Preventing marital distress through communication and conflict management training: a 4- and 5-year follow-up

A Randomized Controlled Trial of the Getting Our Hearts Right Program and the Prevention and Relationship Enhancement Program in a Sample of Iranian Couples

For several decades, to enhance relationship quality, marriage and relationship education (MRE) programs have focused on teaching communication skills and conflict management. However, new explanations reveal that the effectiveness of communication skills in MRE programs may largely depend on virtues. Through a randomized controlled trial (RCT), the present study examined the effectiveness of the Getting Our Hearts Right Program (GOHR; a virtue-based approach) and the Prevention and Relationship Enhancement Program (PREP; a skill-based approach). Forty-five eligible couples (i.e., 90 individuals) were randomly assigned to (a) GOHR intervention condition, (b) PREP intervention condition, or (c) wait-list control condition. The couples filled out the Revised Dyadic Adjustment Scale at baseline, postintervention, and 3-month follow-up phases. The results of both postintervention and 3-month follow-up showed that GOHR was more effective than PREP in improving the spouses' perceived marital adjustment. The findings of this study emphasized the potential value of short-term virtue-based interventions.

Intimate partner violence among women of reproductive age during the COVID-19 pandemic in Ethiopia: a systematic review and meta-analysis

Objectives

Intimate partner violence (IPV) is the violence committed by both current and former spouses and partners, and the rate of this violence is known to increase during different pandemics. The pooled prevalence of IPV among pregnant women before the COVID-19 pandemic was 37%, however, the pooled prevalence of IPV among women during COVID-19 is not yet known. Therefore, this study aimed to assess the pooled prevalence of IPV and its determinants among women of reproductive age during the COVID-19 pandemic in Ethiopia.

Design

Systematic review and meta-analysis.

Data sources

The review was done as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline using different search databases such as: PubMed/Medline, Cochrane Library, Virtual Health Library Regional Portal, HINARI (research4life), and Google Scholar.

Eligibility criteria

Those quantitative studies conducted in Ethiopia during the COVID-19 pandemic, that reported the prevalence of IPV among women of reproductive age, and were published in English from 13 March 2020 to 15 October 2025, were included for this study.

Data extraction and synthesis

All authors independently extracted data using the Joanna Briggs Institute manual for evidence synthesis. Any incongruity of the result in the data extraction process was resolved through discussions and consensus (ie, a Delphi process). The data were analysed using Stata Corp V.11 software. The heterogeneity between studies was assessed using I2 test statistics and the random-effects meta-analysis was done using the restricted maximum likelihood method. Publication bias was assessed using funnel plots, and Egger's and Begg's tests.

Result

In this study, a total of 802 articles were identified using different electronic databases. Finally, 12 studies that fulfilled the eligibility criteria were included for systematic review and meta-analysis. A total of 7397 study participants were sampled from April 2020 to August 2021. The overall estimated pooled prevalence of IPV was 33.5% (95% CI 22.9% to 44.1%) and the prevalence of physical, psychological and sexual violence was 16.4%, 28.2% and 17.4%, respectively. Different factors such as: age of the young women (adjusted odds ratio (AOR)=3.24; 95% CI 0.6, 5.8, p=0.015), lack of formal education (AOR=2.63; 95% CI 1.7, 3.6, p=0.000), partner's substance use (AOR=2.07; 95% CI 1.5, 2.7, p=0.000), partner not attending formal education (AOR=3.38; 95% CI 2.2, 4.6, p=0.000) and partner's alcohol use (AOR=2.82; 95% CI 1.1, 4.6, p=0.000) were found to be significantly associated with IPV among women during the COVID-19 pandemic.

Conclusions

In this study, a third of women of reproductive age experienced IPV during the COVID-19 pandemic. Women whose partners used alcohol and other substances were found to be vulnerable to IPV. Therefore, this finding gives an insight for policymakers to focus on empowering women and their partner's economic and educational status, promoting health education for partners towards the negative impact of bad behaviours like alcohol and other substance utilisation on their health, and the physical, mental and social wellbeing of women. Moreover, the burden of IPV is increased not only during such a pandemic but also during different internal displacements, conflicts and unrest. Therefore, we recommend policymakers to frequently assess IPV-related burdens during such events and act accordingly.

Does Web-Based Relationship Education Improve Sexual Intimacy? Initial Examination, Replication, and Exploration of Moderation in a Low-Income Sample

Sexual intimacy, characterized as the experience between individuals of sharing general affection and sexual activity with one another within the Personal Assessment of Intimacy in Relationships inventory, is positively related to relationship satisfaction and stability. However, many studies of couple therapy have shown that it only results in small-sized (and often non-significant) improvements in sexual intimacy. Furthermore, there are numerous financial, logistical, and psychological barriers to couple therapy. Thus, the current study sought to examine whether two brief online relationship education programs (OurRelationship and ePREP) could overcome these barriers and yield similar-sized effects to more intensive couple therapy. In two independently collected samples of low-income couples (NSample 1 = 742 Couples; M AgeSample 1 = 33.19; NSample 2 = 671 Couples; M AgeSample 2 = 33.48), the current study found that: OurRelationship (d = 0.24-0.28) and ePREP (d = 0.26-0.34) produced small-sized changes in sexual intimacy relative to a waitlist control condition in both samples, the magnitude of the effect size replicated in a second sample and, with rare exception, these changes were generally not moderated by key variables of interest. Given that web-based relationship education is significantly shorter, less expensive, and more accessible than in-person couple interventions, web-based relationship education could be considered a viable candidate for couples experiencing concerns with sexual intimacy.

Development, feasibility, and acceptability of SPoRT: a dating violence and sexual risk prevention intervention for college student-athletes

BACKGROUND

Student-athletes are one subgroup of college students in the USA at risk for dating violence and sexual risk behaviors. Despite this, research on student-athletes' dating behaviors is limited; existing research pertains primarily to the National Collegiate Athletic Association (NCAA) Division I athletes and focuses on male student-athletes as perpetrators of dating and sexual violence. While some existing programs aim to reduce dating violence and promote healthy relationships, these programs are education based, and not tailored to the specific strengths and challenges of student-athletes. We therefore designed Supporting Prevention in Relationships for Teams (SPoRT), a novel, four-session prevention intervention for Division III student-athletes of all genders to reduce dating violence and sexual risk behavior by targeting knowledge and skills identified in pilot research, incorporating psychoeducation with techniques from cognitive-behavioral therapy, mindfulness, bystander intervention, and normative feedback.

