A study of the Couvade syndrome in the male partners of pregnant women in the UK
The Couvade syndrome or pregnancy-related symptoms in men occurs mainly in industrialised countries around the globe. However, a comprehensive review of available literature suggests that there is a notable dearth of research within the United Kingdom. To address this, a 2-phase study was conducted in the UK. Phase I comprised a qualitative phenomenological study of a purposive sample of fourteen .men, who were interviewed to explore the characteristics of the syndrome and explanations for it. The use of interview fieldnotes and summary sheets provided supplementary data. Three themes emerged from an inductive analytical approach: "emotional diversity in response to pregnancy", "nature, duration and management of symptoms" and "explanatory attempts for symptoms". Few, if any, previous study instruments of the Couvade syndrome have been informed by qualitative studies and evidence of their validation is lacking in the literature. Phase II sought to develop and pilot test a structured questionnaire based on the findings of the qualitative study to assess the physical and psychological symptoms of the syndrome in 23 purposively selected male partners of pregnant women. The questionnaire was completed repeatedly over two time periods. The Cronbach Alpha Coefficient of reliability test for the total scale was 0.89. Other tests of internal consistency showed high reliability and validity, except for nine items, which were subsequently removed from the final amended questionnaire. Few studies have investigated the type, severity, distress and duration of the syndrome's symptoms collectively. These were investigated using the newly developed questionnaire and the perceived stress coping scale in an experimental group of men with pregnant partners (n =182) over the 1st and 3rd trimesters of gestation and 4-weeks into the postpartum period. This was compared with a control group (n = 181) whose partners were not pregnant over a 3 and 6-month comparative time period. Results indicated a significantly higher incidence of 26 physical and 17 psychological symptoms associated with the syndrome for those in the experimental group. There were also statistically higher median severity and distress values for the majority of physical and psychological symptoms in the experimental. group. Symptom severity and distress for physical and psychological symptoms commenced in 1st trimester, dissipated in 2nd trimester, returned in the 3rd trimester and then decreased upon the birth or shortly in the postpartum period except for a minority of symptoms. For the control group the median severity and distress scores for physical and psychological symptoms between 3 and 6-month comparative time periods were all non-significant except for "sore gums" which revealed a statistically significant decrease between these periods. In the experimental group the physical symptoms of the longest duration in the 1st trimester were "stomach pain/cramps and "back pain", "weight gain" and, "stomach distension" in the 3rd trimester and, "tiredness" in the postpartum period, The psychological symptom of the longest duration during the 1 st and 3rd trimesters was "sleeping less than usual" and, "early morning waking" in the postpartum period. In the experimental group there no statistically significant associations between age and the severity and distress of physical and psychological symptoms. There was only one significant association between social class and the severity of the physical symptom of "poor appetite" and none for the distress of the remaining physical symptoms. There were statistically significant associations between social class and the severity scores of three psychological symptoms including "early morning waking", "feeling frustrated" and "feeling stressed". There were also statistically significant associations between social class and the distress scores of "sleeping less than usual" and "feeling frustrated". The largest number of associations were evident between the previous number of children and severity scores of "unable to keep food down", "cough"," sore throat", "pain while urinating", "toothache, "sore gums" and "mouth ulcers". Significant associations between previous number of children and the distress scores were also shown for "stomach pain/cramps" (P=O.018), "indigestion, "cough"," urinating more than usual" and "sore gums". There were also significant associations with the severity scores of 2 psychological symptoms namely, "sleeping less than usual" and "unable to cope with daily life" and the distress scores of the preceding symptom and "early morning waking". Binary logistic regression revealed five physical symptoms as strong predictors of the Couvade syndrome namely, "cough", "leg cramps", "headache" and "diarrhoea" and "pain while urinating" and four, which were weak or unreliable predictors with low R2 values. There were also three psychological symptoms, which were revealed as strong predictors of the syndrome including "loss of concentration", "sleeping less than usual" and "lack of motivation" and a further four, which were weak predictors. There was a higher incidence of all perceived stress coping (PSC) indicators as well as statistically higher median scores for the majority of indicators in the experimental compared to the control group. Between the 1st and 3rd trimesters of pregnancy the median scores of all PSC indicators increased, as did seven in the postpartum period where a further two decreased and one remained constant. For the control group the median PSC scores between 3 and 6-month comparative time periods were all non-significant. For the experimental group, the association between total perceived stress coping scores and the severity scores for physical and psychological symptoms showed no statistically significant relationships at all which was surprising. Binary logistic regression revealed 5 perceived stress coping indicators as weak or unreliable predictors of the Couvade syndrome with low R2 values. Thus, the results support the existence of the Couvade syndrome and its time course, and the male partner's of pregnant women in the study confirmed symptoms as severe and distressing. In view of such findings, men's health needs should be accorded a greater profile within the realms of antenatal care as their health can affect pregnancy outcome. In addition, past problems with the syndrome's diagnosis should now be resolved with regression analysis identifying clear symptom predictors for its presence.