Romantic partner support during pregnancy: The discrepancy between self-reported and coder-rated support as a risk factor for prenatal psychopathology and stress

Abstract

Romantic partner support from the father-to-be is associated with women’s mental health during pregnancy. However, most studies of partner support rely upon women’s responses to self-report questionnaires, which may be biased and should be corroborated by efficient, coder-rated measures of partner support. This study tested whether the Five-Minute Speech Sample (FMSS), adapted to assess expressed emotion about romantic partners, can provide information about partner support during pregnancy that is less prone to bias than self-report. Participants were 101 low-income, ethnically diverse pregnant women who completed self-report questions on partner support quality and the FMSS. Self-reported and coder-rated (FMSS) partner support were highly correlated and were each significantly associated with self-reported depressive and post-traumatic stress disorder (PTSD) symptoms, perceived stress, and partner victimization during pregnancy. Self-reported and coder-rated support corresponded in approximately 75% of cases; however, nearly 25% of women self-reported high support but received low FMSS support ratings. These women reported elevated PTSD symptoms, perceived stress, and victimization during pregnancy. While self-reported partner support may be valid for many respondents, the FMSS is less susceptible to reporting biases and may better identify women facing heightened psychopathology and stress during pregnancy, who would benefit from supportive intervention.

Keywords

Fathers FMSS pregnancy psychopathology romantic relationships self-report bias social support stress

Social support from family, friends, and romantic partners is reliably associated with greater well-being (Turner, 1981). During the pregnancy period, social support is critical for women’s physical and mental health, as well as fetal and neonatal well-being (Collins, Dunkel-Schetter, Lobel, & Scrimshaw, 1993). Specifically, support from a romantic partner during pregnancy, typically the father-to-be, is a robust predictor of psychological adaptation to parenthood (Stapleton et al., 2012). However, responses to self-report measures of romantic partner support may be biased and should be complemented by efficient coder-rated assessments, but few such measures exist (Humbad, Donnellan, Klump, & Burt, 2011). Within a sample of low-income, ethnically diverse pregnant women, the current study examines the utility and convergent validity of a brief coder-rated instrument, the Five-Minute Speech Sample (FMSS) (Magaña et al., 1986), as an assessment of pregnant women’s romantic partner support from the baby’s father. This study compares coder-ratings from the FMSS with self-reports of romantic partner support and examines how discrepancies in support between these two instruments relate to women’s psychopathology symptoms, stress, and intimate partner violence (IPV) victimization during pregnancy.

Social support and well-being during pregnancy

The pregnancy period can be a time of hope, excitement, and positive transformation in preparation for parenthood (Slade, Cohen, Sadler, & Miller, 2009). For many women, pregnancy is also accompanied by tremendous change and challenges, as it may involve radical shifts in mood, hormones, sleep, and relationships (Nelson, Kushlev, & Lyubomirsky, 2014). Psychopathology symptoms, including symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD), are highly prevalent during pregnancy, particularly among women at high sociodemographic risk (Choi & Sikkema, 2016; Seng et al., 2010). Clearly, the transition to parenthood can introduce new—or exacerbate existing—sources of stress. For this reason, scientific attention has turned toward identifying factors that are associated with better mental health among low-income, ethnically diverse pregnant women (Narayan, Rivera, Bernstein, Harris, & Lieberman, 2018).

Social support is thought to buffer against or alleviate the negative effects of stress on women’s physical and mental health, and therefore protect maternal and fetal well-being during pregnancy (Cohen & Wills, 1985). Social support refers to the provision of resources—emotional (e.g., conversations to process stressful events), informational (e.g., advice on proper diet), or instrumental (e.g., transportation to doctor’s appointments or financial assistance)—by friends, family members, or romantic partners (Collins et al., 1993). Supportive relationships may protect against the effects of stress during pregnancy by reducing perceived threat and harm posed by stressors, reducing physiological reactivity to stressors, increasing positive affect, and promoting self-efficacy and perceived coping ability (Cohen & Wills, 1985; Collins et al., 1993; Giesbrecht et al., 2013). Accordingly, support may be most needed and beneficial for low-income pregnant women, who experience greater stress than their higher income counterparts (e.g., Collins et al., 1993).

Romantic partner support from the father-to-be

Romantic partners—the fathers of the babies—are a primary source of social support for women during pregnancy, but the quality of that support is highly variable. Many factors can strengthen or challenge pregnant women’s relationships with their partners, including changes in priorities and intimacy, the couple’s identity as a family, division of responsibilities, and financial strain. In brief, the dyadic romantic relationship must grow and adapt to accommodate another person and facilitate coparenting, either for the first time or for a new member of the family (Slade et al., 2009). Preparation for parenthood may also lead pregnant women to reexamine or reconsider their satisfaction and commitment in romantic relationships, and even to end relationships with the fathers-to-be (Slade et al., 2009). Additionally, the pregnancy period is a time of heightened risk for IPV, perhaps due to increases in the above stressors (Burch & Gallup, 2004). For these reasons, there may be considerable variability in how pregnant women perceive romantic partner support quality.

In turn, variation in romantic relationship quality is closely related to pregnant women’s well-being. In anticipation of the demands of parenting, relationships with partners become more significant and are critical for prenatal mental health (Narayan, Hagan, Cohodes, Rivera, & Lieberman, 2016; Slade et al., 2009). Indeed, greater self-reported romantic partner support during pregnancy is associated with lower levels of perinatal depression and anxiety (Rini, Dunkel Schetter, Hobel, Glynn, & Sandman, 2006; Stapleton et al., 2012). Little is known, however, about the associations of romantic partner support with PTSD symptoms and IPV victimization. Research on non-pregnant women shows that general social support is associated with lower PTSD symptoms (Vranceanu, Hobfoll, & Johnson, 2007), but it remains unknown whether greater support from romantic partners, specifically, might be linked to lower PTSD symptoms during pregnancy. In addition, given that romantic relationship conflict is a risk factor for IPV, it is likely that partner support is negatively associated with IPV, but this remains to be tested (Capaldi, Knoble, Shortt, & Kim, 2012). Therefore, it is important to assess the link between romantic partner support and PTSD symptoms and IPV victimization during pregnancy. Moreover, few studies have examined the importance of support from the father-to-be in the absence of a current romantic partnership, although it stands to reason that support from the father-to-be, who was recently a romantic partner and may be involved in coparenting, remains meaningful for women’s mental health and stress (Bloch et al., 2009).