METHODS

This study represents stage 1 of the National Institutes of Health (NIH) Stage Model for Behavioral Intervention Development, evaluating the feasibility and acceptability of SPoRT. We describe the development, content, and proposed delivery methods for SPoRT and evaluated the feasibility and acceptability of the program using a mixed-methods approach. Thirty college student-athletes (12 men, 18 women) completed questionnaires and participated in focus groups to provide feedback on the program's length, timing, group size and dynamics, content, and suggestions for making the SPoRT prevention intervention more feasible and acceptable.

RESULTS

Our recruitment procedures were successful, and participants rated the program as feasible in terms of delivery methods and logistics. Participants liked that SPoRT was developed based on pilot data collected from student-athletes, brief, and skills based and tailored to athletic team needs. SPoRT was perceived as appropriate and relevant to student-athlete needs in terms of dating violence and sexual risk prevention knowledge and skills. Most participants (63%) rated the program as "excellent" and said they would recommend it to others.

CONCLUSIONS

We found SPoRT to be both feasible and acceptable in terms of content and delivery. Suggested modifications will be incorporated into the SPoRT healthy relationships prevention intervention to be tested in an NIH Stage 1 efficacy trial.

A test of the dyadic associations between ineffective arguing, emotional distress, and violence perpetration and victimization among couples seeking therapy

Researchers have tested associations between ineffective arguing and emotional distress among couples without relationship violence. Moreover, studies have demonstrated associations between physical violence perpetration and victimization in the aftermath of emotional distress. However, there is a paucity of research examining linkages between ineffective arguing, emotional distress, and physical violence perpetration or victimization. Dyadic data from 231 married, heterosexual couples seeking therapy were used to test a model examining pathways between ineffective arguing and physical violence perpetration and victimization through emotional distress. The hypothesized model was compared to two plausible alternative models. Results revealed higher levels of men's ineffective arguing were positively associated with men's physical violence perpetration, both directly and indirectly, through higher levels of emotional distress. Higher levels of men's ineffective arguing were associated with lower men's physical violence perpetration through higher levels of women's emotional distress. Results can inform the clinical treatment of interpersonal violence by targeting ineffective arguing and emotional distress.

Adverse Childhood Experiences, Depression, and Intimate Partner Violence Among Chinese Immigrant Women: Mediation by Social and Partner Support

BACKGROUND

Adverse childhood experiences (ACEs) are associated with an increased risk of depression and intimate partner violence (IPV). Social support and partner support may help explain this association. Few researchers have focused on Chinese immigrant women, who are less likely than native-born women to seek help for mental health challenges and IPV.

OBJECTIVE

The purpose of this study was to examine the mediation effects of social and partner support on the relationship between (a) ACEs and (b) depressive symptoms and IPV among Chinese immigrant women living in the United States.

METHODS

This is a secondary analysis of data from 475 Chinese immigrant women recruited online. Depressive symptoms, IPV, ACEs, perceived social support, and perceived partner support were measured cross-sectionally. Mediation analyses were conducted to test the mediating role of social and partner support on the associations between ACEs and depressive symptoms and IPV.

RESULTS

Social support and partner support fully mediated the relationship between ACEs and depressive symptoms. However, partner support only partially mediated the relationship between ACEs and IPV.

DISCUSSION

ACEs indirectly affect depressive symptoms by undermining both general perceptions of support and perceived partner support. The findings of this study underscore the critical influence of a lack of partner support in mediating the effects of ACEs on Chinese immigrant women's risk of IPV. Promoting strong existing support networks, creating new support resources, and improving partner relationships are important targets for interventions to mitigate the effects of ACEs on depression and IPV in Chinese immigrant women.

Do relationship education programs reduce relationship aggression? A meta-analytic study

There is an increasing focus on evaluating the effectiveness of Relationship Education (RE) programs on reducing relationship aggression. Nevertheless, there has been little by way of a systematic quantitative synthesis of research to date. The primary aim of this research was to conduct a meta-analysis into the effects of RE programs on relationship aggression and provide a comprehensive assessment as to the moderating effects of various methodological characteristics of studies. A secondary aim was to determine whether RE programs reduce negative aspects of relationship functioning that are known to exacerbate relationship aggression. Thirty-one studies (n = 25,527) were included comprising of pre-post comparison studies and control trials. Overall, RE programs were significantly associated with reductions in relationship aggression (d = 0.11, p = .001). Pre-post studies yielded a significantly larger effect size (d = 0.28, p < .001) than RCT studies (d = 0.05, p = .10). Subgroup analysis revealed that participants who reported moderate to severe relationship aggression upon RE program entry demonstrated large reductions in physical (d = 0.66, p = .01) and psychological (d = 0.85, p < .001) aggression compared to those who reported minimal to low relationship aggression on entry (physical aggression d = 0.07, p = .009; psychological aggression d = -0.04; p = .17). Amongst participants who reported moderate to severe relationship aggression, RE programs were also found to reduce controlling behavior (d = 0.20, p < .01) and conflict behavior (d = 0.40, p < .001). Findings demonstrate the emerging efficacy of RE programs for reducing relationship aggression and conflict behavior, particularly in those with a history of moderate to severe levels of relationship aggression.

Effects of online relationship programs for low-income couples during the perinatal period

Low-income couples experience increased stress and declines in relationship quality during the perinatal period. They also encounter many barriers to accessing relationship services. Using a subsample of low-income perinatal couples (n = 180) from two randomized controlled trials, the current study examined the impact of online relationship interventions, OurRelationship (OR) and ePREP, in a Bayesian framework. From pre to post, relative to waitlist control couples, couples in OR and ePREP experienced improvements in relationship quality (Mean d = 0.51) and psychological distress (Mean d = 0.28); OR couples, relative to waitlist control couples, also experienced improvements in perceived stress (Mean d = 0.33). These improvements were maintained through four-month follow-up and did not differ across gender. These findings suggest brief online relationship interventions may be an important resource for low-income perinatal couples.

Heterogeneity in the Effects of Interventions to Prevent Depression in Couples Facing Job Loss: Studying Baseline Target Moderation of Impact

Couples' communication styles are associated with depression following job loss for both job seekers and their partners. The Couples Employment Program (CEP), an eight-session program for couples facing job loss, was developed to integrate job search strategies sessions from the JOBS program with couple communication sessions, targeting job search behavior, motivation, mastery, and couple communication. We hypothesized that CEP would have compensatory effects, such that those who began the program with lower job search behavior, lower motivation, less mastery, and more negative or less positive couple communication would make more gains on these targets, and this would mediate impact on reducing risk for depression. We conducted a randomized field trial of CEP with 1477 heterosexual couples facing recent unemployment. Baseline levels of job search behavior and motivation, but not mastery or depression, moderated the impact of intervention on job seeker depression slopes over 12 months; job seekers reporting less job search behavior and motivation at baseline benefited more. Male partners with higher baseline depression also benefited. Opposite to our hypothesis, baseline levels of couple's communication moderated the impact of intervention such that partners in couples with more negative and less positive communication showed iatrogenic effects. There was no evidence that baseline target levels moderated the impact of the intervention on any of these targets. We speculate that more intensive communication training may be necessary for positive impact.

