
