ImportanceMale postpartum depression is prevalent across populations; however, there is limited evidence on strategies to address it, particularly in low-income settings.ObjectiveTo 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 ParticipantsThis 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.InterventionsLTP + 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 MeasuresThe 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.ResultsOf 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 RelevanceThe 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 RegistrationClinicalTrials.gov Identifier: NCT03564847

中文翻译：

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男性产后抑郁症的集体育儿干预


重要性男性产后抑郁症在人群中普遍存在;然而，关于解决这一问题的策略的证据有限，特别是在低收入环境中。目的评价非专业提供的社会心理干预 Learning Through Play Plus Dads （LTP + Dads） 在改善男性产后抑郁症状方面的有效性。设计、设置和参与者该整群随机临床试验于 2018 年 6 月至 2019 年 11 月在巴基斯坦卡拉奇进行。评估人员对治疗分配不知情。参与者是通过基本卫生单位从卡拉奇市的 2 个大城镇招募的。招募了 18 岁及以上且 DSM-5 诊断为重度抑郁发作的父亲和年龄小于 30 个月的孩子。在接触的 1582 名父亲中，筛查了 1527 名，以 1：1 的比例随机分配了 357 名父亲，接受干预或照常治疗;328 例被纳入最终分析。干预LTP + Dads 是一种结合育儿技能训练、游戏疗法和认知行为疗法的手动干预。社区卫生工作者在 4 个月内通过 12 次小组会议进行干预。主要结局和测量主要结局是 4 个月时 17 项汉密尔顿抑郁量表评分的变化。次要结局包括焦虑症状;育儿压力;亲密伴侣暴力;功能;生活质量;以及儿童的社交、情感和身体健康结果。评估在基线以及随机分组后 4 个月和 6 个月完成。结果在纳入的 357 名父亲 （平均 [SD] 年龄，31.44 [7.24] 岁） 中，171 名被随机分配接受干预，186 名被随机分配接受常规治疗。 随机接受干预的参与者在抑郁方面表现出显著更大的改善（组差比 [GDR]，0.66;95% CI，0.47 至 0.91;P < .001）、焦虑 （GDR，0.62;95% CI，0.48 至 0.81;P < .001）、育儿压力（GDR，-12.5;95% CI，-19.1 至 -6.0;P < .001）、亲密伴侣暴力 （GDR， 0.89;95% CI， 0.80 至 1.00;P = .05）、残疾 （GDR，0.77;95% CI，0.61 至 0.97;P = .03） 和健康相关生活质量 （GDR， 12.7;95% CI， 0.17 至 0.34;P < .001） 在 4 个月时。抑郁和育儿压力的差异在 6 个月时持续存在。随机接受养育干预的父亲的孩子在社交情感发展评分方面的改善显著更大（平均差，-20.8;95% CI，-28.8 至 -12.9;P < .001） 在 6 个月时。结论和相关性本研究中的社会心理育儿干预有可能改善巴基斯坦的父亲心理健康和儿童发展。有必要在其他人群中进行进一步研究并进行更长时间的随访。试验注册临床试验。gov 标识符： NCT03564847