Romantic Relationship Education: A Literature Review with Recommendations for Turkiye

Intimate relationships are the focal aspiration for human beings. Romantic relationship education is described as a road map for helping people to find strategies and solutions that fit their context, values and relationship goals. By using evidence-based skills training, people can learn techniques to navigate typical relationship challenges and safely express emotions. Being in a mutually satisfying committed relationship has proven to be associated with many positive outcomes including life satisfaction, physical well-being, better coping with major illness, as well as longer life expectancy and career achievement. Relationship education programs are developed by psychologists in Western countries as a preventive intervention for couples, adolescents and emerging adults before relationships reach crisis stage. There is, however, a lack of empirical studies to examine the effectiveness of relationship education within the Turkish cultural context. The overarching aim of this study is to review the relationship education programs within Turkish and international literature. This study provides an overview of the relationship education, and its scope, and theoretical foundations and also effectiveness of relationship education programs for couples, adolescents and emerging adults. The study further provides cultural, theoretical and practical recommendations for future directions in Turkish relationship education programs.

Technology-based and digital interventions for intimate partner violence: A systematic review and meta-analysis

Background

A growing body of research shows the promise and efficacy of technology-based or digital interventions in improving the health and well-being of survivors of intimate partner violence (IPV). In addition, mental health comorbidities such as anxiety, post-traumatic stress disorder (PTSD), and depression occur three to five times more frequently in survivors of IPV than non-survivors, making these comorbidities prominent targets of technology-based interventions. Still, research on the long-term effectiveness of these interventions in reducing IPV victimization and adverse mental health effects is emergent. The significant increase in the number of trials studying technology-based therapies on IPV-related outcomes has allowed us to quantify the effectiveness of such interventions for mental health and victimization outcomes in survivors. This meta-analysis and systematic review provide critical insight from several randomized controlled trials (RCTs) on the overall short and long-term impact of technology-based interventions on the health and well-being of female IPV survivors.

Objectives

To synthesize current evidence on the effects of technology-based or digital interventions on mental health outcomes (depression, anxiety, and PTSD) and victimization outcomes (physical, psychological, and sexual abuse) among IPV survivors.

Search Methods

We examined multiple traditional and grey databases for studies published from 2007 to 2021. Traditional databases (such as PubMed Central, Web of Science, CINAHL Plus, and PsychINFO) and grey databases were searched between April 2019 and February 2021. In addition, we searched clinical trial registries, government repositories, and reference lists. Authors were contacted where additional data was needed. We identified 3210 studies in traditional databases and 1257 from grey literature. Over 2198 studies were determined to be duplicates and eliminated, leaving 64 studies after screening titles and abstracts. Finally, 17 RCTs were retained for meta-analysis. A pre-registered protocol was developed and published before conducting this meta-analysis.

Selection Criteria

We included RCTs targeting depression, anxiety, PTSD outcomes, and victimization outcomes (physical, sexual, and psychological violence) among IPV survivors using a technology-based intervention. Eligible RCTs featured a well-defined control group. There were no study restrictions based on participant gender, study setting, or follow-up duration. Included studies additionally supplied outcome data for calculating effect sizes for our desired outcome. Studies were available in full text and published between 2007 and 2021 in English.

Data Collection and Analysis

We extracted relevant data and coded eligible studies. Using Cochrane's RevMan software, summary effect sizes (Outcome by Time) were assessed using an independent fixed-effects model. Standardized mean difference (SMD) effect sizes (or Cohen's d) were evaluated using a Type I error rate and an alpha of 0.05. The overall intervention effects were analyzed using the Z-statistic with a p-value of 0.05. Cochran's Q test and Higgins' I 2 statistics were utilized to evaluate and confirm the heterogeneity of each cumulative effect size. The Cochrane risk of bias assessment for randomized trials (RoB 2) was used to assess the quality of the studies. Campbell Systematic Reviews registered and published this study's protocol in January 2021. No exploratory moderator analysis was conducted; however, we report our findings with and without outlier studies in each meta-analysis.

Main Results

Pooled results from 17 RCTs yielded 18 individual effect size comparisons among 4590 survivors (all females). Survivors included college students, married couples, substance-using women in community prisons, pregnant women, and non-English speakers, and sample sizes ranged from 15 to 672. Survivors' ages ranged from 19 to 41.5 years. Twelve RCTs were conducted in the United States and one in Canada, New Zealand, China (People's Republic of), Kenya, and Australia. The results of this meta-analysis found that technology-based interventions significantly reduced depression among female IPV survivors at 0-3 months only (SMD = -0.08, 95% confidence interval [CI] = -0.17 to -0.00), anxiety among IPV survivors at 0-3 months (SMD = -0.27, 95% CI = -0.42 to -0.13, p = 0.00, I 2 = 25%), and physical violence victimization among IPV survivors at 0-6 months (SMD = -0.22, 95% CI = -0.38 to -0.05). We found significant reductions in psychological violence victimization at 0-6 months (SMD = -0.34, 95% CI = -0.47 to -0.20) and at >6 months (SMD = -0.29, 95% CI = -0.39 to -0.18); however, at both time points, there were outlier studies. At no time point did digital interventions significantly reduce PTSD (SMD = -0.04, 95% CI = -0.14 to 0.06, p = .46, I 2 = 0%), or sexual violence victimization (SMD = -0.02, 95% CI = -0.14 to 0.11, I 2 = 21%) among female IPV survivors for all. With outlier studies removed from our analysis, all summary effect sizes were small, and this small number of comparisons prevented moderator analyses.

Authors' Conclusions

The results of this meta-analysis are promising. Our findings highlight the effectiveness of IPV-mitigating digital intervention as an add-on (not a replacement) to traditional modalities using a coordinated response strategy. Our findings contribute to the current understanding of "what works" to promote survivors' mental health, safety, and well-being. Future research could advance the science by identifying active intervention ingredients, mapping out intervention principles/mechanisms of action, best modes of delivery, adequate dosage levels using the treatment intensity matching process, and guidelines to increase feasibility and acceptability.