Problems with self-reports of romantic partner support

Self-report measures of partner support are commonly used, but can be susceptible to bias and inaccuracy. In general, participants in research studies may respond in socially desirable ways, such that they present themselves more favorably because they have a distorted self-view, or are motivated to gain approval or avoid judgment, especially in response to socially sensitive questions (van de Mortel, 2008). Participants may also have distorted perceptions of their lives due to faulty comparison to others (e.g., thoughts like, It could be worse) or may have a tendency towards self-deception to avoid painful feelings, leading them to underreport on problems they may be experiencing. Further, participants may respond quickly and reflexively to questionnaire items, without reflection or consideration. This style is associated with the tendency to use the extreme answers on a rating scale and can decrease validity of responses (Paulhus & Vazire, 2007).

There are several ways in which self-reports of romantic relationship quality in particular may be biased. Respondents may answer questions about their interactions and behaviors with partners through the lens of “sentiment override,” such that their responses are dictated by a globally positive or negative view of the relationship rather than its nuanced and specific aspects, like support quality (Hawkins, Carrere, & Gottman, 2002). Research finds that this effect may be especially pronounced for women, rather than men, in relationships (Hawkins et al., 2002). Moreover, the pregnancy period is uniquely characterized by hope and anticipation: For this reason, pregnant women may be prone to idealized views of the support they receive from partners (Slade et al., 2009). For instance, it is possible that some pregnant women may respond to questions about partner support with optimism, referring to what they hope the relationship will become after the baby’s birth rather than the current reality of the relationship.

The FMSS for romantic partner support

With these limitations of self-report measures in mind, non-self-report assessments of social support may provide a more accurate view of romantic partner support quality (Humbad et al., 2011). Many existing coder-rated assessments of romantic partner support are time-intensive, or require the participation of both partners, like videotaped observational measures of support quality (Humbad et al., 2011). By contrast, the FMSS is a brief instrument—audio-recorded and later coded by raters—that was originally developed to assess caregivers’ expressed emotion (EE) toward offspring (Magaña et al., 1986). EE is believed to reflect the emotional tone of a relationship, or the attitudes and feelings held toward another person, including negative attitudes (e.g., criticism, hostility) and positive attitudes (e.g., warmth) (Magaña et al., 1986). FMSS ratings show strong convergence with observed relationship behavior (Narayan, Herbers, Plowman, Gewirtz, & Masten, 2012).

Here, we adapted the FMSS to assess pregnant women’s thoughts and feelings about the babies’ fathers, with specific attention to how supported women felt by the fathers. The FMSS was chosen for its brevity and feasibility, since it can be difficult to conduct studies in which both members of a couple must participate together. These constraints are often exacerbated for low-income families who may have inflexible schedules, priorities to secure basic needs, and potentially, safety issues, such as ongoing IPV in their relationships (Narayan et al., 2012). The FMSS was also chosen in order to overcome some limitations of self-report measures. First, the FMSS encourages active reflection on the part of the speaker. The prompt is broad and open-ended, making it more likely that speakers share information that is on their mind, rather than saying what they think that interviewers want to hear or choosing a socially desirable response. Additionally, the quality of partner support is not derived from subjective report but is instead inferred from anecdotes and examples offered by the speaker, which are then more objectively evaluated by coders. Although the FMSS has previously been used to assess EE about romantic partners (e.g., Yan, Hammen, Cohen, Daley, & Henry, 2004), to the best of our knowledge, this is the first study to utilize the FMSS to assess support quality from partners. The standardized prompt for the FMSS asks the speaker to comment on “how the two of you get along together” (Magaña et al., 1986); therefore, we predicted that narratives would include relevant descriptions of partners’ behaviors that we could code for support quality.

The current study

The current study examined the association between self-reported romantic partner support quality from the baby’s father and coder-ratings of pregnant women’s descriptions of this support quality in the FMSS. First, it was hypothesized that self-reported support and coder-rated support on the FMSS would be significantly associated, illustrating concordance of support on both instruments. Second, it was predicted that higher levels of self-reported and coder-rated support would be comparably associated with lower levels of depressive symptoms, PTSD symptoms, perceived stress, and IPV victimization during pregnancy. We expected that the associations of self-reported and coder-rated support with outcomes would not significantly differ based on whether or not women were currently partnered with the father of the baby, reasoning that the relationship with the baby’s father has important implications for mental health and stress regardless of current romantic involvement (Bloch et al., 2009). Third, we anticipated that we would find evidence of self-report bias, such that a subgroup of women would self-report high support, but receive low coder-ratings of support on the FMSS. Fourth and finally, we conducted exploratory analyses to examine how women with high self-reported support but low coder-rated support on the FMSS (the “discrepant” group) would differ from subgroups of women with concordant self-reported and coder-rated support (both high or both low) in terms of psychopathology symptoms, stress, and IPV victimization. We thought it was possible that women in the “discrepant” group would report low psychopathology symptoms and stress, consistent with socially desirable responding. Alternatively, it seemed equally plausible that reporting biases might be limited to aspects of relationship quality, but not psychopathology or stress, because perceptions of one’s partner are often influenced by relationship-specific dynamics, such as distorted relationship expectations or idealization of one’s partner during pregnancy. Given these competing possibilities, we did not have specific hypotheses about levels of psychopathology, stress, and IPV in the “discrepant” group of women.

