Mindfulness-based relationship education for couples expecting their first child--part 1: a randomized mixed-methods program evaluation

Efficacy of contextual therapies in perinatal depression and anxiety: A systematic review and meta-analysis

BACKGROUND

There are previous meta-analyses on the efficacy of cognitive behavioral therapy or mindfulness-based therapies in the perinatal period, but no previous review has focused on contextual therapies as a whole. The aim of this study was to carry out a systematic review and meta-analysis of the efficacy of contextual therapies on depressive and anxious symptoms in women in the perinatal period.

METHODS

A systematic search for randomized clinical trials has been carried out in the PUBMED, CINAHL, Psyc-INFO and Cochrane Library search engines. For the quantitative synthesis, the Morris effect size measure has been used.

RESULTS

A total of 34 RCTs have been found, of which 30 have been used for meta-analysis. The mean effect size of the studies on depression scores was dppc2 = -0.81 (95% CI = -1.12 to -0.50), while it was dppc2 = -1.04 (95% CI = -1.54 to -0.53) in the case of studies on anxiety scores. These effect sizes decreased to medium effect sizes when corrected for publication bias.

LIMITATIONS

The main limitations are the quality of the included studies, publication bias, and the limited number of studies on contextual therapies other than mindfulness-based therapies.

CONCLUSIONS

In conclusion, this systematic review found a large number of efficacy studies on mindfulness-based therapies and a small number of studies on the other contextual therapies. The effect sizes found are consistent with previous meta-analyses in the perinatal period.

MIESRA mHealth: Marital satisfaction during pregnancy

The transition of a pregnant woman's role often causes emotional changes that have an impact on marital satisfaction. We develop MIESRA mHealth and evaluate its impact on satisfaction of husband-wife relationship during pregnancy. A quasi-experimental study was conducted on 82 couples of pregnant women and divided into control, single, and paired group. We implemented MIESRA mHealth for four weeks. In the couple group, the wife did mindfulness based on the information in the MIESRA mHealth together with her husband. In a single group, the wife sees the video as an initial guide to doing mindfulness. In the control group, respondents received programme interventions from hospitals which included education and consultation with obstetricians. Husband-wife relationship is evaluated using Compatibility of Husband-and-Wife Relationships / Kesesuaian Hubungan Suami Istri (KHSI) questionnaire and the generalised estimating equations (GEE) was used to analyse the data. The women's KHSI scores in the couple and single intervention groups (β = -7.46, p = 0.002; β = -9.11, p = 0.001) were better than the control group. The husbands' KHSI scores in the paired and individual intervention groups (β = -7.04, p<0.001; β = -3.74, p = 0.024) were better than the control group. Nursing interventions to build emotional bonds between parents and foetuses based on mHealth can be a promising intervention for marital harmony during the perinatal period. MIESRA m-Health is a promising intervention on marital satisfaction during pregnancy and can be implemented as a part of the antenatal care programme to increase marital satisfaction.

Is mindfulness one-size-fits-all?: Consulting community members and stakeholders to adapt mindfulness for communities with low-income and economic marginalization

BACKGROUND AND PURPOSE

Although stress is pertinent to all people, individuals with low-income and economic marginalization (LIEM) tend to experience greater psychosocial stressors as well as different relationship stressors than individuals with higher income. While mindfulness may be a particularly useful tool for individuals with LIEM, it has yet to be adapted for this community. Using a community-based participatory research (CBPR) approach, the present study conducted focus groups with community members with LIEM to identify effective dissemination strategies.

MATERIALS AND METHODS

Thirteen individuals with LIEM were recruited to participate in one of two focus groups. The focus groups collected information on how individuals with LIEM cope with stress, how these individuals perceive mindfulness, and how to reduce barriers to participating in a brief mindfulness intervention for stress. Focus groups were transcribed and coded by four coders using thematic analysis within a grounded theory framework.

RESULTS

Twelve themes were identified: movement-based coping, behavioral/tactile coping, interest in mindfulness, familiarity with mindfulness, tangible mindfulness, narrow understanding of practicing mindfulness, relaxing, affiliation, alliance with healthcare facility, storytelling, breaking bread, and mental health treatment stigma.

CONCLUSION

Themes derived from the focus groups were discussed with community stakeholders. Findings from this study informed clinical considerations for using mindfulness with individuals with LIEM.