Preventing Relationship Abuse Among College Students: A Controlled Trial of the Skills for Healthy Adult Relationships (SHARe) Program

Intimate partner violence (IPV), which includes emotional, physical, and sexual violence in casual/dating and committed relationships, occurs at disproportionately high rates among college students. Prevention in college-age years is developmentally crucial, as college is associated with IPV risk. Relationship skills training has shown preliminary efficacy in decreasing IPV among college students. This article presents data from a controlled trial of Skills for Healthy Adult Relationships (SHARe), a weekly eight-session (12-hr) group program for college students, which aims to prevent interpersonal conflict and IPV through enhancing positive communication, reducing negative communication, promoting positive relationship attitudes, and strengthening ability to self-regulate in interpersonal contexts. Sixty-two college students (54.8% female) were allocated to the SHARe group or a wait-list control by randomizing to condition and then reassigning some individuals to control based on schedule availability to attend groups. Participants completed self-report measures of positive and negative communication, interpersonal confidence, and perpetration of physical, emotional, psychological, injurious, and sexual violence at baseline, post-group, and at a 3-month follow-up. At baseline, participants reported low levels of recent severe IPV perpetration, but controls reported higher levels of emotional abuse. Analyses controlled for baseline IPV. SHARe participants reported significantly higher confidence in their ability to manage conflicts at post-intervention and significantly lower psychological aggression at the follow-up compared with wait-listed controls. At the 3-month follow-up, self-reported perpetration of psychological abuse was 1.5 times higher for wait-list controls versus SHARe participants. The findings indicate that SHARe can help college students improve their interpersonal skills and develop healthy, non-abusive relationships.

Using systemic interventions to reduce intimate partner violence or child maltreatment: A systematic review of publications between 2010 and 2019

This systematic review seeks to understand the effectiveness of systemic interventions to reduce Intimate Partner Violence (IPV) or child maltreatment published between January 2010 and December 2019. We found nine studies reviewing systemic interventions for IPV and 12 studies reviewing systemic interventions for child maltreatment. In our discussion, we added relevant articles published before 2010 to determine the overall state of the evidence for these interventions. We determined that parent training programs with in vivo coaching components for child maltreatment meet the criteria for well-established interventions. Relationship education approaches are probably efficacious. Parent education and family therapy programs to reduce child maltreatment, and cognitive behavioral couples treatment to reduce IPV are possibly efficacious interventions. Programs based on "naturalistic" couples therapy for IPV are experimental interventions. This review also highlights limitations in this research in addressing the needs of marginalized couples and families.

Optimising a couples-focused intervention to increase couples' HIV testing and counselling using the person-based approach: a qualitative study in Kwa-Zulu Natal, South Africa

OBJECTIVES

This qualitative study explored how to optimise a couples-focused intervention to promote couples HIV testing and counselling (CHTC).

SETTING

Community setting in Kwa-Zulu Natal, South Africa.

PARTICIPANTS

Qualitative interviews were conducted with 20 couples who had participated in a couples-focused intervention and five staff members delivering the intervention. Partners were interviewed individually by researchers of the same gender.

INTERVENTION

A couples-focused intervention comprised of two group sessions and four couples counselling sessions was previously shown to significantly increase uptake to CHTC in Kwa-Zulu Natal, South Africa. However, more than half of couples participating in the intervention still chose not to test together during follow-up.

ANALYSIS

The transcripts were analysed using the table of changes from the person-based approach. Proposed optimisations were discussed with a community group to ensure the intervention was as persuasive and acceptable as possible.

RESULTS

Many couples found it challenging to discuss CHTC with their partner due to an implied lack of trust. Optimisations to the intervention were identified to increase readiness to discuss CHTC, including education about serodiscordance, discussions about CHTC by peer mentors and open discussion of personal barriers to CHTC during couples' counselling sessions. Additional training for staff in open questioning techniques could help them feel more comfortable to explore couples' perceived barriers to CHTC, rather than advising couples to test. A logic model was developed to show anticipated mechanisms through which the optimised intervention would increase uptake to CHTC, including increasing knowledge, increasing positive outcome beliefs and managing negative emotions.

CONCLUSIONS

In-depth qualitative research informed optimisations to a couples-focused intervention for further evaluation in South Africa to encourage uptake to CHTC. Suggestions are made for optimal methods to gain open feedback on intervention experiences where participants may be reluctant to share negative views.

The impact of a maternal mental health intervention on intimate partner violence in Northern Ghana and the mediating roles of social support and couple communication: secondary analysis of a cluster randomized controlled trial

BACKGROUNDS

Diverse intervention efforts are implemented to address intimate partner violence (IPV) against women. Via a syndemics theory lens and emerging empirical evidence, mental health interventions demonstrate promise to partially ameliorate IPV. However, the mechanisms of change underlying many IPV interventions are not well understood. These gaps impede our efforts to strengthen or integrate effective components into the current mental health resources, especially in low- and middle-income countries (LMICs). This study aims to examine the impact of a maternal mental health intervention called Integrated Mothers and Babies Course & Early Childhood Development (iMBC/ECD) on IPV and whether social support and/or couple communication mediates the intervention effects among women in rural, Northern Ghana.

METHODS

The current study is a secondary data analysis of a cluster randomized controlled trial. IPV was measured at baseline and 8 months post-intervention (~ 19 months post-baseline). At baseline, 84.8% of the women enrolled in the study (n = 374) reported some type of IPV in the past 12 months. Logistic regression models and multiple mediation analyses were used to address the study aims.

RESULTS

iMBC/ECD did not reduce IPV in the intervention group compared to the control group. Social support and couple communication did not mediate the intervention effects on IPV as indicated by the indirect effects of the multiple mediation models. However, increase in social support reduced women's odds of experiencing emotional violence by 7%, odds ratio (OR) = 0.93, p = 0.007; b = - 0.07, 95% confidence interval (CI) = (- 0.13, - 0.02), and improvement in couple communication demonstrated promise in reducing women's odds of experiencing controlling behaviors by 7%, OR = 0.93, p = 0.07; b = - 0.07, CI = (- 0.14, 0.005), though the improvements were not due to the intervention.

CONCLUSION

This maternal mental health intervention did not reduce IPV; however, the findings extend our knowledge about the impact of such interventions on IPV and the potential mechanisms of change via social support and couple communication. Future research evaluating the impact of mental health interventions on IPV and mechanisms of change is essential for the development of effective interventions. Future programs addressing IPV in LMICs should consider risk factors beyond relationship level (e.g. poverty and gender inequity).

TRIAL REGISTRATION

ClinicalTrials.gov # NCT03665246 , Registered on August 20th, 2018.

Examining differences between mass, multiple, and single-victim homicides to inform prevention: findings from the National Violent Death Reporting System

Background

Multi-victim homicides are a persistent public health problem confronting the United States. Previous research shows that homicide rates in the U.S. are approximately seven times higher than those of other high-income countries, driven by firearm homicide rates that are 25 times higher; 31% of public mass shootings in the world also occur in the U.S.. The purpose of this analysis is to examine the characteristics of mass, multiple, and single homicides to help identify prevention points that may lead to a reduction in different types of homicides.

