Archives of Women's Mental Health

, Volume 20, Issue 4, pp 525–537 | Cite as

Strongest Families™ Managing Our Mood (MOM): a randomized controlled trial of a distance intervention for women with postpartum depression

  • Lori WozneyEmail author
  • Janine Olthuis
  • Patricia Lingley-Pottie
  • Patrick J. McGrath
  • William Chaplin
  • Frank Elgar
  • Brianna Cheney
  • Anna Huguet
  • Karen Turner
  • Jillian Kennedy
Original Article


The present study investigated whether a distance-delivered intervention could significantly decrease mild to moderate postpartum depression (PPD) in mothers as compared to usual care. Mothers with PPD (n = 62) were randomly assigned to the intervention or standard community care. Participants receiving the intervention followed a 12-session cognitive behavioural informed handbook supplemented with telephone-based coaching support. Diagnostic status and depressive symptoms were assessed at baseline and 3, 6 and 12 months postrandomization. Odds ratios indicated that intervention group participants were 1.5 times as likely to experience diagnostic remission at 3 months (mid-intervention) (p = 0.742), 1.54 times as likely at 6 months (p = 0.696) and 12.5 times as likely at 12 months (p = 0.009). Intervention ‘dosage’ significantly moderated this effect; for every additional coaching session completed, individuals had a 1.4 times greater chance of showing improvement at 3 and 6 months. Mothers reported high satisfaction with the intervention. Findings suggest positive outcomes at each time point and superior outcomes to the control condition at the long-term follow-up. Caution in interpreting these results is warranted due to small sample size and incomplete data; however, they support further investigation into the use of distance interventions as an accessible and effective solution for women with PPD.


Postpartum depression Randomized controlled trial Telehealth Cognitive behavioural intervention Health care access 



The authors would like to thank the following individuals for their significant contributions to the advisory committee: Cathy Thurston, Helen Gould, Kathy Inkpen, Lee Johnson, Jenny MacCormick, Marilyn Martin, Nancy Thurston, Karen Blanchard, Anne MacKenzie, Lisa MacRae, Darla MacPherson, Kim MacClellan, Michelle Pickles, Christine Saulnier, Kim Barro and Liz MacKay. We thank the study staff. We sincerely thank all referring health professionals from across Nova Scotia’s health regions and, most importantly, all mothers who volunteered their valued time to participate.

Authors’ contributions

PJ-M and P-LP conceived of the study and developed the background, methods and design. LM-W and J-O drafted the manuscript and critically revised it for important intellectual content. K-T provided overall trial management and staff supervision and provided substantial revision to the content of the manuscript. W-C and B-C conducted statistical analysis and drafted the main results. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

Dr. McGrath is a volunteer Chair of the Board and Dr. Lingley-Pottie and Jillian Kennedy are paid employees of the Strongest Families Institute, a not-for-profit organization. Dr. Lingley-Pottie’s academic time on this study was in-kind.


The study was funded by the Women’s Health in Rural Communities (WHIRC) research program funded by the Canadian Institutes of Health Research (CIHR; Funding Reference Number 70789).


