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. Author manuscript; available in PMC: 2024 Mar 1.
Published in final edited form as: Fam Process. 2022 May 24;62(1):387–405. doi: 10.1111/famp.12788

Promoting Resilience to Depression Among Couples During Pregnancy: The Protective Functions of Intimate Relationship Satisfaction and Self-Compassion

Shaina A Kumar 1, Molly R Franz 2, David DiLillo 1, Rebecca L Brock 1
PMCID: PMC9899353  NIHMSID: NIHMS1866643  PMID: 35610976

Abstract

Pregnancy, while often marked by joy, may pose considerable risk for depression among parents. Against a backdrop of adverse life events, expectant parents may be even more vulnerable to developing symptoms of depression during the prenatal period. Thus, it is critical to identify sources of resilience that might facilitate a successful transition to parenthood among couples who have a history of adversity. Prior work suggests that interpersonal and intrapersonal factors associated with resilience, such as intimate relationship satisfaction and self-compassion (i.e., self-kindness, common humanity, mindfulness), have the potential to attenuate prenatal depression among couples with a history of stressful life experiences. We tested this possibility in a sample of 159 couples navigating pregnancy. As predicted, a greater number of prior stressful life experiences was associated with increased depression symptom severity for both mothers and fathers. However, moderation analyses revealed the positive link between cumulative stressful life experiences and depression symptom severity was attenuated among mothers who reported greater self-compassion in the form of feelings of common humanity, and fathers who reported higher levels of intimate relationship satisfaction and self-compassion in the form of mindfulness. Findings suggest enhancing intimate relationship satisfaction and self-compassion among expectant couples may be valuable in attenuating prenatal depression among those with a greater history of adversity.

Keywords: adversity, couples, depression, family, relationship satisfaction, self-compassion

Pregnancy is a milestone punctuated by considerable and rapid psychosocial changes for both mothers and fathers. Though pregnancy is accompanied by marked joy for many, it is also a time in which couples are tasked with new challenges, amplifying risk for negative mental health outcomes. In particular, both pregnant women and their partners are at elevated risk for experiencing depression, which is predictive of myriad negative family outcomes, including negative parenting behaviors (Paulson et al., 2006) and socioemotional dysfunction among children (Madigan et al., 2018). Thus, it is important to uncover risk and protective factors for prenatal depression to inform prevention and intervention treatments and interrupt this cycle for families experiencing mental health challenges. The primary aims of the present study were to (1) examine a salient risk factor for prenatal depression—prior life adversity—and (2) identify protective factors that weaken the association between prior adversity and prenatal depression to better understand ways of promoting positive adjustment during the transition to parenthood.

Stressful Life Experiences and Risk for Prenatal Depression

Millions of couples navigate pregnancy and childbirth each year (Centers for Disease Control and Prevention, 2022) and, consistent with family systems theory, this transition introduces unique challenges as couples reorganize the family to meet the demands of the newest family member and adjust to new or modified caregiving roles (Cox & Paley, 2003). Parents are also faced with stress and anxiety related to potential complications and risks to both mother and infant during the childbirth process (Olde et al., 2006). Consequently, although considered a normative life transition, the experience of pregnancy and childbirth is considered uniquely challenging and poses significant risk for mental health of both parents. Compounding this risk, pregnant women experience hormonal changes that elevate risk for psychiatric illness (Brummelte & Galea, 2010). In particular, pregnant women are at significant risk for depression, with meta-analytic estimates ranging from 6.5% to 12.9% across pregnancy to three months postpartum (Gavin et al., 2005). Though comparatively understudied, the mental health of men is also impacted during pregnancy largely due to spillover effects of maternal depression and other stressors associated with the birth of a child, such as economic burden and concern for the welfare of mother and infant (Fentz et al., 2021; Lino et al., 2017). Indeed, rates of depression in men have been estimated at 9.76% across pregnancy and 8.75% within one year postpartum (Rao et al., 2020).

Researchers have long sought to identify factors associated with heightened risk for prenatal depression among mothers and fathers, although risk for perinatal depression in fathers has received considerably less attention. Among the most commonly examined risk factors is exposure to adversity, defined here as previous experiences of stressful life events. Against a backdrop of greater adverse life events, both mothers (Racine et al., 2021) and fathers (Kiviruusu et al., 2020) may be more vulnerable to developing symptoms of depression during or immediately following the prenatal period. For example, exposure to adversity in childhood (e.g., childhood sexual abuse; Robertson-Blackmore et al., 2013), as well as a history of multiple traumatic exposures (Holzman et al., 2006), are robust predictors of maternal prenatal depression.

Prior findings and theory support the notion that stressful life events increase risk for depression (i.e., diathesis-stress models), and depression in turn augments the likelihood that individuals will experience additional stressful life events in the future (i.e., the stress generation hypothesis; Hammen, 1991; Liu & Alloy, 2010). The reciprocal link between stressful life experiences and depression is particularly concerning in the context of the transition into parenthood because stress generated by way of parental depression is likely to have cascading effects on the family unit through several routes, including disrupted parenting and elevated exposure to stressful environments for the child (Goodman & Gotlib, 1999).

