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

Interventions that prevent or respond to intimate partner violence against women and violence against children: a systematic review

Efforts to prevent or respond to intimate partner violence (IPV) and violence against children (VAC) are still disparate worldwide, despite increasing evidence of intersections across these forms of violence. We conducted a systematic review to explore interventions that prevent or respond to IPV and VAC by parents or caregivers, aiming to identify common intervention components and mechanisms that lead to a reduction in IPV and VAC. 30 unique interventions from 16 countries were identified, with 20 targeting both IPV and VAC. Key mechanisms for reducing IPV and VAC in primary prevention interventions included improved communication, conflict resolution, reflection on harmful gender norms, and awareness of the adverse consequences of IPV and VAC on children. Therapeutic programmes for women and children who were exposed to IPV facilitated engagement with IPV-related trauma, increased awareness of the effects of IPV, and promoted avoidance of unhealthy relationships. Evidence gaps in low-income and middle-income countries involved adolescent interventions, post-abuse interventions for women and children, and interventions addressing both prevention and response to IPV and VAC. Our findings strengthen evidence in support of efforts to address IPV and VAC through coordinated prevention and response programmes. However, response interventions for both IPV and VAC are rare and predominantly implemented in high-income countries. Although therapeutic programmes for parents, caregivers, and children in high-income countries are promising, their feasibility in low-income and middle-income countries remains uncertain. Despite this uncertainty, there is potential to improve the use of health services to address IPV and VAC together.

Dyadic sleep intervention for adult patients with cancer and their sleep-partner caregivers: A feasibility study

OBJECTIVES

Sleep disturbances are common among adult patients with cancer and their caregivers. To our knowledge, no sleep intervention to date has been designed to be provided to both patients with cancer and their caregivers simultaneously. This single-arm study aimed to pilot test the feasibility and acceptability, and to illustrate the preliminary efficacy on sleep efficiency of the newly developed dyadic sleep intervention, My Sleep Our Sleep (MSOS: NCT04712604).

METHODS

Adult patients who were newly diagnosed with a gastrointestinal (GI) cancer and their sleep-partner caregivers (n = 20 persons: 10 dyads, 64 years old, 60% female patients, 20% Hispanic, 28 years relationship duration), both of whom had at least mild levels of sleep disturbance (Pittsburgh Sleep Quality Index [PSQI] ≥ 5) participated in this study. MSOS intervention consists of four 1-hour weekly sessions delivered using Zoom to the patient-caregiver dyad together.

RESULTS

We were able to enroll 92.9% of the eligible and screened patient-caregiver dyads within 4 months. Participants reported high satisfaction in 8 domains (average 4.76 on a 1-5 rating). All participants agreed that the number of sessions, interval (weekly), and delivery mode (Zoom) were optimal. Participants also preferred attending the intervention with their partners. Both patients and caregivers showed improvement in sleep efficiency after completing the MSOS intervention: Cohen's d = 1.04 and 1.47, respectively.

SIGNIFICANCE OF RESULTS

Results support the feasibility and acceptability, as well as provide the preliminary efficacy of MSOS for adult patients with GI cancer and their sleep-partner caregivers. Findings suggest the need for more rigorous controlled trial designs for further efficacy testing of MSOS intervention.

Does group-based parent support during the transition to parenthood affect child socio-emotional problems and health care utilization? A randomized controlled trial

As government-funded universal programs for new parents continue to expand, it is critical to investigate their short- and longer-term effects. The level of knowledge, especially on the effect of group-based interventions, is sparse. This study is the second report from a large trial of a widely implemented universal group-based parenting program in Denmark and includes outcomes on child socio-emotional problems and use of health services. A sample of 1701 unborn children from families representative within the area, were randomized to intervention or care as usual beginning November 2014. From these families, 1268 mothers and 999 partners (mean age 29.4 and 31.19, respectively; 6% migration background) filled in the Ages and Stages Questionnaire. Intention-to-treat-analyses showed fewer socio-emotional problems in the intervention group (between-group difference - 2.34, 95% CI [0.40, 4.30], d = - 0.13) as reported by mothers, but not partners, when children were 10 months old. This finding was transitory (no longer significant at 19 months). No effects were found on health care utilization. The previous report from this trial showed no effects on measures of parenting. In total, these findings serve the purpose of adjusting future expectations to the size and type of effect to be gained from a universal parent program in a resourceful setting. We conclude that even if the Family Startup Program (DK: Familieiværksætterne) 2 was liked, well implemented, and well attended by the parents, the positive effect on children's socio-emotional problems, was too modest to be the argument that can carry the weight of policy going forward. PUBLIC SIGNIFICANCE STATEMENT: This study examined the effects of the Family Startup Program (DK: Familieiværksætterne), a universal, group-based program to support parents during the transition to parenthood. Results showed a modest transitory preventive effect on children's socio-emotional problems and no effects on health care utilization. These findings adjust down previous expectations to the size and type of effects to be gained from universal group-based parent support in a well-resourced setting.

Satisfaction with parental responsibilities and disorganized attachment among infants of mothers at risk for depression

Growing attention has been placed on examining the family environment as antecedent of attachment, including the coparenting relationship. Parents' satisfaction with the coparenting relationship may be particularly of interest when parents are at heightened risk for depression, as depression has been consistently linked to negative coparenting, poor quality of parenting, and insecure infant attachment. However, no study has examined the effects of parents' satisfaction with the coparenting relationship on attachment. The present study examined mothers' satisfaction with division of childrearing responsibilities, a component of coparenting, and its longitudinal and cross-sectional links with infant disorganized attachment, examining the quality of mothering as a mediator, in a sample of infants and mothers at elevated risk for depression (N = 234). We assessed maternal depressive symptoms at 3, 6, and 12 months of infant age, mothers' satisfaction with the division of parental responsibilities at 3 and 12 months, the quality of mothering at 6 and 12 months, and infant disorganized attachment at 12 months. Mediation analyses revealed that at 12 months, mothers who were unsatisfied with fathers' childrearing responsibilities had poorer quality of mothering, which in turn was linked to disorganized attachment in their infants. However, the longitudinal indirect association between satisfaction with childrearing responsibilities at 3 months and disorganization at 12 months mediated by maternal parenting at 6 months was not significant. Findings emphasize the importance of partner support in childrearing for mothers at risk for depression in shaping a healthy relationship between mothers and their infants, particularly as infants get older. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supporting the transition to parenthood: a systematic review of empirical studies on emotional and psychological interventions for first-time parents

OBJECTIVES

The transition to parenthood can evoke a range of concerns in parents, profoundly impacting their psychological well-being. The literature regarding the transition to parenthood focuses primarily on functional aspects of parenthood, generally overlooking the psychological well-being of parents.

METHOD

This comprehensive review synthesized studies describing emotional and psychological interventions during the transition to parenthood among participants between 2013 and 2022. A rigorous screening process, conducted by three of the authors, resulted in 18 studies that met the inclusion criteria.

RESULTS

This report provides detailed descriptions of these studies, including their characteristics, demographics, types of interventions, and main outcomes. The majority of interventions focused on mothers and mother-infant dyads, with fewer interventions targeting couples, and none addressing fathers or father-infant dyads.

CONCLUSIONS

The interventions examined were found to be effective in reducing symptoms such as depression, anxiety, and stress among mothers and had positive effects on infants' behaviors, mother-infant synchrony, and co-parenting.

PRACTICE IMPLICATIONS

This review stresses the necessity of interventions targeting the transition to parenthood, especially among fathers and marginalized populations, as well as serves to identify barriers faced by vulnerable and minority populations.

Early parenting interventions to prevent internalising problems in children and adolescents: a global systematic review and network meta-analysis

QUESTION

We compared the effectiveness of different types of parenting interventions based on an a priori taxonomy, and the impact of waitlists versus treatment as usual (TAU), in reducing child internalising problems.

STUDY SELECTION AND ANALYSIS

We conducted a systematic review and network meta-analysis of published and unpublished randomised controlled trials (RCTs) until 1 October 2022 that investigated parenting interventions with children younger than 4 years.

EXCLUSION CRITERIA

studies with children born preterm, with intellectual disabilities, or families receiving support for current abuse, neglect, and substance misuse. We assessed the certainty of evidence using the Confidence in Network Meta-Analysis framework. We used random-effects network meta-analysis to estimate standardised mean differences (SMDs) with 95% credible intervals (CrIs).

