Women’s perceived partner support during the perinatal and early childhood period: changes over time for women with and without Major Depressive Disorder

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Although there is likely a bidirectional relationship between support and mental health, a research gap exists in understanding changes in women’s experience of partner support over pregnancy and early childhood, and whether this differs for women with Major Depressive Disorder (MDD). This study examines whether women diagnosed with MDD antenatally are at increased risk of deteriorating partner support over the perinatal period, after accounting for demographic effects, ongoing depressive symptoms, stressful life events, and attachment patterns. 731 women recruited into a longitudinal pregnancy cohort study, the Mercy Pregnancy Emotional Wellbeing Study, were included, of whom 124 met MDD criteria at recruitment. MDD was diagnosed at early pregnancy using the Structured Clinical Interview for the DSM (SCID). Perceived partner support was measured with the Social Support Effectiveness Questionnaire (SSEQ) in third trimester, 6 and 12 months, and 4 years postpartum. Partner support changes over time were analysed with mixed effects modelling. There was an overall small but significant decline in partner support over time for all women. However, this decline was larger for women with MDD between 12 months and 4 years postpartum. Ongoing depressive symptoms, stressful life events, and insecure attachment patterns contributed to perceptions of lower partner support. The perinatal and early childhood period poses an increased risk for the partner relationship for all women, but this risk is increase for women with MDD. This knowledge could be translated into identifying vulnerable women and offering appropriate interventions. Social Support Partner Pregnancy Postpartum Depression Figures Figure 1 Introduction The transition to parenthood can be a time of joy, but it is also one of the most demanding and challenging life stages. It brings change to roles and relationships, requiring re-organisation and re-negotiation of individuals’ roles, as well as intimate partner relationship and family roles (Figueiredo et al., 2018 ). During this transition, a poor-quality interpersonal relationship is a risk factor for the development of postnatal depression (for example: Boyce and Hickey, 2005 ; Boyce et al., 1991 ), while positive partner relationship, especially perceived partner support, is a very important protective and potentially modifiable factor (Pilkington et al., 2015a ). Research evidence has clearly shown that a good quality partner relationship is protective against women’s perinatal mental health problems (e.g. Bedaso et al., 2021 , 2023 ; Figueiredo et al., 2008 ; Galbally et al., 2019 ; Whisman et al., 2011 ) and is linked to more positive child outcomes (e.g. Lähdepuro et al., 2024 ; Ray et al., 2024 ; Schuijers et al., 2024 ; Stapleton et al., 2012 ). In our previous research Galbally et al. ( 2019 ) found that partner support had a protective role against parenting distress for women with no history of childhood abuse and low depressive symptoms, but not for women with trauma history and high depressive symptoms. A good understanding of how the partner relationship changes over time is essential to improve the effectiveness, and timing, of clinical interventions. This is best achieved through longitudinal research. Many of the existing longitudinal studies have focused on how the quality of the intimate partner relationship affects a woman’s mental health. However, this is a bi-directional relationship: a good quality relationship and support can help women to adjust and cope with the stresses of parenthood, and be protective against mental health problems. Conversely, women’s experiences, the external environment, and caring for a newborn can affect the intimate relationship (Najman et al., 2014 ; e.g.Nakamura et al., 2020 ). Numerous studies have found relationship quality to be a protective factor for women’s perinatal mental health problems, as described earlier (e.g. Bedaso et al., 2021 , 2023 ; Figueiredo et al., 2008 ; Galbally et al., 2019 ; Whisman et al., 2011 ). Although fewer studies have examined the effect of mental health problems on the relationship, a consistent finding is that depressive and/or anxiety symptoms contribute to deterioration in the marital relationship (e.g. Bower et al., 2013 ; Parfitt and Ayers, 2014 ). Large longitudinal studies have found a bi-directional association between poor marital quality and depressive symptoms over time, from pregnancy to 2 years (Salmela-Aro et al., 2006 ) and even 21 years postpartum (Najman et al., 2014 ). Nevertheless, one study (Figueiredo et al., 2018 ) found that anxiety and depression symptoms had no moderating effect on trajectories of positive and negative couple interactions, although mothers and fathers with high negative interactions had a greater increase in depressive symptoms from 3 to 30 months postpartum. Longitudinal studies, examining the trajectory of the quality of partner relationship over the perinatal period across different countries, have found a small to moderate decline in couple relationship satisfaction from pregnancy to postpartum (Kluwer, 2010 ; Mitnick et al., 2009 ). A sharp decline has been shown up to 1 year postpartum (Lawrence et al., 2008 ; Twenge et al., 2003 ), but also up to early childhood (Kohn et al., 2012 ), and even 14.5 years after the birth of a baby (Keizer and Schenk, 2012 ), with a levelling off after 15 months postpartum (Kluwer and Johnson, 2007 ). Conversely, some studies examining subgroups with varying patterns of relationship changes, have found a stable relationship satisfaction trajectory for substantial proportions of couples, from 47% (Leonhardt et al., 2022 ) to 93% (Kingsbury et al., 2023 ). A steeper relationship satisfaction decline has been shown in first- than second-time parents (Canário and Figueiredo, 2016 ), and for couples with initial lower relationship satisfaction (Don and Mickelson, 2014 ). A larger and more sudden relationship decline has been found in childbearing couples compared to childless couples (Doss et al., 2009 ; Kluwer, 2010 ; Lawrence et al., 2008 ). A meta analytic study (Twenge et al., 2003 ) found a cohort effect, with more recent generations of parents reporting greater relationship decline, perhaps due to changes in gender roles over time. Women’s low socio-economic status (Nakamura et al., 2020 ), no employment during early parenthood (Hetherington et al., 2020 ; Keizer et al., 2010 ), and minority ethnicity (Hetherington et al., 2020 ) tend to contribute to lower partner or overall social support perinatally. Women’s anxious or avoidant attachment patterns in close relationships have also been associated with a decline in relationship satisfaction during the perinatal period (Kohn et al., 2012 ; Leonhardt et al., 2022 ; Rholes et al., 2014 ). Most longitudinal studies have focused on overall relationship quality and relatively few have examined specific aspects of partner support during the perinatal period. Focusing on specific aspects of support, such as emotional and practical, will enhance the translation of this information into targeted preventions and interventions (Pilkington et al., 2015a ). Both emotional and practical partner support have been established as important protective factors against women’s perinatal menta health symptoms (Pilkington et al., 2015a ). However, little is known about how they change over time during the transition to parenthood. During the perinatal period partner support is especially important compared to support from other sources and uniquely contributes to women’s perinatal adjustment (Kroelinger and Oths, 2000 ; Pajulo et al., 2001 ; Rini, 2001 ). In addition to the quantity of received support, women’s perceived effectiveness of received support is an important determinant of whether the support will have beneficial effects for their wellbeing (Rini, 2001 ). There is also a lack of longitudinal studies examining the perinatal trajectory of partner support for women with diagnosed mental health disorders, with most studies focusing only on depressive symptoms. Major Depressive Disorder is prevalent and causes significant burden for women perinatally. It is important to understand if women with Major Depressive Disorder are at an increased risk for insufficient or deteriorating partner support over the perinatal period. To address these identified gaps in research this study aims to examine first, how women’s perceptions of the effectiveness of emotional and practical partner support change from late pregnancy, to 6 and 12 months postpartum, and then when the child is 4 years of age. Secondly, we aim to examine whether these changes over time differ between women with, and without, Major Depressive Disorder (MDD). Finally, we aim to investigate whether socioeconomic factors, stressful life events, attachment patterns in close relationships, and childhood trauma affect women’s perceptions of partner support over time. Methods Sample Participant for this longitudinal study were women initially recruited at 20 weeks. The MPEWS is an Australian prospective pregnancy cohort study of women recruited at less than 20 weeks of pregnancy and followed up overtime. Women were recruited from Victoria and Western Australia. For the purposes of this study we used a nested sample from the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS). We used data collected at less than 20 weeks pregnancy (recruitment), third trimester, 6 months postpartum, 12 months postpartum, and when the child was 4 years old. The MPEWS used a selected cohort design to oversample women diagnosed with MDD at recruitment. Further details of MPEWS are described in the published study protocol (Galbally et al., 2017 ). Inclusion criteria Since this study focused on changes in perceived partner support over time, only women with a continuous relationship from first trimester to when the child is 4 years of age were included. Ethics The Ethics Committees of the participating institutions approved this study and all participants provided informed, written consent. Measures Demographic and socioeconomic characteristics MPEWS collected data on maternal age, university education, employment, ethnicity of the mother and father, and parity at recruitment. Reliable data on parity was only available at recruitment, and therefore the analysis could not account for women giving birth to additional children within the four years timespan of the study. Data on relationship status was collected at recruitment and at the follow up time points. Maternal Major Depressive Disorder and depressive symptoms At recruitment (less than 20 weeks gestation), the Structured Clinical Interview for DSM-IV (SCID-IV) was administered (First et al., 1997 ) to diagnose MDD. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) (Cox et al., 1987 ). For this study EPDS data at third trimester, 6 and 12 months, and 4 years postpartum was used. The EPDS has been validated for use with Australian women during the perinatal period (Boyce et al., 1993 ). Social Support Effectiveness Questionnaire Social support was measured using two, of the three, subscales from the Social Support Effectiveness Questionnaire (SSEQ) (Rini, 2001 ). These two scales, ‘Help with tasks and responsibilities’ and ‘Emotional support’, each consist of 10 items, asking the respondent to evaluate the quantity and effectiveness of the support provided by her partner. The SSEQ asks the extent to which the partner’s attempts at support meets the needs of the respondent, including the ease with which the support is obtained, and the match between what is needed and what is provided. Women’s perceived effectiveness of received support is an important determinant of whether the support will have beneficial effects for their wellbeing (Rini, 2001 ). The SSEQ has been shown to predict maternal and infant distress in the postpartum period, and to relate to facets of maternal attachment patterns (Stapleton et al., 2012 ). The SSEQ was administered to women at third trimester, six, 12 months, and four years postpartum. Stressful Life Events Scale (SLES) Stressful life events were assessed using a perinatally adapted Stressful Life Events Scale, which includes 24 common stressful life events (Brown et al., 2011b ). Items specifically for the perinatal period were selected from the Stressful Life Events Scale (Whitehead et al., 2003 ), and adapted and extended by Brown and colleagues. The measure includes items such as whether the respondent had a major illness or injury, got separated or divorced, lost her job, or was humiliated or emotionally abused by her partner. The items were adapted from Brown et al. ( 2011a ). A count of stressful life events was calculated separately for third trimester, six and 12 months, and 4 years postpartum. Adult attachment patterns in close relationships Adult attachment relationship orientation was evaluated using the Experiences in Close Relationships – Short Form (ECR-SF) (Wei et al., 2007 ), a 12-item self-report measure which yields two aspects of adult attachment patterns – avoidance and anxiety. Avoidance involves fear of dependence and interpersonal intimacy, excessive need for self-reliance, and reluctance to self-disclose. Anxiety involves fear of rejection or abandonment, excessive need for approval, and distress when one’s partner is unavailable or unresponsive (Wei et al., 2007 ). The ECR-CF was administered at early and late pregnancy and 6 months postpartum. Statistical analysis Descriptive statistics of the sociodemographic characteristics of the sample were examined by diagnosis of MDD, using χ 2 tests for frequencies, t-tests for continuous, and Mann-Whitney tests for non-normally distributed continuous variables. To investigate the change in women’s perceptions of partner support over time, mixed effect models were used. Random effects for the intercept and for time were estimated. Separate models were fitted for emotional support, support with tasks and responsibilities, and overall support (the total score of the two subscales). For each of the above outcomes, a model with an interaction term between diagnosis of MDD and time was tested, to determine if perceived partner support of women with and without MDD differed significantly over the time points of the study. A statistically significant interaction term would indicate that for women with and without MDD perceptions of partner support changed differently over time. All models were controlled for maternal age, university education (yes vs no), employment, parity, maternal and partner ethnicity, depressive symptoms over time, stressful life events, and attachment patterns in close relationships, based on the literature. Depressive symptoms and stressful life events were modelled as time varying variables. The ECR measures of anxious and avoidant attachment patterns were averaged over time from early pregnancy to 6 months postpartum. All analysis was conducted with Stata 18 (StataCorp, 2021 ). Results Sample A total of 731 women who were in a continuing relationship from first trimester to when the child was four years of age were included in the analysis. Demographics and descriptive characteristics Demographics and descriptive characteristics of the women are presented in Table 1 . The mean age of the women was 32.0 (SD 4.0) and 31.3 (SD 5.2) years for women without and with MDD, respectively. Women with MDD were significantly less likely to be university educated (45%) and employed (75%) at recruitment than women without MDD (63% and 84% respectively), see table. There were no significant differences in other demographic characteristics. Women with MDD were significantly more likely to have experienced childhood trauma (44%) than women without MDD (28%). Table 1 Demographics and descriptive characteristics by MDD. No MDD (n = 607) MDD (n = 124) p n % n % University educated 385 63.4% 56 45.2% < .001* Not nulliparous 199 32.9% 50 40.3% .112 Employed 508 84.0% 93 75.0% .017* Mather not of Oceanic/European background 74 12.2% 16 12.9% .826 Father not of Oceanic/European background 170 28.1% 26 21.0% .105 Mother experienced childhood trauma 105 27.6% 30 43.5% .008* M SD M SD p Maternal age at recruitment 32.0 4.4 31.3 5.2 .160 EPDS at recruitment 5.3 4.3 9.0 5.4 < .0001* Maternal anxiety in close relationships 19.2 5.7 21.2 6.0 .0004* Maternal avoidance in close relationships 11.6 4.4 13.5 5.0 .05. Abbreviations: MDD = Major Depressive Disorder; M = Mean; SD = Standard Deviation; IQR = Interquartile Range; EPDS = Edinburgh Postnatal Depression Scale. Results from mixed effects models The results from the mixed effects models are presented in Table 2 . Time was modelled as discrete time points (6, 12 months and 4 years postpartum), since it was found to have non-linear trend and since there are only a small number of time points. Plots of the estimated mean trajectories of task, emotional, and overall partner support for women with and without MDD are shown in Fig. 1 . Table 2 Mixed effects models for predictors of perceived emotional, task, and overall support. Model 1 with no interactions Model 2 with interaction term SSEQ Emotional Support b 95% CI p b 95% CI p Time: 6 months postpartum -1.01 -1.32 -0.70 < .001* -0.94 -1.29 -0.60 < .001* 12 months postpartum -1.94 -2.27 -1.61 < .001* -1.88 -2.24 -1.52 < .001* 4 years -2.49 -2.90 -2.09 < .001* -2.21 -2.64 -1.77 < .001* MDD -0.51 -1.15 0.13 .121 -0.13 -0.87 0.61 .732 EPDS -0.18 -0.21 -0.14 < .001* -0.18 -0.22 -0.14 < .001* Maternal age -0.04 -0.09 0.02 .203 -0.03 -0.09 0.02 .217 University educated -0.19 -0.71 0.32 .464 -0.19 -0.70 0.33 .474 Parity (not nulliparous) -0.13 -0.67 0.40 .621 -0.15 -0.68 0.39 .594 Employed 0.08 -0.60 0.75 .828 0.07 -0.61 0.74 .846 Maternal minority ethnicity -0.53 -1.30 0.25 .183 -0.53 -1.30 0.25 .181 Partner minority ethnicity 0.01 -0.55 0.56 .982 0.01 -0.54 0.57 .969 Number of stressful life events -0.11 -0.20 -0.02 .016* -0.11 -0.20 -0.02 .013* Maternal anxiety in close relationships -0.09 -0.14 -0.04 < .001* -0.09 -0.14 -0.04 < .001* Maternal avoidance in close relationships -0.29 -0.36 -0.23 < .001* -0.29 -0.36 -0.23 < .001* Intercept 15.19 14.43 15.94 < .001* 15.13 14.37 15.89 < .001* Interaction term Time*MDD: 6 months postpartum*MDD - - - - -0.38 -1.19 0.42 .354 12 months postpartum*MDD - - - - -0.37 -1.28 0.54 .429 4 years*MDD - - - - -1.66 -2.70 -0.63 .002* Random effects parameters Estimate 95% CI Estimate 95% CI Variance of the random intercept 6.58 5.64 7.68 6.60 5.66 7.70 Variance of the random time effects: 6 months postpartum 0.48 0.02 12.59 0.57 0.04 8.97 12 months postpartum 1.65 0.59 4.63 1.71 0.63 4.62 4 years 5.14 3.41 7.73 4.92 3.24 7.47 Emotional support There was a significant decline over time in emotional support for all women, as indicated from the significant coefficients of time in Model 1 and the main effects of time in Model 2 (Table 2 ). There was no significant difference between the two groups for the first three time points, but at 4 years the difference in perceived emotional support between the two groups increased, indicated by the significant interaction term at 4 years postpartum in Model 2. Figure 1 shows this non-linear trend, with perceived emotional support for women without MDD beginning to level off after 12 months postpartum, but continuing to decline for women with MDD up to 4 years postpartum. Other significant predictors for declining perceived emotional support were ongoing depressive symptoms, number of stressful life events and maternal anxiety or avoidance in close relationships. Support with tasks and responsibilities For support with tasks and responsibilities, there was also a significant decline over time for both women with and without MDD, as indicated from the significant coefficients of time in Model 1 and the main effects of time in Model 2 (Table 2 ). For women with MDD, perceptions of support for tasks and responsibilities declined further at 12 months postpartum and remained lower at 4 years, as indicated by the significant interaction terms at these time points (Table 2 , Model 2). For women without MDD, perceived task support levelled off after 6 months postpartum, as shown in Fig. 1 . Again, the trend of perceived support with tasks and responsibilities over time was non-linear. Other significant predictors for declining support with tasks and responsibilities were ongoing depressive symptoms, number of stressful life events, and