  1. Affonso DD, De AK, Horowitz JA, Mayberry LJ (2000) An international study exploring levels of postpartum depressive symptomatology. J Psychosom Res 49(3):207–216. doi: 10.1016/s0022-3999(00)00176-8 CrossRefPubMedGoogle Scholar
  2. Alhusen JL, Hayat MJ, Gross D (2013) A longitudinal study of maternal attachment and infant developmental outcomes. Arch Womens Ment Health 16(6):521–529. doi: 10.1007/s00737-013-0357-8 CrossRefPubMedGoogle Scholar
  3. Allen K, Cull A, Sharpe M (2003) Diagnosing major depression in medical outpatients. J Psychosom Res 55(4):385–387. doi: 10.1016/s0022-3999(02)00637-2 CrossRefPubMedGoogle Scholar
  4. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn. APA, Washington.Google Scholar
  5. Andreescu C, Lenze EJ, Dew MA, Begley AE, Mulsant BH, Dombrovski AY, Reynolds CF (2007) Effect of comorbid anxiety on treatment response and relapse risk in late-life depression: controlled study. Br J Psychiatry 190(4):344–349. doi: 10.1192/bjp.bp.106.027169 CrossRefPubMedGoogle Scholar
  6. Arnberg FK, Linton SJ, Hultcrantz M, Heintz E, Jonsson U (2014) Internet-delivered psychological treatments for mood and anxiety disorders: a systematic review of their efficacy, safety, and cost-effectiveness. PLoS One 9(5):e98118. doi: 10.1371/journal.pone.0098118 CrossRefPubMedPubMedCentralGoogle Scholar
  7. Beck CT (1999) Maternal depression and child behaviour problems: a meta-analysis. J Adv Nurs 29(3):623–629. doi: 10.1046/j.1365-2648.1999.00943.x CrossRefPubMedGoogle Scholar
  8. Beck AT, Steer RA, Brown GK (1996) Manual for the Beck Depression Inventory—II. Psychological Corporation, San AntonioGoogle Scholar
  9. Cacciola JS, Alterman AI, Rutherford MJ, Mckay JR, May DJ (1999) Comparability of telephone and in-person structured clinical interview for DSM-III-R (SCID) diagnoses. Assessment 6(3):235–242. doi: 10.1177/107319119900600304 CrossRefPubMedGoogle Scholar
  10. Carpiniello B, Pariante CM, Serri F, Costa G, Carta MG (1997) Validation of the Edinburgh Postnatal Depression Scale in Italy. J Psychosom Obstet Gynecol 18(4):280–285. doi: 10.3109/01674829709080700 CrossRefGoogle Scholar
  11. Cohen LS, Wang B, Nonacs R, Viguera AC, Lemon EL, Freeman MP (2010) Treatment of mood disorders during pregnancy and postpartum. Psychiatr Clin North Am 33(2):273–293. doi: 10.1016/j.psc.2010.02.001 CrossRefPubMedGoogle Scholar
  12. Cooper PJ, Murray L (1995) Course and recurrence of postnatal depression. Evidence for the specificity of the diagnostic concept. Br J Psychiatry 166(2):191–195. doi: 10.1192/bjp.166.2.191 CrossRefPubMedGoogle Scholar
  13. Corkum P, Lingley-Pottie P, Davidson F, McGrath PJ, Chambers C, Mullane J, Laredo S, Woodford K, Weiss S (2016) Better nights/better days—distance intervention for insomnia in school-aged children with/without ADHD: a randomized controlled trial. J Pediatr Psychol 41(6):701–713CrossRefPubMedGoogle Scholar
  14. Cornish AM, Mcmahon CA, Ungerer JA, Barnett B, Kowalenko N, Tennant C (2005) Postnatal depression and infant cognitive and motor development in the second postnatal year: the impact of depression chronicity and infant gender. Infant Behav Dev 28(4):407–417. doi: 10.1016/j.infbeh.2005.03.004 CrossRefGoogle Scholar
  15. Cornish AM, Mcmahon CA, Ungerer JA, Barnett B, Kowalenko N, Tennant C (2006) Maternal depression and the experience of parenting in the second postnatal year. J Reprod Infant Psychol 24(2):121–132. doi: 10.1080/02646830600644021 CrossRefGoogle Scholar
  16. Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150(6):782–786. doi: 10.1192/bjp.150.6.782 CrossRefPubMedGoogle Scholar