Methods

We used all available years (2003–2017) and U.S. states/jurisdictions (35 states, the District of Columbia, and Puerto Rico) included in CDC’s National Violent Death Reporting System (NVDRS), a public health surveillance system which combines death certificate, coroner/medical examiner, and law enforcement reports into victim- and incident-level data on violent deaths. NVDRS includes up to 600 standard variables per incident; further information on types of mental illness among suspected perpetrators and incident resolution was qualitatively coded from case narratives. Data regarding number of persons nonfatally shot within incidents were cross-validated when possible with several other resources, including government reports and the Gun Violence Archive. Mass homicides (4+ victims), multiple homicides (2-3 victims) and single homicides were analyzed to assess group differences using Chi-square tests with Bonferroni-corrected post-hoc comparisons.

Results

Mass homicides more often had female, child, and non-Hispanic white victims than other homicide types. Compared with victims of other homicide types, victims of mass homicides were more often killed by strangers or someone else they did not know well, or by family members. More than a third were related to intimate partner violence. Approximately one-third of mass homicide perpetrators had suicidal thoughts/behaviors noted in the time leading up to the incident. Multi-victim homicides were more often perpetrated with semi-automatic firearms than single homicides. When accounting for nonfatally shot victims, over 4 times as many incidents could have resulted in mass homicide.

Conclusions

These findings underscore the important interconnections among multiple forms of violence. Primary prevention strategies addressing shared risk and protective factors are key to reducing these incidents.

When the loss of positives feels negative: Exploring the loss of positive experiences in committed couples

Despite romantic relationships being characterized by high positives (e.g., enjoyable activities, positive feelings) early in commitment, many couples experience a loss of positives over time. However, interventions are typically not as effective at enhancing positives as they are at reducing negatives (e.g., hostile conflict). Thus, it is important to understand why positives decrease and how to use interventions to enhance positives optimally. In this article, we present how the field has evolved to (a) heighten focus on positives independent of negatives, (b) identify trajectories of positives over time, and (c) clarify major factors which predict loss of positives. From a cognitive-behavioral couple therapy perspective, we offer therapeutic strategies that may hold promise for enhancing positives in relationships.

Cumulative risk of compromised physical, mental and social health in adulthood due to family conflict and financial strain during childhood: a retrospective analysis based on survey data representative of 19 European countries

Background

Childhood adversity (CA) has previously been linked to various health problems in adulthood. Investigations into the differential impact of distinct types of CA on a wide range of outcomes are scarce. This study aimed to assess the impact of self-reported childhood family conflict and/or financial strain on health and social functioning in adulthood among Europeans, while taking into account the mediating role of adulthood socioeconomic disadvantage (SED) in these associations.

Methods

Using the European Social Survey (ESS) collected in 2014, nationally representative cross-sectional data from 35 475 participants aged 15 years and older in 19 European countries were analysed. Logistic regressions were conducted to assess associations of retrospectively reported family conflict and/or financial strain in childhood with physical and mental health as well as health behaviours and social functioning in adulthood.

Results

A quarter of the European population reported having experienced family conflict, financial strain or both in childhood. Financial strain was reported more among older age groups and conflict more among younger age groups. A dose-response pattern with increased risk was demonstrated for almost all physical, behavioral, mental and social outcomes for these aspects of CA compared with no CA, with the highest risk observed in those who experienced both financial strain and family conflict. Adulthood SED mediated a significant proportion of the associations with financial strain (ranging from 5.4% to 72.4%), but did not mediate the associations with conflict.

Conclusion

Individuals reporting family conflict or financial strain during childhood are at increased risk of developing a wide range of health and social problems. Those who report financial strain in childhood are more likely to experience SED in adulthood, which in turn increases their risk of experiencing health and social problems. Reported family conflict during childhood conferred increased risk of health and social problems, but adulthood SED did not appear to operate as an indirect pathway.

Romantic relationships and sexual minority health: A review and description of the Dyadic Health Model

A large body of literature has documented the health promotive effects of healthy committed relationships on the health and wellbeing of heterosexual people in different-sex relationships, including observational and longitudinal studies, couple-based intervention development and evaluation efforts, and articulation of theoretical frameworks. A much smaller but growing field of research has observed that same-sex relationships have similar effects on health outcomes but that these couples face unique stressors that may impact relationship functioning and health. Further, extant theoretical frameworks do not sufficiently address the multiple pathways by which psychosocial vulnerabilities and stressors impact same-sex relationship functioning, engagement in health-related risk behaviors, and the mental and physical health of sexual minorities in relationships. The purpose of this manuscript is to: a) review the existing literature on relationship functioning and health among sexual minorities, including both observational and intervention studies; and b) present an integrated model of relationship functioning and health for same-sex couples that can be used as a basis for further studies on sexual minority dyads, as well as the development of novel couple-based interventions to optimize the health promoting effects of relationships.

Can Interventions that Strengthen Couples' Relationships Confer Additional Benefits for their Health? A Randomized Controlled Trial with African American Couples

This study examined the effects of the Protecting Strong African American Families (ProSAAF) prevention program on adults' self-reported health outcomes 25 months after enrollment. ProSAAF is a couple-focused prevention program specifically designed to meet the needs of African-American families residing in the rural South. African-American couples (N = 346) with an early adolescent child participated in a randomized controlled trial of the program. Dyadic data analyses indicated significant direct effects on changes in couple functioning post-intervention as well as significant indirect effects of ProSAAF on changes in health through post-intervention improvements in couple functioning. These benefits were documented for men's and women's general health, depressive symptoms, and problematic sleep. There were no significant direct effects of ProSAAF participation on changes in health. Findings provide tempered optimism regarding the potential benefits of couple-focused programming for adults' physical, mental, and behavioral health.