Method

Participants were 101 pregnant women drawn from a larger study of intergenerational risk and resilience during the transition to parenthood (Narayan et al., 2018). Women were eligible to participate if they were at least 18 years old (M _age = 29.10, SD _age = 6.56), English- or Spanish-speaking (26% Spanish), in their second or third trimesters of pregnancy (range: 13–41 weeks gestation; M _weeks = 28.09, SD _weeks = 7.65), and planning to deliver at a large urban hospital that serves predominantly low-income families. For most women (79%), this was not their first pregnancy. Women were low-income (70% lived below the federal poverty line), ethnically diverse (37% Latina, 22% African American, 20% White, 14% biracial or multiracial, 7% Asian American, 1% American Indian), and had an average of 12.62 years of education (SD _years = 2.56, range = 5–21). The majority of women were presently romantically involved with the baby’s father (75%; n = 76). Only four women (4%) reported a current romantic relationship during pregnancy with someone other than the baby’s biological father.

All procedures were approved by the Institutional Review Board at the hospital where this study was conducted. After providing informed consent, women completed interviews and questionnaires about their pregnancy, demographics, relationships (including self-reported support), mental health, perceived stress, and IPV victimization, and they completed the FMSS. All interviews and questionnaires were administered orally in women’s preferred language of English or Spanish to reduce disparities associated with reading level or comprehension. Women received gift cards as compensation.

Measures

Self-reported support

Women responded to two items adapted from the Social Support Questionnaire (Sarason, Levine, Basham, & Sarason, 1983) to assess quality of and satisfaction with support from the baby’s father. The first item was: “How supported in general (emotionally, financially, etc.) do you feel by the baby’s father?” Women indicated their feelings about the quality of support they received on the following Likert-type scale: 1 = very unsupported, 2 = fairly unsupported, 3 = a little unsupported, 4 = a little supported, 5 = fairly supported, or 6 = very supported. The second item read: “How satisfied in general are you with this support?” Women rated their support satisfaction on the following Likert-type scale: 1 = very unsatisfied, 2 = fairly unsatisfied, 3 = a little unsatisfied, 4 = a little satisfied, 5 = fairly satisfied, or 6 = very satisfied. Scores on the 2 items were averaged (M = 4.36, SD = 1.68, range = 1–6).

Coder-rated support

Women completed the FMSS (Magaña et al., 1986), an audio-recorded procedure in which participants are asked to speak uninterruptedly for five minutes about, What kind of a person [name of baby’s father] is and how the two you get along together. Even if women were not presently romantically involved with their baby’s father, they were still requested to speak about him, rather than a different romantic partner, for standardization across all participants. FMSS were transcribed and later coded for how supported women felt by the baby’s father, using validated Likert-type scale ratings adapted from the Minnesota Longitudinal Study of Risk and Adaptation (Sroufe, Egeland, Carlson, & Collins, 2005). English FMSS were evaluated by two trained raters, and Spanish FMSS were evaluated by another two trained raters fluent in Spanish, one of whom was a native speaker. Two raters coded each narrative, listening to audio-recordings and reading transcripts as many times as needed before assigning one of the following codes: 0 (no support; e.g., examples of partner being unsupportive), 1 (very little support; e.g., partner once was, but no longer is supportive, or speaker provides more support than partner), 2 (some support; e.g., partner is mostly unsupportive, perhaps inconsistently supportive), 3 (moderate support; e.g., speaker mostly describes being supported by partner but provides limited examples or the examples only reflect instrumental support), 4 (moderately high support; e.g., one detailed example of partner giving emotional support), or 5 (high support; e.g., several detailed examples of partner giving emotional support). Emotional and instrumental support were each considered in scoring, but the highest ratings (4 or 5) were reserved for narratives describing high levels of emotional support.

Inter-rater reliability was excellent for English coders, ICC = .93, and Spanish coders, ICC = .81. After calculating reliability, any discrepancies between raters were conferenced to reach final consensus codes. Scores for support ranged from 0 to 5 (M = 2.61; SD = 1.48).

Depressive symptoms

Prenatal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) (Cox, Holden, & Sagovsky, 1987). The EPDS lists 10 symptoms (e.g., I have felt sad or miserable) that participants rate for frequency in the past week on scales from 0 (e.g., No, not at all) to 3 (e.g., Yes, most of the time). Raw scores were summed, with a potential range of 0–30. Sample scores ranged from 0 to 27 (M = 9.14, SD = 5.92).

PTSD symptoms

Women reported on prenatal PTSD symptoms using the PTSD Checklist for DSM-5 (PCL-5) (Weathers et al., 2013). The PCL-5 contains 20 symptoms (e.g., Feeling jumpy or easily startled) that participants rate for frequency in the past month on a scale from 0 = not at all to 4 = extremely. Raw scores were summed, with a potential range of 0–80. Sample scores ranged from 0 to 74 (M = 22.49, SD = 17.50).

Perceived stress

Women completed the Perceived Stress Scale (PSS) (Cohen, Karmarck, & Mermelstein, 1983) to assess perceived stress levels and difficulties in coping with stress during the last month. The PSS has 10 items (e.g., How often have you been upset because of something that happened unexpectedly?) rated on a scale from 0 = never to 4 = very often. Raw scores were summed, with a potential range of 0–40. Sample scores ranged from 0 to 35 (M = 16.92, SD = 7.70).