Concurrent randomized control trials of the 1-year efficacy of two couple relationship education programs: ELEVATE and Couples Connecting Mindfully

A long-standing university-community partnership used a longitudinal randomized control trial to implement and evaluate two couple relationship education (CRE) curricula, ELEVATE and Couples Connecting Mindfully (CCM), among an economically and racially diverse population of adult couples. Married and non-married couples (n = 929 couples) completed baseline surveys and were randomly assigned to either one of the two program groups or to the control group by implementation site. Follow-up surveys were collected at 2 months, 6 months, and 1 year after baseline. Using an intent-to-treat approach, growth curve modeling comparisons of trajectories indicated program effects at 1 year post-baseline in key outcome areas. Both the ELEVATE and the CCM group reported significant gains in couple relationship skills, couple quality, and family harmony over time compared to the control group that experienced either no change or declines. Further, the ELEVATE group also demonstrated positive program effects on measures of mental health and sleep quality. An assessment of the central premise of CRE indicated that the immediate post-program improvements in couple relationship skills predicted later couple quality for both program groups. This study indicates that both ELEVATE and CCM can be considered evidence-based CRE programs for use with a broad population of couples.

Keeping your coparent in mind: A longitudinal investigation of mindfulness in the family system

Recent studies have increasingly focused on mindfulness as it relates to interpersonal processes. In particular, cross-sectional research has shown that parents' dispositional mindfulness is associated with increased mindful parenting and coparenting, as well as improved coparenting relationship quality. The current study replicates and extends such work, representing the first longitudinal investigation of mindful coparenting. A sample of 449 parents (60% mothers) of children between the ages of 3 and 17 years were recruited online through Amazon's Mechanical Turk (MTurk) as part of a larger study on the assessment of parenting. Parents reported on their dispositional mindfulness, mindful coparenting, and coparenting relationship quality at three time points across an 8-month period. Results from a cross-lagged panel model using maximum likelihood estimation suggested that higher levels of parental mindfulness at baseline were related with higher levels of mindful coparenting at 4 months, which, in turn, were related to higher quality coparenting relationship at 8 months. Support for this model was found for both mothers and fathers and across all examined child age groups (i.e., early childhood, middle childhood, and adolescence), highlighting the robust nature of these effects. Overall, findings suggest that increasing mindfulness at an individual level can promote meaningful change within a family system, specifically through improvements in coparenting and parent-child interactions.

Self-compassion mediates the link between attachment security and intimate relationship quality for couples navigating pregnancy

Millions of couples navigate the transition from pregnancy to postpartum in a given year, and this period of change and adjustment in the family is associated with elevated risk for intimate relationship dysfunction. Self-compassion has the potential to promote skills that are essential for healthy adaptation (e.g., emotion regulation, greater openness and flexibility, and more awareness of the needs of oneself and one's partner). The overarching goal of the present study was to investigate the role of self-compassion in intimate relationship quality during pregnancy. A sample of 159 couples completed semi-structured interviews and questionnaires. Parents engaging in more compassionate self-responding during pregnancy have higher-quality intimate relationships as measured across multiple facets-the degree of emotional intimacy and closeness in the relationship, adaptive conflict management and resolution, high-quality support in response to stress, and a high degree of respect and acceptance directed toward each other. Furthermore, compassionate self-responding emerged as a mediator of the link between attachment security and intimate relationship quality. Specifically, mothers who were higher in attachment anxiety reported lower levels of compassionate self-responding, which in turn undermined multiple dimensions of the intimate relationship. Furthermore, fathers who were higher in attachment avoidance practiced less self-compassion, which have deleterious consequences for the couple. These results provide implications that can inform conceptual frameworks of intimate relationship quality and clinical implications for interventions targeting the transition into parenthood.

Mindfulness-Based Couple Interventions: A Systematic Literature Review

Over the past decades, mindfulness-based interventions have been shown to improve individual health and well-being in clinical and nonclinical settings. More recently, secular contemplative trainings were adapted to the couple context as research showed satisfying couple relationships to be one of the strongest predictors of physical and mental health. Mindfulness-based interventions hence seem to be a promising treatment in couple counseling and therapy in both clinical and nonclinical settings. Therefore, we conducted a systematic review to provide an overview of the emerging literature in the field of mindfulness-based interventions for couples and other dyads. Overall, sixteen studies met the inclusion criteria. To summarize the heterogeneous quantitative literature regarding individual outcomes, mindfulness interventions for couples seem to increase mindfulness, self-compassion, well-being, and quality of life. Additionally, we found initial evidence of beneficial effects on relieving psychopathological symptoms and psychobiological stress measures. Measures of relationship quality were the predominant dyadic outcome. Based on these studies, we cautiously conclude that mindfulness trainings can enhance relationship quality. Practitioners should be aware that mindfulness-based interventions for couples can potentially improve the perceived relationship quality between partners and the individual burden. Future studies should expand the field, particularly with regard to other contemplative practices for couples such as compassion interventions.

