A Co-parent Intervention to Prevent Prenatal Stress and Depression in Parents with Lower Incomes

• In Event: Extended family roles, parenting, and child development

Abstract

Significant health disparities in the U.S. place low-income and racial and ethnic minority families at greater risk for parental depression, stress and poor child outcomes (Stewart et al., 2007). Research indicates that prenatal depression and stress interfere with optimal child development (Werner et al., 2013); some evidence suggests that such exposure is especially potent in the second trimester of pregnancy (Davis et al., 2011). Given the detrimental effects of prenatal depression and stress on new parents and their infants, there is a critical need to develop effective preventative programs for expectant parents early in pregnancy.
The goal of this pilot study was to evaluate the feasibility and efficacy of a new program, Preparing for Parenthood (PREP). PREP is a group-based, educational program that focuses on: a) depression reduction and stress management, b) strengthening co-parenting relationships and, c) increasing knowledge and preparation for childbirth. PREP is novel for a few reasons. First, PREP was developed to address the life stressors of lower income, racially and ethnically diverse families. Second, few interventions include fathers of infants in low-income families, despite evidence that couple-focused interventions yield stronger effects on parent and child outcomes than interventions targeting only one parent (Feinberg et al., 2010). Third, PREP is brief (six weeks), and delivered by family support paraprofessionals, making it less resource-intensive than many other family programs.
To evaluate PREP, we conducted a pilot pre-post, non-randomized control study. Twenty-four couples (48 participants) were assigned to the 6-week PREP intervention and 22 couples (46 participants) received treatment-as-usual (optional home visiting). Data were collected at three time points across the transition to parenthood: 1) Baseline (12-18 weeks gestation), 2) Post-Intervention (18-24 weeks gestation), and 3) Post-Birth (6 weeks postnatal). Self-report measures of stress (PSS) and depression (CES-D) were collected at each interview. Feasibility of recruitment, retention, assessment, and implementation of PREP were also evaluated.
In terms of feasibility, participants attended 5.4 (out of 6) classes on average. Satisfaction was high across the six sessions: the majority of parents reported “strongly agreeing” that the class topics were relevant; the group leaders were engaging and well-prepared; and that the class exercises were useful and engaging. Analyses were conducted in Mplus using multilevel modeling (MLM; Muthén & Muthén, 1998–2017). Results (see Figures 1 and 2) revealed a significant decrease in depressive symptoms and self-reported stress from baseline to post-birth for mothers in the intervention group compared to mothers in the control group. Fathers’ stress decreased significantly from pre-intervention to post-intervention in the intervention group, but results were not sustained post-birth.
Our findings suggest that a prenatal, partner-inclusive intervention is effective in reducing women’s depressive symptoms and men’s stress symptoms during pregnancy. Specifically, we found that explicitly targeting co-parenting relationships in early pregnancy appears to be an effective method for enhancing mental health during the transition to parenthood, even among unmarried couples. The present study makes a meaningful contribution to the perinatal prevention literature by developing and pilot testing the first partner-inclusive intervention for use with underserved families during the second trimester of pregnancy.

Authors

• Rachel Herman, Brown University
  Presenting Author

• Alexandrea L. Craft, Brown University
  Non-Presenting Author

• Christina Albina Rowley, University of Massachusetts Amherst
  Non-Presenting Author

• Maureen A Perry-Jenkins, University of Massachusetts Amherst
  Non-Presenting Author

• Marsha Kline Pruett, Smith College
  Non-Presenting Author

• Sally Powers, University of Massachusetts Amherst
  Non-Presenting Author

• Robert Straus
  Non-Presenting Author

• Nancy Byatt, UMass Memorial Medical Center
  Non-Presenting Author