maternal anxiety and avoidance in close relationships. Overall support The results for perception of overall support were similar, with a significant decline overall in perceptions of partner support for both women with and without MDD. The two groups only differed at 4 years postpartum, with lower perceptions of overall support for women with MDD. Ongoing symptoms of depression and distress were significantly associated with lower perceptions of overall support, even after diagnosis of MDD was controlled for. Other significant predictors of decline in overall support were number of ongoing stressful life events and maternal anxiety or avoidance in close relationships Interpretation of random effects parameters The random intercepts of all models had significant variances, as indicated by their confidence intervals (Table 2 ). This indicates that the perceived partner support baseline scores at recruitment varied significantly between individuals. Some of the variances of the random time effects were also significantly above zero, suggesting that the effects of time may vary between individuals. Thus, the use of mixed models with random effects for the intercept and for time is appropriate for this data, allowing for individual variation. Discussion This study was unique in focusing on the longitudinal pattern of the perceived effectiveness of partner support in women with and without a diagnosis of MDD. We found a small but significant decrease in perceived effectiveness of partner support over time for all women. For women without MDD this decline flattened off after 6 months postpartum for emotional support and 12 months postpartum for task support. However, for women with MDD there was a longer-term decline until 4 years postpartum. Ongoing depressive symptoms, stressful life events, and insecure attachment patterns all contributed to a perception of lower support effectiveness for all women. These results suggest that the perinatal and early childhood period poses a small increased risk to the partner relationship for all women, but this risk is higher for women with MDD. The findings of decreased perceived support over time are consistent with many existing studies indicating a relationship decline postpartum (e.g. Kluwer, 2010 ; Mitnick et al., 2009 ) and in early childhood (e.g. Kohn et al., 2012 ). Nevertheless, some large studies have found stable relationship satisfaction trajectory over time for the majority of women (e.g. Kingsbury et al., 2023 ). The contribution of both ongoing distress and an insecure attachment pattern to the decline in perceived partner support effectiveness was consistent with previous literature (Kohn et al., 2012 ; Leonhardt et al., 2022 ; Rholes et al., 2014 ). We did not find significant effects for demographic and socioeconomic factors, as some previous studies have (Hetherington et al., 2020 ; Keizer et al., 2010 ; Nakamura et al., 2020 ). The steepest decline in perceived support for all women occurred in the months after the birth. This often coincided with the partner returning to work with less available support and high mothering demands. This is combined with increased household labour and responsibilities for the baby, as well as sleep deprivation and fatigue (Kluwer, 2010 ). At the same time women’s social networks narrow and the importance of partner support increases (Kroelinger and Oths, 2000 ; Pajulo et al., 2001 ; Rini, 2001 ). In the longer term, as the child gets older, women may also need to juggle more roles and responsibilities, including returning to employment and other children in the family. These stresses may have more impact on women with MDD and in the long term increase the discrepancy between the support needed and support provided. Depression may also affect women’s perceptions of support negatively, which will be reflected in self-report questionnaires. Since perceived emotional and practical support are potentially modifiable protective factors (Pilkington et al., 2015a ), our findings have a clinical significance. The perinatal period is a time when women are more frequently in contact with health services, providing the opportunity for identifying risk factors and offering interventions. It is important for health professionals to regularly assess the quality of the partner relationship throughout the perinatal period and offer appropriate interventions to strengthen the relationship. Although the differences between women with and without MDD were small, they were long lasting. Therefore, it is important to provide targeted mental support for women with MDD which includes involving the partner, perhaps in the form of psychoeducation and practical relationship and support skills training. Online support, such as the SMS4Dads (Fletcher et al., 2025 ; Lanning et al., 2022 ) program for partners of mothers with a major mental illness, shows promising evidence. Availability of parental leave for fathers is another significant factor associated with higher relationship quality postpartum (e.g. Petts and Knoester, 2019 ). It is also important to offer intervention programs and parental support in the longer term, not just the early months postpartum. Pilkington et al. ( 2015a ) found in a systematic review that key factors which can be targeted to reduce perinatal depression are: positive communication, emotional closeness, emotional support, satisfaction with the division of household labour following childbirth, instrumental/practical support, and global support. However, systematic reviews show inconclusive evidence for the effectiveness of existing partner-inclusive perinatal mental health prevention (Pilkington et al., 2015b ) and intervention (Alves et al., 2018 ) programs which have included a partner component, with low attendance rate being a major limitation. This underlines the importance of further research in this area, including for programs targeted for women with MDD. Strengths This study makes an important and unique contribution to a better understanding of the changes in perceived partner support over the perinatal period and early childhood by focusing on women with diagnosed MDD and specific types of partner support, for which the existing literature is scarce. The longitudinal design is also a strength of the study. Moreover, this study included a deliberate oversampling of women with MDD, thus providing an adequate sample size to focus on this group. Limitations The study did not collect data from the partner, thus we were not able to explore the couples’ reciprocal perceptions of support. There was no baseline data on partner support pre-pregnancy or during early pregnancy, although some studies indicate improvement in relationship satisfaction during pregnancy (Kluwer, 2010 ). The spacing of time points with a gap between 12 months and 4 years postpartum, meant that we were not able to determine if there were changes during this period. Nevertheless, our results of overall decline during this period are consistent with other studies (e.g. Kohn et al., 2012 ). Symptoms of distress and partner support were measured by self-report questionnaires. However, evidence indicates that self-reported perceived support is a more useful measure than received support measured by observed quantity, as it has a stronger association with mental health (Lakey and Cronin, 2008 ; Uchino, 2009 ). The significant variances of the random intercept and the random effects at some time points suggest that there may be subgroups of women with different pattern of changes of partner support over time. However, it was not feasible to investigate this in the current study due to insufficient sample size. Conclusions This study found an overall small but significant decline in partner support over time for all women. However, this decline was larger for women with MDD between 12 months and 4 years postpartum. Ongoing depressive symptoms, stressful life events, and insecure attachment style also contributed to perceptions of lower partner support. The perinatal and early childhood period poses an increased risk for the partner relationship for all women, but there is an increased risk for women with MDD. This knowledge could be translated into identifying vulnerable women and offering appropriate interventions. To examine the generalisability of our results, future research should specifically focus on women from various backgrounds, including socioeconomically disadvantaged, women without a continuing relationship, and same sex couples. Declarations Competing Interests The authors declare no competing interests. Consent to Participate Declaration All participants provided informed written consent to participate in this study. Ethics Approval The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. Ethics approval through Mercy Health Human Research Ethics Committee and WA Health South Metropolitan Human Research Ethics Committee and all participants provided written informed consent. Funding Declaration This study was funded by a 2012 National Priority Funding Round of Beyond Blue in a three-year research grant (ID 519240) and a 2015 National Health and Medical Research Council (NHMRC) project grant for 5 years (APP1106823). Clinical Trial Number Not applicable. References Alves, S., Martins, A., Fonseca, A., Canavarro, M.C., Pereira, M., 2018. Preventing and treating women’s postpartum depression: a qualitative systematic review on partner-inclusive interventions. Journal of Child and Family Studies 27, 1-25. Bedaso, A., Adams, J., Peng, W., Sibbritt, D., 2021. The relationship between social support and mental health problems during pregnancy: a systematic review and meta-analysis. Reproductive health 18, 1-23. Bedaso, A., Adams, J., Peng, W., Sibbritt, D., 2023. The direct and mediating effect of social support on health-related quality of life during pregnancy among Australian women. BMC Pregnancy and Childbirth 23, 372. 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Social psychiatry and psychiatric epidemiology 55, 259-267. Keizer, R., Dykstra, P.A., Poortman, A.