  17. de Graaf LE, Gerhards SA, Arntz A, Riper H, Metsemakers JFM, Evers SMAA, Severens JL, Widdershoven G, Huibers MJH (2009) Clinical effectiveness of online computerised cognitive-behavioural therapy without support for depression in primary care: randomised trial. Brit J Psych 195 (1):73–80Google Scholar
  18. Denis A, Ponsin M, Callahan S (2012) The relationship between maternal self-esteem, maternal competence, infant temperament and post-partum blues. J Reprod Infant Psychol 30(4):388–397. doi: 10.1080/02646838.2012.718751 CrossRefGoogle Scholar
  19. Dennis CL, Chung-Lee L (2006) Postpartum depression help-seeking barriers and maternal treatment preferences: a qualitative systematic review. Birth 33(4):323–331. doi: 10.1111/j.1523-536x.2006.00130.x CrossRefPubMedGoogle Scholar
  20. Dennis CL, Dowswell T (2013) Psychosocial and psychological interventions for preventing postpartum depression. Cochrane Database Syst Rev 2:CD001134. doi: 10.1002/14651858.cd001134.pub3 Google Scholar
  21. Dennis CL, Heaman M, Vigod S (2012) Epidemiology of postpartum depressive symptoms among Canadian women: regional and national results from a cross-sectional survey. Can J Psychiatr 57(9):537–546. doi: 10.1177/070674371205700904 CrossRefGoogle Scholar
  22. Dennis CL (2003) The effect of peer support on postpartum depression: a pilot randomized controlled trial. Can J Psychiatr 48(2):115–124. doi: 10.1177/070674370304800209 Google Scholar
  23. Donkin L, Hickie IB, Christensen H, Naismith SL, Neal B, Cockayne NL, Glozier N (2013) Rethinking the dose-response relationship between usage and outcome in an online intervention for depression: randomized controlled trial. JMIR 15(10):e231. doi: 10.2196/jmir.2771
  24. Dyck KG, Hardy C (2013) Enhancing access to psychologically informed mental health services in rural and northern communities. Can Psychol 54(1):30–37. doi: 10.1037/a0031280 CrossRefGoogle Scholar
  25. Enders CK (2001) The performance of the full information maximum likelihood estimator in multiple regression models with missing data. Educ Psychol Meas 61(5):713–740. doi: 10.1177/0013164401615001 CrossRefGoogle Scholar
  26. Epperson CN (1999) Postpartum major depression: detection and treatment. Am Fam Physician 59(8):2247–2254PubMedGoogle Scholar
  27. Feldman R, Granat A, Pariente C, Kanety H, Kuint J, Gilboa-Schechtman E (2009) Maternal depression and anxiety across the postpartum year and infant social engagement, fear regulation, and stress reactivity. J Am Acad Child Adolesc Psychiatry 48(9):919–927. doi: 10.1097/chi.0b013e3181b21651 CrossRefPubMedGoogle Scholar
  28. First MB, Spitzer RL, Gibbon M, Williams JBW (2002) Structured clinical interview for DSM–IV-TR axis I disorders, research version, patient edn. Biometrics Research, New York State Psychiatric Institute, New YorkGoogle Scholar
  29. Gellatly J, Bower P, Hennessy S, Richards D, Gilbody S, Lovell K (2007) What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression. Psychol Med 37(09):1217–1228. doi: 10.1017/s0033291707000062 CrossRefPubMedGoogle Scholar
  30. Glenn D, Golinelli D, Rose RD, Roy-Byrne P, Stein MB, Sullivan G, Craske MG (2013) Who gets the most out of cognitive behavioral therapy for anxiety disorders? The role of treatment dose and patient engagement. J Consult Clin Psychol 81(4):639–649. doi: 10.1037/a0033403 CrossRefPubMedPubMedCentralGoogle Scholar
  31. Goodman SH, Rouse MH, Connell AM, Broth MR, Hall CM, Heyward D (2011) Maternal depression and child psychopathology: a meta-analytic review. Clin Child Fam Psychol Rev 14(1):1–27. doi: 10.1007/s10567-010-0080-1 CrossRefPubMedGoogle Scholar