Longitudinal changes in HRV across pregnancy and postpartum: Effect of negative partner relationship qualities

During pregnancy, there are significant physiological changes to support a healthy fetus. Parasympathetic activity normatively decreases across pregnancy, and psychological stress can promote even further decreased heart rate variability (HRV). This study evaluated (1) changes in vagally-mediated HRV from pregnancy to postpartum, (2) changes in vagally-mediated HRV from pregnancy to postpartum based on negative partner relationship qualities, and (3) changes in depressive symptoms from pregnancy to postpartum based on negative partner relationship qualities. 78 participants in their 3rd trimester self-reported their relationship quality with their partner at the first visit. Depressive symptoms and vagally-mediated HRV were evaluated at rest at five time points from 3rd trimester to 12 months postpartum. On average, the only significant increase in vagally-mediated HRV occurred between the 3rd trimester and 4-6 weeks postpartum. However, those who reported more negative partner relationship qualities during their 3rd trimester of pregnancy maintained lower vagally-mediated HRV levels across all of the first year postpartum and significantly lower vagally-mediated HRV at both 4 and 8 months postpartum as compared to people who reported fewer negative partner relationship qualities. Across the first year postpartum, people reporting more negative partner relationship qualities experienced more severe depressive symptoms than their counterparts with fewer negative partner relationship qualities; however, there was no difference in the rate of change of depressive symptoms across the first year postpartum based on negative partner relationship qualities. Because lower vagally-mediated HRV is associated with depressive symptoms, future work should explore the temporal relationship between vagally-mediated HRV and depressive symptoms in the postpartum period.

Perinatal Depression, Birth Experience, Marital Satisfaction and Childcare Sharing: A Study in Russian Mothers

BACKGROUND

Over 300,000 women in Russia face perinatal depressive disorders every year, according to the data for middle-income countries. This study is the first attempt to perform a two-phase study of perinatal depressive disorders in Russia. The paper examines risk factors for perinatal depressive symptoms, such as marital satisfaction, birth experience, and childcare sharing.

METHODS

At 15-40 gestational weeks (M = 30.7, SD = 6.6), 343 Russian-speaking women, with a mean age of 32 years (SD = 4.4), completed the Edinburgh Postnatal Depression Scale, Couples Satisfaction Index, Birth Satisfaction Scale, and provided socio-demographic data. Two months after childbirth, 190 of them participated in the follow-up.

RESULTS

The follow-up indicated that 36.4% of participants suffered from prenatal depression and 34.3% of participants had postnatal depression. Significant predictors of prenatal depression were physical well-being during pregnancy (β = -0.25; p = 0.002) and marital satisfaction during pregnancy (β = -0.01; p = 0.018). Birth satisfaction (β = -0.08; p = 0.001), physical well-being at two months after delivery (β = -0.36; p < 0.01), and marital satisfaction during pregnancy (β = 0.01; p = 0.016) and after delivery (β = -0.02; p < 0.01) significantly predicted postnatal depression at 2 months after delivery.

CONCLUSION

Our study identified that physical well-being during pregnancy and marital satisfaction during pregnancy significantly predicted prenatal depression. Birth satisfaction, physical well-being at 2 months after delivery, and marital satisfaction during pregnancy and after delivery significantly predicted postnatal depression. To our knowledge, this is the first study of perinatal depressive disorders in the context of marital satisfaction and birth satisfaction in the Russian sample. The problem of unequal childcare sharing is widely spread in Russia. Adjusting spousal expectations and making arrangements for childcare may become the focus of psychological work with the family. The availability of psychological support during pregnancy and labor may be important in the context of reducing perinatal depression risks.

The Indirect Effect of Parental Intolerance of Uncertainty on Perinatal Mental Health via Mindfulness During COVID-19

Objectives

The COVID-19 pandemic is associated with mental health difficulties, especially during pregnancy and early postpartum. Intolerance of uncertainty (IU) and reduced capacity for mindfulness-a protective factor for child-bearers-may be particularly relevant factors driving mental health problems given the unpredictable nature of the pandemic. The current study aims to shed light on modifiable paths to perinatal psychological distress by testing whether there is an indirect effect of IU on psychological symptoms through a perceived reduction in mindfulness during the pandemic.

Methods

Pregnant individuals (67%, n = 133) and new mothers within 6 months postpartum (33%, n = 66) participated in a cross-sectional online survey assessing IU, current and retrospective pre-pandemic mindfulness (FFMQ), and psychological symptoms (anxiety, depression, somatization; BSI). Perceived change in mindfulness was captured by including retrospective mindfulness as a covariate in the PROCESS macro used for analyses.

Results

Tests of the direct association between mindfulness, IU, and psychological symptoms showed significant effects of IU (b = 0.46, SE = 0.064; p < .001) and perceived decrease in mindfulness during the pandemic (b =  - 0.72, SE = 0.08, p < .001) on psychological symptoms (R ² = .21-.34; F[2, 197] = 51.13-52.81, p < .001). The indirect effect of IU on symptoms via perceived decrease in mindfulness during the pandemic (b = 0.13, SE = 0.043, 95%CI [.060, .226]) was significant (R ² = .41, F[3, 195] = 45.08, p < .001).