-R., 2010. The transition to parenthood and well-being: the impact of partner status and work hour transitions. Journal of family psychology 24, 429. Keizer, R., Schenk, N., 2012. Becoming a parent and relationship satisfaction: A longitudinal dyadic perspective. Journal of marriage and family 74, 759-773. Kingsbury, M., Clayborne, Z., Nilsen, W., Torvik, F.A., Gustavson, K., Colman, I., 2023. Predictors of relationship satisfaction across the transition to parenthood: results from the Norwegian mother, father, and child cohort study (MoBa). Journal of Family Issues 44, 2846-2869. Kluwer, E.S., 2010. From partnership to parenthood: A review of marital change across the transition to parenthood. Journal of Family Theory & Review 2, 105-125. Kluwer, E.S., Johnson, M.D., 2007. Conflict frequency and relationship quality across the transition to parenthood. Journal of marriage and family 69, 1089-1106. Kohn, J.L., Rholes, S.W., Simpson, J.A., Martin III, A.M., Tran, S., Wilson, C.L., 2012. Changes in marital satisfaction across the transition to parenthood: The role of adult attachment orientations. Personality and Social Psychology Bulletin 38, 1506-1522. Kroelinger, C.D., Oths, K.S., 2000. Partner support and pregnancy wantedness. Birth 27, 112-119. Lähdepuro, A., Räikkönen, K., Pham, H., Thompson-Felix, T., Eid, R.S., O'Connor, T.G., Glover, V., Lahti, J., Heinonen, K., Wolford, E., 2024. Maternal social support during and after pregnancy and child cognitive ability: examining timing effects in two cohorts. Psychological Medicine 54, 1661-1670. Lakey, B., Cronin, A., 2008. Low social support and major depression: Research, theory and methodological issues. Risk factors in depression, 385-408. Lanning, P., Rawlinson, C., Hoehn, E., De Young, A., StGeorge, J., Fletcher, R., 2022. Primary mental health prevention in partners of mothers with a major mental illness: SMS4Dads. Journal of Reproductive and Infant Psychology 40, 623-632. Lawrence, E., Rothman, A.D., Cobb, R.J., Rothman, M.T., Bradbury, T.N., 2008. Marital satisfaction across the transition to parenthood. Journal of family psychology 22, 41. Leonhardt, N.D., Rosen, N.O., Dawson, S.J., Kim, J.J., Johnson, M.D., Impett, E.A., 2022. Relationship satisfaction and commitment in the transition to parenthood: A couple‐centered approach. Journal of Marriage and Family 84, 80-100. Mitnick, D.M., Heyman, R.E., Smith Slep, A.M., 2009. Changes in relationship satisfaction across the transition to parenthood: a meta-analysis. Journal of Family Psychology 23, 848. Najman, J.M., Khatun, M., Mamun, A., Clavarino, A., Williams, G.M., Scott, J., O’Callaghan, M., Hayatbakhsh, R., Alati, R., 2014. Does depression experienced by mothers leads to a decline in marital quality: a 21-year longitudinal study. Social psychiatry and psychiatric epidemiology 49, 121-132. Nakamura, A., Lesueur, F.E.-K., Sutter-Dallay, A.-L., Franck, J.-è., Thierry, X., Melchior, M., van der Waerden, J., 2020. The role of prenatal social support in social inequalities with regard to maternal postpartum depression according to migrant status. Journal of Affective Disorders 272, 465-473. Pajulo, M., Savonlahti, E., Sourander, A., Helenius, H., Piha, J., 2001. Antenatal depression, substance dependency and social support. Journal of affective disorders 65, 9-17. Parfitt, Y., Ayers, S., 2014. Transition to parenthood and mental health in first-time parents. Infant Mental Health Journal 35, 263-273. Petts, R.J., Knoester, C., 2019. Paternity leave and parental relationships: Variations by gender and mothers' work statuses. Journal of Marriage and Family 81, 468-486. Pilkington, P.D., Milne, L.C., Cairns, K.E., Lewis, J., Whelan, T.A., 2015a. Modifiable partner factors associated with perinatal depression and anxiety: a systematic review and meta-analysis. Journal of affective disorders 178, 165-180. Pilkington, P.D., Whelan, T.A., Milne, L.C., 2015b. A review of partner‐inclusive interventions for preventing postnatal depression and anxiety. Clinical Psychologist 19, 63-75. Ray, J.K., Stürmlinger, L.L., von Krause, M., Lux, U., Zietlow, A.-L., 2024. Disentangling the trajectories of maternal depressive symptoms and partnership problems in the transition to parenthood and their impact on child adjustment difficulties. Development and Psychopathology 36, 1988-2003. Rholes, S., Kohn , J.L., Simpson, J.A., 2014. A longitudinal study of conflict in new parents: The role of attachment. Personal Relationships 21, 1-21. Rini, C.M., 2001. Social support effectiveness: Measurement, prediction, and relation to psychological health during pregnancy. University of California, Los Angeles. Salmela-Aro, K., Aunola, K., Saisto, T., Halmesmäki, E., Nurmi, J.-E., 2006. Couples share similar changes in depressive symptoms and marital satisfaction anticipating the birth of a child. Journal of Social and Personal Relationships 23, 781-803. Schuijers, M., Greenwood, C.J., McIntosh, J.E., Youssef, G., Letcher, P., Macdonald, J.A., Spry, E., Le Bas, G., Teague, S., Biden, E., 2024. Maternal perinatal social support and infant social-emotional problems and competencies: a longitudinal cross-cohort replication study. Archives of Women's Mental Health, 1-9. Stapleton, L.R.T., Schetter, C.D., Westling, E., Rini, C., Glynn, L.M., Hobel, C.J., Sandman, C.A., 2012. Perceived partner support in pregnancy predicts lower maternal and infant distress. Journal of family psychology 26, 453. StataCorp, 2021. Stata Statistical Software: Release 17. College Station, TX: StataCorp LLC. Twenge, J.M., Campbell, W.K., Foster, C.A., 2003. Parenthood and marital satisfaction: a meta‐analytic review. Journal of marriage and family 65, 574-583. Uchino, B.N., 2009. Understanding the links between social support and physical health: A life-span perspective with emphasis on the separability of perceived and received support. Perspectives on psychological science 4, 236-255. Wei, M., Russell, D.W., Mallinckrodt, B., Vogel, D.L., 2007. The Experiences in Close Relationship Scale (ECR)-short form: Reliability, validity, and factor structure. Journal of personality assessment 88, 187-204. Whisman, M.A., Davila, J., Goodman, S.H., 2011. Relationship adjustment, depression, and anxiety during pregnancy and the postpartum period. Journal of Family Psychology 25, 375. Whitehead, N.S., Brogan, D.J., Blackmore-Prince, C., Hill, H.A., 2003. Correlates of experiencing life events just before or during pregnancy. Journal of Psychosomatic and Obstetric Gynaecololgy 24, 77-86. Additional Declarations No competing interests reported. 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13:42:04","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":165766,"visible":true,"origin":"","legend":"","description":"","filename":"048cb61efc524d63a6c6b1cc3b5069bf1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7598161/v1/880f879b3ae3f90dc8f930d2.xml"},{"id":93406570,"identity":"cfcc56dd-d2f7-4b46-9f34-440f7bea0c10","added_by":"auto","created_at":"2025-10-13 13:50:04","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":169578,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7598161/v1/77258ea706843673305386aa.html"},{"id":93406095,"identity":"23f862ab-1330-45a6-9bd6-fdb6ef3650c6","added_by":"auto","created_at":"2025-10-13 13:42:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":36256,"visible":true,"origin":"","legend":"\u003cp\u003eTrajectories of perceived partner support over the perinatal period for women with and without Major Depressive Disorder (MDD).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7598161/v1/3a71d40d9e2c9b4657c0e6d2.png"},{"id":93407535,"identity":"4e15a30a-a3f8-4f61-8c49-91ac27c38681","added_by":"auto","created_at":"2025-10-13 13:58:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1096851,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7598161/v1/f4afd09d-87d2-4858-978a-44cc5131ed19.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Women’s perceived partner support during the perinatal and early childhood period: changes over time for women with and without Major Depressive Disorder","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe transition to parenthood can be a time of joy, but it is also one of the most demanding and challenging life stages. It brings change to roles and relationships, requiring re-organisation and re-negotiation of individuals’ roles, as well as intimate partner relationship and family roles (Figueiredo et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDuring this transition, a poor-quality interpersonal relationship is a risk factor for the development of postnatal depression (for example: Boyce and Hickey, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; Boyce et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e1991\u003c/span\u003e), while positive partner relationship, especially perceived partner support, is a very important protective and potentially modifiable factor (Pilkington et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2015a\u003c/span\u003e). Research evidence has clearly shown that a good quality partner relationship is protective against women’s perinatal mental health problems (e.g. Bedaso et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Figueiredo et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Galbally et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Whisman et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) and is linked to more positive child outcomes (e.g. Lähdepuro et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Ray et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Schuijers et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Stapleton et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). In our previous research Galbally et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) found that partner support had a protective role against parenting distress for women with no history of childhood abuse and low depressive symptoms, but not for women with trauma history and high depressive symptoms.