IPV victimization

Women reported on the occurrence of physical and sexual victimization by the father of the baby during pregnancy, using the Conflict Tactics Scale (CTS) (Straus, 1979). The CTS is composed of 78 yes or no items with 18 items tapping experiences of physical victimization (e.g., I had a sprain, bruise, or small cut because of a fight with a partner) and 7 items tapping experiences of sexual victimization (e.g., A partner [used force (hitting, holding down, using a weapon) to make me have sex]). Due to high skew, with only 12% of women (n = 12) endorsing any physical victimization during pregnancy and only 4% (n = 4) endorsing any sexual victimization during pregnancy, we dichotomized each type of IPV victimization for presence/absence of any physical victimization and presence/absence of any sexual victimization during pregnancy. We then summed these two dichotomized variables for an IPV victimization variable ranging from 0 to 2 to reflect whether women had experienced neither type of victimization during pregnancy (score = 0; n = 85, 86%), either physical or sexual victimization during pregnancy (score = 1; n = 12, 12%), or both types of victimization during pregnancy (score = 2; n = 2, 2%).

Demographic covariates

Women reported on their age, gestational age (in weeks), years of educational attainment, primiparity (first pregnancy or not), and primary language (English or Spanish). We also calculated whether women were living below the federal poverty line using federal criteria, according to women’s reports of current average monthly income divided by the number of reported people supported by that income (Narayan et al., 2018).

Data analytic plan and missing data

We first tested the associations between demographic variables and independent and dependent variables to select covariates for study analyses (see Table 1). Age, gestational age, educational attainment, and primiparity were not significantly associated with any of the key variables. Language was associated with key variables, such that Spanish-speaking women had significantly greater self-reported support, t(99) = −2.09, p < .05, greater coder-rated support, t(93) = −2.67, p < .01, and lower depressive symptoms, t(97) = 2.13, p < .05. Women living below the federal poverty line had significantly lower coder-rated support, t(93) = 3.42, p < .01, higher PTSD symptoms, t(98) = −2.89, p < .01, and higher perceived stress, t(97) = −2.07, p < .05. For these reasons, we included language and poverty status as covariates in all analyses.

Table 1.
Bivariate correlations among study variables.

Variable 1 2 3 4 5 6 7 8 9 10 11 12

1. Self-reported support —

2. Coder-rated support .69 —

3. Depressive symptoms −.54 −.36 —

4. PTSD symptoms −.52 −.43 .73 —

5. Perceived stress −.41 −.30 .70 .65 —

6. IPV victimization −.29 −.33 .23* .32** .24* —

7. Maternal age −.05 .12 .05 −.05 −.08 −.08 —

8. Gestational age .07 .03 −.14 −.16 −.13 −.06 −.04 —

9. Education .07 −.02 .03 .01 .11 −.08 .22* .03 —

10. Primiparity .07 .02 −.13 .03 .02 .15 −.30** .02 .13 —

11. Spanish language .21* .27** −.21* −.17 −.14 −.06 .22* .09 −.18 −.13 —

12. Poverty −.18 −.34 .20 .28 .21* .04 −.27** −.13 −.25* .01 −.21* —

13. Unpartnered with father −.74 −.54 .29 .36 .23* .26* .07 −.16 −.19 −.04 −.15 −.20

Note. PTSD = post-traumatic stress disorder; IPV = intimate partner violence.

*p < .05; **p < .01.

For core study analyses, first, we conducted partial correlations to assess the relation between self-reported and coder-rated support, controlling for language and poverty status. Second, we conducted partial correlations to test the associations between self-reported and coder-rated support with psychopathology, stress, and IPV victimization, controlling for language and poverty status. We used Fisher’s r-to-z transformations to determine whether self-reported and coder-rated support were comparably associated with psychopathology, stress, and IPV victimization. Additionally, we tested whether associations of self-reported and coder-rated support with psychopathology, stress, and victimization were moderated by whether the participant was currently romantically partnered with the father of the baby. Moderation analyses were conducted using Model 1 of the PROCESS macro for SPSS (Hayes, 2018). PROCESS assesses significance using 1,000 bias-corrected, bootstrapped samples to estimate 95% confidence intervals.

Third, we conducted a χ² test to examine concordance and discrepancies between self-reported and coder-rated support, after dichotomizing these variables to reflect low versus high support in a manner consistent with the scale point definitions. For self-reported support, mean continuous scores of 1–3 were classified as “low” support and mean continuous scores from 3.5 to 6 were classified as “high” support. For coder-rated support on the FMSS, scores of 0–2 were classified as “low” and scores of 3–5 were classified as “high.” We decided to dichotomize scores to examine discrepancies, rather than calculate difference scores, because we were interested in pronounced discrepancies (i.e., when participants reported high support, but coders deemed support to be low). Fourth, in a set of exploratory analyses, these dichotomous scores were used to compare levels of psychopathology symptoms, stress, and IPV victimization across four groups: low self-reported and low coder-rated support (“low-low”), high self-reported and high coder-rated support (“high-high”), high self-reported but low coder-rated support (“high-low”), and low self-reported but high coder-rated support (“low-high”).

Missing data were very minimal. Data were missing for six women for coder-rated support on the FMSS, because women did not provide any information for coders to evaluate level of support (n = 3) or declined to talk about the father of the baby (n = 3). An additional three women did not complete the full interview and were missing partial data for depressive and PTSD symptoms, perceived stress, IPV, and/or partnership status with the father of the baby.

Finally, we conducted a power analysis and determined that the effect of partner support on depressive symptoms could be detected with a sample size of 87 (80% power; r = .26, Stapleton et al., 2012). Therefore, we concluded that our sample (N = 101) was adequately powered.

Results

Aim 1: Association between self-reported and coder-rated support

Partial correlations revealed that self-reported and coder-rated romantic partner support were significantly correlated, r = .67, p < .001.

Aim 2: Associations of self-reported and coder-rated support with psychopathology, stress, and IPV victimization

Partial correlations indicated that greater self-reported support was significantly correlated with lower depressive symptoms, r = −.50, p < .001; PTSD symptoms, r = −.48, p < .001; perceived stress, r = −.37, p < .01; and IPV victimization, r = −.28, p < .01. Regression analyses showed that partnership status with the baby’s father only significantly moderated the association between self-reported support and perceived stress, p < .05, such that greater self-reported support was only significantly associated with lower perceived stress among women who were partnered, p < .001, but not women who were unpartnered, p = n.s.

