Midwife-led psychoeducational life skills training reduces anxiety, stress, and depression in pregnant adolescents: a randomized trial.

Adolescent pregnancy is associated with elevated stress, anxiety, and depression, often exacerbated by limited social support. Despite the recognized risks faced by pregnant adolescents, there is a paucity of research evaluating the effectiveness of psychoeducational interventions specifically integrated into antenatal care for this population. Midwife-led care is widely recognized for its holistic and personalized approach, which is particularly valuable for adolescent mothers. Psychoeducational interventions, enhancements have shown promise in reducing psychological distress and improving well-being among pregnant adolescents. However, evidence remains limited, with few randomized controlled trials evaluating the impact of these interventions when delivered as part of routine childbirth preparation classes. This study aimed to assess the effect of a midwife-led psychoeducational life skills intervention, incorporated into routine childbirth preparation classes, on pregnancy-related anxiety, stress, depression, and perceived social support in pregnant adolescents. This randomized controlled trial involved 90 pregnant adolescents recruited from health centers, with 45 participants assigned to the intervention group and 45 to the control group. The intervention group received ten structured psychoeducational sessions focusing on life skills, delivered by a trained instructor alongside standard childbirth preparation classes. The control group received only routine prenatal education. The control group received routine care only. Outcome assessors were blinded to group allocation. Primary outcomes were pregnancy-related anxiety, perceived stress, and depression; the secondary outcome was perceived social support. Data were collected using validated self-report measures at three time points: baseline (pre-intervention), immediately post-intervention, and one month after the intervention. Statistical analyses were performed using SPSS version 22, including repeated-measures analysis of variance (ANOVA), independent t-tests, and chi-square tests. Ethical approval: IR.AJUMS.REC.1402.140. Trial registration: IRCT20190129042544N1 (26 June 2023). Compared with controls, the intervention group demonstrated significant reductions in anxiety (η² = 0.32, p < 0.001), perceived stress (η² = 0.29, p < 0.001), and depression (η² = 0.31, p < 0.001). Perceived social support increased within both groups, but between-group differences were not significant (p = 0.238). The group × time interaction was statistically significant for anxiety, stress, and depression, compared with the control group, and this effect was maintained at both the 1-month and 3-month follow-up assessments, indicating the sustained efficacy of the midwife-led psychoeducational life skills program. The integration of a psychoeducational life skills program into routine midwife-led antenatal education proved effective in improving the psychological well-being of pregnant adolescents, as evidenced by significant reductions in anxiety, stress, and depression. These findings support the inclusion of structured psychoeducational interventions in adolescent maternity care services to promote mental health during pregnancy. While both the intervention and control groups experienced increased perceived social support, the lack of a significant between-group difference suggests that additional or alternative strategies may be needed to further enhance social support outcomes in this population.Trial registration: The study protocol was prospectively registered in the Iranian Registry for Randomized Controlled Trials on 26 June 2023 (registration number: IRCT20190129042544N1), and participant recruitment began on October 1, 2024.