\u003c/p\u003e\u003cp\u003eA good understanding of how the partner relationship changes over time is essential to improve the effectiveness, and timing, of clinical interventions. This is best achieved through longitudinal research. Many of the existing longitudinal studies have focused on how the quality of the intimate partner relationship affects a woman’s mental health. However, this is a bi-directional relationship: a good quality relationship and support can help women to adjust and cope with the stresses of parenthood, and be protective against mental health problems. Conversely, women’s experiences, the external environment, and caring for a newborn can affect the intimate relationship (Najman et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; e.g.Nakamura et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eNumerous studies have found relationship quality to be a protective factor for women’s perinatal mental health problems, as described earlier (e.g. Bedaso et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Figueiredo et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Galbally et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Whisman et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Although fewer studies have examined the effect of mental health problems on the relationship, a consistent finding is that depressive and/or anxiety symptoms contribute to deterioration in the marital relationship (e.g. Bower et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Parfitt and Ayers, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Large longitudinal studies have found a bi-directional association between poor marital quality and depressive symptoms over time, from pregnancy to 2 years (Salmela-Aro et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2006\u003c/span\u003e) and even 21 years postpartum (Najman et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Nevertheless, one study (Figueiredo et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) found that anxiety and depression symptoms had no moderating effect on trajectories of positive and negative couple interactions, although mothers and fathers with high negative interactions had a greater increase in depressive symptoms from 3 to 30 months postpartum.\u003c/p\u003e\u003cp\u003eLongitudinal studies, examining the trajectory of the quality of partner relationship over the perinatal period across different countries, have found a small to moderate decline in couple relationship satisfaction from pregnancy to postpartum (Kluwer, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Mitnick et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). A sharp decline has been shown up to 1 year postpartum (Lawrence et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Twenge et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2003\u003c/span\u003e), but also up to early childhood (Kohn et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), and even 14.5 years after the birth of a baby (Keizer and Schenk, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), with a levelling off after 15 months postpartum (Kluwer and Johnson, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). Conversely, some studies examining subgroups with varying patterns of relationship changes, have found a stable relationship satisfaction trajectory for substantial proportions of couples, from 47% (Leonhardt et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) to 93% (Kingsbury et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA steeper relationship satisfaction decline has been shown in first- than second-time parents (Canário and Figueiredo, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), and for couples with initial lower relationship satisfaction (Don and Mickelson, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). A larger and more sudden relationship decline has been found in childbearing couples compared to childless couples (Doss et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Kluwer, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Lawrence et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). A meta analytic study (Twenge et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2003\u003c/span\u003e) found a cohort effect, with more recent generations of parents reporting greater relationship decline, perhaps due to changes in gender roles over time.\u003c/p\u003e\u003cp\u003eWomen’s low socio-economic status (Nakamura et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), no employment during early parenthood (Hetherington et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Keizer et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2010\u003c/span\u003e), and minority ethnicity (Hetherington et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) tend to contribute to lower partner or overall social support perinatally. Women’s anxious or avoidant attachment patterns in close relationships have also been associated with a decline in relationship satisfaction during the perinatal period (Kohn et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Leonhardt et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Rholes et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMost longitudinal studies have focused on overall relationship quality and relatively few have examined specific aspects of partner support during the perinatal period. Focusing on specific aspects of support, such as emotional and practical, will enhance the translation of this information into targeted preventions and interventions (Pilkington et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2015a\u003c/span\u003e). Both emotional and practical partner support have been established as important protective factors against women’s perinatal menta health symptoms (Pilkington et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2015a\u003c/span\u003e). However, little is known about how they change over time during the transition to parenthood. During the perinatal period partner support is especially important compared to support from other sources and uniquely contributes to women’s perinatal adjustment (Kroelinger and Oths, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Pajulo et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2001\u003c/span\u003e; Rini, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). In addition to the quantity of received support, women’s perceived effectiveness of received support is an important determinant of whether the support will have beneficial effects for their wellbeing (Rini, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2001\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThere is also a lack of longitudinal studies examining the perinatal trajectory of partner support for women with diagnosed mental health disorders, with most studies focusing only on depressive symptoms. Major Depressive Disorder is prevalent and causes significant burden for women perinatally. It is important to understand if women with Major Depressive Disorder are at an increased risk for insufficient or deteriorating partner support over the perinatal period.\u003c/p\u003e\u003cp\u003eTo address these identified gaps in research this study aims to examine first, how women’s perceptions of the effectiveness of emotional and practical partner support change from late pregnancy, to 6 and 12 months postpartum, and then when the child is 4 years of age.\u003c/p\u003e\u003cp\u003eSecondly, we aim to examine whether these changes over time differ between women with, and without, Major Depressive Disorder (MDD). Finally, we aim to investigate whether socioeconomic factors, stressful life events, attachment patterns in close relationships, and childhood trauma affect women’s perceptions of partner support over time.\u003c/p\u003e\n\n\n\n\n\n\n\n"},{"header":"Methods","content":"\u003cp\u003eSample\u003c/p\u003e\u003cp\u003eParticipant for this longitudinal study were women initially recruited at 20 weeks. The MPEWS is an Australian prospective pregnancy cohort study of women recruited at less than 20 weeks of pregnancy and followed up overtime. Women were recruited from Victoria and Western Australia.\u003c/p\u003e\u003cp\u003eFor the purposes of this study we used a nested sample from the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS). We used data collected at less than 20 weeks pregnancy (recruitment), third trimester, 6 months postpartum, 12 months postpartum, and when the child was 4 years old. The MPEWS used a selected cohort design to oversample women diagnosed with MDD at recruitment. Further details of MPEWS are described in the published study protocol (Galbally et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eInclusion criteria\u003c/p\u003e\u003cp\u003eSince this study focused on changes in perceived partner support over time, only women with a continuous relationship from first trimester to when the child is 4 years of age were included.\u003c/p\u003e\u003cp\u003eEthics\u003c/p\u003e\u003cp\u003e The Ethics Committees of the participating institutions approved this study and all participants provided informed, written consent.\u003c/p\u003e\u003cp\u003eMeasures\u003c/p\u003e\u003ch3\u003eDemographic and socioeconomic characteristics\u003c/h3\u003e\u003cp\u003eMPEWS collected data on maternal age, university education, employment, ethnicity of the mother and father, and parity at recruitment. Reliable data on parity was only available at recruitment, and therefore the analysis could not account for women giving birth to additional children within the four years timespan of the study. Data on relationship status was collected at recruitment and at the follow up time points.\u003c/p\u003e\u003ch2\u003eMaternal Major Depressive Disorder and depressive symptoms\u003c/h2\u003e\u003cp\u003eAt recruitment (less than 20 weeks gestation), the Structured Clinical Interview for DSM-IV (SCID-IV) was administered (First et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e1997\u003c/span\u003e) to diagnose MDD. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) (Cox et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e1987\u003c/span\u003e). For this study EPDS data at third trimester, 6 and 12 months, and 4 years postpartum was used. The EPDS has been validated for use with Australian women during the perinatal period (Boyce et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e1993\u003c/span\u003e).