Skip to main content
SpringerLink
Log in

Effects of ePREP and OurRelationship on Low-Income Couples’ Mental Health and Health Behaviors: a Randomized Controlled Trial

Prevention Science volume 21, pages 861–871 (2020)Cite this article

Abstract

Relationship distress is a pervasive problem in the USA that disproportionally impacts couples with low-income levels. The goal of the present study was to evaluate the effectiveness of two online relationship interventions, OurRelationship and ePREP, both of which were supported by a paraprofessional coach, in improving mental health and physical health behaviors with low-income couples. Couples (N = 742) were randomized to either intervention or a 6-month waitlist control group and assessed pre-, mid-, and post-intervention as well at 4 and 6 months after randomization. Results from multilevel models indicated that during treatment, compared to couples in the waitlist group, couples in the intervention groups reported significantly greater improvements in mental health that were small to moderate in magnitude (psychological distress, anger, problematic alcohol use, and perceived stress) as well as improvements in physical health/health behaviors (perceived health, insomnia, and exercise) that were small in magnitude. Furthermore, the differences between intervention and waitlist groups were maintained over follow-up. Treatment gains in both mental health and physical health behaviors were generally stronger for those who began treatment with greater difficulties in those areas. Implications of these findings with regard to intervention and policy are discussed.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

Notes

  1. According to one partner’s reports of annual household income, all couples were within 200% of the federal poverty line. However, when annual household income was extrapolated from each individual’s reports of individual income in the last 30 days, 85% of couples fell within that range. It is unclear which method of reporting is more accurate, so we include both here.

  2. In addition to testing initial levels of individual mental and physical health as moderators of outcomes, initial levels of relationship distress using the Couple Satisfaction Index (CSI-4; Funk and Rogge 2007) were tested as a moderator of mental health and physical health/health behaviors in separate analyses. No significant moderation effects were observed for initial gains during the intervention or for maintenance of those gains over follow-up by initial relationship distress with the exception of perceived health maintenance from post to follow-up such that those with distress reported greater gains over follow-up (see Supplementary Table 5).

References

  • Atkins, D. C. (2005). Using multilevel models to analyze couple and family treatment data: Basic and advanced issues. Journal of Family Psychology, 19, 98–110. https://doi.org/10.1037/0893-3200.19.1.98.

    Article  PubMed  Google Scholar 

  • Atkins, D. C., Dimidjian, S., Bedics, J. D., & Christensen, A. (2009). Couple discord and depression in couples during couple therapy and in depressed individuals during depression treatment. Journal of Consulting and Clinical Psychology, 77, 1089–1099.

    Article  PubMed  Google Scholar 

  • Barton, A. W., Beach, S. R., Bryant, C. M., Lavner, J. A., & Brody, G. H. (2018). Stress spillover, African Americans’ couple and health outcomes, and the stress-buffering effect of family-centered prevention. Journal of Family Psychology, 32, 186–196. https://doi.org/10.1037/fam0000376.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bastien, C. H., Vallières, A., & Morin, C. M. (2001). Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Medicine, 2, 297–307. https://doi.org/10.1016/S1389-9457(00)00065-4.

    Article  PubMed  Google Scholar 

  • Beach, S. R., & O’Leary, K. D. (1993). Marital discord and dysphoria: For whom does the marital relationship predict depressive symptomatology? Journal of Social and Perssonal Relationships, 10, 405–420.

    Article  Google Scholar 

  • Bessaha, M. L. (2017). Factor structure of the Kessler psychological distress scale (K6) among emerging adults. Research on Social Work Practice, 27, 616–624. https://doi.org/10.1177/1049731515594425.

  • Braithwaite, S. R., & Fincham, F. D. (2007). ePREP: Computer based prevention of relationship dysfunction, depression and anxiety. Journal of Social and Clinical Psychology, 26, 609–622. https://doi.org/10.1521/jscp.2007.26.5.609.

    Article  Google Scholar 

  • Braithwaite, S. R., & Fincham, F. D. (2009). A randomized clinical trial of a computer based preventive intervention: Replication and extension of ePREP. Journal of Family Psychology, 23, 32–38. https://doi.org/10.1037/a0014061.

