Motivating paternal empathy and egalitarian attitudes to prevent maternal postpartum depressive symptoms: A randomized controlled trial

OBJECTIVE: To evaluate the effectiveness of a motivation-based intervention for fathers to enhance empathy and egalitarian gender-role attitudes, aiming to prevent maternal postpartum depressive symptoms. METHODS: This was a single-blind, parallel-group randomized controlled trial conducted at a regional hospital in Japan. Eligible couples were recruited during the postpartum stay if the mother had a full-term birth and no psychiatric history. From October 2023 to November 2024, 262 fathers were enrolled and randomly assigned to the intervention or control group. The brief online intervention was delivered at 1 month postpartum. Follow-up assessments were conducted at 3 months (n = 221) and 6 months (n = 220). The primary outcome was maternal depressive symptoms (Japanese version of the Edinburgh Postnatal Depression Scale [EPDS]). Secondary outcomes included paternal gender-role attitudes, empathy, childcare and housework involvement, and paternal depressive symptoms. RESULTS: Sociodemographic variables were comparable between study arms. Maternal postpartum depression (EPDS ≥ 9) was 4.5% in the intervention group and 9.3% in the control groups (adjusted odds ratio [aOR] 0.45; 95% confidence interval [CI]: 0.14-1.50). With respect to paternal outcomes, the intervention arm significantly reduced traditional gender-role attitudes at 3 months (-1.74; 95% CI: -3.08 to -0.40) and 6 months (-1.52; 95% CI: -2.98 to -0.07), but no significant differences were observed in mother-rated paternal empathy or childcare and housework involvement. CONCLUSION: The intervention shifted paternal gender-role attitudes towards greater equality and flexibility, but did not produce measurable changes in paternal behavior or maternal depressive symptoms. Further studies are needed to confirm these findings. TRIAL REGISTRATION: The trial was registered with the UMIN Clinical Trials Registry (trial registration number: UMIN000051884. URL: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000058421).