It is already known that pregnancy and the transition to parenthood include significant biological and psychosocial changes that have been associated with increased anxiety symptoms, depressive symptoms and discomfort. Approximately 20 to 50% of women in developing countries will be confronted with issues related to mental health during the perinatal period [1]. Perinatal mental illness is a major complication of pregnancy and the postpartum period. These disorders include depression, anxiety disorders and postpartum psychosis, which usually manifests as bipolar disorder [2], maternal obsessive compulsive disorder (OCD) [3] and postpartum posttraumatic stress disorder (PTSD) [4]. Perinatal mental illness has been recognized since the time of Hippocrates and commented on through the centuries. The International Marce Society for Perinatal Mental Health, devoted to the study of perinatal mental disorders, has published a significant number of case studies of women suffering from various forms of perinatal mental disorders, 150 years ago [5]. Nowadays, research in this field on the prevalence and risk factors of mental illness has increased dramatically; as a result, many government agencies and specialist teams have developed guidelines for the diagnosis and management of these diseases ^[6][7][8][6,7,8].

Depression and anxiety symptoms have been found to be the most frequent mental health issues that are manifested by women during the perinatal period from the beginning of pregnancy until one year later [9], while proposals have been made to ensure the provision of perinatal mental health services to women two years after childbirth [10]. Depression and anxiety have been found to affect both potential mothers and fathers ^[11][12][11,12]. The manifestation of mental health issues during the perinatal period can be attributed to the drastic psychological and psychosocial changes that the future parents face during the perinatal period [10].

The data presented above suggest that the mental health of both women and men faces many challenges during the perinatal period. However, data deriving from relevant studies regarding the prevalence rates of depression and anxiety symptoms among women and men during the perinatal period is controversial, since the prevalence rates range from 4.8 to 86.5% for depression and from 10.1 to 75.6% for anxiety [13]. Moreover, depression and anxiety symptoms manifested during the perinatal period have been found to have a significantly negative effect on the infant’s mental and physical health, since the manifestation of mental health issues has been found to be positively associated with preterm birth, lower birth weight [14], perinatal effects and cesarean section [15]. Thus, depression and anxiety symptoms during the perinatal period have been found to be both of high prevalence and a significant risk factor for the infant’s health. The symptoms of depression, anxiety and stress that women may experience from conception to one year after giving birth are described as perinatal distress [16]. Although perinatal distress can be connected to physiological processes, the literature shows that the social support [17] and the quality of social relationships are responsible for much of the variability in depressive symptoms among young mothers [18].

The term social support refers mainly to any kind of help received from various sources, with an emphasis on how the support is perceived by the recipient [19]. The term “partner support” means the process of responding with supportive actions (behavioral as well as psychological) to a difficulty or problem experienced by the partner in a couple relationship [20]. However, the most significant support source for the reduction of mental health issues during the perinatal period is the relationship with the partner. Many studies indicate that a future mother not only has a wide and effective social support network to deal with the risk of developing mental health problems during the perinatal period [21], but also the future mother’s relationship with her partner has been found to be one of the most effective and important protective factors during the perinatal period ^{[22][23][24][25]}[22,23,24,25]. It is a fact that effective supportive behavior from the partner enhances relationship satisfaction and promotes mental and physical health. Satisfaction through a quality relationship, and the intimacy that results from it, has proven to be a strong prognostic factor of adequate mental health in the perinatal period for women [26]. Even in the case of women suffering from depression in pregnancy, the supportive role of the husband managed to minimize these depressive symptoms in the postnatal period [18].

Based upon the information provided above, it is evident that the manifestation of depression and anxiety symptoms is of high prevalence during the perinatal period, affecting both women and men. Moreover, the manifestation of mental health issues during the perinatal period is a significant risk factor negatively affecting the infant’s health [27].

Severe mental health problems during the antenatal period were a more frequent sign in women with low partner support. More specifically, there is a strong correlation between prenatal depression ^[28][29][28,30], prenatal anxiety ^[30][31][33,35] or prenatal distress ^{[21][32][33][34][35]}[21,29,31,32,34], which constitutes an umbrella term to describe anxiety and depressive symptoms during the perinatal period ^[36][52], with low partner support. Of course, domestic violence during pregnancy ^[28][29][33][28,30,31], partner infidelity ^[28][29][28,30] or partner tension ^[30][33] are considered factors of low satisfaction in a partner relationship ^[37][53]. However, the probabilities that increase the levels of woman’s dissatisfaction in the partner are explained by the positive or negative support provided to her by her partner and financial difficulties. In fact, prosperity in the relationship can be disrupted through financial problems ^{[28][32][29][38]}[28,29,30,54], while lower educational levels ^[32][34][29,32], younger age ^[29][30] and a history of mental illness ^[33][30][31,33] can be contributing factors to prenatal distress ^[29][30]. Furthermore, the fact that women with unplanned and unwanted pregnancies have a significantly higher rate of depression symptoms than women with planned pregnancies ^[34][35][32,34] suggests that they may need more partner and social support.

Certainly, a non-supportive partner during pregnancy will not be able to offer support to the mother during labor and also will not be able to offer her support during the postpartum period ^[39][40][36,55]. This can be explained by the opportunity provided to the partner by his wife to become part of the experience of childbirth and to participate directly in the care of the woman and the infant. At this point, it should be mentioned that a postpartum woman needs more support from her family than in pregnancy, especially from her husband ^[41][37]. A possible explanation for this phenomenon could be that some women may be more vulnerable to partner and family postpartum support, due to the need for infant care and the hormonal variability that makes her more sensitive ^[42][56].

The high quality and quantity of prenatal support of the partner can contribute not only to the improvement of the health of the mother, but also of the infant during the postpartum period ^[43][39]. One possible indirect mechanism is that effective partner support and lower maternal emotional distress could both enable mothers to adopt more sensitive and committed behaviors.

Finally, partner support was a major predictor for maternal distress. A poor-quality couple relationship, particularly in conjunction with other stressors such as financial difficulties, partner infidelity, partner tension and domestic violence, is a strong predictor for perinatal distress. The World Health Organization has advised health policies on mental health problems ^[44][57] and especially on maternal mental health ^[45][58], emphasizing the importance of early detection and screening for perinatal distress, perinatal care and implications for training.

3. Conclusions

Pregnancy is a period of hormonal and emotional changes in a woman’s life. During this period the woman has more access to the health system and therefore, it is a reasonable period to apply screening for prenatal distress. Given the high prevalence of perinatal distress, early midwifery interventions may have important maternal and child outcomes. The role of the partner should be strengthened and included in prenatal care as it seems it is very helpful. The partner’s own mental health should be evaluated at the same time, since it is expected to contribute substantially to the improvement of the mother’s mental health. Furthermore, midwives and other perinatal health care professionals should work together to provide support and empowerment to women and couples throughout the perinatal period. In addition, through the Mental Health Liaison Team, suspicious cases will be detected, evaluated and treated individually.