Engaging Couples in an Online Intervention to Improve Perinatal Mental Health

Background and Purpose: Untreated perinatal mood and anxiety disorders (PMADs) have short- and long-term consequences for mental, physical, developmental, social, and economic outcomes affecting the mother, infant, family, and community. Online health interventions effectively treat mental health disorders and increase access to care for people at risk of experiencing PMADs. Successful interventions utilize cognitive behavioral therapy to deliver psycho-educational materials, targeting women at various perinatal times, and suggest the content applicable for key support people (i.e., partner, family, friends). Perception of social support is known to be protective for PMADs, and partners are a primary source. However, less is known about engaging the couple in preventative programming, and few studies have included or recruited partners.

Design and Methods: This pilot study is one of the first to engage couples (N = 31) in a sequential, mixed-methods research project using randomized control trial to test the efficacy of an existing Online Mothers and Babies Course (eMB) for reducing symptoms of anxiety, depression, or perception of stress and adds a new population of participants in the programming-the couple. Participants were cluster-randomized as treatment with eMB or control. Validated instruments were used to measure anxiety, depression, and stress outcomes three times over eight weeks. An intent-to-treat analytic strategy using a factorial ANOVA with repeated measures on group and couple roles (i.e., pregnant woman or partner) and SPSS was used to test the study hypotheses. Post-hoc comparisons were conducted when higher-order interactions were significant. An inductive, thematic analysis was used to analyze qualitative data from post-study intervention group interviews (n = 15). Data were coded with Dedoose analytic software; primary and secondary themes were identified and defined in response to the study research question. Data from surveys and interviews were used to explore participant satisfaction and feelings about partner support while using eMB.

Results: There were significant higher-order interactions for all hypotheses. Pairwise comparisons revealed significant role differences for anxiety and depression at various study times, with partners scoring lower than pregnant women on average. Similarly, there were significant differences between women across groups for anxiety and perception of stress in favor of the intervention. In general, participants found the eMB satisfactory and suggested thoughtful inclusion of partner-related materials. Regarding feelings about partner supportiveness, participants described eMB as promoting PMAD awareness for both members of the couple and described engaging in, or becoming aware of socio-cultural tensions including “end goal” thoughts and behaviors, partners putting off their mental health needs in efforts to be supportive of the pregnant woman, and women describing feeling like “a vessel”.

Conclusions and Implications: In sum, eMB participants were satisfied with the course content, yet there was a clear desire for material applicable and relatable to all end users indicating the need for modifications in future studies. Inclusion of partners in accessible interventions may increase perceived support within couples through increased awareness of perinatal mental health experiences and needs. Addressing socio-cultural tensions through education, policy, and practice changes more supportive of perinatal mental health are needed.