  32. Grace SL, Evindar A, Stewart DE (2003) The effect of postpartum depression on child cognitive development and behavior: a review and critical analysis of the literature. Arch Womens Ment Health 6(4):263–274. doi: 10.1007/s00737-003-0024-6 CrossRefPubMedGoogle Scholar
  33. Groer MW, Davis MW, Hemphill J (2002) Postpartum stress: current concepts and the possible protective role of breastfeeding. J Obstet Gynecol Neonatal Nurs 31(4):411–417. doi: 10.1111/j.1552-6909.2002.tb00063.x CrossRefPubMedGoogle Scholar
  34. Halbreich U, Karkun S (2006) Cross-cultural and social diversity of prevalence of postpartum depression and depressive symptoms. J Affect Disord 91(2–3):97–111. doi: 10.1016/j.jad.2005.12.051 CrossRefPubMedGoogle Scholar
  35. Handley TE, Kay-Lambkin FJ, Inder KJ, Lewin TJ, Attia JR, Fuller J, Kelly BJ (2014) Self-reported contacts for mental health problems by rural residents: predicted service needs, facilitators and barriers. BMC Psychiatry 14:249. doi: 10.1186/s12888-014-0249-0 CrossRefPubMedPubMedCentralGoogle Scholar
  36. Hegel MT, Unützer J, Tang L, Areán PA, Katon W, Noël PH, Williams JW, Lin EH (2005) Impact of comorbid panic and posttraumatic stress disorder on outcomes of collaborative care for late-life depression in primary care. Am J Geriatr Psychiatry 13(1):48–58. doi: 10.1097/00019442-200501000-00008 CrossRefPubMedGoogle Scholar
  37. Horowitz JA, Cousins A (2006) Postpartum depression treatment rates for at-risk women. Nurs Res 55(2 Suppl):S23–S27. doi: 10.1097/00006199-200603001-00005 CrossRefPubMedGoogle Scholar
  38. Johnson J (1992) Service utilization and social morbidity associated with depressive symptoms in the community. JAMA 267(11):1478–1483. doi: 10.1001/jama.267.11.1478 CrossRefPubMedGoogle Scholar
  39. Klier CM, Muzik M, Rosenblum KL, Lenz G (2001) Interpersonal psychotherapy adapted for the group setting in the treatment of postpartum depression. J Psychother Pract Res 10:124–131PubMedPubMedCentralGoogle Scholar
  40. Kumar R, Robson KM (1984) A prospective study of emotional disorders in childbearing women. Br J Psychiatry 144(1):35–47. doi: 10.1192/bjp.144.1.35 CrossRefPubMedGoogle Scholar
  41. Lanes A, Kuk JL, Tamim H (2011) Prevalence and characteristics of postpartum depression symptomatology among Canadian women: a cross-sectional study. BMC Public Health 11(1):302. doi: 10.1186/1471-2458-11-302 CrossRefPubMedPubMedCentralGoogle Scholar
  42. Lefkovics E, Baji I, Rigó J (2014) Impact of maternal depression on pregnancies and on early attachment. Infant Ment Health J 35(4):354–365. doi: 10.1002/imhj.21450 CrossRefPubMedGoogle Scholar
  43. Leipert BD, George JA (2008) Determinants of rural women’s health: a qualitative study in Southwest Ontario. J Rural Health 24(2):210–218. doi: 10.1111/j.1748-0361.2008.00160.x CrossRefPubMedGoogle Scholar
  44. Lingley-Pottie P, McGrath PJ (2007) Distance therapeutic alliance: the participant’s experience. ANS Adv Nurs Sci 30(4):353–366CrossRefPubMedGoogle Scholar
  45. Manian N, Schmidt E, Bornstein MH, Martinez P (2013) Factor structure and clinical utility of BDI-II factor scores in postpartum women. J Affect Disord 149(1–3):259–268. doi: 10.1016/j.jad.2013.01.039 CrossRefPubMedPubMedCentralGoogle Scholar
  46. McGrath PJ, Lingley-Pottie P, Thurston C, MacLean C, Cunningham C, Waschbusch DA, Watters C, Stewart S, Bagnell A, Santor D, Chaplin W (2011) Telephone-based mental health interventions for child disruptive behavior or anxiety disorders: randomized trials and overall analysis. J Am Acad Child Adolesc Psychiatry 50(11):1162–1172. doi: 10.1016/j.jaac.2011.07.013 CrossRefPubMedGoogle Scholar
  47. Milgrom J, Holt C, Holt CJ, Ross J, Ericksen J, Gemmill AW (2015) Feasibility study and pilot randomised trial of an antenatal depression treatment with infant follow-up. Arch Womens Ment Health 18(5):717–730. doi: 10.1007/s00737-015-0512-5 CrossRefPubMedGoogle Scholar