Partial correlations indicated that greater coder-rated support was significantly correlated with lower depressive symptoms, r = −.30, p < .01; PTSD symptoms, r = −.36, p < .001; perceived stress, r = −.25, p < .05; and IPV victimization, r = −.33, p < .01. Partnership status did not significantly moderate any of these associations.

According to Fisher’s r-to-z transformations, the strength of associations for self-reported versus coder-rated support with outcomes did not significantly differ for depressive symptoms, z = 1.66, p = n.s.; PTSD symptoms, z = 1.01, p = n.s.; perceived stress, z = 0.95, p = n.s.; or IPV, z = −0.34, p = n.s.

Aim 3: Concordance between self-reported and coder-rated support

A χ² test confirmed that self-reported and coder-rated support were significantly associated, χ²(1) = 27.29, p < .001. The dichotomized grouping procedure described above resulted in four groups, two of which reflected concordance in support: low self-reported and low coder-rated support (“low-low,” n = 21, 22%) and high self-reported and high coder-rated support (“high-high”; n = 51, 54%); and two of which reflected discrepancies in support: high self-reported but low coder-rated support (“high-low”; n = 21, 22%) and low self-reported but high coder-rated support (“low-high”; n = 2, 2%). The majority of women (n = 72, 76%) had concordant scores (“high-high” or “low-low”) across self-reported and coder-rated support. Table 2 provides sample excerpts from concordant narratives, and Table 3 provides sample excerpts from discrepant narratives.

Table 2.
FMSS excerpts from concordant participants.

Low self-reported and low coder-rated support High self-reported and high coder-rated support

Excerpt from FMSS “He has been a bit of an asshole. After I told him I was keeping the child, he was just ignoring me completely. But now that the financial situation on his side has improved, he’s a bit more relaxed and now we are on good terms. I’m making a lot of efforts to be on good terms as well. Because I need him, you know. But after the house is sold, he’s thinking about moving out of state. I’m a bit upset when he talks like that, because I’m like: what about me? What about us?” “He’s always been a shoulder I’d like run to. He’s always been like just a stone for me, ever since I met him…He’s helped me a lot with boundaries and with my mental health issues. He’s just very aware and emotional and caring and he makes me want to be more, which makes him want to be more. He’s always been there for me. And always will. And there’s nobody I’d rather have a child with.”

Self-report score 3 6

Coder-rated (FMSS) score 0 5

Note. FMSS = Five-Minute Speech Sample.

Table 3.
FMSS excerpts from discrepant participants.

High self-reported but low coder-rated support Low self-reported but high coder-rated support

Excerpt from FMSS “I think that our relationship has become much better as the pregnancy got farther along. He became more mature about having a baby and taking responsibilities. I have to talk to him about things like that, because sometimes he’ll forget, or sometimes he’ll act like he doesn’t know. But yeah, he’s just a good person to be around. Hopefully when the baby comes he’ll be a whole lot more supportive than what he is now. He will be when the baby gets here. He says he would, so I believe in him, I believe he would.” “In a way I do like the fact that he makes quick decisions. But sometimes I feel like when he does make decisions very quick, I feel like it was just too quick. Like, for example, if I tell him that there’s this certain restaurant or movie that I want to go watch, I’m thinking that it’s probably going to be like OK let’s go do it today or let’s go do it right now. And I’m like, I thought it was going to be a special moment or a special time and you just did it because you knew I wanted it, but not because you wanted to make it special for me.”

Self-report score 5.5 3

Coder-rated (FMSS) score 2 3

Note. FMSS = Five-Minute Speech Sample.

Considering only the women with complete data for self-reported and coder-rated support who were currently unpartnered with the baby’s father (n = 20), 85% of these unpartnered women (n = 17) had concordant scores across self-reported and coder-rated support. Further, the majority (n = 15, 75%) of women who were unpartnered with the baby’s father were in the “low-low” group, and the remaining two concordant, unpartnered women were in the “high-high” group. Only two unpartnered women were in the “high-low” group, and one unpartnered woman was in the “low-high” group.

Exploratory Aim 4: Unpacking discrepancies between self-reported and coder-rated support

A sizeable subset of women (n = 21, 22%) reported high support but received low coder-rated support scores on the FMSS. Within this group, the average discrepancy between self-reported and coder-rated support was large (M = 2.26, SD = 0.86), and the majority of participants (n = 18, 86%) had a discrepancy of 1.5 or greater (when variables were transformed to be on the same scale). We examined whether these “discrepant” women differed from “concordant” women in terms of psychopathology symptoms, perceived stress, and IPV victimization. To do so, we created a new categorical variable (0 = “low-low” (low self-reported and low coder-rated); 1 = “high-low” (high self-reported and low coder-rated); and 2 = “high-high” (high self-reported and high coder-rated)) and conducted analysis of covariance (ANCOVA) tests. For these analyses, we excluded the two women who had low self-reported support but high coder-rated support, due to insufficient cell size.

To reduce the risk of type I error, we used Bonferroni corrections for all pairwise comparisons of outcome variables in the ANCOVAs. Given three pairwise comparisons per ANCOVA, our adjusted α value was α′ = .05/3 = .017, and we now report contrasts at .017 ≤ α < .10 to be marginally significant.

Support grouping was significantly associated with depressive symptoms, F(2, 86) = 7.11, p < .01 (see Table 4). Women in the “low-low” group had significantly greater depressive symptoms than women in the “high-high” group, p < .001, and women in the “high-low” group, p < .01. Women in the “high-low” group did not significantly differ in depressive symptoms from women in the “high-high” group, p = n.s. Language and poverty were not significant predictors in the model.

Table 4.
Estimated marginal means and standard errors from ANCOVA analyses.

