Copyright Partners to Parents 2016. Award winning speech presented at the Australasian Marce Society for Perinatal Mental Health 2015 Conference. Findings used to create www.partnerstoparents.org

1. How Can Partners Support One Another to
Prevent Perinatal Depression and Anxiety?
A Delphi Consensus Study
Pam Pilkington, Dr Lisa Milne, Kathryn Cairns, and Dr Tom Whelan

2. Aim
To identify how partners can support one
another to reduce their vulnerability to
depression and anxiety during pregnancy and
following childbirth

3. The case for prevention
• Only 1 in 2 parents affected by perinatal mood problems
seek treatment (Woolhouse, Brown, Krastev, Perlen, & Gunn, 2009).
• Parents who experience perinatal depression and
anxiety are less able to
– Parent warmly (Seymour et al., 2015)
– Be involved (Seymour et al., 2015)
– Bond with their infant(McLearn, Minkovitz, Strobino, Marks, & Hou, 2006)
• And their infant is more likely to have cognitive and
emotional development problems (Murray & Cooper, 2003; Ramchandani,
Stein, Evans, & O'Connor, 2005; Sim & England, 2009).

4. The case for prevention

5. What is partner support?
• Partner: Someone with whom the individual shares an intimate
relationship, and can include de facto and same-sex relationships.
• “Partner support”
– Umbrella term for various social exchanges within the couple
relationship. E.g.,
• Emotional support
• Instrumental support
• Satisfaction with the division of labour
– Negative support interactions include
• Verbal disagreements
• Being criticised
• Feeling controlled

6. Why partner support?
• Partner support is one of the strongest protective factors against
perinatal mood problems (Pilkington, Milne, Cairns, Lewis, & Whelan, 2015)
• Partner support is modifiable
• Partners’ mental health is interrelated (Don & Mickelson, 2012)
• 1 in 2 fathers with a partner experiencing perinatal depression
will develop depression themselves
• During the perinatal period:
– The couple relationship is vulnerable to increased conflict
– There is an increased need for social and emotional support
– Parents have less contact with supports outside of the family
(Shapiro & Gottman, 2000)

7. Why partner support?
• Existing prevention interventions tend to rely on professional
support (e.g., home visits)
• BUT parents prefer to access support from their partners (Forsyth et al.,
2011; Rowe et al., 2013)
• It’s father inclusive
• It’s same-sex partner inclusive
• It’s empowering
• It reduces the burden on professionals

8. Method
• We used the Delphi consensus study to identify how partners
can support one another to reduce their risk of developing
depression and anxiety during pregnancy and the postpartum
period.
• What is the Delphi method?
– Used to establish agreement among experts (Jones & Hunter, 1995).
– Experts independently rate the importance of
questionnaire items on over successive rounds.
– Widely-used in health research to develop clinical
guidelines (Jorm, 2015; McKenna, 1994).

10. Questionnaire development
• We systematically searched websites and books to identify
actions that parents could take to prevent depression or
anxiety in their partner.
• We screened the search results using qualitative research
software NVivo 10 (QSR International, 2012).
• The final questionnaire comprised 252 items from 210
webpages and four books.
• Panel members were also given the opportunity to suggest
items

11. Panel members
• 39 Professionals
– 31 clinicians and eight researchers
• Psychologists, psychiatrists, nurses, social workers, and
counsellors.
• Working in hospitals, universities, family therapy,
private practice, and specialist perinatal mental health
services.
• Two thirds had at least 16 years of specialist experience
in perinatal mental health.
• 21 Consumer advocates
– Affiliated with organizations such as Peach Tree Perinatal
Wellness (QLD), PANDA (VIC), PANDSI (ACT) and PANDAS
(UK)

12. Survey rounds
• Experts independently rated questionnaire items on a 5-point
scale ranging from ‘Essential’ to ‘Should not be included’ over
3 successive rounds.
• Items endorsed by >80% of both panels (professionals and
consumers) as either Important or Essential  Included in
guidelines.
• Items endorsed by >80% of ONLY ONE panel as Important or
Essential OR endorsed by 70 to 79% of both panels as
Important or Essential  Rerated.
• Items that did not meet the above criteria were excluded 
Excluded.
End product is a list of recommendations endorsed by at
least 80% of the expert panels as important or essential to
the prevention of perinatal depression and anxiety.

13. Results
• 214 final recommendations.
*Also supported by sound or emerging evidence in our systematic review and meta-
analysis of modifiable partner factors associated with perinatal depression and
anxiety (Pilkington, Milne, Cairns, Lewis, & Whelan, 2015)
 Becoming a parent
 Supporting each other through
pregnancy and childbirth
 Developing acceptance
 Communication*
 Conflict*
 Division of labor*
 Practical support*
 Emotional support*
 Emotional closeness*
 Sexual satisfaction*
 Encouraging self-care
 Using alcohol and drugs*
 Help-seeking

14. Example tips
• Listen to each other’s concerns
• Communicate your expectations about parenting and try to ensure that
your expectations are compatible and realistic
• Try to understand your partner’s point of view even if you don’t agree,
e.g., “I can understand why you’re angry that I asked my parents over for
the weekend without talking to you first“
• Think about the things you used to like doing before you had the baby
and consider how you might do those activities together again
• If you lose interest in sex, explore different types of intimacy, such as
cuddling or hand holding