    Article  PubMed  Google Scholar 

  • Braithwaite, S. R., & Fincham, F. D. (2014). Computer-based prevention of intimate partner violence in marriage. Behaviour Research and Therapy, 54, 12–21. https://doi.org/10.1016/j.brat.2013.12.006.

    Article  PubMed  Google Scholar 

  • Bramlett M. D. & Mosher, W. D. Cohabitation, marriage, divorce, and remarriage in the United States. Hyattsville, MD 2002.

  • Carlson, R. G., Daire, A. P., & Bai, H. (2014). Examining relationship satisfaction and individual distress for low-to-moderate income couples in relationship education. The Family Journal, 22, 282–291. https://doi.org/10.1177/1066480714529741.

    Article  Google Scholar 

  • Carlson, R. G., Rappleyea, D. L., Daire, A. P., Harris, S. M., & Liu, X. (2017). The effectiveness of couple and individual relationship education: Distress as a moderator. Family Process, 56, 91–104. https://doi.org/10.1111/famp.12172.

    Article  PubMed  Google Scholar 

  • Cheng, S. K., & Dizon, J. (2012). Computerised cognitive behavioural therapy for insomnia: A systematic review and meta-analysis. Psychotherapy and Psychosomatics, 81, 206–216. https://doi.org/10.1159/000335379.

    Article  PubMed  Google Scholar 

  • Christensen, A., Atkins, D. C., Berns, S., Wheeler, J., Baucom, D. H., & Simpson, L. E. (2004). Traditional versus integrative behavioral couple therapy for significantly and chronically distressed married couples. Journal of Consulting and Clinical Psychology, 72, 176–191. https://doi.org/10.1037/0022-006X.72.2.176.

    Article  PubMed  Google Scholar 

  • Cohen, S., & Williamson, G. M. . (1988). Perceived stress in a probability sample of the United States The Social Psychology of Health (pp. 31–67). Newbury Park, CA.

  • Doss, B. D., Cicila, L. N., Georgia, E. J., Roddy, M. K., Nowlan, K. M., Benson, L. A., & Christensen, A. (2016). A randomized controlled trial of the web-based OurRelationship program: Effects on relationship and individual functioning. Journal of Consulting and Clinical Psychology, 84, 285–296. https://doi.org/10.1037/ccp0000063.

    Article  PubMed  PubMed Central  Google Scholar 

  • Doss, B. D., Knopp, K., Roddy, M. K., Rothman, K., Hatch, S. G., & Rhoades, G. (in press). Online programs improve relationship functioning for low-income couples: Results from a nationwide randomized controlled trial. Journal of Consulting and Clinical Psychology.

  • Doss, B. D., Mitchell, A., Georgia, E. J., Biesen, J. N., & Rowe, L. S. (2015). Improvements in closeness, communication, and psychological distress mediate effects of couple therapy for veterans. Journal of Consulting and Clinical Psychology, 83, 405–415. https://doi.org/10.1037/a0038541.

    Article  PubMed  Google Scholar 

  • Doss, B. D., Roddy, M. K., Nowlan, K. M., Rothman, K., & Christensen, A. (2019). Maintenance of gains in relationship and individual functioning following the online OurRelationship program. Behavior Therapy, 50, 73–86. https://doi.org/10.1016/j.beth.2018.03.011.

    Article  PubMed  Google Scholar 

  • Enders, C. K., Keller, B. T., & Levy, R. (2017). A chained equations imputation approach for multi-level data with categorical and continuous variables. Psychological Methods, Advance online publication. https://doi.org/10.1037/met0000148.

  • Funk, J. L., & Rogge, R. D. (2007). Testing the ruler with item response theory: Increasing precision of measurement for relationship satisfaction with the Couples Satisfaction Index. Journal of Family Psychology, 21, 572–583. https://doi.org/10.1037/0893-3200.21.4.572.

    Article  PubMed  Google Scholar 

  • Georgia Salivar, E. J., Roddy, M. K., Nowlan, K. M., & Doss, B. D. (2018). Effectiveness of OurRelationship program for underserved couples. Couple and Family Psychology: Research and Practice, 7, 212–226. https://doi.org/10.1037/cfp0000110.

