Couple-Focused Prevention at the Transition to Parenthood, a Randomized Trial: Effects on Coparenting, Parenting, Family Violence, and Parent and Child Adjustment

Advancing Research and Measurement on Fathering and Child Development

Fathers are more than social accidents. Research has demonstrated that fathers matter to children's development. Despite noted progress, challenges remain on how best to conceptualize and assess fathering and father-child relationships. The current monograph is the result of an SRCD-sponsored meeting of fatherhood scholars brought together to discuss these challenges and make recommendations for best practices for incorporating fathers in studies on parenting and children's development. The first aim of this monograph was to provide a brief update on the current state of research on fathering and to lay out a developmental ecological systems perspective as a conceptual framework for understanding the different spaces fathers inhabit in their children's lives. Because there is wide variability in fathers' roles, the ecological systems perspective situates fathers, mothers, children, and other caregivers within an evolving network of interrelated social relationships in which children and their parents change over time and space (e.g., residence). The second aim was to present examples of empirical studies conducted by members of the international working group that highlighted different methods, data collection, and statistical analyses used to capture the variability in father-child relationships. The monograph ends with a commentary that elaborates on the ecological systems framework with a discussion of the broader macrosystem and social-contextual influences that impinge on fathers and their children. The collection of articles contributes to research on father-child relationships by advancing theory and presenting varied methods and analysis strategies that assist in understanding the father-child relationship and its impact on child development.

Prospective, dyadic links between posttraumatic stress disorder symptoms and family violence in the early years of parenthood

Cross-sectional research has suggested that posttraumatic stress disorder (PTSD) symptom severity may be an important predictor of family violence perpetration; however, causal inference is limited by the absence of studies designed to prospectively predict family violence by PTSD symptoms. In the current study, PTSD symptoms were assessed among 250 trauma-exposed heterosexual couples 10 months after having their 1st child. The number of acts of psychological and physical intimate partner aggression (IPA) and parent-to-child aggression (PCA) that occurred during the past year was assessed at 10 and 24 months postpartum to account for stability in family violence perpetration when prospectively predicting perpetration. Longitudinal actor-partner interdependence models revealed that women's and men's PTSD symptoms positively predicted increases in the frequency of their own perpetration of psychological and physical IPA as well as psychological PCA. Additionally, partners' PTSD symptoms prospectively predicted psychological and physical IPA perpetration but not psychological or physical PCA perpetration, suggesting that partners' PTSD symptoms may directly impact dyadic processes during incidents of IPA but may not generally affect the family environment in a way that potentiates all forms of aggression. No significant gender differences were revealed. Overall, results of the current study largely support existing research and theory while clarifying inconsistencies that have emerged when examining cross-sectional associations. Further, the current results highlight the potential utility of PTSD treatment as an avenue for aggression prevention and intervention efforts during the early parenting years. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The prevalence of intimate partner violence among couples signing up for universally offered parent preparation

BACKGROUND

Intimate partner violence (IPV) during pregnancy can have serious health consequences for mothers and the unborn child. Nevertheless, IPV is seldom addressed in the context of parent preparation.

AIM

This study aimed to map the prevalence, direction, and severity of IPV in a sample of expectant couples signing up for universally-offered parent preparation.

METHOD

A total of 1726 Danish couples expecting their first child provided data on physical and psychological IPV by completing the Family Maltreatment measure during the second trimester of pregnancy.

RESULTS

In 18.5% of the couples, at least one partner reported psychological or physical IPV acts during the past year. In more than 8% of couples, one or both partners reported acts and impacts above the ICD-11 threshold for clinically-significant IPV (CS-IPV) during the past year (3.6% physical CS-IPV, 5.3% psychological CS-IPV, and 0.8% both physical and psychological CS-IPV). Among couples with physical IPV below the clinical threshold, pregnant-woman-to-partner (50%) and bidirectional (38.2%) IPV were more common than partner-to-pregnant-woman IPV (11.8%). Among couples with physical CS-IPV, pregnant-woman-to-partner (36.1%), partner-to-pregnant-women (29.1%) and bidirectional (34.4%) forms were equally common. Among couples with psychological IPV, pregnant-woman-to-partner (54.9%) and partner-to-pregnant-woman (39.6%) IPV were more common than bidirectional IPV (5.5%).