Importantly, because pregnancy is a period of rapid change and adjustment, it can also be conceptualized as a sensitive period in which parents may be especially vulnerable to the downstream consequences of prior life adversity. Indeed, the reorganization of the family system during this time period is distinct from other life transitions creating instability in a system that often serves as a key resource for coping with stress and regulating emotions (Brock et al., 2014). However, in tandem, this period also has the potential to set the stage for positive transformation in the family, rendering parents more receptive to resilience-promoting factors (see Davis & Narayan, 2020 for a discussion). Because prior experiences of adversity represent fixed risk factors, it is critical to identify modifiable protective factors that promote resilience during pregnancy to help reduce depression among those with greater exposure to stressful life events. Given the transactional links between stressful life events and depression, identifying sources of resilience to depression might also facilitate the prevention of additional stress generation following the birth of a child.

Applying a Model of Resilience to Mitigate Risk for Prenatal Depression

The multi-system model of resilience proposes that resilience is a tiered system with multiple dimensions, including (1) aspects within an individual representative of trait-resilience (e.g., genetic and neurobiological determinants of individual health), (2) characteristics developed over time representative of psychological resilience (e.g., coping styles and cognitions such as self-compassion), and (3) socio-ecological factors that facilitate coping and adjustment representative of community resilience (e.g., social support and connectedness, socioeconomic status; Liu et al., 2017, 2020). By characterizing resilience as an evolving capacity that can be sourced from multiple domains, it is possible to protect against negative outcomes following hardship and encourage wellbeing during stressful life periods in ways beneficial to each individual (Liu et al., 2020). In the context of the current study, couples may be able to draw resilience from multiple sources to successfully navigate the transition to parenthood despite adversity they have faced.

Evidence across both cross-sectional and longitudinal studies suggests intimate relationship satisfaction contributes to positive outcomes throughout the lifespan; for example, those in more satisfying relationships tend to demonstrate higher self-esteem, increased optimism, and heightened positive affect, as well as greater perceived support and better overall mental health (Tissera et al., 2020). A high-quality intimate relationship might be of particular importance during pregnancy when both partners are navigating the shared experience of excitement and apprehension about childbirth while also working as a team to ensure a smooth transition for the family. In the absence of a strong bond and cooperative relationship, risk for maternal and paternal prenatal depression is elevated (e.g., Brock et al., 2020). In contrast, psychopathology may be lower among couples who derive stability and support from one another during this sensitive period pointing to the interparental relationship as a key resource for resiliency during pregnancy.

Intimate relationship satisfaction is expected to be a uniquely protective factor in the context of pregnancy; however, consistent with the multi-system model of resilience, sources of intrapersonal resilience should also be considered. Although multiple dimensions of trait-resilience have been identified (e.g., certain coping styles), researchers are increasingly considering the role of self-compassion in resiliency. Compassionate self-responding reflects kind and nonjudgmental relating to oneself and one’s emotional experiences and is comprised of three key components: (1) self-kindness (extending kindness to oneself and accepting imperfections), (2) common humanity (seeing one’s life events as part of the larger human experience), and (3) mindfulness (holding one’s thoughts and feelings in balanced awareness; Neff, 2003b). Self-compassion along these dimensions has been linked to greater life satisfaction, heightened social connectedness, increased optimism, higher self-efficacy, and improved mental health across the lifespan (MacBeth & Gumley, 2012; Smeets et al., 2014).

Given that pregnant couples experience a great deal of uncertainty, apprehension, and adjustment as they navigate this transition, adopting habits of compassionate self-responding may be important for mobilizing psychological resources during pregnancy. Compassionate responding may protect against poorer mental health during pregnancy by allowing mothers and fathers to better reflect on their emotions and worldviews, as well as engage in proactive behaviors aimed at promoting their wellbeing (e.g., requesting leave from work before becoming overly stressed; Neff, 2003b). Indeed, in a study of wellbeing among perinatal women, self-kindness and a greater sense of common humanity were associated with better mental health (Felder et al., 2016). Mindfulness-based interventions for pregnant women have also demonstrated improvements in psychological distress extending into the postnatal period (Dunn et al., 2012). As applied to the transition to parenthood, here we examine whether compassionate self-responding might also serve as a unique source of resilience for preventing prenatal depression among expectant couples with a greater history of significant life adversity.

The Present Study

Drawing on theory and prior research, we hypothesized that a greater number of past stressful life experiences would be associated with increased depression symptom severity among mothers and fathers during pregnancy (H1); the strength of the association between stressful life experiences and depression symptom severity would be weaker among parents who endorse greater intimate relationship satisfaction (H2); and the strength of the association between stressful life experiences and depression symptom severity would be weaker among parents who endorse heightened compassionate self-responding, including self-kindness (H3), common humanity (H4), and mindfulness (H5). The present study is innovative in its examination of both interpersonal and intrapersonal factors as promoting resilience to depression among mothers and fathers during pregnancy, a high-risk period where parents might benefit drawing from multiple sources of strength in their lives.