    Article  Google Scholar 

  • Hawkins, A. J., & Erickson, S. E. (2015). Is couple and relationship education effective for lower income participants? A meta-analytic study. Journal of Family Psychology, 29, 59–68. https://doi.org/10.1037/fam0000045.

    Article  PubMed  Google Scholar 

  • HHS. Healthy People 2020. (2014); http://www.healthypeople.gov.

  • Johnson, C. A., Stanley, S. M., Glenn, N. D., Amato, P. R., Nock, S. L., & Markman, H. J. (2002). Marriage in Oklahoma: 2001 baseline statewide survey on marriage and divorce (S02096 OKDHS). Oklahoma City: Oklahoma Department of Human Services.

    Google Scholar 

  • Keller, B. T., & Enders, C. K. (2018). Blimp User’s manual (version 1.1). Los Angeles, CA.

  • Lorenz, F. O., Wickrama, K. A. S., Conger, R. D., & Elder Jr., G. H. (2006). The short-term and decade-long effects of divorce on women's midlife health∗. Journal of Health and Social Behavior, 47, 111–125. https://doi.org/10.1177/002214650604700202.

    Article  PubMed  Google Scholar 

  • Lundquist, E., Hsueh, J., Lowenstein, A. E., Faucetta, K., Gubits, D., Michalopoulos, C., & Knox, V. (2014). A family strengthening program for low-income families: Final impacts from the supporting healthy marriage evaluation. Washington: Office of Planning, Research and Evaluation, Administration for Children and Families.

    Google Scholar 

  • Markman, H. J., Stanley, S. M., & Blumberg, S. L. (2010). Fighting for your marriage. San Francisco: Jossey-Bass.

    Google Scholar 

  • McShall, J. R., & Johnson, M. D. (2015). The association between relationship distress and psyhopathology is consistent across racial and ethnic groups. Journal of Abnormal Psychology, 124, 226–231. https://doi.org/10.1037/a0038267.

    Article  PubMed  Google Scholar 

  • Pilkonis, P. A., Choi, S. W., Reise, S. P., Stover, A. M., Riley, W. T., & Cella, D. (2011). Item banks for measuring emotional distress from the patient-reported outcomes measurement information system (PROMIS®): Depression, anxiety, and anger. Assessment, 18(3), 263–283. https://doi.org/10.1177/1073191111411667.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pilkonis, P. A., Yu, L., Colditz, J., Dodds, N., Johnston, K. L., Maihoefer, C., et al. (2013). Item banks for alcohol use from the patient-reported outcomes measurement information system (PROMIS®): Use, consequences, and expectancies. Drug and Alcohol Dependence, 130, 167–177. https://doi.org/10.1016/j.drugalcdep.2012.11.002.

    Article  PubMed  Google Scholar 

  • Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods (Vol. 1). Sage.

  • Raudenbush, S. W., Bryk, A. S., Cheong, Y. F., Congdon Jr., R. T., & Toit, M. D. (2011). HLM7: Hierarchical linear and nonlinear modeling. Lincolnwood: Scientific Software International.

    Google Scholar 

  • Reger, M. A., & Gahm, G. A. (2009). A meta-analysis of the effects of internet-and computer-based cognitive-behavioral treatments for anxiety. Journal of Clinical Psychology, 65, 53–75. https://doi.org/10.1002/jclp.20536.

    Article  PubMed  Google Scholar 

  • Richards, D., & Richardson, T. (2012). Computer-based psychological treatments for depression: A systematic review and meta-analysis. Clinical Psychology Review, 32, 329–342. https://doi.org/10.1016/j.cpr.2012.02.004.

    Article  PubMed  Google Scholar 

  • Riper, H., Spek, V., Boon, B., Conijn, B., Kramer, J., Martin-Abello, K., & Smit, F. (2011). Effectiveness of E-self-help interventions for curbing adult problem drinking: A meta-analysis. Journal of Medical Internet Research, 13. https://doi.org/10.2196/jmir.1691.

  • Robles, T. F., Slatcher, R. B., Trombello, J. M., & McGinn, M. M. (2014). Marital quality and health: A meta-analytic review. Psychological Bulletin, 140, 140–187. https://doi.org/10.1037/a0031859.