FINDINGS

Of 20 520 citations identified, 59 RCTs (18 349 participants) were eligible for the network meta-analysis. Parenting interventions focusing on the dyadic relationship (SMD: -0.26, 95% CrI: -0.43 to -0.08) and those with mixed focus (-0.09, -0.17 to -0.02) were more effective in reducing internalising problems than TAU at the first time point available. All interventions were more effective than waitlist, which increased the risk of internalising problems compared with TAU (0.36, 0.19 to 0.52). All effects attenuated at later follow-ups. Most studies were rated as with 'high risk' or 'some concerns' using the Risk of Bias Assessment Tool V.2. There was no strong evidence of effect modification by theoretically informed components or modifiers.

CONCLUSIONS

We found preliminary evidence that relationship-focused and mixed parenting interventions were effective in reducing child internalising problems, and the waitlist comparator increased internalising problems with implications for waiting times between referral and support. Considering the high risk of bias of most studies included, the findings from this meta-analysis should be interpreted with caution. PROSPERO registration number CRD42020172251.

Contextual considerations in infant sleep: Offering alternative interventions to families

Infant sleep problems are one of the commonly reported reasons parents seek professional help, yet what constitutes a "sleep problem" depends on the models used to explain the development of infant sleep. The current models are based on research conducted in the western context where infant solitary sleeping is the norm. Parent-child co-sleeping is the norm in many cultures around the world. We argue that the primary focus of current research on parent-child interactions as the mediating context for the development of infant sleep problems has inherently made these models and ensuing interventions less sensitive and applicable to infant sleep problems in the context of co-sleeping families. When families present for help with infant sleep difficulties, extinction based behavioral interventions or interventions focused on reducing parental presence at bedtime are commonly recommended. These recommendations may not always align with cultural values and parenting practices of all families, therefore precluding these families from getting necessary help. In attempting to provide families with choices that depart from behavioral based interventions, this paper draws on research and adapts current models to propose an alternative to conceptualize perceptions of infant sleep problems that may be sensitive to and applied across various cultural and personal contexts. We attempt to provide a rationale for interventions that are inclusive and sensitive to families where reduced parental nighttime responsiveness may not be a preferred choice.

Trajectories of Parental Daily Stress: An Ecological Momentary Assessment Study during the COVID-19 Lockdown

The COVID-19 pandemic was a source of significant stress due to health and safety concerns and measures to control the virus' spread, such as mobility restrictions. This measure was especially demanding for parents with school aged children, who had to find new work-family balance as their children participate in online education while attempting to work remotely. To evaluate parents' stress trajectories during the pandemic, we conducted Ecological Momentary Assessments (EMAs) during lockdown for 29 days in 68 families in Santiago, Chile. In addition, we evaluated the role of educational level and income, co-parenting, and number of children in parents' stress trajectories. Our results showed that during the first weeks of lockdown expected protective factors (i.e., income and co-parental support) were not able to influence parents' daily stress management. Moreover, parents with higher educational levels reported worse stress adaptation than less educated parents. On the other hand, co-parental conflict was significantly associated with parent's stress. Our study captured an acute response to COVID-19 related challenges. This study contributes to understanding how parents adjust to stress during adverse circumstances such as the COVID-19 pandemic.

The relationship between parental mental health, reflective functioning coparenting and social emotional development in 0-3 year old children

Introduction

The transition to parenthood is a high-risk period for many parents and is an important period for child development. Research has identified that parental mental health, reflective functioning (capacity to consider mental states of oneself and others) and coparenting (capacity to work together well as a parenting team) may be particularly significant predictors of later child outcomes, however these factors have seldom been considered together. The present study therefore aimed to investigate the relationship between these factors and the extent to which they predict child social emotional development.

Methods

Three hundred and fifty parents of infants aged 0 to 3 years 11 months were recruited to complete an online Qualtrics questionnaire.

Results

Results indicate that both positive coparenting and parental reflective functioning (Pre-mentalizing and Certainty subscales) were found to significantly predict child development. General reflective functioning (Uncertainty subscale) predicted parental depression and anxiety, however unexpectedly, parental mental health was not a significant predictor of child development, but did predict coparenting. General reflective functioning (Certainty subscale) was also found to predict coparenting, which in turn was found to predict parental reflective functioning. We found an indirect effect of general reflective functioning (Certainty) on child SE development via parental reflective functioning (Pre-mentalizing). We also found an indirect effect of negative coparenting on child development via parental reflective functioning (Pre-mentalizing).

Discussion

The current results support a growing body of research highlighting the important role reflective functioning plays in child development and wellbeing as well as parental mental health and the interparental relationship.

Caregiving and Support Issues Identified by Parents of an Infant With Congenital Heart Disease for Interactive Problem-Solving

Background and Purpose: Parents of an infant with complex congenital heart disease report caregiving challenges in the infant's first half year. We studied the issues parent dyads (mothers and fathers) were dealing with and their effect on their coparenting competencies in interactive problem-solving. Methods: The issues 31 parent dyads identified for interactive problem-solving at either or both infants aged 2 and 6 months were typed as caregiving or relational/support. The parent dyad's interactive competencies were assessed from video recording for two types of tasks (i.e., caregiving and the parent dyad's relationship as caregivers). Constructs of Iowa Family Interaction Rating Scales were applied to assess the competencies of mothers, fathers, and the parent dyad for a group that received guided participation (n = 17) and a group that received usual care (n = 8). Results: Pie charts showed feeding, most frequently identified for interactive problem-solving at 2 months, was surpassed at 6 months by growth and development. The time parents spent together was the most mentioned relationship issue at 2 and 6 months. Forest plots showed caregiving issues were associated with at least medium effect sizes for dyadic problem-solving for both parents at 2 and 6 months and for problem-solving for fathers at 2 and 6 months. Relational/support issues were associated with higher hostility and communication hindering than caregiving issues. Implications for Practice: Intervention to aid parents in interactive problem-solving for both caregiving and relationship/support issues merits development and testing.

Midwives and child health nurses' support is associated with positive coparenting for fathers of infants: A cross-sectional analysis

AIMS AND OBJECTIVES

To examine if the professional support that fathers received from midwives and child health nurses was associated with improvements in fathers' coparenting. A secondary aim was to investigate if there were any support differences between fathers based on parity.

BACKGROUND

Stronger coparenting is associated with improved maternal, paternal and child health. It is unclear if routine prenatal and postnatal professional support is associated with improved coparenting in fathers of infants.

DESIGN

Cross-sectional online survey.

METHODS

In total, 612 fathers of infants (aged 0-24 months) completed baseline data between November 2018 and March 2020. Socio-demographics, pregnancy control variables, social support, professional support, being invited to attend and attending three specific visits for fathers, respectively, and the fathers' coparenting relationship, using the Brief Coparenting Relationship Scale, were assessed. The STROBE checklist was used as the reporting guideline for this study.

RESULTS

Fathers' attendance at child health visits, support from the prenatal and postnatal midwife, respectively, and total support from the child health nurse, are associated with more positive coparenting. Primiparous fathers reported more received social and professional support, as well as a more positive coparenting relationship than multiparous fathers.

CONCLUSIONS

Receiving clinical support from both midwives and child health nurses is associated with fathers' positive coparenting. All fathers should be invited and encouraged to attend prenatal, postnatal and child health visits to further support their coparenting relationship. Relative to primiparous fathers, multiparous fathers may require targeted and additional clinical support regarding their coparenting relationship.

RELEVANCE TO CLINICAL PRACTICE

With fathers becoming more involved in childrearing, having stronger coparenting skills can help them better adapt to their parental roles. Our findings help understand how routine professional support from midwives and child health nurses are experienced among new fathers and that multiparous fathers are in further need of coparenting support.

Promoting resilience to depression among couples during pregnancy: The protective functions of intimate relationship satisfaction and self-compassion

Pregnancy, while often marked by joy, may pose considerable risk for depression among parents. Against a backdrop of adverse life events, expectant parents may be even more vulnerable to developing symptoms of depression during the prenatal period. Thus, it is critical to identify sources of resilience that might facilitate a successful transition to parenthood among couples who have a history of adversity. Prior work suggests that interpersonal and intrapersonal factors associated with resilience, such as intimate relationship satisfaction and self-compassion (i.e., self-kindness, common humanity, and mindfulness), have the potential to attenuate prenatal depression among couples with a history of stressful life experiences. We tested this possibility in a sample of 159 couples navigating pregnancy. As predicted, a greater number of prior stressful life experiences was associated with increased depression symptom severity for both mothers and fathers. However, moderation analyses revealed the positive link between cumulative stressful life experiences and depression symptom severity was attenuated among mothers who reported greater self-compassion in the form of feelings of common humanity, and fathers who reported higher levels of intimate relationship satisfaction and self-compassion in the form of mindfulness. Findings suggest enhancing intimate relationship satisfaction and self-compassion among expectant couples may be valuable in attenuating prenatal depression among those with a greater history of adversity.