Method

Participants and Procedures

All procedures were approved by the university’s Institutional Review Board and took place during 2016–2017. Flyers and brochures were broadly distributed to businesses and clinics frequented by pregnant women (e.g., obstetric clinics). We established cooperative arrangements with multiple agencies in the community. If an establishment permitted, members of the research team approached potential participants and provided a five-minute overview of the study along with a brochure. Eligibility criteria included: (a) 19 years of age or older (legal age of adulthood where the research was conducted), (b) English speaking, (c) pregnant at the time of the initial appointment (but not necessarily the first pregnancy to increase generalizability of results), (d) singleton pregnancy, (e) both partners identify as biological parents of the child, and (f) report being in a committed cohabitating intimate relationship. One hundred sixty-two couples enrolled. Three couples were excluded from the final sample, due to either ineligibility or invalid data, for a final sample of 159 couples (159 women and 159 men).

Participants were primarily White (89.3% of women; 87.4% of men); 9.4% of women and 6.4% of men identified as Hispanic or Latino/a. On average, women were 28.67 years of age (SD = 4.27) and men were 30.56 years of age (SD = 4.52). Couples had dated an average of 81.90 months (SD = 49.59) and cohabited an average of 61.00 months (SD = 41.80). The majority of couples were married (84.9%). Most women were in the second (38.4%) or third (58.5%) trimester of pregnancy. On average, couples had one child living at home (SD = 1.18); 57.9% reported that they had no children and, therefore, were experiencing the transition into parenthood for the first time. Annual joint income ranged from less than $9,999 to more than $90,000 with a median joint income of $60,000 to $69,999, and most participants were employed at least 16 hours per week (74.2% of women; 91.8% of men). Modal education was a bachelor’s degree (46.5% of women; 34.6% of men).

Both partners attended a three-hour laboratory appointment during which they completed a series of questionnaires in addition to other procedures beyond the scope of the present study. Partners were escorted to separate rooms to complete the questionnaires and did not interact with one another until the task was complete. Participants were compensated with $50 (for a total of $100 per couple) for attending the appointment.

Measures

Demographics

Participants completed a demographics measure including questions regarding their age, race/ethnicity, educational attainment, average yearly income, characteristics of the relationship (e.g., length of relationship), and characteristics of the pregnancy (e.g., week of pregnancy). These demographic characteristics were screened for potential inclusion in our models as control variables. None of the aforementioned characteristics were correlated with both the predictor (i.e., stressful life experiences) and outcome (i.e., depression symptom severity). Thus, in favor of parsimony, demographic characteristics were not included as control variables in analyses (Becker, 2005).

Stressful Life Experiences

The Life Events Checklist for DSM-5 (LEC-5; Weathers et al., 2013) is a 17-item self-report measure that assesses exposure to “difficult or stressful” events across one’s lifespan. Participants were asked to report whether they had ever been exposed to each of 16 specific events (e.g., natural disaster, serious accident, sexual assault), in addition to any other very stressful event. For each event, participants indicated if they directly experienced the event, witnessed it, learned about it, experienced it as part of their job, were unsure if they experienced the event, or felt the event did not apply to them (i.e., an endorsement of yes [1] or no [0]). The present study used a cumulative indicator of the 16 specific stressful life events such that each direct exposure was summed to create a total numerical score, with observed scores ranging from 0 to 7 for mothers and 0 to 12 for fathers.

Depression Symptom Severity

Participants completed the expanded form of the Inventory of Depression and Anxiety Symptoms (IDAS-II; Watson et al., 2012) to assess symptom dimensions of depression and anxiety. For the purpose of the current study, we examined the 20-item depression subscale. Participants were asked to rate the extent to which they “felt or experienced things this way during the past 2 weeks, including today” in response to various depression symptoms using a five-point scale from 1 (not at all) to 5 (extremely). Items were summed such that higher scores indicated greater severity of depression symptoms (α = .86), with observed scores ranging from 23.00 to 69.00 for mothers and 22.00 to 64.00 for fathers.

Intimate Relationship Satisfaction

The Quality of Marriage Index (QMI; Norton, 1983) is a six-item self-report questionnaire designed to assess the essential “goodness” of a relationship. Items on the QMI were modified for the present study, which was comprised of couples who were not necessarily married, to refer to one’s “relationship with my partner.” Participants indicated the extent to which they agreed or disagreed with five items (e.g., “Our relationship is strong”) using a scale from 1 (very strong disagreement) to 7 (very strong agreement). Participants also rated their global relationship “happiness” on a scale from 1 (very unhappy) to 10 (perfectly happy) for the item, “All things considered, how happy are you in your relationship?” Items were summed to create an overall score of intimate relationship satisfaction (α = .95), with observed scores ranging from 13.00 to 45.00 for mothers and 17.00 to 45.00 for fathers.

Self-Compassion

Participants completed the Self-Compassion Scale (SCS; Neff, 2003a) to measure compassionate self-responding. Participants rated each of the items on a five-point scale of 1 (almost never) to 5 (almost always). Given the focus of the present study was on resilience, we used SCS subscales measuring three key dimensions of compassionate self-responding: self-kindness (five items; e.g., “When I’m going through a very hard time, I give myself the caring and tenderness I need”), common humanity (four items; e.g., “I try to see my failings as part of the human condition”), and mindfulness (four items; e.g., “When something upsets me I try to keep my emotions in balance”). Items on each subscale were summed to obtain an overall score such that higher scores indicated greater levels of each dimension of compassionate self-responding (self-kindness α = .79; common humanity α = .76; mindfulness α = .75). Observed scores ranged from 1.00 to 5.00 for both mothers and fathers on the self-kindness subscale; 1.00 to 5.00 for both mothers and fathers on the common humanity subscale; and 1.25 to 5.00 for mothers and 1.00 to 5.00 for fathers on the mindfulness subscale.

