Principal Findings
PES, anxiety, depressive symptoms
PND
This study examined the effectiveness of SPA on parental outcomes during the perinatal period. Most of the parents participating in this study were Malay and Chinese, and most of them worked full time. The most popular features of the SPA were the knowledge base and expert advice column. Owing to the longitudinal nature of the study, there was an attrition rate of 28.5%, which was higher than expected, because of the failure to complete follow-up questionnaires and disengagement with the SPA intervention. Furthermore, the control group had higher attrition compared with the intervention group. The lower level of social support received by parents in the control group because of the lack of SPA might have made them even more occupied with parenting responsibilities and thus less motivated to respond to follow-up messages. As the COVID-19 outbreak occurred soon after the study began in February 2020, it is possible that the COVID-19 pandemic undermined some of the positive impacts that SPA could have had on parental outcomes because of the uncertainties and unprecedented stress experienced by parents during this period. Nonetheless, the intervention group generally showed more improvements in parental outcomes than the control group.The increase in EPDS scores from baseline to 1 month post partum indicated that parents from both groups experienced more depressive symptoms after their baby was born. This was not unexpected, as previous research has shown that mothers who scored higher on the EPDS after childbirth reported significantly poorer well-being and experienced difficulties in coping with daily responsibilities [Consistent with existing literature, this study found that mothers were more likely to exhibit possible PND symptoms, as the mean EPDS scores of mothers were significantly higher than those of fathers [The anxiety levels of parents generally decreased across all time points in both groups in this study. As elaborated previously, the COVID-19 pandemic might have hindered a larger reduction in anxiety levels, as the pandemic brought new sets of difficulties that caused parents to experience more stress [Contrary to the hypothesis, parent-infant bonding of the parents in the intervention group was significantly poorer than the parents in the control group at 6 months post partum. This was an unexpected result; similar to other outcomes, parents received parent-infant bonding-related educational information via the SPA. Response-shift bias could have affected how the intervention group participants responded to PIBQ. Rosenman et al [This study found that the scores for parental self-efficacy and parenting satisfaction were highly similar in both the intervention and control groups. The mean PES and WPBL scores of all parents were also high, even at baseline. This negatively skewed distribution of scores may be attributed to a ceiling effect [The SPA intervention provided both informational and emotional support, both of which are important forms of social support that parents desire during the perinatal period [