1—Low-low support group (n = 21) 2—High-low support group (n = 21) 3—High-high support group (n = 51) Total sample M (SD) Significant contrast (marginal contrast) Sample range

Depressive symptoms 13.36 (1.25) 8.76 (1.26) 7.66 (0.82) 9.14 (5.92) 1 versus 21 versus 3 0–27

PTSD symptoms 34.15 (3.55) 26.94 (3.53) 16.76 (2.34) 22.49 (17.50) 1 versus 3(2 versus 3) 0–74

Perceived stress 19.51 (1.70) 18.99 (1.73) 14.91 (1.12) 16.92 (7.70) (1 versus 3)(2 versus 3) 0–35

IPV victimization 0.30 (0.09) 0.36 (0.09) 0.01 (0.06) 0.16 (0.42) 1 versus 32 versus 3 0–2

Spanish language 1 (5%) 1 (5%) 20 (39%) 26 (26%) Yes —

Below federal poverty line 18 (86%) 17 (81%) 29 (57%) 71 (70%) Yes —

Note. All significant contrasts p < .017 according to Bonferroni correction. Marginally significant contrasts are shown in parentheses in the contrast column, p < .10. ANCOVA = analysis of covariance; SD = standard deviation; PTSD = post-traumatic stress disorder; IPV = intimate partner violence.

Support grouping was also significantly associated with PTSD symptoms, F(2, 87) = 8.20, p < .01 (see Table 4). Women in the “low-low” group had significantly greater PTSD symptoms than women in the “high-high” group, p < .001, but not than women in the “high-low” group, p = n.s. Women in the “high-low” group had marginally significantly greater PTSD symptoms than women in the “high-high” group, p < .05. Poverty was a marginally significant predictor in the model, p < .05, but language was not, p = n.s.

Support grouping was also significantly associated with perceived stress, F(2, 86) = 3.09, p < .05 (see Table 4). Women in the “low-low” group had marginally significantly greater perceived stress than women in the “high-high” group, p < .05, but not than women in the “high-low” group, p = n.s. Women in the “high-low” group had marginally significantly greater perceived stress than women in the “high-high” group, p < .10. Language and poverty were not significant predictors in the model.

Finally, support grouping was significantly associated with IPV victimization during pregnancy, F(2, 86) = 6.09, p < .01 (see Table 4). Women in the “low-low” group had significantly greater IPV than women in the “high-high” group, p < .017, but not than women in the “high-low” group, p = n.s. Women in the “high-low” group had significantly greater IPV than women in the “high-high” group, p < .01. Language and poverty were not significant predictors in the model. Of 14 total women who experienced any physical or sexual IPV during pregnancy, 6 women (43%) were in the “high-low” group: 5 of these women (24%) reported experiencing either physical or sexual victimization during pregnancy, and 1 of these women (5%) reported experiencing both forms of victimization during pregnancy.

Discussion

This study tested the utility and convergent validity of the FMSS as a novel assessment of pregnant women’s romantic partner support from the baby’s father. Results indicated that coder-rated partner support on the FMSS is strongly associated with a widely used self-report measure of partner support (Sarason et al., 1983). When ratings from both self-reported and coder-rated instruments were dichotomized into low versus high support, self-reports and coder-ratings were highly concordant: 76% of women received “high-high” or “low-low” concordant scores across both measures. Additionally, coder-rated partner support showed expected associations with depressive symptoms, PTSD symptoms, perceived stress, and IPV victimization, comparable to associations between self-reported support and outcomes. Taken together, these results demonstrate that the FMSS is a valid index of romantic partner support compared to self-reported support.

Although the majority of women had concordant support scores across self-reports and coder-ratings, as predicted, there was a sizeable subgroup (22%) of “discrepant” women who reported high support but received low coder-rated support scores. Compared to women with high scores on both instruments, “discrepant” women reported marginally higher PTSD symptoms and perceived stress (according to Bonferroni corrections, although both at p < .05), and significantly greater IPV victimization (p < .017). There are several potential explanations for these findings. First, it is possible that “discrepant” women were honestly and thoughtfully evaluating and reporting on partner support, but that these perceptions were not aligned with coder-ratings of support from women’s descriptions of the relationship. This would suggest that when coder-ratings of support disagree with women’s subjective perceptions of support, coder-ratings are able to flag women at risk of psychopathology symptoms, stress, and IPV during pregnancy.

Alternatively, it may be that “discrepant” women displayed biases that are specific to reporting on the romantic relationship, such as sentiment override or idealization of the partner. Given that these women still reported higher levels of PTSD symptoms, stress, and IPV, it is unlikely that social desirability bias—which influences scores on socially sensitive questions more globally (van de Mortel, 2008)—played a role in their reporting on partner support. Rather, sentiment override or partner idealization may have been at play, such that women made an idealistic assessment of the relationship. This idealization could have occurred due to increases in hope and optimism associated with the pregnancy period (Slade et al., 2009) or because women responded according to a globally positive view of the relationship without reflecting on the nuances of partner support, per se (Hawkins et al., 2002). However, it appears that when more objective measures (i.e., coder-rated FMSS support) indicate low support, such optimism may be insufficient to guard against psychopathology symptoms, stress, and IPV victimization.

An important next step for researchers will be to carefully analyze the potential risks associated with sentiment override, specifically in terms of IPV victimization. Women who tend to focus on and prioritize positive aspects of the romantic relationship could be vulnerable to IPV victimization because they idealize the partner rather than recognizing the partner’s violent tendencies. To test this theory, it may be beneficial to utilize self-report questionnaires with items that more directly assess whether women endorse idealized views (e.g., My partner is the best person in the world) and examine whether and how idealization is associated with psychopathology and stress.