The Tavistock First-Time Parent Study: a pilot randomised controlled feasibility trial of a brief couple-focused perinatal intervention to reduce inter-parental discord

Numerous studies report that some first-time parents experience a decline in relationship quality and an increase in conflict after the birth of a first baby. Inter-parental discord that is frequent, intense, and poorly resolved increases the likelihood of relationship breakdown and adversely impacts child development. We investigated the feasibility of a brief preventative couple-focused psychotherapeutic intervention in the perinatal period in a general population sample. Sixty couples expecting their first baby were recruited from the Royal Free Hospital, London. Thirty were randomly assigned to treatment (TMT, a newly developed five-session couple-focused intervention), and 30 to usual care (TAU). Outcomes were collected at 28 weeks into pregnancy, 6-8 weeks after birth, and when the baby was 6 months old. The intervention was feasible and acceptable, evidenced by 100% attendance. However, no change in relationship quality or inter-parental discord was detected in either TMT or TAU groups across the transition to parenthood. The intervention did not improve outcomes vs. TAU. Depression assessed by the Hospital Anxiety and Depression Scale increased across the cohort and mood symptoms assessed by the Edinburgh Postnatal Depression Scale decreased in mothers but not fathers. The absence of a decline in relationship quality could reflect sample attributes: couples were older than average UK first-time parents, had high levels of educational qualifications, and low discord. Even in this low-risk sample, only 20 out of 30 TAU couples completed all three assessments, vs. 29 out of 30 TMT couples. Larger-scale RCTs of perinatal couple-focused psychosocial interventions may be hampered by selection effects and attrition. They may benefit from co-design with stakeholders and active control conditions.Trial registration: ISRCTN12258825; 1st May 2020 (retrospectively registered).

Factors associated with family function in school children: Case-control study

Background

Family functionality is that which promotes the integral development of its members, as well as a favorable state of health in them; fulfilling the basic parameters of adaptation, participation, growth, affection, and resources. Family dysfunction is understood as the failure to comply with any of these functions due to an alteration in one or more of the subsystems.

Objective

There is little research on variables related to family functioning with a case-control design, for this reason, we present the family functioning of school students, identify variables found to be related to family functioning, and describe a model of variables related to family dysfunction.

Materials and methods

Analytical study of cases and controls. The sample was made up of 290 students. The APGAR scale was used to identify family dysfunction. The statistical processing was done in Epi-Info 7.0 and STATA 14.

The variables that were considered were

Municipality, area, age, sex, school grade, mother's age, disability, and displacement.

Results

The factors associated with adequate family function were: displacement, (OR = 0.17, CI: 0.03-0.99). You are followed, your parents pay attention and listen to you (OR = 0.25, CI: 0.08-0.74), you talk to your mother every day (OR = 0.35 CI: 0.16-0.74), you spend free time with your parents (OR = 0.41, CI: 0.20-0.86), play sports at least once a week (OR = 0.42, CI = 0.20-0.91), and finally, attend religious services (OR = 0.51, CI: 0.29-0.90). While the factors associated with family dysfunction were: your parents punish you by forbidding you things (OR = 2.98, CI: 1.32-6.71) and you have friends close to where you live followed by an (OR = 2.60, CI: 1.13-5.96).

Conclusions

Dysfunctionality was evident in the four municipalities of the Valley. Among the main factors associated with dysfunctionality was punishment by parents for forbidding things and having friends near the schoolchild's home.

A genetically informed Registered Report on adverse childhood experiences and mental health

Children who experience adversities have an elevated risk of mental health problems. However, the extent to which adverse childhood experiences (ACEs) cause mental health problems remains unclear, as previous associations may partly reflect genetic confounding. In this Registered Report, we used DNA from 11,407 children from the United Kingdom and the United States to investigate gene-environment correlations and genetic confounding of the associations between ACEs and mental health. Regarding gene-environment correlations, children with higher polygenic scores for mental health problems had a small increase in odds of ACEs. Regarding genetic confounding, elevated risk of mental health problems in children exposed to ACEs was at least partially due to pre-existing genetic risk. However, some ACEs (such as childhood maltreatment and parental mental illness) remained associated with mental health problems independent of genetic confounding. These findings suggest that interventions addressing heritable psychiatric vulnerabilities in children exposed to ACEs may help reduce their risk of mental health problems.

Protocol of a dyadic sleep intervention for adult patients with cancer and their sleep-partner caregivers

Background

Sleep disturbance is common and problematic among both patients with cancer and their sleep partner caregivers. Although 70% of the general adult population sleep in the same bed with a significant other, as do adult cancer patients and their spousal/partner caregivers, and one's sleep affect the partner's sleep, existing psychobehavioral interventions have targeted patients' and caregivers' sleep problems independently.

Methods

We developed a new sleep intervention, My Sleep Our Sleep (MSOS), for both adult patients with cancer and their sleep-partner caregivers together. This protocol is to test the feasibility and acceptability as well as to provide preliminary efficacy of the MSOS intervention, which is a dyadic intervention designed to reduce sleep disturbance and improving sleep quality of both adult cancer patients and their sleep-partner caregivers (dyads). The intervention will be delivered weekly for 4 weeks. Questionnaire and daily sleep logs will be collected at baseline (T1) and one-week after conclusion of the intervention (T2). Satisfaction with the intervention will be assessed weekly for 4 weeks.

Results

We estimate 43 dyads be enrolled (43 patients and 43 sleep-partner caregivers). We expect >75% of eligible and screened dyads will enroll within the enrollment period, >80% of enrolled dyads will complete the intervention, and >80% of participants will report satisfaction across all acceptability measures. We also expect MSOS will reveal a small-to-medium effect on sleep efficiency (primary outcome), overall sleep disturbance, subjective sleep quality, and insomnia severity (secondary outcomes).

Conclusions

Results will inform the feasibility and acceptability of conducting a dyadic sleep intervention, and provide preliminary efficacy data to guide further refinement of the intervention content and procedure for adult patients with cancer and their sleep-partner caregivers.

Trial registration

NCT04712604 Clinicaltrials.gov.

Prenatal Stress and the Developing Brain: Postnatal Environments Promoting Resilience

Heightened maternal stress during pregnancy is associated with atypical brain development and an elevated risk for psychopathology in offspring. Supportive environments during early postnatal life may promote brain development and reverse atypical developmental trajectories induced by prenatal stress. We reviewed studies focused on the role of key early environmental factors in moderating associations between prenatal stress exposure and infant brain and neurocognitive outcomes. Specifically, we focused on the associations between parental caregiving quality, environmental enrichment, social support, and socioeconomic status with infant brain and neurocognitive outcomes. We examined the evidence that these factors may moderate the effects of prenatal stress on the developing brain. Complementing findings from translational models, human research suggests that high-quality early postnatal environments are associated with indices of infant neurodevelopment that have also been associated with prenatal stress, such as hippocampal volume and frontolimbic connectivity. Human studies also suggest that maternal sensitivity and higher socioeconomic status may attenuate the effects of prenatal stress on established neurocognitive and neuroendocrine mediators of risk for psychopathology, such as hypothalamic-pituitary-adrenal axis functioning. Biological pathways that may underlie the effects of positive early environments on the infant brain, including the epigenome, oxytocin, and inflammation, are also discussed. Future research in humans should examine resilience-promoting processes in relation to infant brain development using large sample sizes and longitudinal designs. The findings from this review could be incorporated into clinical models of risk and resilience during the perinatal period and used to design more effective early programs that reduce risk for psychopathology.

