Comparison of Depression and Anxiety Symptoms between Husbands of Women with High-Risk and Low-Risk Pregnancies: A Case-Control Study - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Official websites use .gov A .gov website belongs to an official government organization in the United States. Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. Search Log in Dashboard Publications Account settings Log out Search… Search NCBI Primary site navigation Search Logged in as: Dashboard Publications Account settings Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide PERMALINK Copy As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice Int J Fertil Steril . 2026 Apr 13;20(2):147–153. doi: 10.22074/IJFS.2025.2047264.1790 Search in PMC Search in PubMed View in NLM Catalog Add to search Comparison of Depression and Anxiety Symptoms between Husbands of Women with High-Risk and Low-Risk Pregnancies: A Case-Control Study Azita Ghanbarpour Azita Ghanbarpour , M.D. 1. Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran Find articles by Azita Ghanbarpour 1, * , Hossein Soltani Hossein Soltani , M.D. 2. Student Research Committee, Health Research Institute, Babol University of Medical Sciences, Babol, Iran Find articles by Hossein Soltani 2 , Zahra Geraili Zahra Geraili , Ph.D. 3. Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran Find articles by Zahra Geraili 3 , Seyyedeh Mahboubeh Mirtabar Seyyedeh Mahboubeh Mirtabar , Ph.D. 4. Clinical Research Development Unit of Rohani Hospital, Health Research Institute, Babol University of Medical Sciences, Babol, Iran Find articles by Seyyedeh Mahboubeh Mirtabar 4 , Hajar Adib-Rad Hajar Adib-Rad , Ph.D. 3. Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran Find articles by Hajar Adib-Rad 3, # , Mahbobeh Faramarzi Mahbobeh Faramarzi , Ph.D. 3. Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran Find articles by Mahbobeh Faramarzi 3, #, * Author information Article notes Copyright and License information 1. Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran 2. Student Research Committee, Health Research Institute, Babol University of Medical Sciences, Babol, Iran 3. Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran 4. Clinical Research Development Unit of Rohani Hospital, Health Research Institute, Babol University of Medical Sciences, Babol, Iran # These authors equally contributed to this work. * Corresponding Address: P.O.Box: 4717647745 Department of General Courses Social Determinants of Health Research Center Health Research Institute Babol University of Medical Sciences Babol, Iran Email: [email protected] Received 2024 Dec 2; Revised 2025 Jun 7; Accepted 2025 Jul 12; Issue date 2026 Apr-Jun. Any use, distribution, reproduction or abstract of this publication in any medium, with the exception of commercial purposes, is permitted provided the original work is properly cited. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial 3.0 (CC BY-NC 3.0) License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. PMC Copyright notice PMCID: PMC13080714 PMID: 41983362 Abstract Background: High-risk pregnancies, due to the need for special care and medical risks, can lead to increased stress, anxiety, and even depression in the spouses of pregnant women. This study aimed to compare symptoms of depression and anxiety in the spouses of women with high-risk and low-risk pregnancies. Materials and Methods: This case-control study was conducted using a case-control design. The study population included the spouses of women with high-risk and low-risk pregnancies who entered in the Babol Pregnancy Mental Health Registry. A purposeful sampling method was used, with 160 participants (80 in each group) selected for the study. Two groups were matched for age, education, job, and history of having psychiatric disorders. Data were collected using a demographic questionnaire and the Brief Symptom Index (BSI-18), and data analysis was performed using independent t tests and multivariate logistic regression. Results: The frequency of depression (66.3 vs. 51.2%), anxiety (65.0 vs. 33.8%), and psychological distress (48.8 vs. 31.3%) was significantly higher in the spouses of women with high-risk pregnancies compared to those with low-risk pregnancies. Logistic regression analysis revealed that the factors of high-risk pregnancy (B=0.195, 95% confidence interval (Cl)=[0.300-3.142], P=0.018) and a history of previous high-risk pregnancies (B=0.214, 95% Cl=[0.559-4.107], P=0.010) were significant predictors of depression in the spouses of women with high-risk pregnancies. Additionally, educational level (B=-0.185, 95% Cl=[0.258-3.278], P=0.022) and high-risk pregnancy status (B=0.293, 95% Cl=[1.295-4.240], P<0.001) were identified as predictors of anxiety in the spouses. Conclusion: High-risk pregnancy may be an important factor in the increased prevalence