Surprisingly, when compared to women who received low scores on both measures of support, “discrepant” women reported significantly lower depressive symptoms. This finding suggests that whereas coder-ratings of low support may most closely signal risk for heightened PTSD symptoms, stress, and IPV victimization, self-report ratings of high support may be the signal for low levels of depressive symptoms. In other words, perceiving high support may be adequate to fend off depressive symptoms. (Since this study is cross-sectional, this is only a tentative interpretation that longitudinal data would need to investigate.) Alternatively, it is also possible that a subset of “discrepant” women responded in a socially desirable manner for both romantic partner support and depressive symptoms (but not PTSD symptoms or perceived stress). Future studies should include a measure of socially desirable responding for depression or more objective assessments of depression (e.g., a diagnostic clinical interview) to test this possibility.

In order to further unpack the reasons for discrepant responses across self-reported and coder-rated support measures, it would be revealing to administer measures of attachment avoidance. Attachment theorists posit that some adults may be defensive and avoidant with respect to close relationships and attempt to minimize feelings of vulnerability and dependence by failing to reflect upon and retrieve unpleasant attachment-related memories (Fraley & Brumbaugh, 2007). In this way, it is possible that some adults respond to questions about their romantic relationships by responding reflexively and downplaying negative emotion or experiences (i.e., reporting high partner support when it actually may not be high).

Another noteworthy finding was that greater coder-rated partner support was associated with lower levels of depressive and PTSD symptoms, perceived stress, and IPV victimization, regardless of whether women were currently romantically involved with the father of the baby. This is an important extension of prior work on partner support during pregnancy, demonstrating that support from the baby’s father is an important factor in pregnant women’s mental health and well-being, even when the mother and father are not presently in a romantic relationship. The same pattern held true for self-reported support, with one exception: Greater self-reported support was only associated with lower perceived stress among women who were partnered with the baby’s father, but not among women who were unpartnered. Perhaps women who are unpartnered do not expect the father of the baby to be very involved or supportive in helping them to cope with daily hassles and stressors (indeed, 75% of the unpartnered women, n = 15, were concordantly low on support across both measures), thus explaining the weak association between their self-reported support from him and their perceived stress. Future studies should further investigate this finding.

Strengths and limitations

In terms of measurement strengths, this study elucidated the FMSS as a promising methodological tool for romantic relationship research, by assessing positive aspects of relationships, such as support, rather than more traditional, negative aspects of EE (e.g., Yan et al., 2004). As a methodological tool, the FMSS overcomes several limitations of self-report and traditional observational partner support measures. Unlike self-report, the FMSS encourages reflection by speakers and reduces bias by allowing coders to more objectively identify evidence about partner support. The FMSS lacks face validity, which also guards against reporting bias—speakers are merely asked to talk for five minutes about the baby’s father, but they do not know what the task is actually assessing or what coders are rating. Furthermore, unlike many traditional observational measures of partner support, the FMSS is brief and does not require both members of a romantic relationship to be observed simultaneously, making it easier to study low-income couples who may have competing priorities to work long hours and secure basic needs rather than participate in lengthy research studies together. For these reasons, the FMSS may prove useful as an efficient indicator of risk for prenatal psychopathology, stress, and IPV, particularly when pregnant women’s reports of partner support do not converge with coders’ perceptions.

Notably, this study is among the first to demonstrate that pregnant women who receive low levels of romantic partner support may be at risk for higher PTSD symptoms and greater IPV victimization. This extends prior work showing that high social support is linked to lower PTSD symptoms and that romantic relationship conflict is a risk factor for IPV (Capaldi et al., 2012; Vranceanu et al., 2007) to the context of romantic partner support. Although the present study cannot identify mechanisms linking partner support with PTSD and IPV, previous research suggests that women who experienced childhood maltreatment are at risk for less supportive romantic relationships (Colman & Widom, 2004), which may then contribute to higher levels of PTSD symptoms and IPV victimization. Additional studies should examine how histories of childhood maltreatment and related traumatic experiences affect the well-being of women with low partner support.

Additional strengths of this study include the multimethod approach to measuring romantic partner support, which allowed for an examination of discrepancies between self-reported and coder-rated support and raised several key questions for future research. Furthermore, the study was conducted in the context of an ethnically diverse, low-income sample that included women experiencing a wide range of social support from their babies’ fathers. By capturing a wide range of support and increasing cell size in groups of women with low levels of partner support, the findings provide new insight that levels of partner support are tied to women’s mental health, even if they are not currently in a romantic relationship with the partner. Together, these demographic characteristics enhance the generalizability of the findings.

In terms of limitations, the format of the FMSS contributed to some missing data in our sample. Due to the low face validity of the FMSS—which is primarily a strength because it helps to guard against reporting bias—a small number of women (n = 3) did not think to comment on partner support because they were not specifically prompted to do so. Furthermore, a few women (n = 3) who were unpartnered with the father of the baby reported having too many negative feelings about the relationship to complete the task. Thus, there are some minor trade-offs to using the FMSS rather than self-report measures of social support.

Critically, the directionality of associations between support and outcomes could not be conclusively determined in this cross-sectional study. It could be that “discrepant” women reported high partner support because their experiences of psychopathology symptoms and stress skewed their perception of support, or that symptoms of psychopathology and stress are aversive to partners, leading to relationship withdrawal and lower levels of coder-rated support. Along similar lines, “discrepant” women who were experiencing IPV (n = 6, 29%) may have reported high support because of their views of violence as acceptable (Kaura & Lohman, 2007) or because violence contributed to a sense of financial or psychological dependence on the partner (Rhatigan & Street, 2005). Future studies with longitudinal designs will be able to test these competing possibilities. Finally, it is important to replicate our results, to enhance confidence in our exploratory findings that draw upon small subgroups, ideally utilizing a larger sample.

