Couples-based interventions for perinatal depression and anxiety: A global systematic review

Globally, perinatal depression and anxiety affect approximately 26% and 12% of women, respectively, with partner support recognized as a protective factor. This systematic review aimed to synthesize the evidence on the effectiveness of couples-based interventions for perinatal depression and/or anxiety. We searched PsycINFO, Embase, PubMed, CENTRAL, and CINAHL from inception through December 1, 2024, identifying studies published in English that met our eligibility criteria. Two reviewers independently screened records, extracted data, and assessed risk of bias using the Joanna Briggs Institute critical appraisal tools. We conducted a narrative synthesis. From 4,733 screened records, 26 studies (23 RCTs, three quasi-experimental) met the inclusion criteria, comprising 4,547 women from 14 countries. Fourteen of 26 studies (54%) demonstrated significant reductions in maternal depressive symptoms. Descriptive synthesis suggested effectiveness may depend more on intervention content than partner attendance patterns: interventions teaching specific support skills (symptom recognition, practical assistance, help-seeking facilitation) appeared effective across varying attendance levels, while relationship enhancement approaches showed inconsistent results. Six of 12 studies measuring anxiety reported significant reductions, with mixed evidence regarding the role of partner attendance. Studies reported inconsistent effects on paternal mental health and relationship quality. Risk of bias was low in 52% of RCTs. Couples-based interventions show promise for reducing perinatal depression and anxiety, though substantial heterogeneity prevents identification of optimal approaches. Descriptive patterns suggest effectiveness may depend more on intervention content than on the number of sessions partners attended, though this hypothesis requires formal testing through meta-analysis with moderator analyses. Absence of mediation analyses across all studies prevented understanding of mechanisms, and geographic concentration in high-income settings limited generalizability to LMIC contexts. Masked. • Majority of couples-based interventions reduced perinatal depression and anxiety • Novel framework documented intended versus achieved partner participation • Geographic concentration in high-income countries limits generalizability