Universal Intervention to Strengthen Parenting and Prevent Child Maltreatment: Updated Systematic Review

Child maltreatment is a severe worldwide public health problem because of its negative consequences and should therefore be prevented through parenting programs to improve parental behavior and practices. The present review aimed to update a published review of 5 years of empirical studies on universal parenting programs to strengthen positive parenting and prevent child maltreatment. A systematic search of the PubMed, Web of Science, PsycINFO, Lilacs, and SciELO databases was performed to identify the studies of group-based structured parenting programs published from 2015 to 2019. Eighteen studies were found that fulfilled the inclusion and exclusion criteria. The results showed that 14 different parenting programs were conducted in high-, medium-, and low-income countries, showing an increase in the number of studies in low-income countries compared with the previous review. In 89% of the studies, the parenting outcomes improved in the post-intervention. Additionally, studies have demonstrated that these programs also improved other parental outcomes such as mental health, couple relationships, coparenting, and coping ability of parents. From 18 studies, nine child variables were evaluated, and eight of them showed a decrease in behavior problems. Regarding the methodological quality of the studies, 55%, 28%, and 17% were classified as moderate, weak, and strong, respectively. In conclusion, the positive changes in parenting and child behavior outcomes encourage the implementation of parenting programs as a universal prevention strategy. Further research should increase the methodological quality of the design study.

The Effectiveness of Interventions for the Prevention or Treatment of Paternal Perinatal Anxiety: A Systematic Review

Background: The worldwide prevalence of paternal perinatal anxiety (PPA) ranges between 3.4% and 25.0% antenatally, and 2.4% and 51.0% postnatally. Experiencing PPA can adversely impact the individual, partners, and infants. Research concerning PPA is lagging and fragmented compared to research for new mothers. Objectives: To establish the effectiveness of prevention or treatment interventions for PPA in adults identifying as male. Data sources: We completed searches of Medline, EMBASE, PsycINFO and Web of Science from inception to 2 December 2021, as well as hand searches of references from relevant papers. Search selection and data extraction: Randomised controlled trials delivering prevention or treatment interventions and reporting anxiety outcomes for new/expectant fathers in the perinatal mental health period were included. Our review follows the PRISMA reporting guidelines. One reviewer independently screened 5170 titles/abstracts; second reviewers screened 50%. Two reviewers independently screened full text, extracted data, and conducted risk of bias assessments. Synthesis: Cochrane's collaboration tool 2 was used to assess quality. Primarily results are synthesised narratively, a post-hoc sub-group analysis was completed on four studies using the same outcome measure. Main results: Twelve of the 5170 studies fulfilled the inclusion criteria. Studies used psychoeducational or practical skills interventions. Interventions mostly involved couple-dyads and three studies assessed PPA as a primary outcome. Included interventions were prevention-based; no treatment interventions were found. Father-only interventions consistently reported a significant reduction of PPA. Conclusions: Systematic searching yielded no treatment interventions, highlighting a substantial gap in the evidence base. Within a limited and heterogenous sample, no studies targeted diagnosed PPA. Evidence suggested father-focused interventions may be effective in preventing PPA, regardless of the intervention delivery mode or intervention content. However, consistency between study design and options within the field are lacking compared to interventions available for mothers.

Couple's Relationship and Depressive Symptoms during the Transition to Parenthood and Toddler's Emotional and Behavioral Problems

The couple’s relationship and mother and father’s depressive symptoms during the transition to parenthood were associated with the toddler’s emotional and behavioral problems. This study aimed to analyze how the couple’s positive and negative interactions and mother and father’s depressive symptoms during the transition to parenthood impact toddlers’ emotional and behavioral problems. A sample of 95 mothers and fathers (N = 190) were recruited and individually completed questionnaires to assess couples’ positive and negative interactions and depressive symptoms during the first trimester of pregnancy and at 3 and 30 months postpartum, and they completed the Child Behavior Checklist 1.5–5 at 30 months postpartum. The path analyses revealed that the couple’s postnatal negative interaction partially mediates the impact of the mother’s prenatal depressive symptoms on the toddler’s internalizing problems at 30 months postpartum. The father’s postnatal depressive symptoms and the couple’s concurrent positive interaction mediated the impact of the couple’s prenatal positive interaction on the toddler’s externalizing problems at 30 months postpartum. The screening of the couple’s negative interaction and depressive symptoms during pregnancy and the postnatal period can help to identify mothers, fathers, and toddlers at risk for mental health problems.

Mogle J, Lee J, Tornello SL, Hostetler ML, Cifelli JA, Bai S, Hotez E. Impact of the COVID-19 Pandemic on Parent, Child, and Family Functioning

To quantify the impact of the COVID-19 pandemic and public health interventions on parent and child mental health and family relationships, we examined change in individual and family functioning in a sample of parents enrolled in a prevention trial; we examined change before the pandemic (2017-2019) when children were an average of 7 years old to the first months after the imposition of widespread public health interventions in the United States (2020) with paired t tests and HLM models. We examined moderation by parent gender, education, family income, and coparenting conflict. We found large deteriorations from before the pandemic to the first months of the pandemic in child internalizing and externalizing problems and parent depression, and a moderate decline in coparenting quality. Smaller changes were found for parent anxiety and parenting quality. Mothers and families with lower levels of income were at particular risk for deterioration in well-being. Results indicate a need for widespread family support and intervention to prevent potential family "scarring," that is, prolonged, intertwined individual mental health and family relationship problems.

Relational impacts of capitalization in early parenthood

Relationship difficulties are common during the transition to parenthood and may persist for years. Strategies that enhance couples' daily relational experiences early in the parenting years may serve a protective role. In general, engaging in a capitalization attempt (i.e., sharing personal good news) with one's romantic partner and perceiving the partner to be responsive are associated with better relationship outcomes among committed couples. However, it is unknown whether these relational benefits extend to the early parenting years or to other relational domains such as coparenting, which plays a central role in family functioning. The current study examined same-day associations between couples' capitalization process and relationship closeness and perceived coparenting support in a dyadic context during the first year of parenthood. A subsample of primarily non-Hispanic White coresident mixed-gender couples who participated in a randomized controlled trial of a transition to parenthood program (N = 141) completed daily diaries at 10 months postpartum for 8 consecutive days. On days when mothers shared, both partners reported greater closeness. On days when fathers shared, mothers reported greater closeness and perceived coparenting support. Furthermore, perceived partner responsiveness was associated with greater closeness for both partners and greater coparenting support for fathers. Fathers also perceived greater closeness and coparenting support on days when mothers shared about the child. Findings highlight the potential benefits of capitalization in early parenthood for both closeness and perceived coparenting support and suggest that capitalization may be a low cost, high yield strategy for enhancing new parents' daily relational experiences. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychological and Physical Intimate Partner Aggression Are Associated with Broad and Specific Internalizing Symptoms during Pregnancy

Background: Intimate partner violence (IPV) has serious consequences, particularly during high-risk periods such as pregnancy, which poses a significant risk to maternal mental health. However, it is unclear whether IPV presents a broad risk for psychopathology or is specific to distinct diagnoses or symptom dimensions (e.g., panic, social anxiety). Further, the relative impact of physical versus psychological aggression remains unclear. Methods: One hundred and fifty-nine pregnant couples completed surveys assessing psychological and physical intimate partner aggression unfolding in the couple relationship, as well as a range of internalizing symptoms. Results: Psychological and physical aggression were each associated with broad negative affectivity, which underlies mood and anxiety disorders; however, only psychological aggression demonstrated a unique association. Further, for pregnant women, aggression was uniquely associated with several symptom dimensions characteristic of PTSD. In contrast, men demonstrated a relatively heterogeneous symptom presentation in relation to aggression. Conclusion: The present study identifies unique symptom manifestations associated with IPV for couples navigating pregnancy and suggests psychological aggression can be more detrimental to mental health than physical aggression. To promote maternal perinatal mental health, clinicians should screen for covert forms of psychological aggression during pregnancy (e.g., raised voices, insults), trauma-related distress, and symptom elevations in women and their partners.

Helping couples achieve relationship success: A decade of progress in couple relationship education research and practice, 2010-2019

This article systematically reviewed 34 rigorous evaluation studies of couple relationship education (CRE) programs from 2010 to 2019 that met the criteria for Level 1 well-established interventions. Significant advances include reaching more diverse and disadvantaged target populations with positive intervention effects on a wider range of outcomes beyond relationship quality, including physical and mental health, coparenting, and even child well-being, and evidence that high-risk couples often benefit the most. In addition, considerable progress has been made delivering effective online CRE, increasing services to individuals rather than to couples, and giving greater attention to youth and young adults to teach them principles and skills that may help them form healthy relationships. Ongoing challenges include expanding our understanding of program moderators and change mechanisms, attending to emerging everyday issues facing couples (e.g., healthy breaking ups, long-distance relationships) and gaining increased institutional support for CRE.