DISCUSSION

The prevalence of violence was markedly higher in this study compared with previous reports from the Nordic region and highlights a previous oversight of a substantial and clinically significant level of pregnant-woman-to-partner IPV-as well as the reverse. Data from this study call for IPV to be addressed in universally offered parent preparation programs.

Fathers' perpetration of intimate partner violence and parenting during early childhood: Results from the Fragile Families and Child Wellbeing Study

BACKGROUND

Experiences of intimate partner violence (IPV) victimization negatively impact maternal parenting. However, little is known about the association between fathers' perpetration of IPV and paternal parenting.

OBJECTIVE

To examine associations between fathers' IPV perpetration against the child's mother and fathers' stimulation and spanking practices with their young child.

PARTICIPANTS AND SETTING

We used two waves of data from the Fragile Families and Child Wellbeing Study in the United States. The analytic sample comprised of 2,257 biological fathers who had been in a romantic relationship with the child's mother.

METHODS

Fathers' IPV perpetration at year 1 and 3 was measured based on maternal report. Fathers were categorized into: never perpetrators (no IPV at either year), persisters (IPV at both years), desisters (IPV at year 1 only), and emergers (IPV at year 3 only). Fathers' parenting at year 3 was measured based on self-reported stimulation (e.g., reading books, playing games, telling stories) and spanking.

RESULTS

Approximately one-third of fathers never perpetrated IPV, 35.8% were persisters, 14.4% were desisters, and 16.9% were emergers. For stimulation, persisters (β=-0.16, 95% CI: -0.25, -0.06) and emergers (β=-0.25, 95% CI: -0.36, -0.14), but not desisters (β=-0.02, 95% CI: -0.14, 0.11), were less engaged in stimulation than fathers who never perpetrated IPV. However, for spanking, there were no differences in the associations by father IPV profiles.

CONCLUSIONS

Findings suggest that fathers' perpetration of IPV is related to their stimulation practices. Partner-abusive men and their children may benefit from parenting programs that promote engagement in stimulation and improve the quality of parent-child relationships.

The Effectiveness of Parent Training Programs for Child Maltreatment and Their Components: A Meta-Analysis

This is the first meta-analytic review investigating what components and techniques of parent training programs for preventing or reducing child maltreatment are associated with program effectiveness. A literature search yielded 51 studies (N = 6670) examining the effectiveness of parent training programs for preventing or reducing child maltreatment. From these studies, 185 effect sizes were extracted and more than 40 program components and techniques were coded. A significant and small overall effect size was found (d = 0.416, 95% CI (0.334, 0.498), p < 0.001). No significant moderating effects were found for contextual factors and structural elements (i.e., program duration, delivery location, and delivery setting). Further, no significant moderating effects were found for most of the coded program components and techniques, indicating that these components are about equally effective. Only a few program components and techniques moderated program effectiveness, however these effects were negative. These results indicated that improving parental personal skills, improving problem solving skills, and stimulating children’s prosocial behavior should not be the main focus of parental training programs for preventing and reducing child maltreatment. This also holds for practicing new skills by rehearsal and giving direct feedback in program sessions. Further clinical implications and directions for future research are discussed.

Dyadic Coping in Foster and Biological Parents and Its Relation to Child Psychopathology

Abstract. This study investigated whether foster parents’ reports of their dyadic coping competencies differ from biological parents, whether there are differences with regard to the temporal associations between maternal and paternal dyadic coping in the two samples, and whether parental dyadic coping competencies predict future mental health problems in children. A total of 94 foster children and 157 children living in their biological families, both samples aged 2–7 years, as well as their (foster) parents were assessed three times over a 12-month period. The mothers’ and fathers’ dyadic coping competencies were assessed using the Dyadic Coping Inventory (DCI). Child psychopathology was assessed using the Child Behavior Checklist (CBCL) and a standardized clinical interview (Kinder-DIPS), both mainly based on maternal report. Foster parents reported better dyadic coping competencies across the three assessments than did biological parents. There were no significant differences with regard to the temporal associations between mothers’ and fathers’ report over time between the two samples. Cross-lagged panel models yielded a high within person stability across the three assessments for both, mothers and fathers (actor effects), as well as some significant interpersonal effects primarily from paternal to maternal dyadic coping (partner effects). In contrast to the expectation, mothers’ and fathers’ dyadic coping did not predict child mental health problems at the third assessment. The results make an important contribution to the research on dyadic coping and on how child mental health problems affect parental dyadic coping competencies and vice versa.