Individual Versus Group Cognitive-Behavioral Therapy for Partner-Violent Men: A Preliminary Randomized Trial

A randomized clinical trial tested the hypothesis that a flexible, case formulation-based, individual treatment approach integrating motivational interviewing strategies with cognitive-behavioral therapy (ICBT) is more efficacious than a standardized group cognitive-behavioral approach (GCBT) for perpetrators of intimate partner violence (IPV). Forty-two men presenting for services at a community domestic violence agency were randomized to receive 20 sessions of ICBT or a 20-week group cognitive-behavioral therapy (CBT) program. Participants and their relationship partners completed assessments of relationship abuse and relationship functioning at baseline and quarterly follow-ups for 1 year. Treatment uptake and session attendance were significantly higher in ICBT than GCBT. However, contrary to the study hypothesis, GCBT produced consistently equivalent or greater benefits than ICBT. Participant self-reports revealed significant reductions in abusive behavior and injuries across conditions with no differential benefits between conditions. Victim partner reports revealed more favorable outcomes for group treatment, including a statistically significant difference in psychological aggression, and differences exceeding a medium effect size for physical assault, emotional abuse, and partner relationship adjustment. In response to hypothetical relationship scenarios, GCBT was associated with greater reductions than ICBT (exceeding a medium effect) in articulated cognitive distortions and aggressive intentions. Treatment competence ratings suggest that flexible, individualized administration of CBT creates challenges in session agenda setting, homework implementation, and formal aspects of relationship skills training. Although caution is needed in generalizing findings from this small-scale trial, the results suggest that the mutual support and positive social influence available in group intervention may be particularly helpful for IPV perpetrators.

Skills for Healthy Adult Relationships at the University of Maryland, Baltimore County: Program Development and Preliminary Data

The present study examines the development and preliminary pilot findings of Skills for Healthy Adult Relationships at the University of Maryland, Baltimore County (SHARe@UMBC)-an intimate partner violence prevention program for college students. SHARe@UMBC is based on an integrative cognitive-behavioral model of communication and emotion regulation in close interpersonal relationships. There were four aims of the present study: first, to describe program development; second, to examine program acceptability and participant satisfaction; third, to examine the extent to which participants acquired relationship skills and their level of confidence in using those skills; and fourth, to examine perpetration and victimization of physical, sexual, and psychological aggression. These aims utilized data collected before program initiation, immediately after program completion, and at a follow-up 9 to 15 months after program completion. Findings from two pilot groups (15 students in total; eight women and seven men) indicated high ratings of program acceptability and satisfaction, reductions in negative communication, improvements in confidence using conflict management strategies with romantic partners and peers, and confidence initiating new romantic relationships. In addition, large effect sizes were observed for confidence providing emotional support to a romantic partner and self-disclosure with peers. Participants reported no incidents of physical, sexual, or psychological aggression perpetration or victimization at follow-up. Pilot implementation and initial uncontrolled results are encouraging and provide support for initiating a more extensive controlled investigation of program efficacy.

Results of a Couples-Based Randomized Controlled Trial Aimed to Increase Testing for HIV

BACKGROUND

Although couples HIV testing and counseling (CHTC) is effective for facilitating mutual disclosure and linkage to HIV care, uptake remains low. Using a randomized controlled design, we tested the efficacy of a behavioral couples-based intervention aimed to increase CHTC.

SETTING

The Vulindlela district of KwaZulu-Natal, South Africa.

METHODS

Couples were recruited from the community (eg, markets and community events). Couples were excluded if mutual HIV serostatus disclosure had occurred. Both partners had to report being each other's primary partner and relationship length was at least 6 months. Assessments occurred at baseline, and 3, 6, and 9 months after intervention. Eligible couples attended a group session (3-4 hours) after which randomization occurred. Intervention couples additionally received: one couples-based group session followed by 4 couples' counseling sessions (1-2 hours). Intervention topics included communication skills, intimate partner violence, and HIV prevention. Our primary outcomes were CHTC and sexual risk behavior.

RESULTS

Overall, 334 couples were enrolled. Intervention couples were significantly more likely to have participated in CHTC [42% vs. 12% (P ≤ 0.001)]. In addition, their time to participate in CHTC was significantly shorter (logrank P ≤ 0.0001) (N = 332 couples). By group, 59% of those who tested HIV-positive in intervention and 40% of those who tested in control were new HIV diagnoses (P = 0.18). There were no group differences in unprotected sex.

CONCLUSIONS

Our intervention improved CHTC uptake-a vehicle for mutual serostatus disclosure and entrée into HIV treatment, both of which exert a significant public health impact on communities substantially burdened by HIV.

Couple relationship education program "Living as Partners": evaluation of effects on marital quality and conflict

Relationship education programs are strategies that can favor better marital quality and conflict management between spouses. The relationship education program “Living as Partners: Turning Challenges into Opportunities” seeks to promote the couples’ learning of conflict resolution strategies and better quality levels in the relationship. This study evaluates the capacity of this program to produce results regarding marital quality and three dimensions of the couple’s conflict: frequency, intensity, and resolution strategies. Data from 41 couples were analyzed before and after the program, and a follow-up after 5 months (n = 33 couples) were conducted as well (single group, pre-test, post-test, and follow-up quasi-experimental design). Results show that the program produced immediate effects in all the outcome variables, which remained significant after 5 months, except for marital quality and for the strategy of compliance. These outcomes showed effect sizes ranging from low to high levels. The study presents evidence about the ability of the “Living as Partners” program to produce improvements in couple’s conflict indicators, addressing an unexplored field of research and intervention focused on Brazilian cultural specificities.

Hand-in-Hand Combat: Affectionate Touch Promotes Relational Well-Being and Buffers Stress During Conflict

Relational conflict has a considerable impact on relational and personal well-being, but whether that impact is positive or negative depends on how the conflict is managed. Individuals struggle to have constructive conflicts that protect their relationships and avoid excess stress, which can lead to declines in relationship quality over time. The current set of experiments tested whether a brief touch intervention would promote relational well-being and prevent stress during couple conflict discussions. Results indicated that engaging in touch prior to and during conflict was effective to improve couple-members’ conflict behavior and to buffer stress in real (Experiment 1) and imagined (Experiments 2a and 2b) contexts. The results of these experiments suggest that touch may be a simple yet effective intervention for improving couple conflict discussions. In addition, we provide initial evidence that enhanced state security and cognitive interdependence serve as mechanisms underlying these effects.

A Developmental Perspective on Young Adult Romantic Relationships: Examining Family and Individual Factors in Adolescence

The ability to develop and maintain healthy romantic relationships is a key developmental task in young adulthood. The present study investigated how adolescent interpersonal skills (assertiveness, positive engagement) and family processes (family climate, parenting practices) influence the development of young adult romantic relationship functioning. We evaluated cross-lag structural equation models with a sample of 974 early adolescents living in rural and semi-rural communities in Pennsylvania and Iowa, starting in sixth grade (mean age = 12.4, 62.1% female) and followed into young adulthood (mean age = 19.5). Findings revealed that adolescents who had experienced a more positive family climate and more competent parenting reported more effective problem-solving skills and less violent behavior in their young adult romantic relationships. Adolescent assertiveness was consistently positively associated with relationship problem-solving skills, and adolescents' positive engagement with their family was associated with feeling more love in young adult romantic relationships. In addition, family functioning and adolescent interpersonal skills exhibited some reciprocal relations over the adolescent years. In summary, family processes and interpersonal skills are mutually influenced by each other across adolescence, and both have unique predictive implications to specific facets of young adult romantic relationship functioning.