15. Differences between panels
Item CONSUMERS
“Essential” or
“Important” (%)
PROFESSIONALS
“Essential” or
“Important” (%)
If their partner is experiencing problems with anxiety, partners should
encourage them to consider taking supplements such as magnesium and
calcium, as these are effective in reducing anxiety
71.4 33.3
If their partner is resistant to going out, partners should think of things that
they can do together in the home that give them a break from parenting,
e.g., board games, watching a movie
95.2 67.6
Partners should be aware that there is very little they can do to help the
child-bearing mother during labour
47.6 20.5
Partners should help with the cleaning 90.5 63.9
Partners should help with housework before having to be asked by the
primary caregiver
95.2 69.4
Partners should try to get outdoors together with the baby as much as
possible
90.5 64.7
Partners should help the primary caregiver with preparing meals, e.g., food 90.5 66.7

17. Implications
The guidelines can now be promoted to new and expectant
parents in English-speaking countries to help them understand
how they can support their partner to reduce their risk of
developing depression and anxiety

18. Strengths
• Evidence-based information supported by CONSENSUS,
not just the opinions of a single person or a working
group
• Father-inclusive
• Same-sex partner inclusive
• Targets depression AND anxiety
• Targets both post and antenatal outcomes
• Involvement of consumers and key stakeholders

19. Limitations
• Relevance is limited to parents who are in a relationship with a
partner
• Does not address intimate partner violence (but does address
verbal aggression and criticism)
• Yet to be seen whether the guidelines are relevant to parents
culturally and linguistically diverse backgrounds
• Gender neutral approach may obscure important gender
differences and/or reduce uptake (e.g., lack of tailoring for
fathers) (Fletcher, Vimpani, Russell, & Keatinge, 2008).

20. Next steps
• Evaluate the effectiveness of the guidelines in preventing perinatal
depression and anxiety and enhancing partner support
• Translate the recommendations into an on-line intervention

21. Acknowledgements
• Dr Tom Whelan, Supervisor
• Dr Lisa Milne, Supervisor
• Kathryn Cairns, University of Melbourne
• Alain Martineau, Web Developer
• James Lewis, La Trobe
• Dr Rebecca Giallo, Murdoch Children’s Research Institute
• Holly Rominov, Australian Catholic University
• Bianca Whiteman, Australian Catholic University
Please get in touch (Pam.Pilkington@acu.edu.au) if you would like
a copy of the final guidelines or you would like to be notified when
the website is launched.

22. References
Don, B. P., & Mickelson, K. D. (2012). Paternal postpartum depression: the role of maternal postpartum depression, spousal support,
and relationship satisfaction. Couple and Family Psychology: Research and Practice, 1(4), 323-334. doi: 10.1037/a0029148
Fletcher, R., Vimpani, G., Russell, G., & Keatinge, D. (2008). The evaluation of tailored and web-based information for new fathers.
Child: Care, Health and Development, 439-446. doi: 10.1111/j.1365-2214.2008.00811.x
Forsyth, C., Skouteris, H., Wertheim, E. H., Paxton, S. J., & Milgrom, J. (2011). Men's emotional responses to their partner's pregnancy
and their views on support and information received. Australian and New Zealand Journal of Obstetrics and Gynaecology, 51(1), 53-
56. doi: 10.1111/j.1479-828X.2010.01244.x
Murray, L., & Cooper, P. (2003). Intergenerational transmission of affective and cognitive processes assiociated with depression:
infancy and the preschool years. New York: Oxford University Press.
Pilkington, P. D., Milne, L. C., Cairns, K. E., Lewis, J., & Whelan, T. A. (2015). Modifiable partner factors associated with perinatal
depression and anxiety: a systematic review and meta-analysis. Journal of Affective Disorders, 178, 165-180. doi:
10.1016/j.jad.2015.02.023
Ramchandani, P., Stein, A., Evans, J., & O'Connor, T. G. (2005). Paternal depression in the postnatal period and child development: a
prospective population study. The Lancet, 365(9478), 2201-2205. doi: 10.1016/s0140-6736(05)66778-5
Rowe, H., Holton, S., & Fisher, J. (2013). Postpartum emotional support: a qualitative study of women's and men's anticipated needs
and preferred sources. Australian Journal of Primary Health, 19(1), 46-52. doi: 10.1071/PY11117
Seymour, M., Giallo, R., Cooklin, A., & Dunning, M. (2015). Maternal anxiety, risk factors and parenting in the first post-natal year.
Child: Care, Health and Development, 41(2), 314-323. doi: 10.1111/cch.12178
Shapiro, A., Gottman, J., & Carrere, S. (2000). The baby and the marriage: identifying factors that buffer against decline in marital
satisfaction after the first baby arrives. Journal of Family Psychology, 14(1), 59-70. doi: 10.1037//0893-3200.14.1.59
Sim, L. J., & England, M. J. (2009). Depression in parents, parenting, and children: opportunities to improve identification, treatment,
and prevention: National Academies Press.
Woolhouse, H., Brown, S., Krastev, A., Perlen, S., & Gunn, J. (2009). Seeking help for anxiety and depression after childbirth: results of
the Maternal Health Study. Archives of Women’s Mental Health, 12(2), 75-83. doi: 10.1007/s00737-009-0049-6