How Couples Cope Together Shapes Prenatal Depression and Anxiety Risk

Pregnancy is often portrayed as a joyful countdown, but for a substantial share of expectant parents it is a period of quiet psychological strain. A new study published in BMC Public Health offers one of the most detailed portraits yet of how depression and anxiety distribute themselves across both members of a couple during pregnancy, and how the way partners cope together as a team shapes that distribution. Drawing on 503 heterosexual expectant couples recruited from two tertiary hospitals in Zhejiang Province, China, researchers led by Yue Sun of Hangzhou Normal University and Universiti Malaya applied a statistical technique known as latent profile analysis to sort couples into distinct groups based on their joint patterns of perceived dyadic coping and emotional symptoms. The results carry a striking message: prenatal emotional health is not simply an individual matter, but a property of the relationship itself.

The numbers alone are sobering. Approximately 18.7 percent of expectant mothers and 13.3 percent of expectant fathers reported depressive symptoms during pregnancy, while anxiety was even more prevalent, affecting 31.0 percent of mothers and 21.3 percent of fathers. These figures confirm what perinatal mental health researchers have long suspected: the transition to parenthood is a critical window for psychological adjustment in both partners, not just the pregnant woman. Fathers, though often overlooked in research and clinical screening, showed meaningful levels of distress, suggesting that paternal emotional health deserves far more attention than it typically receives in antenatal care.

Dyadic coping, the central concept of the study, refers to the ways partners respond to each other’s stress: how they communicate about problems, provide emotional support, offer practical help, and jointly tackle shared challenges. The researchers measured this using the Dyadic Coping Inventory, a validated instrument that captures how each partner perceives the coping behaviors of the other, as well as their own contributions. Depression was assessed with the Edinburgh Postnatal Depression Scale, and anxiety with a Generalized Anxiety Disorder Scale, both administered through an online matched-pair survey that allowed researchers to link each woman’s responses directly to her partner’s.

Latent profile analysis is a person-centered statistical method that identifies unobserved subgroups within a population based on patterns of responses across multiple indicators. Rather than treating dyadic coping as a single continuous score averaged across all couples, the technique asks whether distinct configurations of coping exist, and whether couples cluster into recognizable types. In this study, the analysis revealed six distinct dyadic coping profiles, ranging from couples who perceived strong and balanced coping within their relationship to those with low or discordant patterns. Similarly, three emotional-symptom profiles emerged, capturing different combinations of maternal and paternal depression and anxiety.

The cross-tabulation of these profiles revealed a compelling architecture. Couples who perceived stronger and more balanced coping within their relationship were significantly more likely to belong to the low-symptom group, where neither partner showed elevated depression or anxiety. In contrast, couples with discordant or low perceived coping patterns showed a markedly higher likelihood of elevated maternal distress. In other words, when a pregnant woman perceives that her partner is not coping well with her stress, or when the couple’s coping is unbalanced, her own emotional symptoms rise. This finding reframes prenatal mental health as a dyadic phenomenon, one that cannot be fully understood or treated without considering the relationship context.

The study went further, using multinomial logistic regression to identify sociodemographic and relational factors associated with profile membership. Three factors stood out as significantly associated with the likelihood of high maternal symptoms: maternal employment, paternal gender expectations, and a loving paternal marital relationship. Maternal employment likely reflects the additional stress load carried by working pregnant women, who must balance professional demands with the physical and emotional challenges of pregnancy. Paternal gender expectations point to the role of traditional attitudes about male and female responsibilities within the household, which may shape how partners share stress and support. The association with a loving paternal marital relationship is particularly intriguing, suggesting that the emotional quality of the relationship as experienced by the father influences the mother’s symptom profile.

These findings arrive at a moment when perinatal mental health is gaining recognition as a major public health priority. Depression and anxiety during pregnancy are associated with adverse outcomes for both mother and child, including preterm birth, low birth weight, and long-term developmental challenges. Yet screening and intervention remain largely individual-focused, targeting the pregnant woman in isolation. This study suggests that relationship-focused approaches, which engage both partners and address the couple’s joint coping patterns, may offer a more effective route to prevention and early intervention. Couple-based interventions, which have shown promise in other areas of health psychology, could be adapted to the perinatal context to strengthen dyadic coping before symptoms escalate.

The methodological rigor of the study deserves note. By recruiting matched pairs rather than individuals, the researchers captured the interdependence that defines couple relationships. Statistical indicators such as the Akaike Information Criterion, the Bayesian Information Criterion, and the Lo–Mendell–Rubin likelihood ratio test were used to determine the optimal number of profiles, ensuring that the six coping profiles and three symptom profiles were not statistical artifacts but robust subgroups. The use of validated instruments, including the Dyadic Coping Inventory, the Edinburgh Postnatal Depression Scale, and the Generalized Anxiety Disorder Scale, strengthens confidence in the measurements.

Some limitations temper the conclusions. The cross-sectional design captures a single moment in time, so the direction of the associations between coping and symptoms cannot be definitively established. It is possible that elevated distress distorts perceptions of a partner’s coping, rather than the other way around. The sample was drawn from tertiary hospitals in a single Chinese province, and cultural factors specific to the region may shape both coping patterns and symptom expression. Longitudinal studies following couples from pregnancy through the postpartum period would help clarify whether dyadic coping predicts later symptoms or merely reflects them.

Nevertheless, the study’s central insight is difficult to ignore: the emotional climate of a couple’s relationship during pregnancy is closely tied to the mental health of both partners. As researchers and clinicians continue to refine perinatal mental health care, the couple, rather than the individual, may prove to be the most meaningful unit of assessment and intervention. For the millions of expectant parents navigating this transformative period, the quality of their shared coping may be as important to their emotional well-being as any individual risk factor. The study, funded by the Humanities and Social Science Research Program of the Ministry of Education of China, was approved by the Medical Ethics Committee of Hangzhou First People’s Hospital and conducted in accordance with the Declaration of Helsinki, with all participants providing written informed consent.

Subject of Research: Dyadic coping and factors associated with prenatal depression and anxiety profiles: a couple-level latent profile analysis study

Article Title: Dyadic coping and factors associated with prenatal depression and anxiety profiles: a couple-level latent profile analysis study

Article References: Sun, Y., Chui, P. L., Chong, M. C., Zhou, L., Xu, F., & Zhang, J. (2026). Dyadic coping and factors associated with prenatal depression and anxiety profiles: a couple-level latent profile analysis study. BMC Public Health. https://doi.org/10.1186/s12889-026-29959-6

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29959-6

Keywords: Dyadic, coping, factors, associated, prenatal, depression, anxiety, profiles, couple-level, latent, profile, analysis