Evidence base review of couple- and family-based psychosocial interventions to promote infant and early childhood mental health, 2010-2019

Infant and early childhood mental health (IECMH) has been defined as the capacity of infants and young children to regulate their emotions, form secure relationships, and explore their environments. For this special issue, we conducted a review of IECMH outcomes from evaluations of couple- and family-based psychosocial interventions not explicitly designed for trauma exposure published from 2010 through 2019, following Evidence Base Update criteria and the current convention of classifying general categories of intervention approaches rather than the former practice of evaluating specific brand-name packaged programs. Full-text review of 695 articles resulted in 39 articles eligible for categorization into intervention approaches, taking into consideration the theoretical orientation of the treatment, the population served, the intervention participants, the target outcomes, the treatment theory of change, and the degree to which the intervention was standardized across participants. Four intervention approaches were identified in this review as Probably Efficacious: Behavioral Interventions to Support Parents of Toddlers, Interventions to Support Adolescent Mothers, Tiered Interventions to Provide Support Based on Assessed Risk, and Home Visiting Interventions to Provide Individualized Support to Parents. Other intervention approaches were classified as Possibly Efficacious, Experimental, or did not have sufficient evidence in this time period to classify under these criteria. Further research could explore how to ensure that all families who need support can receive it, such as by increasing the reach of effective programs and by decreasing the number of families needing additional support.

The Roles of Mothers' Perceptions of Grandmothers' Gatekeeping and Fathers' Parenting Competence in Maternal Gatekeeping

OBJECTIVE

This study investigated how new mothers' perceptions of maternal grandmothers' gatekeeping behaviors and perceptions of fathers' parenting competence are associated with maternal gatekeeping behaviors.

BACKGROUND

In the development of coparenting relationships at the transition to parenthood, the roles of extended family members, although important, have received little research attention. Grandmothers' gatekeeping may serve as a reference for maternal gatekeeping behaviors, but its role depends on mothers' own perceptions of fathers' parenting competence.

METHOD

Mothers from 172 dual-earner, different-gender couples reported their own mothers' gatekeeping behaviors and their own perceptions of fathers' parenting competence at 3 months postpartum. Maternal gatekeeping behaviors toward fathers were reported by mothers at both 3 and 9 months postpartum.

RESULTS

When mothers perceived that maternal grandmothers engaged in higher levels of gatekeeping behaviors, mothers engaged in more gate-opening behaviors but only when mothers perceived fathers as highly competent. There were no significant associations between mothers' perceptions of grandmothers' gatekeeping and maternal gate-closing behaviors.

CONCLUSION

Adult mothers, who likely have developed their own sets of ideas about parenting, are still susceptible to support and criticism from their own mothers.

IMPLICATIONS

Practitioners would do well to encourage expectant and new parents to consider the role of extended family in the development of their coparenting relationships, and to develop plans for support-seeking, boundary management, and negotiation of conflicts. To help reduce maternal gate-closing and enhance maternal gate-opening behaviors, practitioners could support fathers' development of parenting skills and help mothers develop awareness of fathers' skills.

Factors contributing to coparenting quality: characteristics at the individual level and the relational level

This study aimed to explore how characteristics of parents at the individual level (i.e. anxiety, depression, and psychological resilience) and the relational level (i.e. family functioning) are associated with their coparenting quality in Chinese context. A total of 432 parents whose first child aged 1-18 were recruited to complete online self-measures of anxiety, depression, psychological resilience, family functioning, and coparenting quality. The findings indicated that parents with more anxiety and depression tended to have worse resilience and family functioning, as well as poorer coparenting quality. There were strong correlations between resilience, family functioning, and coparenting quality. Mediation analysis showed that resilience and family functioning partially mediated the link between anxiety and coparenting and fully mediated the link between depression and coparenting. Moreover, family functioning fully carried the impact of resilience on coparenting. These results extended our understanding by demonstrating that resilience and family functioning serve as mediators between negative emotions and coparenting quality. The significant implications for parental practice and research were also discussed.

Quality of coparenting and infant-mother attachment: The mediating role of maternal emotional availability

Increasing attention has been paid to the influence of family contextual factors in predicting infant attachment security. However, little is known about the influence of coparenting quality on attachment. The goal of the present study was to examine the associations among parental perceptions of coparenting quality, quality of mothering (as indexed by maternal emotional availability), and infant-mother attachment. Parental reports of positive and negative coparenting quality, maternal emotional availability, and infant-mother attachment were assessed in 152 infants and their parents at 1, 3, 6, 9, and 12 months postpartum. Direct and indirect effects were assessed within a structural equation modeling framework to examine: (a) direct effects of mother-reported coparenting on infant-mother attachment, (b) indirect effects of mother-reported coparenting on infant-mother attachment through maternal emotional availability, and (c) indirect effects of father-reported coparenting on infant-mother attachment through maternal emotional availability. Results indicated that there was an indirect, but not direct, association between mother-reported coparenting quality across the first year of life and infant-mother attachment at 1 year through maternal emotional availability across the first year. Father-reported coparenting across infants' first year was not associated with infant-mother attachment at 1 year. Post hoc analyses revealed that mothers' perceptions of coparenting at 1 month were indirectly linked to attachment at 1 year through maternal emotional availability across the first year. Findings highlight the importance of coparenting quality, especially in the early postpartum, in organizing quality of parenting and infant attachment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Prevention of Mental Health Difficulties for Children Aged 0-3 Years: A Review

The period of infancy and early childhood is a critical time for interventions to prevent future mental health problems. The first signs of mental health difficulties can be manifest in infancy, emphasizing the importance of understanding and identifying both protective and risk factors in pregnancy and the early postnatal period. Parents are at a higher risk of developing mental health problems during the perinatal period. An understanding of the evidence around prevention and intervention for parental anxiety and depression is vital to the process of prevention of early mental health disorders in infants and young children. Here we review the existing prevention and treatment interventions in the early years focusing on the period from conception to 3 years - the majority targeting parents in order to improve their mental health, and that of their infants. Elements of successful programs for parents include psychoeducation and practical skills training, as well as work on the co-parenting relationship, developing secure attachment, and enhancing parental reflective functioning. While both targeted and universal programs have produced strong effect sizes, universal programs have the added benefit of reaching people who may otherwise not have sought treatment. In synthesizing this information, our goal is to inform the development of integrated models for prevention and novel early intervention programs as early in life as possible.

Group-based parent support during the transition to parenthood: Primary outcomes from a randomised controlled trial

RATIONALE

Theory suggests that when parents believe in their ability to positively influence their children, the children are at lower risk of poor developmental outcome. For this reason, parents' sense of competence is a common target in early parenting interventions.

OBJECTIVE

This study assessed effects on parents' sense of competence, parenting stress, and symptoms of depression from a widely implemented universal and group-based parenting program.

METHODS

In total, 1701 families were enrolled and randomised to one of two conditions a) participation in Family Start up Program (FSP), currently implemented at large scale in Denmark, or b) Care as Usual (CAU). FSP aims to empower new parents through knowledge and network. CAU is the public pre- and post-natal care available to families in both conditions. Recruitment was conducted between November 24, 2014, and February 1, 2017 at Aarhus University Hospital, from all incoming pregnant women within one of the larger Danish municipalities. In total, 4313 families were assessed for eligibility. Data were analysed as intention-to-treat and with n = 1255 (74%) mothers and n = 984 (60%) partners who responded at 10 months postpartum.

RESULTS

When randomised to the FSP, 92% of the mothers and 94% of the partners received the intervention attending an average of 8.4 [SD = 3∙4] and 7.9 [SD = 3∙3] group meetings, respectively. The program evaluation data indicated that parents were satisfied with the program. We found no mean differences between FSP and CAU in parental sense of competence, parental stress, or symptoms of depression at 10 months in mothers or partners.

CONCLUSION

The intervention did not influence parents' sense of competence even if the parents attended and liked the group meetings. This highlights the need for refinement of either the intervention approach or the expectation to its outcome. ClinicalTrials.gov ID: NCT02294968.