Data Analytic Plan

We first screened data for accuracy and completeness and then calculated descriptive statistics and correlations among study variables in SPSS v.24. We examined Pearson’s r correlations to evaluate whether there was a positive association between stressful life experiences and depression symptom severity during pregnancy for mothers and fathers (H1). Effect size r (correlations and standardized coefficients) was interpreted based on benchmarks suggested by Cohen (1988), such that 0.2 represents a small effect, 0.5 represents a moderate effect, and 0.8 represents a large effect.

To test our next set of hypotheses, that intimate relationship satisfaction and dimensions of compassionate self-responding would moderate the relation between stressful life experiences and depression symptom severity (H2-H5), we conducted a series of analyses for each hypothesized moderator in Mplus v.8 (Muthén & Muthén, 1998–2017). We used maximum likelihood estimation with robust standard errors (MLR) to address potential violations of normality assumptions. There were no missing data. For each model, we entered the predictor, moderator, and interaction term (e.g., life experiences X relationship satisfaction) simultaneously as predictors of depressive symptoms. We evaluated the significance of the interaction term predicting depressive symptoms. In the presence of a significant interaction, we conducted a Johnson-Neyman regions of significance analysis, which computes simple slopes at all levels of the moderator and identifies at what levels of the moderator the predictor is related to the outcome (Hayes, 2017). All variables were modeled on their raw, continuous scale (no centering) to aid interpretation of simple slopes (i.e., conditional effects) across observed levels of each moderator.

We also implemented certain features of actor-partner interdependence modeling (APIM) for distinguishable dyads (Kenny et al., 2006) that are compatible with the tested moderation model. Specifically, because there were two dyad members, we included two variables (X and Y) for each member and therefore two sets of effects: (a) X affects own Y (actor effects) and (b) X affects partner’s Y (partner effects). Implementation of partner effects allows for the estimation of relational effects rather than focusing only on intrapersonal (actor) effects that can be overestimated when examined alone. There are also two types of correlations in the model between (a) exogenous variables (X1 and X2) and (b) residuals of endogenous variables (Y1 and Y2). We only hypothesized that the measured resiliency factors would moderate actor paths (i.e., one’s own past trauma moderating one’s own depression), not partner paths, although partner paths (e.g., maternal stress → paternal depressive symptoms) were still estimated.

Results

Descriptive and Bivariate Statistics

On average, mothers in the sample reported experiencing 1.43 stressful life experiences of the magnitude included in the LEC (SD = 1.50; observed range: 0–7), and fathers reported experiencing 1.96 stressful life experiences (SD = 2.09; observed range: 0–12; see Table 1 for frequencies of each event type endorsed by expectant parents). Means, standard deviations, observed score ranges, and bivariate correlations among primary study variables are displayed in Table 2. Related to our first hypothesis (H1), a greater number of past stressful life experiences was associated with increased depression symptom severity for both mothers (r = .26, p = .001) and fathers (r = .16, p = .04). These correlations between stress and depression were small in magnitude but are expected to vary at different levels of the measured resiliency factors, with stronger associations at lower levels of resiliency, hence the subsequent moderation analyses.

Table 1.

Frequency of Direct Exposure to Stressful Life Events Reported by Parents on the Life Events Checklist for DSM-5

Event Type Maternal Exposure (N = 159) Paternal Exposure (N = 159)
1. Natural disaster n = 28 n = 29
2. Fire or explosion n = 4 n = 19
3. Transportation accident n = 76 n = 80
4. Serious accident at work, home, or during recreational activity n = 9 n = 31
5. Exposure to toxic substance n = 1 n = 10
6. Physical assault n = 21 n = 42
7. Assault with a weapon n = 8 n = 29
8. Sexual assault n = 26 n = 5
9. Other unwanted or uncomfortable sexual experience n = 32 n = 13
10. Combat or exposure to a war-zone n = 1 n = 12
11. Captivity n = 1 n = 3
12. Life-threatening illness or injury n = 8 n = 13
13. Severe human suffering n = 3 n = 4
14. Sudden violent death n = 2 n = 8
15. Sudden accidental death n = 5 n = 9
16. Serious injury, harm, or death you caused to someone else n = 2 n = 5
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Note. Parents reported whether they had ever been directly exposed to each of the above events in their lifetime (i.e., yes or no).

Table 2.