Parents' PTSD symptoms and child abuse potential during the perinatal period: Direct associations and mediation via relationship conflict

BACKGROUND

Posttraumatic stress disorder (PTSD) symptoms are associated with parental aggression towards children, but little is known about the relation between parents' PTSD symptoms and their risk for perpetrating child physical abuse during the early parenting years, when the potential for prevention of abuse may be highest.

OBJECTIVE

To examine direct associations between mothers' and fathers' PTSD symptoms and child abuse potential, as well as indirect effects through couple relationship adjustment (i.e., conflict and love) in a high-risk sample of parents during the perinatal period, most of whom were first-time parents.

PARTICIPANTS AND SETTING

From March 2013 to August 2016, data were collected from 150 expecting or new parental dyads in which the mother was participating in a home visiting program.

METHODS

Data were analyzed using the Actor-Partner Interdependence Mediation Model.

RESULTS

For mothers and fathers, there were direct associations between PTSD symptom severity and child abuse potential (βs = .51, ps <.001), and this association for fathers was stronger at higher levels of mothers' PTSD symptoms (β = .15, p =  .03). In addition, parents' own and their partners' PTSD symptoms were each indirectly associated with parents' own child abuse potential through parents' report of interparental conflict (standardized indirect effects = .052-.069, ps = .004) but not love.

CONCLUSIONS

Addressing parents' PTSD symptoms and relationship conflict during the perinatal period using both systemic and developmental perspectives may uniquely serve to decrease the risk of child physical abuse and its myriad adverse consequences.

Cross-day influences between couple closeness and coparenting support among new parents

The couple and coparenting relationships are demonstrated to be prospectively and bidirectionally associated over months to years during the early parenting years. However, little is known about these associations at the daily level within the first year of parenthood, when coparenting first emerges. The goal of the current study was to examine the association between couples' daily feelings of relationship closeness and coparenting support in first-time parents and determine directionality of these effects using a dyadic daily diary design. At 10 months postpartum, heterosexual couples (N = 141 dyads) completed daily diaries for 8 consecutive days. An autoregressive cross-lagged model was incorporated within an Actor Partner Interdependence Modeling framework to examine at the daily level: (a) within-person cross-day associations between relationship closeness and coparenting support, (b) cross-partner cross-day associations within relationship closeness and coparenting support, (c) cross-partner cross-day associations between relationship closeness and coparenting support, and (d) gender differences in these associations. Results revealed a prospective, within person bidirectional link between daily relationship closeness and perceived coparenting support for both mothers and fathers. Additionally, an indirect effect from mothers' experiences of coparenting support to fathers' relationship closeness through fathers' experiences of coparenting support was found at the daily level. Findings highlight the interdependent nature of the couple and coparenting relationship at the daily level during the first year of parenthood and suggest that mothers' feeling supported by their coparenting partners may facilitate a "virtuous cycle" between coparenting support and relationship closeness early in the coparenting relationship. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Chapter II: New Fathers' and Mothers' Daily Stressors and Resources Influence Parent Adjustment and Family Relationships

To understand new fathers' experiences and well-being, we examine links between fathers and their partners' replenishing and stressful daily experiences-exercise, sleep, work, chores, general stress, and parenting stress-and their own and their partners' well-being and family relations. Fathers and mothers of ten-month old infants (N=143/140 mothers/fathers) in the U.S. reported on daily experiences for eight consecutive days. Results of multilevel models indicated that more replenishing and fewer stressful daily experiences were generally linked to more parent happiness, better couple relations, and greater closeness with the infant. Several gender differences also emerged that may reflect different stress and coping processes or different social roles for mothers and fathers; most striking was that on days that fathers spent more time on chores, mothers reported greater couple closeness but fathers reported more arguments. This exploration of new parents' daily experiences demonstrates the value of the method to generate intervention-relevant insights, as well as the importance of examining fathers' (and mothers') experiences in the context of couple-level dynamics.

Primary Prevention of Intimate Partner Violence Among Recently Married Dyads Residing in the Slums of Pune, India: Development and Rationale for a Dyadic Intervention

BACKGROUND

Intimate partner violence (IPV) is frequently experienced by women of low socioeconomic status in India. It is a human rights violation and associated with negative effects on physical and mental well-being, underscoring the need for effective prevention strategies.

OBJECTIVE

This study aimed to develop a dyadic intervention for the primary prevention of IPV among newly married couples residing in slum communities in India.