The Impact of Coparenting on Mothers’ COVID-19-Related Stressors

To test and explore whether more positive coparenting will significantly predict lower COVID-19-related stress across family configurations and dynamics and across both higher- and lower-income mothers, we developed and circulated an online survey among mothers from the U.S. and Canada. Coparenting was measured using the Coparenting Across Family Structures (CoPAFS) short form (27 items) scale, comprised of factors representing five coparenting dimensions: communication, respect, trust, animosity, and valuing the other parent. Items specific to COVID-19 stressors assessed the types of stressors each parent faced. The sample consisted of 236 North American mothers, mostly white (n = 187, 79.2%) and aged 30–50 years. The surveyed mothers reported a consistent and significant relation between more positive coparenting and less COVID-19-related stressors whether parents were living together or not, married or divorced, and with a lower or higher income level, suggesting the importance and centrality of positive coparenting as a key factor for family well-being. Coparenting was especially predictive among mothers who were never married and those with lower incomes.

Coparenting Alleviated the Effect of Psychological Distress on Parental Psychological Flexibility

Parenting is full of challenges and responsibilities. It is particularly important for parents to be open to parental difficult experiences and adopt behaviors consistent with self-chosen values, which termed as parental psychological flexibility (PPF). However, few studies have focused on the effect of psychological distress (anxiety and depression) on different components of PPF. This study examined the effect of psychological distress on the three components of PPF (cognitive defusion, committed action, and acceptance) as well as the role of coparenting quality in Chinese parents. A total of 462 parents of children aged 1–18 years completed self-report measures of anxiety, depression, coparenting, and PPF. Our results revealed that higher level of PPF went along with less anxiety and depression, while it was also associated with better coparenting quality. Coparenting partially mediated the effect of anxiety on cognitive defusion and acceptance and fully mediated the effect of depression on cognitive defusion and acceptance. Moderation analyses showed that the link between anxiety and cognitive defusion, as well as the link between anxiety and acceptance were moderated by coparenting. We discussed the implications of coparenting as a protective factor in alleviating the negative effect of psychological distress on PPF.

The effects of co-parenting/intergenerational co-parenting interventions during the postpartum period: A systematic review

BACKGROUND

Co-parenting interventions have been offered, particularly to enhance paternal involvement in infant care. However, little is known about whether such co-parenting interventions can be effective in improving the psychological health of families and co-parenting outcomes during the postpartum period.

OBJECTIVES

The aim of this review was to examine the effects of interventions on the co-parenting relationship of families, the psychological health of members involved, and on co-parenting outcomes during the postpartum period.

METHODS

This was a systematic review with a meta-analysis. Randomized controlled trials of co-parenting intervention studies were selected following the standardized methods recommended by the Cochrane Handbook for Systematic Reviews of Interventions Version 6. The Cochrane Risk of Bias Assessment tool was used to assess the risk of bias in the included studies.

RESULTS

Twelve co-parenting randomized controlled trials were included in this review. Most studies reported positive effects in promoting at least one domain of co-parenting in mothers and/or fathers, especially in co-parenting support, couple communication, parent-child interactions and reducing co-parenting undermining. Meta-analysis showed that mothers in the intervention group showed significantly lower depressive symptoms compared to those in the control group. The only online co-parenting intervention identified produced similar effects to that of face-to-face interventions on improving co-parenting support, and reducing co-parenting undermining. Only one study focused on parent-grandparent co-parenting, which reported positive effects on 'family management' and 'cooperation in childcare between mothers with depressive symptoms and their 'mother-in-law'. Another study found that significantly more mothers continue to breastfeed in the intervention group compared to the control group at 12 weeks postpartum as a positive outcome in co-parenting.

CONCLUSION

Co-parenting interventions have demonstrated some positive effects on co-parenting support, co-parenting undermining, couple communication, parent-child interactions of parents and the depressive symptoms of mothers. Limited evidence was found on the overall effects on co-parenting, division of labor, childrearing agreement, the psychological health of fathers, parenting self-efficacy and baby feeding practices. Further studies are recommended to examine the effects of interventions for intergenerational (parent-grandparent) families on co-parenting, the psychological health in parenting, parenting self-efficacy and baby feeding practices during the postpartum period by adopting online approaches.

Development and application of a couple-centered antenatal education program in Korea

Purpose

This study was conducted to develop a couple-centered antenatal education program and to test the program’s feasibility.

Methods

With a preliminary-experimental study design, 33 pregnant couples who were expecting their first child participated in this study. The program consisted of four sessions (1 hour/session/week) of education and counseling. Data were collected before and after the intervention from September 2018 to April 2019 at a women’s hospital in Daejeon, Korea, with demographic data forms, the Edinburgh Postnatal Depression Scale, Perceived Stress Scale, Maternal–Fetal Attachment Scale, Korean Newborn Care Confidence Scale, Wijma Delivery Expectancy/Experience Questionnaire, and Dyadic Adjustment Scale-10.

Results

The pregnant women and their husbands were on average 32.30±3.10 and 33.21±6.25 years old, respectively. The mean marriage duration was 2.34±1.63 years, the gestational age was 31.30±2.66 weeks, and 78.8% of the couples had a planned pregnancy. After the program, both the pregnant women and their husbands showed significant improvements in attachment to the fetus and confidence in providing infant care. Prenatal depression, prenatal stress, and fear of childbirth in pregnant women significantly decreased after completing the program. However, the dyadic adjustment score did not change significantly either in the pregnant women or their husbands.

Conclusion

A couple-centered antenatal education program seems to be effective for couples adjusting to parenthood, but further studies should explore ways to have a positive impact on couples’ relationships.

Conditional regard, stress, and dyadic adjustment in primiparous couples: A dyadic analysis perspective

Many couples transitioning into parenthood are at risk for dyadic adjustment declines. It is therefore important to explore key, theory-driven deterrents of enduring relationships during this period, as well as potential underlying mechanisms. This study examined the relationship between perceived conditional negative regard (i.e. a behavior that thwarts basic psychological needs; T1), stress (T1), and dyadic adjustment (T2) during the transition to parenthood. Primiparous couples (N = 144) were recruited to fill out an online questionnaire when their babies were 6-months (T1) and 12-months (T2). Path analysis with an Actor-Partner Interdependence Mediation Model was conducted. Results show that for each partner (actor effects), stress (T1) mediated the link between perceived conditional negative regard (T1), and later dyadic adjustment (T2). For the partner effects, while stress (T1) did not play a mediating role between these variables, other partner effects were found. Each primiparous parent's perceived conditional negative regard (T1) was associated with the other parent's later dyadic adjustment (T2). However, when examining longitudinal changes in stress and dyadic adjustment over time (T2, controlling for respective T1), no significant associations were found. Overall, the findings shed light on the dyadic associations of conditional negative regard, and the mechanisms through which it is negatively tied with dyadic adjustment during the transition to parenthood.

Universal and Selective Interventions to Prevent Poor Mental Health Outcomes in Young People: Systematic Review and Meta-analysis

BACKGROUND

Much is not known about the efficacy of interventions to prevent poor mental health outcomes in young people by targeting either the general population (universal prevention) or asymptomatic individuals with high risk of developing a mental disorder (selective prevention).

METHODS

We conducted a PRISMA/MOOSE-compliant systematic review and meta-analysis of Web of Science to identify studies comparing post-test efficacy (effect size [ES]; Hedges' g) of universal or selective interventions for poor mental health outcomes versus control groups, in samples with mean age <35 years (PROSPERO: CRD42018102143). Measurements included random-effects models, I2 statistics, publication bias, meta-regression, sensitivity analyses, quality assessments, number needed to treat, and population impact number.

RESULTS

295 articles (447,206 individuals; mean age = 15.4) appraising 17 poor mental health outcomes were included. Compared to control conditions, universal and selective interventions improved (in descending magnitude order) interpersonal violence, general psychological distress, alcohol use, anxiety features, affective symptoms, other emotional and behavioral problems, consequences of alcohol use, posttraumatic stress disorder features, conduct problems, tobacco use, externalizing behaviors, attention-deficit/hyperactivity disorder features, and cannabis use, but not eating-related problems, impaired functioning, internalizing behavior, or sleep-related problems. Psychoeducation had the highest effect size for ADHD features, affective symptoms, and interpersonal violence. Psychotherapy had the highest effect size for anxiety features.

CONCLUSION

Universal and selective preventive interventions for young individuals are feasible and can improve poor mental health outcomes.

