Depression and anxiety are common in the perinatal period. Between 10-15% of women will have depression and possibly more will experience substantial levels of anxiety during this time. These maternal mental health difficulties, even in the early stages of pregnancy, can translate into significant problems for the mother and her wider family, including the developing child. It’s important that women and their families have access to the best forms of help at this time.

It’s also critical that we consider the possibility of prevention. The majority of women who have experienced poor mental health in the postnatal period report that it is a continuation of an illness they were experiencing prior to their child’s birth, rather than a new episode. It is also estimated that half of the cases of perinatal depression and anxiety in the UK are not detected. Given this, the potential benefits of universal prevention programmes, early in pregnancy, are very appealing.

This paper sets out to address some of the gaps in our knowledge in this area. It is a systematic review and meta-analysis, conducted with the aim of identifying modifiable partner factors (where professional intervention is not required) that have been associated with perinatal depression and anxiety. In doing this, the authors aimed to highlight which factors should be selected as targets for universal prevention interventions in the future.

Method

A search (electronic databases and forward citation search) was conducted for studies published in peer review journals that:

• Employed a case-control, longitudinal, cross sectional or retrospective study design
• Analysed one or more modifiable partner factors assessed during pregnancy or up to 12 months postpartum
• Assessed depression or anxiety diagnoses during pregnancy or up to 12 months postpartum as outcome variables

Separate meta-analyses were carried out for each partner factor and outcomes in the following time frames:

• Factors assessed during pregnancy predicting antenatal outcomes
• Factors assessed during pregnancy predicting postnatal outcomes
• Factors assessed following childbirth predicting child outcomes

Results

120 publications reporting 245 associations with depression and 44 with anxiety were included.

Although there were many factors identified in the studies, the ones with the most consistent evidence were:

• Emotional closeness and global support were identified as protective factors for both perinatal depression and anxiety.
• Communication, low levels of conflict, and high support (emotional, relationship and instrumental support) were found to be protective factors for depression only.

Conclusions

This review found that there are specific partner-related factors that may protect against the development of anxiety and depression in the perinatal period. Some of these are potentially modifiable, and the authors conclude that future interventions should aim to:

enhance relationship satisfaction, communication, and emotional closeness, encourage provision of instrumental and emotional support, and minimise conflict between partners.

The authors also acknowledge that there are gaps in the published research, which has meant that inferences could not be made for a number of factors (such as partner stress). This could mean that potential targets for intervention have been missed. This relates perhaps especially to perinatal anxiety, as there were far fewer studies looking at perinatal anxiety, compared to the numbers focused on depression.

Comments

This is a clearly reported systematic review which nicely summarises the partner-related factors that can be modified to potentially reduce the risk of perinatal depression and anxiety.

Most of the studies included in the analysis were cross-sectional which means that limited conclusions can be made here about causality. Indeed the identification of risk factors in this way is a first, essential step to improving health. Now interventions need to be developed and tested to see if changing these risk factors actually improves maternal mental health and wider family functioning and health. There are some interventions addressing the couple relationship that are available, as the authors acknowledge, but there is still much to be done in really establishing which interventions might work, and for whom.

One of the limitations of the study which the authors highlight is that these findings are not necessarily generalizable to single parent families or families where the parents are not in an intimate relationship. It is important that other relationships in the family and social circle of pregnant women and new mothers are considered, as these might provide alternative sources of social support. This review was able to include some aspects of couple relationships, but one aspect not included was that of coparenting, which may be particularly important when thinking about outcomes for the child. The concept of coparenting can include other family members or parents who are no longer living together in considering the whole family system around the child.

This excellent review further highlights the importance of good partner relationships in terms of maternal mental health in particular, and strengthens the argument for considering this as a priority for intervention, as the quality of this relationship can affect family health in multiple ways.

Link

Primary paper

Pilkington, Pamela D. et al. (2015) Modifiable partner factors associated with perinatal depression and anxiety: A systematic review and meta-analysis. Journal of Affective Disorders , Volume 178 , 165-180. [PubMed abstract]