Eheglück durch „Wenn“ und „Aber“?

Zusammenfassung. Theoretischer Hintergrund: Die Qualität der partnerschaftlichen, verbalen Kommunikation ist ein entscheidender Faktor für Trennung und Scheidung. Durch Konjunktionen können Satzteile sinnvoll miteinander verknüpft und Beziehungen zwischen ihnen hergestellt werden. Fragestellung: Lässt sich anhand von in Konfliktgesprächen verwendeten Konjunktionen die Scheidungswahrscheinlichkeit und die Partnerschaftszufriedenheit von Ehepaaren nach fünf und 25 Jahren vorhersagen? Methode: Zur Untersuchung dieser Hypothesen wurden 172 Transkripte von N = 65 zufriedenen Ehepaaren linguistisch ausgewertet. Ergebnisse: Mithilfe von logistischen und linearen Regressionsmodellen konnte gezeigt werden, dass die verwendeten Konjunktionen einen signifikanten Prädiktor (Schutzfaktor) für die Vorhersage der Scheidungswahrscheinlichkeit darstellen. Zur Vorhersage der Partnerschaftszufriedenheit eigneten sie sich hingegen zu keinem der beiden Untersuchungszeitpunkte. Schlussfolgerungen: Insgesamt stellte der Konjunktionsgebrauch einen Indikator für komplexe soziale Interaktionsprozesse dar.

What Can Elder Mistreatment Researchers Learn About Primary Prevention From Family Violence Intervention Models?

Elder mistreatment (EM) is a public health problem that harms millions of older Americans each year. Despite growing recognition of its occurrence, there are no evidence-based primary prevention programs. Although EM is distinct from other areas of family violence, including child maltreatment and intimate partner violence, common risk factors and theoretical underpinnings point to opportunities for prevention strategies. Drawing on evidence-based best practices found in other fields of family violence, we identify approaches that could be tested to prevent EM at the hands of family caregivers, who are among the most likely to commit mistreatment. Specifically, we examine home visiting approaches primarily used in the child maltreatment field and identify components that have potential to inform EM interventions, including prevention. We conclude that there is enough information to begin testing a prevention intervention for EM that targets caregivers.

Empathy and Romantic Relationship Quality among Cohabitating Couples: An Actor-Partner Interdependence Model

This study employed a dyadic data analysis approach to examine the association between partners' empathy and relationship quality among cohabitating couples. Data were collected from 374 cohabitating but non-married couples, who were participants in the Wave 3 Romantic Pairs Subsample of the National Longitudinal Study of Adolescent Health (Add Health). Men's higher empathy was related to their own perceptions of better relationship quality and women's higher empathy was related to their own as well as their partner's perceptions of better relationship quality. These findings show that individuals' abilities to be understanding, compassionate, and sympathetic may be related to the overall feeling of satisfaction and love in romantic relationships. The only effect that did not reach statistical significance was the partner effect from men's empathy to women's relationship quality. Although previous research with married couples has shown that men's empathy may play a more important role in shaping couples' perceptions of relationship quality, according to the current findings, these findings may not extend to cohabitating couples. The current results provide beneficial guidance to clinicians working with distressed, non-married couples.

Relationship Dissolution and Psychologically Aggressive Dating Relationships: Preliminary Findings From a College-Based Relationship Education Course

This study evaluated the impact of a relationship education program, delivered as part of a college course, among students (N = 152) who reported experiencing psychological aggression in their exclusive dating relationship. Preliminary results showed that compared to those in the control group, participants receiving relationship education were significantly more likely to end their romantic relationship, even after controlling for relationship satisfaction. Furthermore, when relationship termination occurred, those in the intervention group were significantly more likely to attribute the breakup to their participation in the class as compared to those in the control group. The tentative findings are an important preliminary step in assessing the benefits of relationship education in reducing the risk of psychological aggression among college students.

The Association Between Affective and Problem-Solving Communication and Intimate Partner Violence among Caucasian and Mexican American Couples: A Dyadic Approach

The present study examined individuals' subjective evaluation of their effectiveness with regard to affective communication and problem-solving communication, and their relation to intimate partner violence (IPV) victimization. Data from 100 Caucasian American and Mexican American couples were collected during the first and during the third year of marriage. For affective communication, a significant partner effect emerged, indicating that husbands' higher dissatisfaction with affective communication was related to wives' higher IPV victimization. For problem-solving communication, a significant actor effect emerged, indicating that husbands' higher dissatisfaction with problem-solving communication was related to husbands' higher IPV victimization. While these findings largely generalized to Caucasian Americans, they did not generalize to Mexican Americans.

Effects of a Brief Psychoeducational Intervention for Family Conflict: Constructive Conflict, Emotional Insecurity and Child Adjustment

The role of emotional security in promoting positive adjustment following exposure to marital conflict has been identified in a large number of empirical investigations, yet to date, no interventions have explicitly addressed the processes that predict child adjustment after marital conflict. The current study evaluated a randomized controlled trial of a family intervention program aimed at promoting constructive marital conflict behaviors thereby increasing adolescent emotional security and adjustment. Families (n = 225) were randomized into 1 of 4 conditions: Parent-Adolescent (n = 75), Parent-Only (n = 75), Self-Study (n = 38) and No Treatment (n = 37). Multi-informant and multi-method assessments were conducted at baseline, post-treatment and 6-month follow-up. Effects of treatment on destructive and constructive conflict behaviors were evaluated using multilevel models where observations were nested within individuals over time. Process models assessing the impact of constructive and destructive conflict behaviors on emotional insecurity and adolescent adjustment were evaluated using path modeling. Results indicated that the treatment was effective in increasing constructive conflict behaviors (d = 0.89) and decreasing destructive conflict behaviors (d = -0.30). For the Parent-Only Group, post-test constructive conflict behaviors directly predicted lower levels of adolescent externalizing behaviors at 6-month follow-up. Post-test constructive conflict skills also indirectly affected adolescent internalizing behaviors through adolescent emotional security. These findings support the use of a brief psychoeducational intervention in improving post-treatment conflict and emotional security about interparental relationships.