Associations between Coparenting Relationships and Maternal Depressive Symptoms and Negative Bonding to Infant

Maternal mental illnesses during early postpartum may be caused by lack of the coparenting relationship parents share and cooperate regarding child-rearing. This study clarifies the association of the coparenting relationship and negative mental health of mothers at one and three months after childbirth. This study conducted a secondary analysis of data from an intervention study wherein 24 mothers rearing their first child with a cohabitant (husband/partner) participated. Maternal mental health was evaluated using the Edinburgh Postnatal Depression Scale to determine postpartum depressive symptoms and the Mother-to-Infant Bonding Scale to assess negative bonding. Mothers’ average age was 31.5 ± 4.2 years old. All mothers were not working during the research period. The prevalence of postpartum depression and bonding disorder were approximately 13% and 21%, respectively. A better coparenting relationship was associated with lower postpartum depressive symptoms at both one month (β = −0.617, p = 0.002) and three months (β = −0.709, p < 0.01) postpartum. In contrast, no association was found between a coparenting relationship and negative bonding. The results indicate that the coparenting relationship may possibly prevent maternal depression during the early postpartum period.

Intimate Partner Aggression During the Early Parenting Years: The Role of Dissatisfaction with Division of Labor and Childcare

The high rates of intimate partner aggression (IPA) among new parents may be partly due to changes in couples' division of household labor and childcare, which disproportionately negatively impact women. This is the first study to examine the association between division of labor dissatisfaction and IPA perpetration across genders, while also examining whether such dissatisfaction is specifically associated with IPA during conflicts about division of labor issues. Quarterly for one year, 109 women and 94 men from 111 couples with a first-born child approximately 32 months of age at study commencement described each incident of IPA that occurred during the quarter, including conflict topics and number of aggressive acts perpetrated. Division of labor and childcare comprised the largest portion (30%) of IPA conflict topics. Division of labor dissatisfaction at child age 24 months was positively associated with women's, but not men's, IPA perpetration during conflicts about division of labor issues, but not other topics. A similar pattern of results emerged in the examination of division of childcare dissatisfaction and conflicts about childcare vs. other topics. The discovery that the impact of division of labor and childcare dissatisfaction on IPA perpetration is context- and gender-specific suggests that, among women, a history of dissatisfaction may impair appropriate conflict resolution skills specifically when addressing domains of dissatisfaction. These findings support prevention of women's IPA via nonaggressive strategies for addressing division of labor concerns and promotion of equal opportunities for women and men at home and in the workplace during the early parenting years.

Experiences of intergenerational co-parenting during the postpartum period in modern China: A qualitative exploratory study

Most studies conducted in the West on the role played by intergenerational families in co-parenting have focused mostly on families with a single mother or those in difficult circumstances, while little is known about the experiences of members of intergenerational intact families during the early postpartum period. This study aimed to explore the intergenerational co-parenting experiences of young parents and grandmothers in China, focusing on how they shared the responsibility of caring for the new mother and infant during the postpartum period. A total of 16 eligible intergenerational intact families, including 16 mothers, 15 fathers and 12 grandmothers, were interviewed. The data set was analysed using the approach of directed content analysis guided by Feinberg's Ecological Model of Co-parenting. The data were categorized into four themes: 'division of labour', 'postpartum and infant care agreement', 'support-undermining' and 'joint family management'. An additional theme, 'expressed a need for family support', emerged from the data on these intergenerational families. The findings emphasize the importance of intergenerational co-parenting relationships in families where two generations co-parent the newborn together.

Resolving Coparenting Dissatisfaction In Couples: A Preliminary Task Analysis Study

This study explored the change that unfolded when parents resolved their coparenting dissatisfaction during an Integrative Brief Systemic Intervention (IBSI) for parent couples. We conducted a task analysis (Greenberg, 2007) to build a model of resolving coparenting dissatisfaction. We compared a postulated model of change (rational model) based on theoretical and clinical assumptions to the observations of the actual change process that couples experienced in an IBSI (empirical analysis). The empirical analysis was conducted on six IBSI therapy cases (three exhibiting positive development and three exhibiting no development). We defined positive development in IBSI as moving from coparenting dissatisfaction to coparenting satisfaction. The final rational-empirical model included six steps that facilitated the resolution of coparenting dissatisfaction. This study contributes to deepening the knowledge of how coparenting may change during marital therapy.

Factors associated with postpartum depression among women in Vientiane Capital, Lao People's Democratic Republic: A cross-sectional study

Postpartum depression is a worldwide public health concern. The prevalence of postpartum depression is reported to be greater in developing countries than in developed countries. However, to the best of our knowledge, no papers on postpartum depression in the Lao People’s Democratic Republic have been published. In order to strengthen maternal and child health, the current situation of postpartum depression should be understood. This study aims to determine the prevalence of postpartum depression and identify factors associated with postpartum depression in Vientiane Capital, Lao People’s Democratic Republic. Study participants were 428 women 6–8 weeks postpartum who visited four central hospitals in Vientiane Capital for postnatal care from July to August 2019. Structured questionnaires were used to collect socio-demographic, obstetrical and infant, and psychiatric data about the women and their partners. The Edinburgh Postnatal Depression Scale (EPDS) was used to identify suspected cases of postpartum depression with the cut-off score of 9/10. Multivariable logistic regression was used to examine independent factors that were associated with suspected postpartum depression (EPDS ≥10). The mean age of the 428 women was 28.1 years, and the prevalence of suspected postpartum depression was 31.8%. Multivariable logistic regression using variables that were statistically significant on bivariate analyses indicated that three variables were associated with suspected postpartum depression: unintended pregnancy (AOR = 1.66, 95% CI 1.00–2.73, P = 0.049), low birth satisfaction (AOR = 1.85, 95% CI 1.00–3.43, P = 0.049), and depression during pregnancy (AOR = 3.99, 95% CI 2.35–6.77, P <0.001). In this study, unintended pregnancy, low birth satisfaction, and depression during pregnancy were independent risk factors for postpartum depression. These results suggest that the mental health of pregnant women should be monitored, and that health care services, especially family planning and supportive birth care, should be strengthened to prevent postpartum depression.

Children's Adjustment to Parents' Break Up: The Mediational Effects of Parenting and Co-parenting

Although past studies have shown an association between union instability (i.e., change in family structure) and children's aggressive behaviors, the mechanism by which this occurs is less understood. This study (n = 3,387) examined whether father and mother involvement, co-parenting support, and maternal responsiveness explained the association between union instability in early life and children's aggressive behaviors at 9 years, and whether relationship status moderated this association. Findings reveal that only co-parenting support mediated this association and only for children whose mothers divorced (not for mothers who experienced a non-marital separation), suggesting that when a divorce occurs, the relationship between partners (co-parenting) is more important than the relationship with children (parenting) for children's social adjustment.

Psychological therapies for women who experience intimate partner violence

BACKGROUND

Intimate partner violence (IPV) against women is prevalent and strongly associated with mental health problems. Women experiencing IPV attend health services frequently for mental health problems. The World Health Organization recommends that women who have experienced IPV and have a mental health diagnosis should receive evidence-based mental health treatments. However, it is not known if psychological therapies work for women in the context of IPV and whether they cause harm.

OBJECTIVES

To assess the effectiveness of psychological therapies for women who experience IPV on the primary outcomes of depression, self-efficacy and an indicator of harm (dropouts) at six- to 12-months' follow-up, and on secondary outcomes of other mental health symptoms, anxiety, quality of life, re-exposure to IPV, safety planning and behaviours, use of healthcare and IPV services, and social support.

SEARCH METHODS

We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR), CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, and three other databases, to the end of October 2019. We also searched international trials registries to identify unpublished or ongoing trials and handsearched selected journals, reference lists of included trials and grey literature.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), quasi-RCTs, cluster-RCTs and cross-over trials of psychological therapies with women aged 16 years and older who self-reported recent or lifetime experience of IPV. We included trials if women also experienced co-existing mental health diagnoses or substance abuse issues, or both. Psychological therapies included a wide range of interventions that targeted cognition, motivation and behaviour compared with usual care, no treatment, delayed or minimal interventions. We classified psychological therapies according to Cochrane Common Mental Disorders's psychological therapies list.

DATA COLLECTION AND ANALYSIS

Two review authors extracted data and undertook 'Risk of Bias' assessment. Treatment effects were compared between experimental and comparator interventions at short-term (up to six months post-baseline), medium-term (six to under 12 months, primary outcome time point), and long-term follow-up (12 months and above). We used standardised mean difference (SMD) for continuous and odds ratio (OR) for dichotomous outcomes, and used random-effects meta-analysis, due to high heterogeneity across trials.