    Article  PubMed  Google Scholar 

  • Schafer, J., Caetano, R., & Clark, C. L. (1998). Rates of intimate partner violence in the United States. American Journal of Public Health, 88, 1702–1704.

  • Schoenborn, C. A. (2004). Marital status and health: United States, 1999-2002. Advance Data, 351, 1–32.

    Google Scholar 

  • Slatcher, R. B. (2010). Marital functioning and physical health: Implications for social and personality psychology. Social and Personality Psychology Compass, 4, 455–469.

    Article  Google Scholar 

  • Ware Jr., J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 473–483.

  • Webb, T., Joseph, J., Yardley, L., & Michie, S. (2010). Using the internet to promote health behavior change: A systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. Journal of Medical Internet Research, 12, e4.

    Article  PubMed  PubMed Central  Google Scholar 

  • Whisman, M. A. (2007). Marital distress and DSM-IV psychiatric disorders in a population-based national survey. Journal of Abnormal Psychology, 116, 638–643. https://doi.org/10.1037/0021-843X.116.3.638.

    Article  PubMed  Google Scholar 

  • Whisman, M. A., Beach, S. R., & Snyder, D. K. (2008). Is marital discord taxonomic and can taxonomic status be assessed reliably? Results from a national, representative sample of married couples. Journal of Clinical and Consulting Psychology, 76, 745–755. https://doi.org/10.1037/0022-006X.76.5.745.

    Article  Google Scholar 

  • Whisman, M. A., Uebelacker, L. A., & Bruce, M. L. (2006). Longitudinal association between marital dissatisfaction and alcohol use disorders in a community sample. Journal of Family Psychology, 20, 164–167. https://doi.org/10.1037/0893-3200.20.1.164.

    Article  PubMed  Google Scholar 

  • YouGov Online Survey Firm .(2015, February). Nationally-representative sample of 3,000 married individuals ages 25–50 in the United States.

  • Zhang, Z., & Hayward, M. D. (2006). Gender, the marital life course, and cardiovascular disease in late midlife. Journal of Marriage and Family, 68, 639–657. https://doi.org/10.1111/j.1741-3737.2006.00280.x.

    Article  Google Scholar 

Download references

Acknowledgments

We would like to thank Sean Aaron, Zach Blackhurst, Tommy Chou, Krista Dowdle, Meghan Maddock, Ana Martinez de Andino, Hannah Mitchell, Kathryn Nowlan, Lane Richie, Karen Rothman, Alyssa Vazquez, and Sara Wigderson who served as coaches and Scott R. Braithwaite who served as a supervisor as well as Clark Brinson and Samantha Joseph who served as Project Coordinators for this study.

Funding

This research was supported by the U.S. Department of Health and Human Services, Administration for Children and Families, Grant Number 90FM0063. This project was also made possible by Grant Number 90PR0008 from the Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Office of Planning, Research and Evaluation, the Administration for Children and Families, or the U.S. Department of Health and Human Services.

Author information

Authors and Affiliations

  1. Department of Psychology, Univeristy of Miami, Coral Gables, FL, USA

    McKenzie K. Roddy & Brian D. Doss

  2. Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Boulevard, Houston, TX, 77030, USA

    McKenzie K. Roddy

  3. Department of Psychology, University of Denver, Denver, CO, USA

    Galena K. Rhoades

Authors
  1. McKenzie K. Roddy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Galena K. Rhoades
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brian D. Doss
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to McKenzie K. Roddy.

Ethics declarations

Conflict of Interest

Dr. Brian Doss is a co-inventor of the intellectual property used in this study and an equity owner in OurRelationship LCC.

Research Involving Human Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Miami IRB and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic Supplementary Material

ESM 1

(DOCX 78.7 kb)

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Roddy, M.K., Rhoades, G.K. & Doss, B.D. Effects of ePREP and OurRelationship on Low-Income Couples’ Mental Health and Health Behaviors: a Randomized Controlled Trial. Prev Sci 21, 861–871 (2020). https://doi.org/10.1007/s11121-020-01100-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11121-020-01100-y

Keywords

search

Navigation