Implications and conclusions

As an efficient and valid measure of romantic partner support compared to self-report, the FMSS may be a useful screener for elevated prenatal psychopathology, stress, and IPV in research and clinical practice. Women whose self-reports indicate high partner support, but whose FMSS narratives say otherwise, may especially benefit from healthy relationship education, couples counseling, or therapeutic intervention targeted at processing trauma and reducing PTSD symptoms. Low support scores on the FMSS for these women could signal a need for preventive care to mental health and medical providers, who can be quickly trained to administer and score the measure. Such practice would ensure that women who report high support, but are in fact at risk for psychopathology, stress, and IPV victimization, do not fall through the cracks.

In sum, this study sheds light on strengths and weaknesses of self-reported versus coder-rated methodology to assess pregnant women’s romantic partner support. Importantly, both measures of support showed comparable magnitude of associations with psychopathology symptoms and stress, demonstrating that relationship researchers have multiple efficient options with which to measure partner support and to index psychosocial risk during pregnancy. However, the FMSS may be a superior instrument to assess nuances of pregnant women’s mental health and well-being, specifically for subgroups of women whose explanations of support on the FMSS do not align with their self-report ratings. The FMSS may “catch” women who are experiencing sentiment override or idealization associated with pregnancy. Moving forward, this study illustrates a novel coding adaptation for the FMSS as an effective instrument that briefly yet richly captures aspects of at-risk women’s mental health and well-being during the sensitive and transformational period of pregnancy.

Variable	1	2	3	4	5	6	7	8	9	10	11	12
1. Self-reported support	—
2. Coder-rated support	.69**	—
3. Depressive symptoms	−.54**	−.36**	—
4. PTSD symptoms	−.52**	−.43**	.73**	—
5. Perceived stress	−.41**	−.30**	.70**	.65**	—
6. IPV victimization	−.29**	−.33**	.23*	.32**	.24*	—
7. Maternal age	−.05	.12	.05	−.05	−.08	−.08	—
8. Gestational age	.07	.03	−.14	−.16	−.13	−.06	−.04	—
9. Education	.07	−.02	.03	.01	.11	−.08	.22*	.03	—
10. Primiparity	.07	.02	−.13	.03	.02	.15	−.30**	.02	.13	—
11. Spanish language	.21*	.27**	−.21*	−.17	−.14	−.06	.22*	.09	−.18	−.13	—
12. Poverty	−.18	−.34**	.20	.28**	.21*	.04	−.27**	−.13	−.25*	.01	−.21*	—
13. Unpartnered with father	−.74**	−.54**	.29**	.36**	.23*	.26*	.07	−.16	−.19	−.04	−.15	−.20

	Low self-reported and low coder-rated support	High self-reported and high coder-rated support
Excerpt from FMSS	“He has been a bit of an asshole. After I told him I was keeping the child, he was just ignoring me completely. But now that the financial situation on his side has improved, he’s a bit more relaxed and now we are on good terms. I’m making a lot of efforts to be on good terms as well. Because I need him, you know. But after the house is sold, he’s thinking about moving out of state. I’m a bit upset when he talks like that, because I’m like: what about me? What about us?”	“He’s always been a shoulder I’d like run to. He’s always been like just a stone for me, ever since I met him…He’s helped me a lot with boundaries and with my mental health issues. He’s just very aware and emotional and caring and he makes me want to be more, which makes him want to be more. He’s always been there for me. And always will. And there’s nobody I’d rather have a child with.”
Self-report score	3	6
Coder-rated (FMSS) score	0	5

	High self-reported but low coder-rated support	Low self-reported but high coder-rated support
Excerpt from FMSS	“I think that our relationship has become much better as the pregnancy got farther along. He became more mature about having a baby and taking responsibilities. I have to talk to him about things like that, because sometimes he’ll forget, or sometimes he’ll act like he doesn’t know. But yeah, he’s just a good person to be around. Hopefully when the baby comes he’ll be a whole lot more supportive than what he is now. He will be when the baby gets here. He says he would, so I believe in him, I believe he would.”	“In a way I do like the fact that he makes quick decisions. But sometimes I feel like when he does make decisions very quick, I feel like it was just too quick. Like, for example, if I tell him that there’s this certain restaurant or movie that I want to go watch, I’m thinking that it’s probably going to be like OK let’s go do it today or let’s go do it right now. And I’m like, I thought it was going to be a special moment or a special time and you just did it because you knew I wanted it, but not because you wanted to make it special for me.”
Self-report score	5.5	3
Coder-rated (FMSS) score	2	3

	1—Low-low support group (n = 21)	2—High-low support group (n = 21)	3—High-high support group (n = 51)	Total sample M (SD)	Significant contrast (marginal contrast)	Sample range
Depressive symptoms	13.36 (1.25)	8.76 (1.26)	7.66 (0.82)	9.14 (5.92)	1 versus 21 versus 3	0–27
PTSD symptoms	34.15 (3.55)	26.94 (3.53)	16.76 (2.34)	22.49 (17.50)	1 versus 3(2 versus 3)	0–74
Perceived stress	19.51 (1.70)	18.99 (1.73)	14.91 (1.12)	16.92 (7.70)	(1 versus 3)(2 versus 3)	0–35
IPV victimization	0.30 (0.09)	0.36 (0.09)	0.01 (0.06)	0.16 (0.42)	1 versus 32 versus 3	0–2
Spanish language	1 (5%)	1 (5%)	20 (39%)	26 (26%)	Yes	—
Below federal poverty line	18 (86%)	17 (81%)	29 (57%)	71 (70%)	Yes	—

Footnotes

Acknowledgement

The authors would like to thank all of the women who participated in this study and shared their stories during pregnancy.

Authors’ note

This manuscript was presented at the 2018 International Association for Relationship Research Conference in Fort Collins, Colorado.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by a grant from the Coydog Foundation.

Open research statement

As part of IARR’s encouragement of open research practices, the authors have provided the following information: This research was not pre-registered. The data used in the research are available. The data can be obtained by emailing: angela.narayan@du.edu. The materials used in the research are available. The materials can be obtained by emailing angela.narayan@du.edu.

ORCID iD

Laura M. River

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