  48. Milgrom J, Danaher BG, Gemmill AW, Holt C, Holt CJ, Seeley JR, Tyler MS, Ross J, Ericksen J (2016) Internet cognitive behavioral therapy for women with postnatal depression: a randomized controlled trial of MumMoodBooster. J Med Internet Res 18(3):e54. doi: 10.2196/jmir.4993 CrossRefPubMedPubMedCentralGoogle Scholar
  49. Miniati M, Callari A, Calugi S, Rucci P, Savino M, Mauri M, Dell’Osso L (2014) Interpersonal psychotherapy for postpartum depression: a systematic review. Arch Womens Ment Health 17(4):257–268. doi: 10.1007/s00737-014-0442-7 CrossRefPubMedGoogle Scholar
  50. Moher D, Schulz KF, Altman DG (2001) The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet 357(9263):1191–1194. doi: 10.1016/S0140-6736(00)04337-3 CrossRefPubMedGoogle Scholar
  51. Mohr DC, Duffecy J, Jin L, Ludman EJ, Lewis A, Begale M, Jr MM (2010) Multimodal e-mental health treatment for depression: a feasibility trial. J Med Internet Res 12(5):e48. doi: 10.2196/jmir.1370 CrossRefPubMedPubMedCentralGoogle Scholar
  52. Nonacs R, Cohen LS (1998) Postpartum mood disorders: diagnosis and treatment guidelines. J Clin Psychiatry 59(Suppl 2):34–40PubMedGoogle Scholar
  53. Oates MR, Cox JL, Neema S, Asten P, Glangeaud-Freudenthal N, Figueiredo B, Yoshida K (2004) Postnatal depression across countries and cultures: a qualitative study. Br J Psychiatry 184(46):s10–s16. doi: 10.1192/bjp.184.46.s10 CrossRefGoogle Scholar
  54. O’Hara MW (1991) Prospective study of postpartum blues: biologic and psychosocial factors. Arch Gen Psychiatry 48(9):801–806. doi: 10.1001/archpsyc.1991.01810330025004 CrossRefPubMedGoogle Scholar
  55. O’Hara MW (1997) The nature of postpartum depressive disorders. In: Murray L, Cooper PJ (eds) Postpartum depression and child development. Guilford, New York, pp 3–31Google Scholar
  56. O’Hara MW, McCabe JE (2013) Postpartum depression: current status and future directions. Annu Rev Clin Psychol 9:379–407. doi: 10.1146/annurev-clinpsy-050212-185612 CrossRefPubMedGoogle Scholar
  57. O’Hara MW, Stuart S, Gorman LL, Wenzel A (2000) Efficacy of interpersonal psychotherapy for postpartum depression. Arch Gen Psychiatry 57:1039–1045. doi: 10.1001/archpsyc.57.11.1039 CrossRefPubMedGoogle Scholar
  58. O’Mahen HA, Richards DA, Woodford J, Wilkinson E, Mcginley J, Taylor RS, Warren FC (2013a) Netmums: a phase II randomized controlled trial of a guided Internet behavioural activation treatment for postpartum depression. Psychol Med 44(08):1675–1689. doi: 10.1017/s0033291713002092 CrossRefPubMedPubMedCentralGoogle Scholar
  59. O’Mahen HA, Woodford J, Mcginley J, Warren FC, Richards DA, Lynch TR, Taylor RS (2013b) Internet-based behavioral activation—treatment for postnatal depression (Netmums): a randomized controlled trial. J Affect Disord 150(3):814–822. doi: 10.1016/j.jad.2013.03.005 CrossRefPubMedGoogle Scholar
  60. Olsen JM, Nesbitt BJ (2010) Health coaching to improve healthy lifestyle behaviors: an integrative review. Am J Health Promot 25(1):e1–e12. doi: 10.4278/ajhp.090313-lit-101 CrossRefPubMedGoogle Scholar
  61. Olthuis JV, Watt MC, Stewart SH (2015) Therapist-delivered distance cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database Syst Rev 3:CD011565. doi: 10.1002/14651858.cd009028 Google Scholar
  62. Pearson RM, Melotti R, Heron J, Joinson C, Stein A, Ramchandani PG, Evans J (2012) Disruption to the development of maternal responsiveness? The impact of prenatal depression on mother–infant interactions. Infant Behav Dev 35(4):613–626. doi: 10.1016/j.infbeh.2012.07.020 CrossRefPubMedGoogle Scholar