\u003c/p\u003e\u003ch3\u003eSocial Support Effectiveness Questionnaire\u003c/h3\u003e\u003cp\u003eSocial support was measured using two, of the three, subscales from the Social Support Effectiveness Questionnaire (SSEQ) (Rini, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). These two scales, ‘Help with tasks and responsibilities’ and ‘Emotional support’, each consist of 10 items, asking the respondent to evaluate the quantity and effectiveness of the support provided by her partner. The SSEQ asks the extent to which the partner’s attempts at support meets the needs of the respondent, including the ease with which the support is obtained, and the match between what is needed and what is provided. Women’s perceived effectiveness of received support is an important determinant of whether the support will have beneficial effects for their wellbeing (Rini, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). The SSEQ has been shown to predict maternal and infant distress in the postpartum period, and to relate to facets of maternal attachment patterns (Stapleton et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). The SSEQ was administered to women at third trimester, six, 12 months, and four years postpartum.\u003c/p\u003e\u003ch3\u003eStressful Life Events Scale (SLES)\u003c/h3\u003e\u003cp\u003eStressful life events were assessed using a perinatally adapted Stressful Life Events Scale, which includes 24 common stressful life events (Brown et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2011b\u003c/span\u003e). Items specifically for the perinatal period were selected from the Stressful Life Events Scale (Whitehead et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2003\u003c/span\u003e), and adapted and extended by Brown and colleagues. The measure includes items such as whether the respondent had a major illness or injury, got separated or divorced, lost her job, or was humiliated or emotionally abused by her partner. The items were adapted from Brown et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2011a\u003c/span\u003e). A count of stressful life events was calculated separately for third trimester, six and 12 months, and 4 years postpartum.\u003c/p\u003e\u003ch3\u003eAdult attachment patterns in close relationships\u003c/h3\u003e\u003cp\u003eAdult attachment relationship orientation was evaluated using the Experiences in Close Relationships – Short Form (ECR-SF) (Wei et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2007\u003c/span\u003e), a 12-item self-report measure which yields two aspects of adult attachment patterns – avoidance and anxiety. Avoidance involves fear of dependence and interpersonal intimacy, excessive need for self-reliance, and reluctance to self-disclose. Anxiety involves fear of rejection or abandonment, excessive need for approval, and distress when one’s partner is unavailable or unresponsive (Wei et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). The ECR-CF was administered at early and late pregnancy and 6 months postpartum.\u003c/p\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eDescriptive statistics of the sociodemographic characteristics of the sample were examined by diagnosis of MDD, using χ\u003csup\u003e2\u003c/sup\u003e tests for frequencies, t-tests for continuous, and Mann-Whitney tests for non-normally distributed continuous variables.\u003c/p\u003e\u003cp\u003eTo investigate the change in women’s perceptions of partner support over time, mixed effect models were used. Random effects for the intercept and for time were estimated. Separate models were fitted for emotional support, support with tasks and responsibilities, and overall support (the total score of the two subscales).\u003c/p\u003e\u003cp\u003eFor each of the above outcomes, a model with an interaction term between diagnosis of MDD and time was tested, to determine if perceived partner support of women with and without MDD differed significantly over the time points of the study. A statistically significant interaction term would indicate that for women with and without MDD perceptions of partner support changed differently over time.\u003c/p\u003e\u003cp\u003eAll models were controlled for maternal age, university education (yes vs no), employment, parity, maternal and partner ethnicity, depressive symptoms over time, stressful life events, and attachment patterns in close relationships, based on the literature. Depressive symptoms and stressful life events were modelled as time varying variables. The ECR measures of anxious and avoidant attachment patterns were averaged over time from early pregnancy to 6 months postpartum.\u003c/p\u003e\u003cp\u003eAll analysis was conducted with Stata 18 (StataCorp, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eSample\u003c/p\u003e\u003cp\u003eA total of 731 women who were in a continuing relationship from first trimester to when the child was four years of age were included in the analysis.\u003c/p\u003e\u003cp\u003eDemographics and descriptive characteristics\u003c/p\u003e\u003cp\u003eDemographics and descriptive characteristics of the women are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The mean age of the women was 32.0 (SD 4.0) and 31.3 (SD 5.2) years for women without and with MDD, respectively. Women with MDD were significantly less likely to be university educated (45%) and employed (75%) at recruitment than women without MDD (63% and 84% respectively), see table. There were no significant differences in other demographic characteristics. Women with MDD were significantly more likely to have experienced childhood trauma (44%) than women without MDD (28%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographics and descriptive characteristics by MDD.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eNo MDD\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;607)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eMDD\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;124)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eUniversity educated\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e385\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e45.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNot nulliparous\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e199\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.112\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEmployed\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e508\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e75.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.017*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMather not of Oceanic/European background\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.826\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFather not of Oceanic/European background\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e170\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.105\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMother experienced childhood trauma\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e43.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.008*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eM\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eM\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMaternal age at recruitment\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.160\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEPDS at recruitment\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMaternal anxiety in close relationships\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.0004*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMaternal avoidance in close relationships\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMedian\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eIQR\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eMedian\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eIQR\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of stressful life events at recruitment\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e* p-value\u0026thinsp;\u0026gt;\u0026thinsp;.05. Abbreviations: MDD\u0026thinsp;=\u0026thinsp;Major Depressive Disorder; M\u0026thinsp;=\u0026thinsp;Mean; SD\u0026thinsp;=\u0026thinsp;Standard Deviation; IQR\u0026thinsp;=\u0026thinsp;Interquartile Range; EPDS\u0026thinsp;=\u0026thinsp;Edinburgh Postnatal Depression Scale.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eResults from mixed effects models\u003c/p\u003e\u003cp\u003eThe results from the mixed effects models are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Time was modelled as discrete time points (6, 12 months and 4 years postpartum), since it was found to have non-linear trend and since there are only a small number of time points. Plots of the estimated mean trajectories of task, emotional, and overall partner support for women with and without MDD are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMixed effects models for predictors of perceived emotional, task, and overall support.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eModel 1 with no interactions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e\u003cp\u003eModel 2 with interaction term\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSSEQ Emotional Support\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eb\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eb\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6 months postpartum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-1.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-1.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12 months postpartum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-2.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-1.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-2.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-2.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-2.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-2.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-2.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-2.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-1.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMDD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-1.