Conclusions

Results suggest that mothers who are less able to tolerate uncertainty experience more psychological symptoms, in part due to perceived reduction in mindfulness during the pandemic. Future research should examine whether IU is a screening risk marker and target for mindfulness-based interventions to improve maternal well-being and family outcomes.

A systematic review and meta-analysis of psychological interventions to improve mental wellbeing

Our current understanding of the efficacy of psychological interventions in improving mental states of wellbeing is incomplete. This study aimed to overcome limitations of previous reviews by examining the efficacy of distinct types of psychological interventions, irrespective of their theoretical underpinning, and the impact of various moderators, in a unified systematic review and meta-analysis. Four-hundred-and-nineteen randomized controlled trials from clinical and non-clinical populations (n = 53,288) were identified for inclusion. Mindfulness-based and multi-component positive psychological interventions demonstrated the greatest efficacy in both clinical and non-clinical populations. Meta-analyses also found that singular positive psychological interventions, cognitive and behavioural therapy-based, acceptance and commitment therapy-based, and reminiscence interventions were impactful. Effect sizes were moderate at best, but differed according to target population and moderator, most notably intervention intensity. The evidence quality was generally low to moderate. While the evidence requires further advancement, the review provides insight into how psychological interventions can be designed to improve mental wellbeing.

Mindfulness-based programmes for mental health promotion in adults in nonclinical settings: A systematic review and meta-analysis of randomised controlled trials

BACKGROUND

There is an urgent need for mental health promotion in nonclinical settings. Mindfulness-based programmes (MBPs) are being widely implemented to reduce stress, but a comprehensive evidence synthesis is lacking. We reviewed trials to assess whether MBPs promote mental health relative to no intervention or comparator interventions.

METHODS AND FINDINGS

Following a detailed preregistered protocol (PROSPERO CRD42018105213) developed with public and professional stakeholders, 13 databases were searched to August 2020 for randomised controlled trials (RCTs) examining in-person, expert-defined MBPs in nonclinical settings. Two researchers independently selected, extracted, and appraised trials using the Cochrane Risk-of-Bias Tool 2.0. Primary outcomes were psychometrically validated anxiety, depression, psychological distress, and mental well-being questionnaires at 1 to 6 months after programme completion. Multiple testing was performed using p < 0.0125 (Bonferroni) for statistical significance. Secondary outcomes, meta-regression and sensitivity analyses were prespecified. Pairwise random-effects multivariate meta-analyses and prediction intervals (PIs) were calculated. A total of 11,605 participants in 136 trials were included (29 countries, 77% women, age range 18 to 73 years). Compared with no intervention, in most but not all scenarios MBPs improved average anxiety (8 trials; standardised mean difference (SMD) = -0.56; 95% confidence interval (CI) -0.80 to -0.33; p-value < 0.001; 95% PI -1.19 to 0.06), depression (14 trials; SMD = -0.53; 95% CI -0.72 to -0.34; p-value < 0.001; 95% PI -1.14 to 0.07), distress (27 trials; SMD = -0.45; 95% CI -0.58 to -0.31; p-value < 0.001; 95% PI -1.04 to 0.14), and well-being (9 trials; SMD = 0.33; 95% CI 0.11 to 0.54; p-value = 0.003; 95% PI -0.29 to 0.94). Compared with nonspecific active control conditions, in most but not all scenarios MBPs improved average depression (6 trials; SMD = -0.46; 95% CI -0.81 to -0.10; p-value = 0.012, 95% PI -1.57 to 0.66), with no statistically significant evidence for improving anxiety or distress and no reliable data on well-being. Compared with specific active control conditions, there is no statistically significant evidence of MBPs' superiority. Only effects on distress remained when higher-risk trials were excluded. USA-based trials reported smaller effects. MBPs targeted at higher-risk populations had larger effects than universal MBPs. The main limitation of this review is that confidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach is moderate to very low, mainly due to inconsistency and high risk of bias in many trials.

CONCLUSIONS

Compared with taking no action, MBPs of the included studies promote mental health in nonclinical settings, but given the heterogeneity between studies, the findings do not support generalisation of MBP effects across every setting. MBPs may have specific effects on some common mental health symptoms. Other preventative interventions may be equally effective. Implementation of MBPs in nonclinical settings should be partnered with thorough research to confirm findings and learn which settings are most likely to benefit.