METHODS

The intervention was developed using a community-based, mixed-methods design rooted in couple-interdependence theory and guided by the intervention mapping (IM) framework. It used the six critical IM steps to inform the content and delivery of the intervention: (1) needs assessment, (2) preparation of matrices of change objectives, (3) selection of theory-based methods and practical applications, (4) production of intervention components and materials, (5) intervention adoption and implementation, and (6) evaluation planning.

RESULTS

The resulting Ghya Bharari Ekatra (Take a Flight Together) intervention is intended to be delivered in 6 weekly sessions by a trained pair of male and female lay community educators to groups of 3 to 5 newly married couples in the community in which they reside. It uses games, discussions, self-reflections, and skill-building exercises to cover the following topics: enhancing relationship quality time, self-esteem and resilience, communication and conflict management, goal setting and implementation, sexual communication and sexual health and reproductive health knowledge, and redefining and challenging norms surrounding IPV occurrence. The formative work guided the protocol, including module duration and timing (2-hour sessions of convenience to participants), ordering of modules (based on potential level of interest and sensitivity of the topics), content (ie, informed scripts of role plays and films), intervention delivery methods (ie, interactive activities), and selection of the interventionists (based on capacity to connect with participants) and venue (community-based, convenient, and safe spaces). Ghya Bharari Ekatra was piloted between January and May 2018, and evaluation is presently underway.

CONCLUSIONS

Ghya Bharari Ekatra is evidence-based, grounded in intervention-mapping, and developed and iteratively refined using a community-based participatory research approach, suggesting it has great potential to be an acceptable and effective solution to preventing IPV among newly married couples.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03332134; https://clinicaltrials.gov/ct2/show/NCT03332134.

A Randomized, Controlled Trial of the Impact of the Couple CARE for Parents of Newborns Program on the Prevention of Intimate Partner Violence and Relationship Problems

Effective, accessible prevention programs are needed for adults at heightened risk for intimate partner violence (IPV). This parallel group randomized controlled trial examines whether such couples receiving the American version of Couple CARE for Parents of Newborns (CCP; Halford et al. 2009) following the birth of a child, compared with controls, report fewer first occurrences of clinically significant IPV, less frequent physical and psychological IPV, and improved relationship functioning. Further, we test whether intervention effects are moderated by level of risk for IPV. Couples at elevated risk for IPV (N = 368) recruited from maternity units were randomized to CCP (n = 188) or a 24-month waitlist (n = 180) and completed measures of IPV and relationship functioning at baseline, post-program (when child was 8 months old), and two follow-ups (at 15 and 24 months). Intervention effects were tested using intent to treat (ITT) as well as complier average causal effect (CACE; Jo and Muthén 2001) structural equation models. CCP did not significantly prevent clinically significant IPV nor were there significant main effects of CCP on clinically significant IPV, frequency of IPV, or most relationship outcomes in the CACE or ITT analyses. Risk moderated the effect of CCP on male-to-female physical IPV at post-program, with couples with a planned pregnancy declining, but those with unplanned pregnancies increasing. This study adds to previous findings that prevention programs for at-risk couples are not often effective and may even be iatrogenic for some couples.

Opening windows of opportunities: Evidence for interventions to prevent or treat depression in pregnant women being associated with changes in offspring's developmental trajectories of psychopathology risk

Although animal models and correlational studies support a model of fetal programming as a mechanism in the transmission of risk for psychopathology from parents to children, the experimental studies that are required to empirically test the model with the human prenatal dyad are scarce. With a systematic review and meta-analysis of the literature, we critically examined the evidence regarding the neurobiological and behavioral changes in infants as a function of randomized clinical trials to prevent or reduce maternal depression during pregnancy, treating randomized clinical trials as experiments testing the fetal programming model. Based on 25 articles that met inclusion criteria, we found support for interventions designed to change maternal prenatal mood being associated with changes in offspring functioning, but with a very small effect size. Effect sizes ranged broadly, and were higher for younger children. The findings enhance understanding of putative mechanisms in the transmission of risk from women's prenatal depression to infants' vulnerabilities to, and early signs of, the development of psychopathology. We note limitations of the literature and suggest solutions to advance understanding of how preventing or treating depression in pregnant women might disrupt the transmission of risk to the infants.