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.121\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.732\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEPDS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.203\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.217\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUniversity educated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.464\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.474\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParity (not nulliparous)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.621\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.594\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.828\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.846\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal minority ethnicity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-1.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.183\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-1.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.181\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePartner minority ethnicity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.982\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.969\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of stressful life events\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.016*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.013*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal anxiety in close relationships\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal avoidance in close relationships\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntercept\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e15.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInteraction term\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime*MDD:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6 months postpartum*MDD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-1.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.354\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12 months postpartum*MDD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-1.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.429\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4 years*MDD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-1.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-2.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.002*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRandom effects parameters\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eEstimate\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u003cb\u003e95% CI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eEstimate\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e\u003cb\u003e95% CI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariance of the random intercept\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariance of the random time effects:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6 months postpartum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e8.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12 months postpartum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eEmotional support\u003c/h3\u003e\n\u003cp\u003eThere was a significant decline over time in emotional support for all women, as indicated from the significant coefficients of time in Model 1 and the main effects of time in Model 2 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). There was no significant difference between the two groups for the first three time points, but at 4 years the difference in perceived emotional support between the two groups increased, indicated by the significant interaction term at 4 years postpartum in Model 2. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows this non-linear trend, with perceived emotional support for women without MDD beginning to level off after 12 months postpartum, but continuing to decline for women with MDD up to 4 years postpartum.\u003c/p\u003e\u003cp\u003eOther significant predictors for declining perceived emotional support were ongoing depressive symptoms, number of stressful life events and maternal anxiety or avoidance in close relationships.\u003c/p\u003e\n\u003ch3\u003eSupport with tasks and responsibilities\u003c/h3\u003e\n\u003cp\u003eFor support with tasks and responsibilities, there was also a significant decline over time for both women with and without MDD, as indicated from the significant coefficients of time in Model 1 and the main effects of time in Model 2 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). For women with MDD, perceptions of support for tasks and responsibilities declined further at 12 months postpartum and remained lower at 4 years, as indicated by the significant interaction terms at these time points (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Model 2). For women without MDD, perceived task support levelled off after 6 months postpartum, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Again, the trend of perceived support with tasks and responsibilities over time was non-linear.\u003c/p\u003e\u003cp\u003eOther significant predictors for declining support with tasks and responsibilities were ongoing depressive symptoms, number of stressful life events, and maternal anxiety and avoidance in close relationships.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eOverall support\u003c/h2\u003e\u003cp\u003eThe results for perception of overall support were similar, with a significant decline overall in perceptions of partner support for both women with and without MDD. The two groups only differed at 4 years postpartum, with lower perceptions of overall support for women with MDD.\u003c/p\u003e\u003cp\u003eOngoing symptoms of depression and distress were significantly associated with lower perceptions of overall support, even after diagnosis of MDD was controlled for. Other significant predictors of decline in overall support were number of ongoing stressful life events and maternal anxiety or avoidance in close relationships\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eInterpretation of random effects parameters\u003c/h2\u003e\u003cp\u003eThe random intercepts of all models had significant variances, as indicated by their confidence intervals (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This indicates that the perceived partner support baseline scores at recruitment varied significantly between individuals. Some of the variances of the random time effects were also significantly above zero, suggesting that the effects of time may vary between individuals. Thus, the use of mixed models with random effects for the intercept and for time is appropriate for this data, allowing for individual variation.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study was unique in focusing on the longitudinal pattern of the perceived effectiveness of partner support in women with and without a diagnosis of MDD. We found a small but significant decrease in perceived effectiveness of partner support over time for all women. For women without MDD this decline flattened off after 6 months postpartum for emotional support and 12 months postpartum for task support. However, for women with MDD there was a longer-term decline until 4 years postpartum. Ongoing depressive symptoms, stressful life events, and insecure attachment patterns all contributed to a perception of lower support effectiveness for all women. These results suggest that the perinatal and early childhood period poses a small increased risk to the partner relationship for all women, but this risk is higher for women with MDD. The findings of decreased perceived support over time are consistent with many existing studies indicating a relationship decline postpartum (e.g. Kluwer, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Mitnick et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2009\u003c/span\u003e) and in early childhood (e.g. Kohn et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Nevertheless, some large studies have found stable relationship satisfaction trajectory over time for the majority of women (e.g. Kingsbury et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe contribution of both ongoing distress and an insecure attachment pattern to the decline in perceived partner support effectiveness was consistent with previous literature (Kohn et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Leonhardt et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Rholes et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). We did not find significant effects for demographic and socioeconomic factors, as some previous studies have (Hetherington et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Keizer et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Nakamura et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe steepest decline in perceived support for all women occurred in the months after the birth. This often coincided with the partner returning to work with less available support and high mothering demands. This is combined with increased household labour and responsibilities for the baby, as well as sleep deprivation and fatigue (Kluwer, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). At the same time women\u0026rsquo;s social networks narrow and the importance of partner support increases (Kroelinger and Oths, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Pajulo et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2001\u003c/span\u003e; Rini, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). In the longer term, as the child gets older, women may also need to juggle more roles and responsibilities, including returning to employment and other children in the family. These stresses may have more impact on women with MDD and in the long term increase the discrepancy between the support needed and support provided. Depression may also affect women\u0026rsquo;s perceptions of support negatively, which will be reflected in self-report questionnaires.