  63. Perkins D, Fuller J, Kelly BJ, Lewin TJ, Fitzgerald M, Coleman C, Buss R (2013) Factors associated with reported service use for mental health problems by residents of rural and remote communities: cross-sectional findings from a baseline survey. BMC Health Serv Res 13(1):157. doi: 10.1186/1472-6963-13-157 CrossRefPubMedPubMedCentralGoogle Scholar
  64. Priest S, Henderson J, Evans S, Hagan R (2003) Stress debriefing after childbirth: a randomized controlled trial. Med J Aust 178:542–5Google Scholar
  65. Quevedo LA, Silva RA, Godoy R, Jansen K, Matos MB, Pinheiro KA, Pinheiro RT (2011) The impact of maternal post-partum depression on the language development of children at 12 months. Child Care Health Dev 38(3):420–424. doi: 10.1111/j.1365-2214.2011.01251.x CrossRefPubMedGoogle Scholar
  66. Riskind JH (1987) Reliability of DSM-III diagnoses for major depression and generalized anxiety disorder using the structured clinical interview for DSM-III. Arch Gen Psychiatry 44(9):817–820. doi: 10.1001/archpsyc.1987.01800210065010 CrossRefPubMedGoogle Scholar
  67. Sockol LE (2015) A systematic review of the efficacy of cognitive behavioral therapy for treating and preventing perinatal depression. J Affect Disord 177:7–21. doi: 10.1016/j.jad.2015.01.052 CrossRefPubMedGoogle Scholar
  68. Sourander A, McGrath PJ, Ristkari T, Cunningham C, Huttunen J, Lingley-Pottie P, Yli-Hinkka-Salomäki S, Kinnunen M, Vuorio J, Sinokki A, Fossum S, Unruh A (2016) Internet-assisted parent training intervention for disruptive behavior in 4-year-old children: a randomized clinical trial. JAMA Psychiatry 73(4):378–387. doi: 10.1001/jamapsychiatry.2015.3411 CrossRefPubMedGoogle Scholar
  69. Villegas L, Mckay K, Dennis C, Ross LE (2010) Postpartum depression among rural women from developed and developing countries: a systematic review. J Rural Health 27(3):278–288. doi: 10.1111/j.1748-0361.2010.00339.x CrossRefPubMedGoogle Scholar
  70. Vesga-López O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS (2008) Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry 65(7):805. doi: 10.1001/archpsyc.65.7.805 CrossRefPubMedPubMedCentralGoogle Scholar
  71. Whiffen VE, Gotlib IH (1993) Comparison of postpartum and nonpostpartum depression: clinical presentation, psychiatric history, and psychosocial functioning. J Consult Clin Psychol 61(3):485–494. doi: 10.1037/0022-006x.61.3.485 CrossRefPubMedGoogle Scholar
  72. Wisner KL, Chambers C, Sit DK (2006) Postpartum depression: a major public health problem. JAMA 296(21):2616–2618. doi: 10.1001/jama.296.21.2616 CrossRefPubMedGoogle Scholar
  73. Yawn BP, Dietrich AJ, Wollan P, Bertram S, Graham D, Huff J, Kurland M, Madison S, Pace WD (2012) TRIPPD: a practice-based network effectiveness study of postpartum depression screening and management. Ann Fam Med 10(4):320–329. doi: 10.1370/afm.1418 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Wien 2017

Authors and Affiliations

  • Lori Wozney
    • 1
    • 2
    Email author
  • Janine Olthuis
    • 3
  • Patricia Lingley-Pottie
    • 1
    • 2
    • 4
    • 5
  • Patrick J. McGrath
    • 1
    • 2
    • 4
    • 5
  • William Chaplin
    • 6
  • Frank Elgar
    • 7
  • Brianna Cheney
    • 6
  • Anna Huguet
    • 1
    • 2
    • 4
  • Karen Turner
    • 1
  • Jillian Kennedy
    • 5
  1. 1.Centre for Research in Family HealthHalifaxCanada
  2. 2.IWK Health CentreHalifaxCanada
  3. 3.University of New BrunswickFrederictonCanada
  4. 4.Dalhousie UniversityHalifaxCanada
  5. 5.Strongest Families InstituteLower SackvilleCanada
  6. 6.Department of PsychologySt. John’s UniversityQueensUSA
  7. 7.McGill UniversityMontrealCanada

Personalised recommendations