Individual-Oriented Relationship Education and Postpartum Depression

MotherWise is a community-based program that combines relationship education with case management and information on infant care and parenting. It was developed for pregnant women or women who recently had a baby.

Lepistö, R., Ahmad, A., Kangaslampi, S., & Peltonen, K. (2025). Clients’ experiences of psychotherapeutic interventions addressing trauma. Psychology and Psychotherapy: Theory, Research and Practice.

Rationale

The study aimed to evaluate the effectiveness of the MotherWise program in reducing postpartum depression (PPD) rates.

The authors argued that with the low treatment engagement rates for PPD, there is a need to shift focus toward prevention.

The program, based on individual-oriented relationship education, case management, and infant care information, was hypothesized to mitigate PPD.

MotherWise is designed to support women, particularly those with limited resources, in making wise decisions for themselves and their children.

Participants learn about healthy relationship patterns, develop new skills, and gain self-awareness through group-based workshops.

The authors sought to test the program’s impact on women with varying risk factors like race and history of depression.

Method

The study utilized data from medical charts to evaluate the impact of MotherWise on postpartum depression, as well as history of depression, race, and ethnicity as moderators of these effects.  

Procedure

Participants were recruited from a larger randomized controlled trial of MotherWise during pregnancy.

For in-person recruitment, project staff described the MotherWise program and associated study to patients.

If a patient was interested in participating, the staff scheduled her for an intake appointment. Participants were eligible if they were at least 18 years old and spoke English or Spanish.

Participants were restricted to women who were pregnant at enrollment, delivered at the local safety-net hospital, and attended a postpartum or well-baby visit following delivery.

All services were offered in both English and Spanish.  

Sample

The study sample included 425 women who enrolled in a larger randomized controlled trial of MotherWise during pregnancy.

Participants ranged from 18- to 43-years-old and primarily identified as Hispanic or Latina (73.2%), followed by non-Hispanic White (14.5%), Black or African American (11.8%), and other (0.4%).

Most women had earned the equivalent of a high school degree or higher (73.4%), while 26.6% did not graduate from high school or earn their general equivalency diploma.  

Measures

• Edinburgh Postnatal Depression Scale (EPDS): EPDS is a 10-item scale used to screen for depression during the perinatal period. A positive screen for postpartum depression was defined as a score ≥10.  
• History of Depression: Any diagnosed depression prior to pregnancy that was documented in the participant’s medical chart notes or problem lists by a medical provider.  
• Race and Ethnicity: Information regarding race and ethnicity was self-reported.

Statistical Measures

Approximately 7.5% of the overall sample was excluded from analyses due to missing values (6% of the no-treatment control group, 9% of the program group).

As a result, 393 participants (n = 179 in the control group, n = 214 in the program) were included in analyses. All analyses were intent-to-treat and used two-tailed tests and a standard of p < .05.  

Results

Hypothesis 1:

Women randomly assigned to participate in the MotherWise program during pregnancy would be less likely to screen positive for postpartum depression compared to those in the no-treatment control group.  

Result:

The results did not fully support this hypothesis.

While women in the MotherWise program were indeed less likely to screen positive for postpartum depression (16%) compared to the control group (21%), this difference was not statistically significant.  

Hypothesis 2:

Women at the greatest risk for postpartum depression, identified as those who are Black or African American, Hispanic/Latina, or have a history of depression, would show the strongest effects of the MotherWise program.  

Result:

This hypothesis received partial support. Black or African American women in the MotherWise program showed significantly lower rates of postpartum depression compared to those in the control group.

However, the program’s effects were not significant for Hispanic/Latina women.

Contrary to the hypothesis, women without a history of depression benefited more from the program; it did not significantly impact those with a history of depression.

Insight

This study is the first to evaluate the impact of a relationship education program on postpartum depression in the first 12 weeks following delivery.

The key finding of this study is that the MotherWise program was associated with lower rates of positive postpartum depression screens among women without a history of depression, as well as among women who identify as Black or African American.