Cumulative Childhood Trauma and Couple Satisfaction: Examining the Mediating Role of Mindfulness

Objectives

Cumulative childhood trauma (CCT) survivors are at a higher risk of suffering from interpersonal problems including couple dissatisfaction. Dispositional mindfulness is increasingly proposed as a potential explanatory mechanism of post-traumatic symptomatology and has been documented as a predictor of couple satisfaction. Most authors operationalize mindfulness as a multidimensional disposition comprised of five facets (i.e., Describing, Observing, Non-judgment of inner experiences, Non-reactivity, and Acting with awareness), but the role of these facets in the link between CCT and couple satisfaction has yet to be understood. This study aimed to assess mindfulness as a potential mediator in the relationship between CCT and couple satisfaction and to examine the distinctive contributions of mindfulness facets in this mediation.

Methods

A sample of 330 participants from the community completed measures of couple satisfaction, mindfulness, and exposure to eight types of childhood maltreatment experiences.

Results

Path analysis results revealed that mindfulness mediated the relationship between CCT and couple satisfaction. More precisely, two mindfulness facets acted as specific mediators, namely, Describing and Non-judgment of inner experiences. The final integrative model explained 14% (p < .001) of the variance in couple satisfaction.

Conclusions

Findings suggest that mindfulness may be a meaningful mechanism in the link between CCT and couple satisfaction. They also highlight that description of inner experiences and a non-judgmental attitude of these experiences may act as key components to understand the influence of CCT on adults' lower couple satisfaction.

Exploring the Link between Mindfulness and Relationship Quality: Direct and Indirect Pathways

This study serves to advance the empirical research on predictors of relationship quality by considering the role of trait mindfulness in combination with measures of stress and positive relationship behaviors among a diverse sample of men and women in couple relationships. Multi-group structural equation models tested both direct links and indirect pathways and found stronger evidence for an additive model of trait mindfulness, perceived stress, and positive couple behaviors uniquely associated with men's and women's reports of relationship quality. Furthermore, positive relationship behaviors are comparatively the most closely linked with relationship quality for both men and women in our sample. As more clinicians are incorporating mindfulness training with clients, these types of explorations can serve to inform practices on relative value of intervention strategies and possible pathways for enhancing couple relationship quality.

An Examination of the Association Between Relationship Mindfulness and Psychological and Relational Well-being in Committed Couples

Relationship mindfulness is the degree to which individuals tend to be mindful during interactions with romantic partners. In this study, we examined both the intrapersonal and interpersonal links between relationship mindfulness and psychological and relationship functioning in a sample of 219 couples who had been in their relationship for at least 1 year. Even when accounting for the general tendency to be mindful, relationship mindfulness was linked with markers of relationship well-being and psychological functioning, both intrapersonally and interpersonally. The findings bring to light the importance of considering relationship mindfulness in clinical work with couples that focuses on addressing deficiencies in relationship or psychological well-being.

Relationship Distress as a Mediator of Adverse Childhood Experiences and Health: Implications for Clinical Practice with Economically Vulnerable Racial and Ethnic Minorities

Adverse childhood experiences (ACE) are interpersonal sources of distress negatively correlated with physical and mental health, as well as maladaptive intimate partner conflict strategies in adulthood. Economically vulnerable racial and ethnic minorities report the greatest disparities in exposure to ACE, as well as relationship distress and health. Yet, little is known about the connections between ACE, relationship distress, and health. We therefore tested a theoretical model for the mediating role of relationship distress to explain the ACE-health connection with a sample (N = 96) predominantly racial/ethnic minorities (87%) with low income. We applied partial least squares structural equation modeling with bootstrapping (N = 500). Relationship distress strengthened the predictive relationship between ACE and health, and accounted for 42% of the variance in health. The results provide preliminary support for relationship distress as a social determinant of health disparities with implications for interdisciplinary health intervention.

Mindfulness in the Context of Romantic Relationships: Initial Development and Validation of the Relationship Mindfulness Measure

Trait mindfulness and mindfulness in the context of romantic relationships may not be completely overlapping constructs. This study adapted an existing measure of trait mindfulness to assess the tendency to be mindful in romantic relationships, the Relationship Mindfulness Measure (RMM). Using data from 185 young adults, the results supported the RMM's internal consistency, test-retest reliability, and concurrent and predictive validity. The RMM accounted for a significant portion of variance in positive relationship quality, negative relationship quality, and anxious and avoidant attachment, even after controlling for trait mindfulness. Based on these findings, assessing relationship mindfulness may improve research exploring the role of mindfulness in romantic relations and therefore facilitate the development and refinement of mindfulness training programs for couples.

Mindfulness for pregnancy: A randomised controlled study of online mindfulness during pregnancy

OBJECTIVE

Prenatal depression, stress and anxiety are significant predictors of postnatal depression and also have a direct negative impact on the family. Helpful psychological interventions during pregnancy are scarce and expensive, and usually only available for a small percentage of those suffering or deemed to be at risk. The aim of this study was to evaluate the potential of an online mindfulness course for expectant mothers.