Means, Standard Deviations, Ranges, and Correlations

Maternal Paternal
1 2 3 4 5 6 1 2 3 4 5 6
Maternal Variables
1. Stressful Life Experiences - - - - - - - - - - - -
2. Depression .26** - - - - - - - - - - -
3. Intimate Relationship Satisfaction .01 −.18* - - - - - - - - - -
4. Self-Kindness .07 −.32*** .08 - - - - - - - - -
5. Common Humanity .09 −.12 .05 .49*** - - - - - - - -
6. Mindfulness −.003 −.32*** .16* .70*** .62*** - - - - - - -
Paternal Variables
1. Stressful Life Experiences .06 .13 −.09 .03 .10 .001 - - - - - -
2. Depression .14 .20* −.08 −.11 −.11 −.12 .16* - - - - -
3. Intimate Relationship Satisfaction −.13 −.15 .27*** .02 .07 .15 .01 −.33*** - - - -
4. Self-Kindness −.05 .08 .07 −.03 −.12 −.03 .04 −.29*** .13 - - -
5. Common Humanity −.05 .09 −.01 −.17* −.14 −.13 .07 −.08 .02 .60*** - -
6. Mindfulness −.04 .03 .04 −.11 −.08 −.02 .07 −.29*** .15 .74*** .67*** -
Mean 1.43 38.00 41.97 3.23 3.32 3.48 1.96 35.31 41.81 2.98 3.15 3.42
SD 1.50 8.66 4.77 0.67 0.86 0.74 2.09 9.44 4.36 0.83 0.92 0.83
Observed Range 0.00 – 7.00 23.00 – 69.00 13.00 – 45.00 1.00 – 5.00 1.00 – 5.00 1.25 – 5.00 0.00 – 12.00 22.00 – 64.00 17.00 – 45.00 1.00 – 5.00 1.00 – 5.00 1.00 – 5.00
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Note. N = 159.

*

p < .05

**

p < .01

***

p < .001.

Additionally, increased intimate relationship satisfaction (r = −.18, p = .02), self-kindness (r = −.32, p < .001), and mindfulness (r = −.32, p < .001) were all associated with decreased depression symptom severity among mothers. Increased intimate relationship satisfaction (r = −.33, p < .001), self-kindness (r = −.29, p < .001), and mindfulness (r = −.29, p < .001) were also all associated with decreased depression symptom severity among fathers. However, common humanity was not associated with depression symptom severity for either mothers (r = −.12, p = .14) or fathers (r = −.08, p = .35). Of note, while self-kindness and mindfulness were highly correlated for both mothers (r = .70, p < .001) and fathers (r = .74, p < .001), these arguably measure distinct dimensions of compassionate self-responding (Neff, 2003a). In addition, given that the strength of these correlations is under .80, there is enough discrimination between the variables to examine them separately (Brown, 2015, p. 116). Correlations among all predictors and moderators were less than .70 and, as such, there were no concerns about multicollinearity.

Intimate Relationship Satisfaction as a Moderator

Next, we examined whether the associations between stressful life experiences and depression symptom severity varied as a function of intimate relationship satisfaction and dimensions of compassionate self-responding (H2-H5). Regression coefficients for each moderation model are reported in Table 3. The interaction between stressful life experiences and intimate relationship satisfaction did not explain significant variance in depression symptom severity for mothers, B = −0.04, SE = 0.06, p = .52, but did for fathers, B = −0.26, SE = 0.09, p = .003. To the extent that intimate relationship satisfaction was higher for fathers, the positive association between stressful life experiences and depression symptom severity was weaker (H2). Given the significant interaction term, we employed a Johnson-Neyman regions of significance analysis. The positive effect of paternal stressful life experiences on depression symptom severity was significant up to an intimate relationship satisfaction score of 42.11—the effect was no longer present for intimate relationship satisfaction scores exceeding this number. A score of 42.11 on the intimate relationship satisfaction scale was equal to approximately 0.07 SD above the mean level of paternal intimate relationship satisfaction (M = 41.81, SD = 4.36). Taken together, results suggest that the positive association between stressful life experiences and depression symptom severity was buffered by above average levels of intimate relationship satisfaction among fathers, and that the magnitude of the association between stress and depression grew as intimate relationship satisfaction decreased (e.g., the simple slope for paternal stress predicting depression was 0.75 at average levels of relationship satisfaction versus 1.31 at below average levels of relationship satisfaction). In Figure 1, the simple slopes are presented at different levels of relationship satisfaction and at the region of significance barrier (i.e., the point at which the effect becomes non-significant).

Table 3.