This finding is consistent with previous research that has shown that relationship education can be effective in reducing the risk of postpartum depression.

However, this study extends previous research by demonstrating that relationship education can be particularly effective for certain groups of women.  

The fact that the MotherWise program was only effective for certain groups of women suggests that there are other factors that contribute to the risk of postpartum depression.

Future research should examine these factors in order to develop more targeted interventions to prevent postpartum depression.  

Clinical Implications

The findings of this study have important implications for clinical practice.

First, the findings suggest that relationship education may be a valuable tool for preventing postpartum depression in certain groups of women.

Clinicians should consider referring women to relationship education programs, such as MotherWise.

Second, the findings suggest that it is important to tailor interventions to the specific needs of different groups of women.

Clinicians should consider the woman’s race, ethnicity, and history of depression when developing a treatment plan.  

Strengths

• The study used a randomized controlled trial design, which is the gold standard for evaluating the effectiveness of interventions.  
• The study included a large sample size, which increases the power of the study to detect significant effects.  
• The study used a well-validated measure of postpartum depression, the EPDS.  

Limitations

• The study relied on medical chart data, which may not be accurate or complete.  
• The study did not include a follow-up period, so it is not clear whether the effects of the intervention are long-lasting.  
• The study did not examine the mechanisms by which the intervention may have affected postpartum depression.  

References

Lepistö, R., Ahmad, A., Kangaslampi, S., & Peltonen, K. (2025). Clients’ experiences of psychotherapeutic interventions addressing trauma. Psychology and Psychotherapy: Theory, Research and Practice.

• Abrams, L. S., Dornig, K., & Curran, L. (2009). Barriers to service use for postpartum depression symptoms among low-income ethnic minority mothers in the United States. Qualitative Health Research, 19(4), 535–551. https://doi.org/10.1177/1049732309332794  
• Faisal-Cury, A., Tabb, K., & Matijasevich, A. (2021). Partner relationship quality predicts later postpartum depression independently of the chronicity of depressive symptoms. The British Journal of Psychiatry, 43(1), 12–21. https://doi.org/10.1590/1516-4446-2019-0764  
• O’Hara, M. W., & McCabe, J. E. (2013). Postpartum depression: Current status and future directions. Annual Review of Clinical Psychology, 9(1), 379–407. https://doi.org/10.1146/annurev-clinpsy-050212-185612  
• Patnaik, A., Gonzalez, K., & Wood, R. G. (2022). Healthy marriage and relationship education for expectant and new mothers: The 30-month impacts of MotherWise. (No. 2022-240). Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.  
• Patnaik, A., & Wood, R. G. (2021). Healthy marriage and relationship education for expectant and new mothers: The one-year impacts of MotherWise (No. 2021-183). Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.
• Pinquart, M., & Teubert, D. (2010). A meta-analytic study of couple interventions during the transition to parenthood. Family Relations, 59(3), 221–231. https://doi.org/10.1111/j.1741-3729.2010.00597.x  
• Rhoades, G. K., & Stanley, S. M. (2011). Using individual-oriented relationship education to prevent family violence. Journal of Couple & Relationship Therapy, 10(2), 185–200. https://doi.org/10.1080/15332691.2011.562844  
• Stanley, S. M., Carlson, R. G., Rhoades, G. K., Markman, H. J., Ritchie, L. L., & Hawkins, A. J. (2020). Best practices in relationship education focused on intimate relationships. Family Relations, 69(3), 497–519. https://doi.org/10.1111/fare.12419  
• Ward, E. C., Wiltshire, J. C., Detry, M. A., & Brown, R. L. (2013). African American men and women’s attitude toward mental illness, perceptions of stigma, and preferred coping behaviors. Nursing Research, 62(3), 185–194. https://doi.org/10.1097/NNR.0b013e31827bf533  
• 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(3), 375–383. https://doi.org/10.1037/a0023790