DESIGN

A randomised study was conducted to explore differences between control and active participants allocated to take an online mindfulness course, offered free to research participants, or wait.

SETTING

The course provided was online and already available but given to study participants for free. Measures were also taken online using a secure site to collect the data.

PARTICIPANTS

185 mothers were recruited and randomised to the online course (n = 107) or a waitlist control (n = 78), with 72 completers at post-course (n = 22 active, n = 50 control) and 48 completers at postnatal follow-up (n = 16 active and n = 32 control).

INTERVENTION

The online mindfulness course is available at www.bemindfulonline.com and comprises a four-week, condensed version of an eight-week mindfulness course, with videos and written instructions for guided meditation and other mindfulness-based exercises.

MEASUREMENTS AND FINDINGS

A number of psychological well-being measurements were taken including stress, anxiety, depression and pregnancy-specific measure such as labour worry. Intention to treat analysis (baseline carried forwards) showed no group difference in stress from pre to post intervention or control.

KEY CONCLUSIONS

Results indicated that the course was potentially beneficial for those who completed it, but levels of drop out from the course were very high.

IMPLICATIONS FOR PRACTICE

Although outcomes for mothers completing the intervention were improved relative to a waitlist control, high rates of drop out indicate that the online course has low completion rates for pregnant women in its current format.

Clinical effectiveness of family therapeutic interventions in the prevention and treatment of perinatal depression: A systematic review and meta-analysis

BACKGROUND

Family therapy is a potential strategy to increase family support for those suffering from perinatal depression. Family therapeutic interventions for this population typically target depressed women and their adult family members to improve family functioning and reduce depressive symptoms.

OBJECTIVE

This systematic review and meta-analysis is a synthesis of the current evidence on the usefulness of family therapy interventions in the prevention and treatment of perinatal depression and impacts on maternal depressive symptoms and family functioning.

METHODS

This study used the Cochrane Collaboration guidelines for systematic reviews and meta-analyses. Six electronic databases were searched for randomized controlled trials and cluster randomized trials. The primary outcomes included maternal depressive symptoms and family functioning.

RESULTS

Seven studies were included in the qualitative and quantitative analyses. Fixed effects models showed statistically significant reductions in depressive symptoms at post-intervention in intervention group mothers. Intervention intensity and level of family involvement moderated intervention impacts on maternal depression. A fixed effects model showed a trend in improving family functioning at post-intervention in intervention group couples.

CONCLUSION

Although a limited number of controlled trials on family therapeutic interventions for this population exist, the findings show that these types of interventions are effective in both the prevention and treatment of perinatal depression. Recommendations for future research are addressed.

SYSTEMATIC REVIEW AND META-ANALYSIS PROTOCOL REGISTRATION

PROSPERO, CRD42017075150.

Mindful Mates: A Pilot Study of the Relational Effects of Mindfulness-Based Stress Reduction on Participants and Their Partners

Very little is currently known about how increases in dispositional mindfulness through mindfulness training affect the quality of participants' romantic relationships, and no previous studies have examined how increases in specific facets of mindfulness differentially contribute to relationship health. Additionally, even less is known about how an individual's development of mindfulness skills affects the relationship satisfaction of his or her romantic partner. Thus, the purpose of this pilot study was to examine associations between changes in facets of mindfulness and relationship satisfaction among participants enrolled in a Mindfulness-Based Stress Reduction (MBSR) course and their nonenrolled romantic partners. Twenty MBSR participants and their nonenrolled partners (n = 40) completed measures of mindfulness and relationship satisfaction pre- and post-enrolled partners' completion of an MBSR course. Results indicated that enrolled participants significantly improved on all facets of mindfulness and relationship satisfaction, while nonenrolled partners did not significantly increase on any facet of mindfulness or relationship satisfaction. Moreover, enrolled participants' increases in Acting with Awareness were positively associated with increases in their own and their nonenrolled partners' relationship satisfaction, whereas increases in enrolled participants' Nonreactivity were positively associated with increases in their nonenrolled partners' (but not their own) relationship satisfaction. These results suggest that increasing levels of mindfulness (particularly specific aspects of mindfulness) may have positive effects on couples' relationship satisfaction and highlight mindfulness training as a promising tool for education and intervention efforts aimed at promoting relational health.

Efficacy of 8- and 4-Session Mindfulness-Based Interventions in a Non-clinical Population: A Controlled Study

Background: Many attempts have been made to abbreviate mindfulness programmes in order to make them more accessible for general and clinical populations while maintaining their therapeutic components and efficacy. The aim of this study was to assess the efficacy of an 8-week mindfulness-based intervention (MBI) programme and a 4-week abbreviated version for the improvement of well-being in a non-clinical population.