Couples' relationship affects mothers' and fathers' anxiety and depression trajectories over the transition to parenthood

BACKGROUND

The association between the couple relationship and the mothers' and fathers' psychological adjustment to the transition to parenthood has been examined in the literature. However, the direction of effects between these variables has not been extensively explored. This study aimed to assess the direction of effects between mothers' and fathers' positive and negative interactions and anxiety and depression symptoms trajectories over the transition to parenthood.

METHODS

A sample of 129 couples (N = 258) completed self-report measures of positive and negative interactions, anxiety and depression symptoms at each trimester of pregnancy, at childbirth, and at 3- and 30-months postpartum. Dyadic growth curve models were performed using multilevel modeling.

RESULTS

Whereas anxiety and depression showed no moderation effect on positive and negative interactions over time, negative interaction moderated depression from 3- to 30-months postpartum. Mothers and fathers with high negative interaction scores experienced a steeper increase in depression from 3- to 30-months postpartum. Additionally, gender moderated the effect of positive interaction on anxiety from 3- to 30-months postpartum. Fathers with low positive interaction scores experienced an increase in anxiety, whereas fathers with high positive interaction scores and mothers with high or low positive interaction scores did not experience changes in anxiety from 3- to 30-months postpartum.

LIMITATIONS

Despite the longitudinal aspect of the models, a possible causal relationship need to be taken with caution.

CONCLUSIONS

Our results suggest that mothers' and fathers' positive and negative interactions affect their anxiety and depression symptoms trajectories: negative interaction raises mothers' and fathers' depression symptoms and positive interaction prevents the increase of fathers' anxiety symptoms over the postpartum period.

Spouses' prenatal autonomous motivation to have a child and postpartum depression symptoms

OBJECTIVES

Maternal postpartum depression symptoms (PDS) are linked with negative personal, family, and child developmental outcomes. However, paternal PDS, let alone dyadic process, are understudied. Grounded in the Self-Determination Theory of motivation, this longitudinal study examined whether mothers' and fathers' type of prenatal motivation to have a child predicted depression symptoms 3-6 months after birth.

METHOD

The data (N = 90 heterosexual couples) were analyzed using the Actor-Partner Interdependence Model.

RESULTS

Dyadic analyses showed that a person's prenatal autonomous motivation to have a child significantly predicted own PDS and partner's PDS. Importantly, these finding were equivalent across genders.

CONCLUSIONS

The findings highlight the importance of dyadic prenatal motivational processes as antecedents of PDS.

Family and Child Outcomes 2 Years After a Transition to Parenthood Intervention

OBJECTIVE

To examine the impact from Family Foundations, a transition-to-parenting intervention, on parent and child outcomes 2 years after birth.

BACKGROUND

Couples transitioning to parenthood face many stressors and challenges that are not typically addressed through commonly available childbirth preparatory classes. The Family Foundations program was designed for couples expecting their first child and addresses family stressors related to coparenting, parenting, and mental health.

METHOD

The recruited sample of 399 couples expecting their first child were randomly assigned to intervention or control conditions. Data were obtained through home observation and parent surveys before and after intervention.

RESULTS

Intent-to-treat analyses indicated effects on several targeted domains including coparenting, parenting, and relationship quality, as well as on child sleep habits and internalizing behavior problems at 2 years of age. Effects for several outcomes were larger for those couples at greater risk based on pretest observed negative dyadic communication styles.

CONCLUSION

Longer term impact found here on parent and child outcomes provides new evidence of the effectiveness of this program for first-time parents.

IMPLICATIONS

Programs directed toward broader issues related to aspects of coparenting, parenting, and mental health have the potential to have longer term positive impact on the couples and the developing child.

Predictors of Program Use and Child and Parent Outcomes of A Brief Online Parenting Intervention

Web-based parenting interventions have the potential to increase the currently low reach of parenting programs, but few evidence-based online programs are available, and little is known about who benefits from this delivery format. This study investigated if improvements in child behavior and parenting, following participation in a brief online parenting program (Triple P Online Brief), can be predicted by family and program-related factors. Participants were 100 parents of 2-9-year-old children displaying disruptive behavior problems. Regression analyses showed that higher baseline levels of child behavior problems, older parental age and more intense conflict over parenting pre-intervention predicted greater improvement in child behavior at 9-month follow-up. Improvement in parenting was predicted by higher pre-intervention levels of ineffective parenting. Family demographics, parental adjustment and program related factors did not predict treatment outcomes. Younger child age and lower disagreement over parenting pre-intervention predicted completion of the recommended minimum dose of the program.