Regression Model Parameters for Moderation Analyses

Model 1: Intimate Relationship Satisfaction (QMI) as a Moderator
Maternal Depression (R2 = .12, p = .021) Paternal Depression (R2 = .20, p = .006)
Term B SE p-value B SE p-value
LEC-5 (P) 3.28 4.08 .422 11.47 3.63 .002
LEC-5 (M) 3.00 2.39 .209 4.91 0.93 < .001
QMI (P) −0.04 0.17 .812 −0.28 0.20 .165
QMI (M) −0.21 0.28 .444 0.22 0.10 .029
LEC-5*QMI (P) −0.07 0.10 .485 −0.26 0.09 .003
LEC-5*QMI (M) −0.04 0.06 .521 −0.10 0.03 < .001
Model 2: Self-Kindness (SCS-SK) as a Moderator
Maternal Depression (R2 = .21, p = .001) Paternal Depression (R2 = .16, p = .006)
Term B SE p-value B SE p-value
LEC-5 (P) −0.69 1.26 .586 1.73 1.53 .256
LEC-5 (M) 3.96 2.29 .084 4.15 2.37 .081
SCS-SK (P) −0.06 1.09 .959 −2.60 1.44 .071
SCS-SK (M) −3.42 1.68 .041 −0.07 1.76 .968
LEC-5* SCS-SK (P) 0.39 0.46 .399 −0.32 0.55 .558
LEC-5* SCS-SK (M) −0.69 0.72 .334 −1.04 0.69 .134
Model 3: Common Humanity (SCS-CH) as a Moderator
Maternal Depression (R2 = .15, p = .005) Paternal Depression (R2 = .07, p = .104)
Term B SE p-value B SE p-value
LEC-5 (P) −0.34 1.55 .829 1.51 1.54 .328
LEC-5 (M) 6.59 1.49 < .001 −0.39 2.35 .866
SCS-CH (P) 0.18 1.12 .874 −0.54 1.27 .669
SCS-CH (M) 0.36 0.91 .690 −2.09 1.38 .130
LEC-5* SCS-CH (P) 0.29 0.52 .583 −0.24 0.51 .632
LEC-5* SCS-CH (M) −1.47 0.44 .001 0.36 0.64 .573
Model 4: Mindfulness (SCS-M) as a Moderator
Maternal Depression (R2 = .19, p < .001) Paternal Depression (R2 = .17, p = .009)
Term B SE p-value B SE p-value
LEC-5 (P) 0.95 1.18 .418 3.30 1.19 .005
LEC-5 (M) 3.17 1.71 .064 1.76 1.47 .232
SCS-M (P) 0.63 0.85 .458 −1.93 1.20 .108
SCS-M (M) −2.94 1.05 .005 −1.11 1.05 .291
LEC-5* SCS-M (P) −0.15 0.35 .674 −0.75 0.31 .016
LEC-5* SCS-M (M) −0.50 0.49 .299 −0.33 0.39 .388
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Note. M = Maternal; P = Paternal; LEC-5 = Life Events Checklist for DSM-5; QMI = Quality of Marriage Index; SCS = Self-Compassion Scale. The focal parameters of interest, representing the interaction between stressful life events and resiliency factors predicting depression symptom severity, are bolded. Note that variables were not centered; therefore, in the context of a significant interaction, simple slopes of LEC-5 (i.e., effect of LEC-5 on depression when a moderator is zero) are not interpretable. Instead, please refer to regions of significance analyses which probed simple slopes across all observed levels of each moderator.

Figure 1. Paternal Depression and Stressful Life Experiences at Conditional Levels of Intimate Relationship Satisfaction.

Figure 1

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Note. Conditional effects (i.e., simple slopes) of paternal stressful life experiences on depression symptom severity are illustrated at various levels of intimate relationship satisfaction (0.5 SD below = 39.63; average = 41.81; region barrier = 42.12; 0.5 SD above = 43.99) but were estimated at all observed levels of relationship satisfaction. The “region barrier” represents the point on the continuum of relationship satisfaction that the simple slope was no longer significant. To note, relationship satisfaction values were modeled at ±0.5 SD because the observed range of scores in this sample did not extend to ±1 SD. Non-significant effects are dashed and significant effects are solid. All slope coefficients are unstandardized.

Dimensions of Self-Compassion as Moderators

Self-Kindness

Self-kindness was not a significant moderator of the effect of stress on depression symptom severity for mothers, B = −0.69, SE = 0.72, p = .33, or fathers, B = −0.32, SE = 0.55, p = .56 (H3). That is, the positive association between stressful life experiences and depression symptom severity for both mothers and fathers did not vary as a function of self-kindness. When the interaction terms were removed from the model for parsimony, there was a direct association between self-kindness and depression symptom severity for both mothers, B = −4.33, SE = 1.08, p < .001, and fathers, B = −3.37, SE = 0.83, p < .001. Thus, self-kindness is associated with fewer depressive symptoms regardless of past stressful events.

Common Humanity

Common humanity moderated the effect of stress on depression severity for mothers, B = −1.47, SE = 0.44, p = .001, but not fathers, B = −0.24, SE = 0.51, p = .63. To the extent that common humanity was higher for mothers, the positive association between stressful life experiences and depression symptom severity was weaker (H4). The positive effect of maternal stressful life experiences on depression symptom severity was significant up to a common humanity score of 3.86—the effect was no longer present for common humanity scores exceeding this number. A score of 3.86 on the common humanity subscale was equal to approximately 0.63 SD above the mean level of maternal common humanity (M = 3.32, SD = 0.86). In sum, the positive association between stressful life experiences and depression symptom severity was buffered by above average levels of common humanity among mothers. This result is illustrated in Figure 2.

Figure 2. Maternal Depression and Stressful Life Experiences at Conditional Levels of Common Humanity.

Figure 2

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Note. Conditional effects (i.e., simple slope) of maternal stressful life experiences on depression symptom severity are illustrated at various levels of common humanity (1 SD below = 2.46; average = 3.32; region barrier = 3.87; 1 SD above = 4.18), but were estimated at all observed levels of common humanity. The “region barrier” represents the point on the continuum of common humanity that the simple slope was no longer significant. Non-significant effects are dashed and significant effects are solid. All slope coefficients are unstandardized.