Method: A quasi-experimental, controlled, pilot study was conducted with pre-post and 6-month follow-up measurements and three study conditions (8- and 4-session MBI programmes and a matched no-treatment control group, with a sample of 48, 46, and 47 participants in each condition, respectively). Undergraduate students were recruited, and mindfulness, positive and negative affect, self-compassion, resilience, anxiety, and depression were assessed. Mixed-effects multi-level analyses for repeated measures were performed.

Results: The intervention groups showed significant improvements compared to controls in mindfulness and positive affect at the 2- and 6-month follow-ups, with no differences between 8- vs. 4-session programmes. The only difference between the abbreviated MBI vs. the standard MBI was found in self-kindness at 6 months, favoring the standard MBI. There were marginal differences in anxiety between the controls vs. the abbreviated MBI, but there were differences between the controls vs. the standard MBI at 2- and 6-months, with higher levels in the controls. There were no differences in depression between the controls vs. the abbreviated MBI, but differences were found between the controls vs. the standard MBI at 2- and 6-months, favoring the standard MBI. There were no differences with regard to negative affect and resilience.

Conclusion: To our knowledge, this is the first study to directly investigate the efficacy of a standard 8-week MBI and a 4-week abbreviated protocol in the same population. Based on our findings, both programmes performed better than controls, with similar effect size (ES). The efficacy of abbreviated mindfulness programmes may be similar to that of a standard MBI programme, making them potentially more accessible for a larger number of populations. Nevertheless, further studies with more powerful designs to compare the non-inferiority of the abbreviated protocol and addressing clinical populations are warranted.

Clinical Trials.gov Registration ID: NCT02643927

The Postpartum Partner Support Scale: Development, psychometric assessment, and predictive validity in a Canadian prospective cohort

BACKGROUND

postpartum depression is a significant public health issue with well-documented negative consequences. A strong risk factor that has been consistently identified in international samples is a poor partner relationship. However, no instrument exists to measure postpartum-specific partner support.

OBJECTIVES

the objective of this methodological study was to develop and psychometrically test an instrument to assess the perception of postpartum partner support to guide interventions.

DESIGN

using a theoretical model of social relationships and the functional elements of social support, the Postpartum Partner Support Scale was developed and content validity was judged by experts. Following a pilot test, the Postpartum Partner Support Scale was psychometrically assessed.

SETTINGS

the study was conducted in a health region near Vancouver, British Columbia.

PARTICIPANTS

396 women at 1, 4, and 8 weeks postpartum.

METHODS

the psychometric assessment included analysis of internal consistency, exploratory factor analysis, composite reliability, and concurrent and predictive validity.

FINDINGS

the Cronbach's alpha for the Postpartum Partner Support Scale was 0.96, and exploratory factor analysis revealed a unidimensional solution. The Postpartum Partner Support Scale was positively correlated with general partner support and global social support and negatively correlated with perceived stress and child care stress. It also predicted maternal depressive and anxiety symptoms at 8 weeks postpartum among those without depression or anxiety at 1 or 4 weeks postpartum, respectively.

CONCLUSIONS

following further psychometric testing, the Postpartum Partner Support Scale may be used to (1) identify women with inadequate partner support who are at risk for poor mental health, (2) individualise postnatal care, and (3) evaluate preventive interventions.

The use of Theory in Family Therapy Research: Content Analysis and Update

In this study, we evaluated 275 empirical studies from Journal of Marital and Family Therapy and Family Process from 2010 to 2015 on their use of theory, and compared our findings to those of a similar previous analysis (Hawley & Geske, 2000). Overall, theory seems to have become much better incorporated in empirical family therapy research, with only 16.4% of the articles not using theory in either their introductory or discussion sections. Theory appeared better incorporated in the introductory sections than in the discussion sections. Systems theory remained the most commonly used conceptual framework, followed by attachment theory. We discuss areas for improving theory incorporation in family therapy research, and offer suggestions for both family therapy researchers and educators.

Effects of prenatal childbirth education for partners of pregnant women on paternal postnatal mental health and couple relationship: A systematic review

BACKGROUND

Partner education during pregnancy may be able to prevent postnatal mental health problems, and support expectant fathers in their transition to parenthood. The aim of this systematic review is to investigate the effects of prenatal childbirth education among partners of pregnant women, particularly regarding paternal postnatal mental health and couple relationship.

METHODS

We searched Medline, CINAHL, EMBASE, PsycINFO, ERIC, and CENTRAL using terms such as "partners of pregnant women," "education," and "prenatal support." Searches were limited to randomized trials.

