Partners to parents: Development of an on-line intervention for enhancing partner support and preventing perinatal depression and anxiety

Background. Perinatal mood problems are a significant public health issue that adversely affect the individual, compromise the partner relationship, and can have significant deleterious effects on the child’s development. Despite the availability of effective treatments, few parents who experience emotional difficulties during pregnancy or following childbirth seek professional help. The high prevalence of perinatal depression and anxiety and low rates of help-seeking indicate a need for effective universal prevention approaches. Partner support is an ideal target for prevention efforts because it is consistently identified as one of the strongest protective factors against perinatal mood problems. The aim of this thesis by publication was to develop a father and same-sex partner inclusive on-line intervention for preventing perinatal depression and anxiety that enhances partners’ understanding of how they can be mutually supportive of one another during the transition to parenthood. Method. An evidence-informed intervention named Partners to Parents (http://www.partnerstoparents.org) was developed using a mixed methods sequential design. First, a systematic review was conducted to evaluate existing interventions that aim to prevent perinatal depression and anxiety by targeting the intimate partner relationship. Second, the risk and protective factors for perinatal depression and anxiety that are potentially modifiable by partners without professional assistance were identified via a systematic review and meta-analysis. Third, a Delphi consensus study was conducted to translate the research evidence identified by the meta-analysis into specific actions that partners can take to be mutually supportive of one another and reduce their vulnerability to perinatal depression and anxiety. The resulting recommendations were (1) formatted into a guidelines document for dissemination to new and expectant parents, and (2) translated into a prototype of the Partners to Parents on-line intervention. The website was refined through usability testing with a sample of men and women who were pregnant or parenting an infant aged up to 24 months. Results. The initial systematic review of interventions for preventing perinatal distress that address partner support or the couple relationship found that a number of these have shown benefits. Nonetheless, the findings indicated that there remains a need for interventions that are easily accessible, scalable, father-inclusive, and target both antenatal and postnatal outcomes. The systematic review and meta-analysis of risk and protective factors that are modifiable by partners found that there is sound evidence that emotional closeness and partner support protect against perinatal depression and anxiety. There was also sound evidence for the protective effect of communication, emotional and instrumental support, and relationship satisfaction against perinatal depression, while conflict increases risk. The Delphi consensus study recruited two panels of experts in perinatal mental health (21 consumer advocates and 39 professionals) to rate the extent to which they believed a series of actions, derived from a review of academic and lay literature, are important for the prevention of perinatal depression and anxiety. A total of 214 recommendations on how partners can support one another were endorsed as important or essential by at least 80% of both panels, and formed the basis for the content of a prototype of the on-line intervention. Usability testing with 12 parents (7 women and 5 men) to inform development of the website yielded more than 250 comments on system and content quality, potential barriers to accessing the website, and suggestions for improvement. Generally, the findings suggested that the Partners to Parents intervention is perceived as appealing and relevant by expectant and new parents. The feedback also facilitated a series of refinements, including improved graphic design, layout, and navigability, smart phone and tablet compatibility, Search Engine Optimisation, and improved readability. Conclusion. Partners to Parents provides a novel approach to the prevention of perinatal depression and anxiety. It is supported by the research literature, endorsed by perinatal mental health professionals and consumers, and seen as acceptable and relevant by parents. This web-based intervention has the potential to contribute to reducing the public health burden of perinatal depression and anxiety and optimising parental and infant outcomes. Future research is necessary to establish the extent to which the intervention enhances relationship satisfaction and support, and prevents perinatal depression and anxiety.