\u003c/p\u003e\u003cp\u003eSince perceived emotional and practical support are potentially modifiable protective factors (Pilkington et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2015a\u003c/span\u003e), our findings have a clinical significance. The perinatal period is a time when women are more frequently in contact with health services, providing the opportunity for identifying risk factors and offering interventions. It is important for health professionals to regularly assess the quality of the partner relationship throughout the perinatal period and offer appropriate interventions to strengthen the relationship. Although the differences between women with and without MDD were small, they were long lasting. Therefore, it is important to provide targeted mental support for women with MDD which includes involving the partner, perhaps in the form of psychoeducation and practical relationship and support skills training. Online support, such as the SMS4Dads (Fletcher et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Lanning et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) program for partners of mothers with a major mental illness, shows promising evidence. Availability of parental leave for fathers is another significant factor associated with higher relationship quality postpartum (e.g. Petts and Knoester, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). It is also important to offer intervention programs and parental support in the longer term, not just the early months postpartum. Pilkington et al. (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2015a\u003c/span\u003e) found in a systematic review that key factors which can be targeted to reduce perinatal depression are: positive communication, emotional closeness, emotional support, satisfaction with the division of household labour following childbirth, instrumental/practical support, and global support. However, systematic reviews show inconclusive evidence for the effectiveness of existing partner-inclusive perinatal mental health prevention (Pilkington et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2015b\u003c/span\u003e) and intervention (Alves et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) programs which have included a partner component, with low attendance rate being a major limitation. This underlines the importance of further research in this area, including for programs targeted for women with MDD.\u003c/p\u003e\u003cp\u003eStrengths\u003c/p\u003e\u003cp\u003eThis study makes an important and unique contribution to a better understanding of the changes in perceived partner support over the perinatal period and early childhood by focusing on women with diagnosed MDD and specific types of partner support, for which the existing literature is scarce. The longitudinal design is also a strength of the study. Moreover, this study included a deliberate oversampling of women with MDD, thus providing an adequate sample size to focus on this group.\u003c/p\u003e\u003cp\u003eLimitations\u003c/p\u003e\u003cp\u003eThe study did not collect data from the partner, thus we were not able to explore the couples\u0026rsquo; reciprocal perceptions of support. There was no baseline data on partner support pre-pregnancy or during early pregnancy, although some studies indicate improvement in relationship satisfaction during pregnancy (Kluwer, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). The spacing of time points with a gap between 12 months and 4 years postpartum, meant that we were not able to determine if there were changes during this period. Nevertheless, our results of overall decline during this period are consistent with other studies (e.g. Kohn et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Symptoms of distress and partner support were measured by self-report questionnaires. However, evidence indicates that self-reported perceived support is a more useful measure than received support measured by observed quantity, as it has a stronger association with mental health (Lakey and Cronin, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Uchino, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). The significant variances of the random intercept and the random effects at some time points suggest that there may be subgroups of women with different pattern of changes of partner support over time. However, it was not feasible to investigate this in the current study due to insufficient sample size.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study found an overall small but significant decline in partner support over time for all women. However, this decline was larger for women with MDD between 12 months and 4 years postpartum. Ongoing depressive symptoms, stressful life events, and insecure attachment style also contributed to perceptions of lower partner support. The perinatal and early childhood period poses an increased risk for the partner relationship for all women, but there is an increased risk for women with MDD. This knowledge could be translated into identifying vulnerable women and offering appropriate interventions. To examine the generalisability of our results, future research should specifically focus on women from various backgrounds, including socioeconomically disadvantaged, women without a continuing relationship, and same sex couples.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch3\u003eCompeting Interests\u003c/h3\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003ch3\u003eConsent to Participate Declaration\u003c/h3\u003e\n\u003cp\u003eAll participants provided informed written consent to participate in this study.\u003c/p\u003e\n\u003ch2\u003eEthics Approval\u003c/h2\u003e\n\u003cp\u003eThe authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. Ethics approval through Mercy Health Human Research Ethics Committee and WA Health South Metropolitan Human Research Ethics Committee and all participants provided written informed consent.\u003c/p\u003e\n\u003ch2\u003eFunding Declaration\u003c/h2\u003e\n\u003cp\u003eThis study was funded by a 2012 National Priority Funding Round of Beyond Blue in a three-year research grant (ID 519240) and a 2015 National Health and Medical Research Council (NHMRC) project grant for 5 years (APP1106823).\u003c/p\u003e\n\u003ch3\u003eClinical Trial Number\u003c/h3\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAlves, S., Martins, A., Fonseca, A., Canavarro, M.C., Pereira, M., 2018. Preventing and treating women\u0026rsquo;s postpartum depression: a qualitative systematic review on partner-inclusive interventions. 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Marital satisfaction across the transition to parenthood. Journal of family psychology 22, 41.\u003c/li\u003e\n \u003cli\u003eLeonhardt, N.D., Rosen, N.O., Dawson, S.J., Kim, J.J., Johnson, M.D., Impett, E.A., 2022. Relationship satisfaction and commitment in the transition to parenthood: A couple‐centered approach. Journal of Marriage and Family 84, 80-100.\u003c/li\u003e\n \u003cli\u003eMitnick, D.M., Heyman, R.E., Smith Slep, A.M., 2009. Changes in relationship satisfaction across the transition to parenthood: a meta-analysis. Journal of Family Psychology 23, 848.\u003c/li\u003e\n \u003cli\u003eNajman, J.M., Khatun, M., Mamun, A., Clavarino, A., Williams, G.M., Scott, J., O\u0026rsquo;Callaghan, M., Hayatbakhsh, R., Alati, R., 2014. Does depression experienced by mothers leads to a decline in marital quality: a 21-year longitudinal study. 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The Experiences in Close Relationship Scale (ECR)-short form: Reliability, validity, and factor structure. Journal of personality assessment 88, 187-204.\u003c/li\u003e\n \u003cli\u003eWhisman, M.A., Davila, J., Goodman, S.H., 2011. Relationship adjustment, depression, and anxiety during pregnancy and the postpartum period. Journal of Family Psychology 25, 375.\u003c/li\u003e\n \u003cli\u003eWhitehead, N.S., Brogan, D.J., Blackmore-Prince, C., Hill, H.A., 2003. Correlates of experiencing life events just before or during pregnancy. Journal of Psychosomatic and Obstetric Gynaecololgy 24, 77-86.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Social Support, Partner, Pregnancy, Postpartum, Depression","lastPublishedDoi":"10.21203/rs.3.rs-7598161/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7598161/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePartner support is an important protective factor for women\u0026rsquo;s mental health perinatally. Although there is likely a bidirectional relationship between support and mental health, a research gap exists in understanding changes in women\u0026rsquo;s experience of partner support over pregnancy and early childhood, and whether this differs for women with Major Depressive Disorder (MDD). This study examines whether women diagnosed with MDD antenatally are at increased risk of deteriorating partner support over the perinatal period, after accounting for demographic effects, ongoing depressive symptoms, stressful life events, and attachment patterns. 731 women recruited into a longitudinal pregnancy cohort study, the Mercy Pregnancy Emotional Wellbeing Study, were included, of whom 124 met MDD criteria at recruitment. MDD was diagnosed at early pregnancy using the Structured Clinical Interview for the DSM (SCID). Perceived partner support was measured with the Social Support Effectiveness Questionnaire (SSEQ) in third trimester, 6 and 12 months, and 4 years postpartum. Partner support changes over time were analysed with mixed effects modelling. There was an overall small but significant decline in partner support over time for all women. However, this decline was larger for women with MDD between 12 months and 4 years postpartum. Ongoing depressive symptoms, stressful life events, and insecure attachment patterns contributed to perceptions of lower partner support. The perinatal and early childhood period poses an increased risk for the partner relationship for all women, but this risk is increase for women with MDD. This knowledge could be translated into identifying vulnerable women and offering appropriate interventions.\u003c/p\u003e","manuscriptTitle":"Women’s perceived partner support during the perinatal and early childhood period: changes over time for women with and without Major Depressive Disorder","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-13 13:42:00","doi":"10.21203/rs.3.rs-7598161/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f0470e35-a66a-462f-b07a-d338b06ac9db","owner":[],"postedDate":"October 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-23T13:40:17+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-13 13:42:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7598161","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7598161","identity":"rs-7598161","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}