RESULTS

We included 11 trials out of 13 reports that addressed the following topics: childbirth preparation, couple relationship, infants and parenting, postpartum psychosocial issues, and housework sharing. Overall risk of bias was low or unclear. Study outcomes, including parents' mental health (e.g., anxiety, depression, distress), couple relationship, parents' transition adjustment and parenting stress, and parents' satisfaction with their experience of childbirth and prenatal childbirth education programs were reported.

LIMITATIONS

The studies included in this review were very diverse regarding intervention intensity and content, outcome types, measurement tools, and outcome timing. This impeded evaluation of the interventions' effectiveness.

CONCLUSION

No sufficient evidence was identified that prenatal childbirth education for partners of pregnant women protects against paternal postnatal depression and couple relationship; however, paternal postnatal mental health is important to maternal and perinatal healthcare. The results of this review suggest that further research and intervention are required to provide partners of pregnant women with evidence-based information and support whole families during the perinatal period.

The Effectiveness of Mindfulness-Based Interventions in the Perinatal Period: A Systematic Review and Meta-Analysis

Perinatal mental health difficulties are associated with adverse consequences for parents and infants. However, the potential risks associated with the use of psychotropic medication for pregnant and breastfeeding women and the preferences expressed by women for non-pharmacological interventions mean it is important to ensure that effective psychological interventions are available. It has been argued that mindfulness-based interventions may offer a novel approach to treating perinatal mental health difficulties, but relatively little is known about their effectiveness with perinatal populations. This paper therefore presents a systematic review and meta-analysis of the effectiveness of mindfulness-based interventions for reducing depression, anxiety and stress and improving mindfulness skills in the perinatal period. A systematic review identified seventeen studies of mindfulness-based interventions in the perinatal period, including both controlled trials (n = 9) and pre-post uncontrolled studies (n = 8). Eight of these studies also included qualitative data. Hedge's g was used to assess uncontrolled and controlled effect sizes in separate meta-analyses, and a narrative synthesis of qualitative data was produced. Pre- to post-analyses showed significant reductions in depression, anxiety and stress and significant increases in mindfulness skills post intervention, each with small to medium effect sizes. Completion of the mindfulness-based interventions was reasonable with around three quarters of participants meeting study-defined criteria for engagement or completion where this was recorded. Qualitative data suggested that participants viewed mindfulness interventions positively. However, between-group analyses failed to find any significant post-intervention benefits for depression, anxiety or stress of mindfulness-based interventions in comparison to control conditions: effect sizes were negligible and it was conspicuous that intervention group participants did not appear to improve significantly more than controls in their mindfulness skills. The interventions offered often deviated from traditional mindfulness-based cognitive therapy or mindfulness-based stress reduction programmes, and there was also a tendency for studies to focus on healthy rather than clinical populations, and on antenatal rather than postnatal populations. It is argued that these and other limitations with the included studies and their interventions may have been partly responsible for the lack of significant between-group effects. The implications of the findings and recommendations for future research are discussed.

Mindfulness during romantic conflict moderates the impact of negative partner behaviors on cortisol responses

This study was designed to test whether romantic partners' mindfulness-present moment, nonjudgmental awareness-during a conflict discussion could buffer the effects of negative partner behaviors on neuroendocrine stress responses. Heterosexual couples (n=88 dyads) provided 5 saliva samples for cortisol assay during a laboratory session involving a conflict discussion task. Conflict behaviors were coded by outside observers using the System for Coding Interactions in Dyads, and partners rated their mindfulness during the task using the Toronto Mindfulness Scale. Interactions tested using multilevel modeling revealed that participants with higher levels of mindfulness during the conflict showed either quicker cortisol recovery or an absence of slowed recovery in the presence of more negative partner behaviors. Whereas the attitudinal component of mindfulness (curiosity) moderated effects of negative partner engagement in the conflict (i.e., attempts to control, coerciveness, negativity and conflict), the attentional component of mindfulness (decentering) moderated the effect of partner disengagement (i.e., withdrawal). These findings lend support to the idea that mindfulness during a stressful interaction can mitigate the physiological impacts of negative behaviors.

Mindfulness-based relationship education for couples expecting their first child-part 2: phenomenological findings

This phenomenological study is the second phase of a larger mixed methods study of a relationship-enhancement program for couples expecting their first child (see Gambrel & Piercy, this issue). The 4-week Mindful Transition to Parenthood Program uses mindfulness practices and interpersonal activities to develop skills of internal and interpersonal attunement. Based on semi-structured interviews with thirteen couples, four overarching themes emerged: (a) positive changes for self, (b) improvements in couple relationship, (c) more prepared for baby, and (d) male involvement. Participants stated that the program increased their acceptance and awareness, deepened connections with their partners, and led them to be more confident about becoming parents. Male participants felt they became more identified as fathers. The authors discuss the clinical implications of these findings.