Mindfulness

Mindfulness did not moderate the effect of stress on depression severity for mothers, B = −0.50, SE = 0.49, p = .30, but was a significant moderator for fathers, B = −0.75, SE = 0.31, p = .02. To the extent that mindfulness was higher for fathers, the positive association between stressful life experiences and depression symptom severity was weaker (H5). The positive effect of paternal stressful life experiences on depression symptom severity was significant up to a mindfulness score of 3.49—the effect was no longer present for mindfulness scores exceeding this number. A score of 3.49 on the mindfulness subscale was equal to approximately 0.08 SD above the mean level of paternal mindfulness (M = 3.42, SD = 0.83). In sum, the positive association between stressful life experiences and depression symptom severity was buffered by above average levels of mindfulness among fathers. This result is illustrated in Figure 3.

Figure 3. Paternal Depression and Stressful Life Experiences at Conditional Levels of Mindfulness.

Figure 3

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Note. Conditional effects (i.e. simple slopes) of paternal stressful life experiences on depression symptom severity are illustrated at various levels of mindfulness (1 SD below = 2.59; average = 3.42; region barrier = 3.50; 1 SD above = 4.25), but were estimated at all observed levels of mindfulness. The “region barrier” represents the point on the continuum of mindfulness that the simple slope was no longer significant. Non-significant effects are dashed and significant effects are solid. All slope coefficients are unstandardized.

Discussion

The present study contributes to both family and resilience literatures by identifying protective factors that weaken the association between past stressful life experiences and depressive symptoms during pregnancy within a dyadic framework of couples. As predicted, we found a positive association between stressful life experiences and depression symptom severity among expectant mothers and fathers. Moreover, we identified protective factors weakening this association for mothers and fathers. For mothers, the self-compassion dimension related to common humanity moderated this link—to the extent that women were more aware that their suffering is part of the greater human experience, the strength of the positive association between stressful life experiences and depression severity decreased. For fathers, the self-compassion dimension related to mindfulness moderated this link—to the extent that men had greater present-moment awareness, the strength of the positive association between stressful life experiences and depression symptom severity decreased. For fathers, intimate relationship satisfaction was an additional source of resiliency that mitigated depression symptom severity. Unexpectedly, however, the self-compassion dimension related to self-kindness did not moderate the proposed relation, although it was directly associated with depression, suggesting that it is beneficial regardless of history of adversity.

The results revealing a positive association between stressful life experiences and depression symptom severity align with literature showing the experience of stressful life events is associated with increased risk for depression among mothers both during pregnancy and outside the prenatal period (Grote & Bledsoe, 2007) and extend this work to demonstrate similar risk for men. Both mothers and fathers have the potential to influence the family’s mental health, the successful negotiation of parental roles, and their child’s functioning (Davies & Cicchetti, 2004); yet, fathers continue to be understudied in prenatal research (Condon et al., 2004).

We also extend family and resilience research by identifying unique interpersonal and intrapersonal factors that buffer risk for depression among expectant couples who have experienced stressful life events. Specifically, mothers benefited from the common humanity dimension of self-compassion; women tend to derive support from a range of interpersonal relationships (Monin & Clark, 2011) and rely more on external cues to regulate emotions (Gilbert & Waltz, 2010), which might explain why common humanity emerged as key source of resiliency for pregnant women with a history of adversity. In the context of pregnancy, women may benefit from awareness that they are not alone, but rather are part of a larger community navigating the challenges of pregnancy. In contrast, fathers were less depressed in the context of a satisfying intimate relationship and greater mindful self-compassion. This pattern of findings is consistent with research suggesting that men might derive more benefit than women from being in a supportive intimate relationship (Monin & Clark, 2011), which in turn might have implications for relationship satisfaction during times of stress (Kumar et al., 2021). Further, research on interoceptive awareness demonstrates that, compared to women, men rely more on internal cues when making judgments about their internal states (Gilbert & Waltz, 2010), which is why men might benefit from greater present-moment awareness. Together, findings suggest there is value in deconstructing the positive components of self-compassion to examine adaptive coping approaches to stress as these approaches appear to differentially impact prenatal depression among expectant couples exposed to higher adversity; however, our results should be interpreted with caution in light of their novelty. Replication of these findings is critical, and more research is needed to understand why these dimensions serve unique resiliency functions for different people.

In contrast, self-kindness did not significantly buffer the link between stressful life experiences and symptoms of depression among either mothers or fathers. However, it is notable that there were small main effects of self-kindness on depression for both mothers and fathers, suggesting that self-kindness might reduce depression for all parents regardless of past adversity. This finding is consistent with a broader literature documenting the positive effects of self-kindness in lessening symptoms of depression among a general population (Körner et al., 2015). Researchers should continue to delineate the effects of self-compassion and its unique dimensions to determine which aspects are most helpful for families navigating pregnancy.

Limitations and Future Directions

Although the present work furthers the literature in a number of ways, there are several limitations that should be noted. First, parents in the current study identified as heterosexual and predominately White, well-educated, and employed. Further, as one might expect from a community sample, exposure to major stressful life events that tend to be experienced as traumatic and levels of depressive symptom severity were relatively low, while levels of resiliency were somewhat high, on average. As such, generalizability of our results to diverse and/or clinical populations is limited, and thus future researchers should examine whether intimate relationship satisfaction and compassionate self-responding continue to promote resiliency in these groups.