The Effectiveness of the Within Our Reach Relationship Education Program for Couples: Findings from a Federal Randomized Trial

This study examined the effectiveness of a couple-based relationship education program, Within Our Reach. Secondary data (n = 3,609) were analyzed from the federal Supporting Healthy Marriage project. Couples were randomly assigned to receive Within Our Reach and associated services or to a no-treatment (treatment-as-usual) control group. Those assigned to Within Our Reach reported better couple and individual outcomes on 8 of 12 outcomes measured (M ES = .15) at the 12-month follow-up and 6 of 10 outcomes measured at the 30-month follow-up (M ES = .14), including higher relationship happiness, more warmth and support, more positive communication, less negative behavior and emotion, less psychological abuse, less physical assault (for men), lower psychological distress (for women), and less infidelity. They were also less likely to report that their marriage was in trouble. These effects were generally small in size and many were replicated across the two follow-ups. There were no significant differences between those assigned to Within Our Reach versus control on cooperative parenting, severe psychological assault, or percent married. Implications for future research, programming, and policy are discussed.

Sexual satisfaction in couples in the male and female climacteric stage

The objective was to describe the sexual life satisfaction of couples in the climacteric stage and determine whether there are differences between the perception of satisfaction and the sex life of each partner. We studied 142 couples obtained by stratified sampling of family health centers, Concepción, Chile. 66% of women and 84% of men reported being very or somewhat satisfied with their sex lives. Slight concordance was found between the responses of the partners in relation to satisfaction with their sexual life. Moreover, a slight degree of agreement was found between the sexual life satisfaction reported by women and their partners' perceptions of the women's sexual life satisfaction. Additionally, a slight degree of agreement was reported between the sexual life satisfaction reported by men and their partners' perceptions of the men's sexual life satisfaction. This study provides new information about Chilean couples in the climacteric stage in relation to self-reported sexual satisfaction and perceived satisfaction in couples.

Psychosocial interventions for patients and caregivers in the age of new communication technologies: opportunities and challenges in cancer care

Interactive health communication technologies (IHCTs) present a new opportunity and challenge for cancer control researchers who focus on couple- and family-based psychosocial interventions. In this article, the authors first present findings from a systematic review of 8 studies that used IHCTs in psychosocial interventions with cancer patients and their caregivers. Although this research area is still in its infancy, studies suggest that it is feasible to incorporate IHCTs in such interventions, that IHCTs are generally well accepted by patients and caregivers, and that the choice of technology is largely dependent on intervention target (i.e., patient, caregiver, or both) and outcomes (e.g., decision making, symptom management, lifestyle behaviors). A major research gap has been the lack of integration of Web 2.0 technologies (e.g., social media), despite the fact that social support and communication are frequently targeted components of interventions that involve cancer patients and their caregivers. Given this, the authors next present findings from a qualitative study that they conducted to describe the different needs and preferences of 13 cancer survivors and 12 caregivers with regard to social media use. Last, the authors discuss some of the opportunities and challenges of using IHCTs in psychosocial interventions for cancer patients and their caregivers and propose directions for future research.

Prevention of Marital Distress: Current Issues in Programming and Research

Marital dissatisfaction is the most common presenting problem in adults seeking psychological services and is rated as the second most severe stress adults can experience after a death in the family. Almost every married couple is, at some time, at risk for marital distress, conflict, separation, and divorce and for the resulting stress on themselves and their children. Traditionally, theory and practice have focused on tertiary prevention of marital distress (i.e., marital therapies). However, marital therapy has limited efficacy and accesses only limited numbers of couples. Poor communication and dissatisfaction with interactions, assessed premaritally, are strong predictors of marital distress. Several marital distress prevention programs have been developed which generally or specifically target communication behaviour of pre- and early married couples. Outcome evaluations suggest such programs can lead to improved communication and problem-solving skills, improved relationship satisfaction, lower levels of marital violence, and diminished probability of marital dissolution. Suggestions for future research include a more fine-grained analysis of situation-specific cognition, affect, and psychophysiological responses during communication, incorporation of a self-regulatory model within prevention work, and the use of longitudinal research designs.

Prevention of Relationship Problems: Retrospect and Prospect

Whilst nearly all couple relationships start out happy, half of all marriages end in divorce. Relationship education is a potentially effective strategy to reduce the prevalence of relationship problems and divorce. The substantial empirical research on the determinants of relationship satisfaction shows that there are key relationship skills, such as communication and conflict management skills, which impact on the course of relationship satisfaction and stability. Relationship education can teach couples these key relationship skills, and this may prevent relationship problems. However, relationship education is not targeted at those couples who need it most. Research needs to be focused on the effects of relationship education for couples at high risk for relationship problems. The reach of education programs to couples can be enhanced by developing flexible delivery education programs. Relationship education programs also need to promote coping with stressful events that often lead to relationship problems, such as the transition into step-families, the onset of chronic illness, and unemployment.

Preconception care: screening and management of chronic disease and promoting psychological health

INTRODUCTION

A large proportion of women around the world suffer from chronic diseases including mental health diseases. In the United States alone, over 12% of women of reproductive age suffer from a chronic medical condition, especially diabetes and hypertension. Chronic diseases significantly increase the odds for poor maternal and newborn outcomes in pregnant women.

METHODS

A systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for preventing and managing chronic diseases and promoting psychological health on maternal, newborn and child health outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture.

RESULTS

Maternal prepregnancy diabetic care is a significant intervention that reduces the occurrence of congenital malformations by 70% (95% Confidence Interval (CI): 59-78%) and perinatal mortality by 69% (95% CI: 47-81%). Furthermore, preconception management of epilepsy and phenylketonuria are essential and can optimize maternal, fetal and neonatal outcomes if given before conception. Ideally changes in antiepileptic drug therapy should be made at least 6 months before planned conception. Interventions specifically targeting women of reproductive age suffering from a psychiatric condition show that group-counseling and interventions leading to empowerment of women have reported non-significant reduction in depression (economic skill building: Mean Difference (MD) -7.53; 95% CI: -17.24, 2.18; counseling: MD-2.92; 95% CI: -13.17, 7.33).

CONCLUSION

While prevention and management of the chronic diseases like diabetes and hypertension, through counseling, and other dietary and pharmacological intervention, is important, delivering solutions to prevent and respond to women's psychological health problems are urgently needed to combat this leading cause of morbidity.

Preconception care: delivery strategies and packages for care

The notion of preconception care aims to target the existing risks before pregnancy, whereby resources may be used to improve reproductive health and optimize knowledge before conceiving. The preconception period provides an opportunity to intervene earlier to optimize the health of potential mothers (and fathers) and to prevent harmful exposures from affecting the developing fetus. These interventions include birth spacing and preventing teenage pregnancy, promotion of contraceptive use, optimization of weight and micronutrient status, prevention and management of infectious diseases, and screening for and managing chronic conditions. Given existing interventions and the need to organize services to optimize delivery of care in a logical and effective manner, interventions are frequently co-packaged or bundled together. This paper highlights packages of preconception interventions that can be combined and co-delivered to women through various delivery channels and provides a logical framework for development of such packages in varying contexts.