MAIN RESULTS

We included 33 psychological trials involving 5517 women randomly assigned to experimental (2798 women, 51%) and comparator interventions (2719 women, 49%). Psychological therapies included 11 integrative therapies, nine humanistic therapies, six cognitive behavioural therapy, four third-wave cognitive behavioural therapies and three other psychologically-orientated interventions. There were no trials classified as psychodynamic therapies. Most trials were from high-income countries (19 in USA, three in Iran, two each in Australia and Greece, and one trial each in China, India, Kenya, Nigeria, Pakistan, Spain and UK), among women recruited from healthcare, community, shelter or refuge settings, or a combination of any or all of these. Psychological therapies were mostly delivered face-to-face (28 trials), but varied by length of treatment (two to 50 sessions) and staff delivering therapies (social workers, nurses, psychologists, community health workers, family doctors, researchers). The average sample size was 82 women (14 to 479), aged 37 years on average, and 66% were unemployed. Half of the women were married or living with a partner and just over half of the participants had experienced IPV in the last 12 months (17 trials), 6% in the past two years (two trials) and 42% during their lifetime (14 trials). Whilst 20 trials (61%) described reliable low-risk random-sampling strategies, only 12 trials (36%) described reliable procedures to conceal the allocation of participant status. While 19 trials measured women's depression, only four trials measured depression as a continuous outcome at medium-term follow-up. These showed a probable beneficial effect of psychological therapies in reducing depression (SMD -0.24, 95% CI -0.47 to -0.01; four trials, 600 women; moderate-certainty evidence). However, for self-efficacy, there may be no evidence of a difference between groups (SMD -0.12, 95% CI -0.33 to 0.09; one trial with medium-term follow-up data, 346 women; low-certainty evidence). Further, there may be no difference between the number of women who dropped out from the experimental or comparator intervention groups, an indicator of no harm (OR 1.04, 95% CI 0.75 to 1.44; five trials with medium-term follow-up data, 840 women; low-certainty evidence). Although no trials reported adverse events from psychological therapies or participation in the trial, only one trial measured harm outcomes using a validated scale. For secondary outcomes, trials measured anxiety only at short-term follow-up, showing that psychological therapies may reduce anxiety symptoms (SMD -0.96, 95% CI -1.29 to -0.63; four trials, 158 women; low-certainty evidence). However, within medium-term follow-up, low-certainty evidence revealed that there may be no evidence between groups for the outcomes safety planning (SMD 0.04, 95% CI -0.18 to 0.25; one trial, 337 women), post-traumatic stress disorder (SMD -0.24, 95% CI -0.54 to 0.06; four trials, 484 women) or re-exposure to any form of IPV (SMD 0.03, 95% CI -0.14 to 0.2; two trials, 547 women).

AUTHORS' CONCLUSIONS

There is evidence that for women who experience IPV, psychological therapies probably reduce depression and may reduce anxiety. However, we are uncertain whether psychological therapies improve other outcomes (self-efficacy, post-traumatic stress disorder, re-exposure to IPV, safety planning) and there are limited data on harm. Thus, while psychological therapies probably improve emotional health, it is unclear if women's ongoing needs for safety, support and holistic healing from complex trauma are addressed by this approach. There is a need for more interventions focused on trauma approaches and more rigorous trials (with consistent outcomes at similar follow-up time points), as we were unable to synthesise much of the research.

Hindering resilience in the transition to parenthood: a thematic analysis of parents' perspectives

OBJECTIVE

Investigate parents' recollections of resilience hindering experiences in the first year of parenthood.

BACKGROUND

The transition to parenthood is a significant period of change in the lifespan. Understanding the factors which undermine resilience during this process will help illuminate resilience theory and provision of perinatal support.

METHODS

We conducted a thematic analysis of in-depth interviews with 10 parents (including four fathers) and examined factors hindering resilience as a global theme within a broader thematic network.

RESULTS

We identified two organising themes; context which related to external experiences and relationships and appraisals which related to parents' internal attributions and experiences. We refined these organising themes into 24 specific resilience hindering factors including ambivalence about parenthood, fear of judgement, compromised self-care and relationship change. We also collated parents' suggested changes to structural supports such as providing a comprehensive overview of services available to new parents, having credible resources online, engaging fathers directly in perinatal care and a greater focus on postnatal support such as prioritising continuity of care and making longer hospital stays available.

CONCLUSION

Our work illuminates parents' own thoughts about factors hindering resilience in the transition to parenthood and provides direct recommendations from consumers about improvements to provision of support throughout this critical period.

Developing a Prenatal Couple Education Program Focusing on Coparenting for Japanese Couples: A Quasi-Experimental Study

Having and raising children can be a source of joy for parents. However, the transition to parenthood is associated with a certain degree of strain and stress, and couple relationship quality often declines during the transition. Coparenting, the shared responsibility of childrearing, benefits both parents and children and is an important aspect of the transition to parenthood. In this quasi-experimental study, we aimed to develop a couple education program in Japan that focuses on coparenting among couples expecting their first child. Twenty-one healthy couples voluntarily participated in the intervention group (n = 16) or the control group (n = 5). Couples in each group could voluntarily participate in standard childbirth education classes. The intervention was a couple education program designed to enhance coparenting and consisted of two interactive classes, including discussions within each couple and watching a short video showing an example of childrearing. We collected outcome measures on childrearing, couple relationship, parental mental health, and child adjustment at 1 month and 3 months after childbirth. Multiple regression analysis was performed and showed positive effects of the intervention on childrearing and child adjustment. Being in the intervention group had a significant positive effect on Coparenting Support scores at 1 month after childbirth (β = 0.457, p < 0.003, R² = 0.187) and Soothability scores for child adjustment at 3 months after childbirth (β =0.429, p < 0.006, R² = 0.157). In conclusion, we have developed the prenatal education program focusing on coparenting for Japanese couples.

Improvements in coparenting conflict and child adjustment following an online program for relationship distress

Many children never receive treatment for their mental health symptoms-and those that do often receive it only after years of delay. Given that relationship and parenting conflict is an identified mechanism of child mental health symptoms, reducing distress in the parents' romantic relationship may help reduce this unmet need. In the current study, 213 couples with 1 or more children between the ages of 3 and 17 (inclusive) were randomized to receive the web-based OurRelationship program or to a 2-month waitlist condition. Intervention couples were also assessed in the year following the program. Couples in the OurRelationship program experienced a significant decrease in coparenting conflict during the intervention (Cohen's d = -0.27) but also a significant increase in coparenting conflict in the following year, reducing the long-term effects of the intervention (within-group d = -0.20 at 1-year follow-up compared with baseline). Additionally, parent-reported children's externalizing (within-group d = -0.40) and internalizing (within-group d = -0.27) symptoms significantly decreased from baseline to the 1-year follow-up. As hypothesized, improvement in relationship satisfaction during the program was significantly associated with a decrease in coparenting conflict which, in turn, was associated with reduction in both externalizing and internalizing symptoms in the children. These results indicate that online relationship-focused interventions offer an important, adjunctive approach to meet society's need for reducing children's mental health symptoms. Furthermore, the improvements in child functioning strengthen the evidence suggesting the cost-effectiveness of these relationship-focused interventions. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Improved Child Mental Health Following Brief Relationship Enhancement and Co-Parenting Interventions During the Transition to Parenthood

The transition to parenthood has been identified as a significant relationship stressor. Many couples report declines in relationship satisfaction and difficulty with individual stress and co-parenting-problems that have been associated with both child temperament as well as emotional and behavioral problems. Several parenting and relationship interventions have been developed to buffer against these difficulties. In the current study, we report secondary analyses of a randomized controlled trial of brief (6-hr) interventions that focused on improving either relationship satisfaction or co-parenting, delivered during pregnancy and the early postpartum period. In this trial, 90 opposite-sex couples (180 participants), who were pregnant with their first child, and were assessed as being at high risk for declines in relationship satisfaction, were randomized to receive either (1) a relationship intervention, (2) a co-parenting intervention, or (3) an information control. At 12 months postpartum, couples who received either the relationship or co-parenting intervention rated their infants as having lower negative emotionality and as having fewer externalizing symptoms compared to the information-only control. Lower externalizing symptoms at 12 months were, in turn, associated with reduced externalizing symptoms at 24 months postpartum. Whereas, lower ratings of child negative emotionality at 12 months were associated with reduced internalizing symptoms at 24 months postpartum. These results indicate that brief relationship or co-parenting interventions delivered during the transition to parenthood have secondary benefits for child mental health.