Internet-Delivered Cognitive Behavioral Therapy for Fathers With Postnatal Depression: Randomized Controlled Trial of DadBooster

Abstract Background Up to 1 in 10 fathers experience postnatal depression. Fathers are less likely to seek help and receive adequate treatment than depressed mothers. Digital treatments hold significant potential for engaging and supporting fathers, but no effective program exists. Objective The aim of the study is to evaluate the efficacy of an online cognitive behavioral therapy program, DadBooster, for treating postnatal depression in fathers. Methods A parallel, 2-group randomized controlled trial (N=50) was conducted to test the superiority of DadBooster over waitlist control who received routine care. Randomization was computer-generated, with allocation concealment maintained through central, computer-automated administration. Participating fathers were aged 18 years or older, had a baby younger than 12 months, had a depression diagnosis using the Quick Structured Clinical Interview for DSM-5 (QuickSCID-5), were not receiving depression treatment, and did not meet criteria for other mental health disorders. They were recruited Australia-wide and completed questionnaires online and assessments by telephone. Primary outcomes were depression symptom severity (Depression Anxiety Stress Scales-21 [DASS-21]) and depressive episode remission (QuickSCID-5) 12 weeks after enrollment. Participants were not blinded. Assessments (QuickSCID-5) and data analysis were conducted blind to allocation. Results Participants (N=50) were randomized (DadBooster: n=25; waitlist control: n=25) and analyzed as assigned; the trial is complete. Mean depression symptoms (DASS-21) at 12 weeks were significantly lower for DadBooster than waitlist control (adjusted mean difference −7.26, 95% CI −11.34 to −3.18; F 1,47 =12.81; P <.001; η p 2 =0.21); average scores reduced by 72% (compared to 40% in waitlist control) and dropped to the “normal” range at 12 weeks. Of the DadBooster participants assessed, 2 of 23 (9%) still met diagnostic criteria (QuickSCID-5) at 12 weeks compared with 7 of 24 (29%) waitlist controls; not significant (Fisher exact test: P =.14). Significant differences were found for stress (adjusted mean difference −6.55, 95% CI −11.01 to −2.09; F 1,47 =8.73; P =.005; η p 2 =0.16), parenting self-efficacy (adjusted mean difference 4.06, 95% CI 1.16-6.95; F 1,47 =7.93; P =.007; η p 2 =0.14), and negative automatic thoughts (adjusted mean difference −18.10, 95% CI −29.79 to −6.42; F 1,47 =9.71; P =.003; η p 2 =0.17). Participants engaged well with the intervention—80% (20/25) visited 4 or more sessions—and attrition was low. No adverse events were identified. Conclusions This randomized controlled trial demonstrates the efficacy of DadBooster, the first online treatment targeting clinically diagnosed postnatal depression in fathers, addressing a critical gap in the treatment of postnatal depression, an area that has until recently been primarily focused on mothers. By providing evidence for an intervention specifically designed for fathers with potential for broader scalability, this study advances the limited literature on treatment approaches for postnatal depression in fathers. Given its accessibility, privacy, and convenience, DadBooster is a promising and potentially impactful intervention for supporting fathers.