Second, limitations regarding temporal ordering should be acknowledged. Though potential ordering can be inferred from the measures (i.e., lifetime stressful event exposure preceded current depression symptom severity), the cross-sectional design of the study precludes conclusions about causation or the ordering of constructs. Future researchers should consider conducting a longitudinal study with these constructs to establish the proposed temporal sequence. Future researchers should also consider how relationship satisfaction and self-compassion serve as sources of resiliency on a day-to-day basis in intensive longitudinal designs. Relatedly, it is possible that personal resources not measured here (e.g., forgiveness, spirituality, vitality; Peterson & Seligman, 2004) may also buffer the association between stressful life experiences and depression during pregnancy and should be examined over time.

Third, we focused on general depression in the present study given a robust literature suggesting elevated risk during the perinatal period (e.g., Gavin et al., 2005; Rao et al., 2020); however, emerging research also points to elevated risk for related dimensions of mental health (e.g., anxiety; Dennis et al., 2017). Resiliency factors should also be identified for these dimensions. Nonetheless, it is notable that our dimensional measure of depressive symptoms is highly correlated with general negative affectivity common to the spectrum of internalizing disorders (Watson et al., 2012) and, as such, it is possible that results will generalize to other dimensions of mental health (e.g., panic, trauma symptoms, wellbeing).

Finally, although the resiliency factors studied here mitigated risk for prenatal depressive symptoms associated with past stressful life events, we do not expect these factors to promote resilience within the family solely during this life transition. Future research should examine compassionate self-responding, intimate relationship satisfaction, and related resiliency factors during other normative (e.g., when children transition to school) and non-normative (e.g., job loss) family transitions to identify potential targets for interventions customized to unique contexts.

Clinical Implications and Conclusion

Limitations notwithstanding, the present study contributes to a growing understanding of families, mental health, and resilience in the context of pregnancy. To our knowledge, this is the first study to identify both interpersonal and intrapersonal factors as differentially mitigating the association between stressful life experiences and depression among expectant couples. These findings align with prior research indicating that both interpersonal and intrapersonal factors buffer against depression precipitated by stress (e.g., Allen & Leary, 2010; Weitlauf et al., 2014), even during pregnancy (e.g., Collins et al., 1993; Grote & Bledsoe, 2007). Despite these protective factors being conceptualized as relatively stable over time, researchers have found that individuals can develop these resources and utilize them as sources of resilience with targeted intervention (Chmitorz et al., 2018).

Although further examination of the resiliency factors studied here is needed before concrete recommendations for clinical practice can be made, recent research identifying associations between greater self-compassion and better intimate relationship quality (Huynh et al., 2021) suggests a need for combined interventions for promoting both compassionate responding to self and healthy relationship dynamics. Specifically, pregnant women with a history of greater adversity might benefit from supplemental interventions that build a global sense of connectedness and promote understanding that their realities are a part of the common experience during pregnancy. For example, a group-based intervention could provide these women with a brave space to confront societal conventions that pregnancy should be a time filled with happiness and receive validation for an array of positive and negative emotions. On the other hand, men with a history of greater adversity might benefit most from interventions that help them feel connected to their pregnant partners and cultivate present-centered awareness of the pregnancy experience. Such interventions might help men counteract avoidance of new and difficult emotions arising during this stressful time when they have little control of the pregnancy and might experience heightened concern about their partner’s wellbeing.

More generally, it is likely that all parents, regardless of past adversity, might benefit from interventions that foster self-compassion in the form of self-kindness. Helping mothers and fathers learn how to meet moments of hardship with empathy, warmth, and kindness toward oneself might promote a flexible mindset and a less stressful shift to a new stage of life. To that aim, drawing on existing evidence-based practices, therapists might consider pairing compassion-focused therapy (Gilbert, 2014) and mindful self-compassion (Neff & Germer, 2013) treatments with family-based interventions that target pregnancy, such as the family foundations program (e.g., Feinberg et al., 2016), to address the unique needs and histories of couples transitioning to parenthood. Collectively, helping couples build greater resilience has the potential to not only improve their mental health during the prenatal period, but also strengthen their internal and external resources postpartum, effectively creating a healthier environment for the family in the present and future.

Acknowledgments

This research was funded by several internal funding mechanisms awarded to PI Rebecca Brock from the University of Nebraska-Lincoln Department of Psychology, the Nebraska Tobacco Settlement Biomedical Research Development Fund, and the University of Nebraska-Lincoln Office of Research and Economic Development. We thank the families who participated in this research and the entire team of research assistants who contributed to various stages of the study. In particular, we thank Jennifer Blake and Erin Ramsdell for project coordination. Manuscript preparation was supported by a grant from the National Institute of Child Health and Human Development (F31HD101271; PI: Kumar, Sponsor: DiLillo). The content is solely the responsibility of the authors and does not necessarily represent the official views of the University of Nebraska-Lincoln or National Institute of Child Health and Human Development. We do not have any conflicts of interest to disclose.

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