Effects of a family-centered empowerment intervention on role adaptation and depressive symptoms in high-risk primigravidas and their partners

BACKGROUND: First-time parenthood requires substantial role adjustment and may challenge mental health, particularly in families experiencing medically high-risk pregnancies. Evidence is limited on whether empowerment-oriented dyadic interventions can improve parental role adaptation and depressive symptoms among high-risk primigravidas and their partners. AIM: To evaluate the effects of an empowerment-oriented dyadic intervention on parental role adaptation and depressive symptoms among high-risk primigravidas and their partners. METHODS: A randomized controlled trial was conducted in the maternity clinic of a regional hospital in China. A total of 100 high-risk primigravidas and their partners (100 dyads) were randomized 1:1 to an empowerment-based dyadic intervention (four group sessions, 60 min each) or routine antenatal care. Outcomes were assessed at baseline (late pregnancy, T1), 2-3 days postpartum (T2), and 6 weeks postpartum (T3) using the Family Adaptation Scale and the Edinburgh Postnatal Depression Scale (EPDS). Intervention effects were evaluated using dyad-adjusted linear mixed-effects models under the intention-to-treat principle. RESULTS: Compared with controls, mothers in the intervention group showed higher role adaptation at 2-3 days postpartum (T2) and 6 weeks postpartum (T3), with adjusted mean differences (AMD; Intervention-Control) of 5.96 (p < 0.001) and 6.84 (p < 0.001), respectively. Maternal depressive symptoms were also lower in the intervention group at both follow-ups (T2: AMD = - 2.72, p < 0.001; T3: AMD = - 2.26, p = 0.004). For fathers, role adaptation scores were higher in the intervention group at T2 and T3 (AMD = 4.09, p = 0.013; AMD = 3.40, p = 0.046), although the between-group differences in change from baseline were not statistically significant. Paternal depressive symptoms were lower in the intervention group at T2 (AMD = - 2.12, p = 0.006), whereas the between-group difference at T3 was not statistically significant (AMD = - 1.25, p = 0.112). Overall, intervention effects were consistently observed through 6 weeks postpartum for maternal outcomes, while evidence for paternal benefits was less consistent across outcomes and follow-up assessments. CONCLUSION: This brief empowerment-oriented dyadic intervention was associated with improved maternal role adaptation and reduced maternal depressive symptoms through the early postpartum period. Paternal benefits were observed for some outcomes, but were less consistent over time. Further trials in more diverse and higher-risk populations are warranted. CLINICAL TRIAL REGISTRATION: This trial was retrospectively registered in the Chinese Clinical Trial Registry on 18 March 2025 (ChiCTR2500099055).