A process model of the implications of spillover from coparenting conflicts into the parent-child attachment relationship in adolescence

Drawing on a two-wave, multimethod, multi-informant design, this study provides the first test of a process model of spillover specifying why and how disruptions in the coparenting relationship influence the parent-adolescent attachment relationship. One hundred ninety-four families with an adolescent aged 12-14 (M age = 12.4) were followed for 1 year. Mothers and adolescents participated in two experimental tasks designed to elicit behavioral expressions of parent and adolescent functioning within the attachment relationship. Using a novel observational approach, maternal safe haven, secure base, and harshness (i.e., hostility and control) were compared as potential unique mediators of the association between conflict in the coparenting relationship and adolescent problems. Path models indicated that, although coparenting conflicts were broadly associated with maternal parenting difficulties, only secure base explained the link to adolescent adjustment. Adding further specificity to the process model, maternal secure base support was uniquely associated with adolescent adjustment through deficits in adolescents' secure exploration. Results support the hypothesis that coparenting disagreements undermine adolescent adjustment in multiple domains specifically by disrupting mothers' ability to provide a caregiving environment that supports adolescent exploration during a developmental period in which developing autonomy is a crucial stage-salient task.

A Dyadic Perspective on PTSD Symptoms' Associations with Couple Functioning and Parenting Stress in First-Time Parents

Posttraumatic stress disorder (PTSD) symptoms are associated with disruptions in both couple functioning and parenting, and limited research suggests that, among military couples, perceptions of couple functioning and parenting stress are a function of both one's own and one's partner's mental health symptoms. However, this work has not been generalized to civilian couples, and little is known about the associations between PTSD symptoms and family adjustment in specific family developmental contexts. We examined PTSD symptoms' associations with perceived couple functioning and parenting stress within a dyadic context in civilian couples who had participated in a randomized controlled trial of a universal, couple-based transition to parenthood program and at least one member of the couple reported having experienced a Criterion A1 traumatic event. Results of actor-partner interdependence models revealed that parents' own and partners' PTSD symptoms were negatively associated with perceived couple functioning; contrary to expectation, the association of partners' PTSD symptoms with perceived couple functioning was strongest among men who received the intervention. A parent's own PTSD symptoms were positively associated with parenting stress for both men and women and were unexpectedly strongest for men who received the intervention. Partner PTSD symptoms were also positively associated with increased parenting stress for both men and women. Findings support a dyadic conceptualization of the associations between spouses' PTSD symptoms and family outcomes during the transition to parenthood and suggest that participating in a couple-based, psychoeducational program during this phase in the family life cycle may be particularly salient for men.

Preventive Effects on Birth Outcomes: Buffering Impact of Maternal Stress, Depression, and Anxiety

OBJECTIVE

Although maternal stress, anxiety, and depression have been linked to negative birth outcomes, few studies have investigated preventive interventions targeting maternal mental health as a means of reducing such problems. This randomized controlled study examines whether Family Foundations (FF)-a transition to parenthood program for couples focused on promoting coparenting quality, with previously documented impact on maternal stress, depression, and anxiety-can buffer the negative effects of maternal mental health problems.

METHODS

To assess the effects of FF, we used a randomized block design with a sample of 259 expectant mothers assigned to FF or a control condition and analyzed using propensity score models. We examine two-way interactions of condition (intervention vs. control) with maternal mental health problems (financial stress, depression, and anxiety) on birth outcomes (birth weight, days in hospital for mothers and infants). For birth weight, we assess whether intervention effects depend on length of gestation by including a third interaction term.

RESULTS

FF buffered (p < 0.05) the negative impact of maternal mental health problems on birth weight and both mother and infant length of post-partum hospital stay. For birth weight, assignment to FF was associated with higher birth weight for infants born before term.

CONCLUSIONS

These results demonstrate that a psycho-educational program for couples focused on enhancing mutual coparental support, with preventive effects on maternal mental health, can reduce incidence of birth problems among women at elevated risk. Such improvements in birth outcomes could translate into substantial reductions in public and personal healthcare costs. Future work should assess mediating mechanisms of intervention impact and cost-benefit ratio of the intervention.

CLINICAL TRIALS REGISTRATION

The Family Foundations follow-up intervention study is currently registered with www.clinicaltrials.gov . The study identifier is NCT01907412.