of depression and anxiety in spouses of pregnant women. These findings emphasize the importance of providing supportive interventions and psychological counseling for spouses alongside pregnant women with high-risk pregnancies. Keywords: Anxiety, Depression, High-Risk Pregnancy, Husband Introduction Pregnancy is one of the most critical and sensitive periods in a woman’s life, accompanied by numerous physical and psychological changes. These changes not only affect the mental health of pregnant women but also impact their husbands. In low-risk pregnancies, although concerns are generally fewer and more manageable, husbands may still experience emotional and psychological changes. Husbands of pregnant women play a crucial role in providing emotional and psychological support. However, they may also be affected by the changes and stresses associated with pregnancy, potentially experiencing symptoms of depression and anxiety ( 1 - 3 ). High-risk pregnancies, due to specific maternal or fetal conditions, require more specialized medical care, which can lead to heightened stress and anxiety for husbands. As a stressful period, high-risk pregnancy may contribute to increased levels of anxiety and depression not only in pregnant women but also in their husbands. Emerging evidence reveals that 25.6% of fathers in high-risk pregnancy contexts exhibit clinically significant mental health disorders, with anxiety and depression rates exceeding population norms ( 4 ). Longitudinal cohort studies indicate that 8.9% of partners exhibit high-risk depression scores during late pregnancy, increasing to 12.4% for anxiety symptoms one year postpartum ( 5 ). Stressors related to maternal and fetal health, financial and caregiving concerns, and uncertainty about the future can all elevate the risk of psychological symptoms in husbands. Consequently, high-risk pregnancies can negatively impact not only the pregnant women and their husbands but also the overall family dynamics and relationships ( 6 ). Neglecting the issue of paternal perinatal depression has been evident internationally, especially in mental health research and policy priorities. For example, evidence from the National Health Service (NHS) in recent years indicates that a significant number of new fathers, in addition to mothers, may experience symptoms of depression during the perinatal period ( 2 , 7 ). A comprehensive meta-analysis of 47 studies reported that the prevalence of prenatal depression in fathers was 9.76% across all trimesters, with specific rates of 13.59% in the first trimester, 11.31% in the second, and 10.12% in the third ( 8 ). Another meta-analysis on paternal prenatal depression found an overall prevalence of 10.4% during pregnancy ( 2 ). The prevalence of paternal perinatal depression in Iran exhibits substantial heterogeneity across studies, with reported rates ranging from 5 to 38.7% depending on methodological factors such as assessment tools, timing of measurement, and regional disparities ( 9 ). At the local level, a study in Babol reported prevalence rate of 20% among expectant fathers, indicating the potential influence of regional or contextual factors ( 10 ). Additionally, the prevalence of paternal perinatal depression has been reported as 10% in Australia ( 11 ), 9.8% in Germany ( 12 ), and 12.5% in China ( 13 ). The wide variation in prevalence rates may be attributed to geographical location, cultural factors, differences in the timing of depression screening across studies ( 14 ), the use of heterogeneous samples ( 15 ), and the distinct manifestations of depressive symptoms in men and women ( 16 , 17 ). Paternal perinatal anxiety also significantly impacts the father's well-being as well as the mental health of both the mother and child. For example, an anxious father may struggle to communicate his fears, anxieties, and parenting-related stress to his husbands, potentially straining their relationship and contributing to depressive symptoms in both husbands ( 18 ). A systematic review on the prevalence of paternal perinatal anxiety reported that 2 to 18% of fathers exhibited symptoms of anxiety during this period ( 19 ). The reported prevalence of paternal perinatal anxiety ranges from 2.4 to 12% in Australia ( 20 ), 10% in Portugal ( 21 ), and 2 to 3.5% in China ( 22 ). Growing evidence indicates that women experiencing high-risk pregnancies are more likely to suffer from severe psychiatric symptoms, such as anxiety and depression, compared to those undergoing low-risk pregnancies ( 23 ). One specific type of high-risk pregnancy is when there is a threat of miscarriage, which significantly increases psychological distress in expectant mothers. Although these maternal psychological effects have been well-documented, much less is known about the psychological impact on the husbands of women facing such complications. Studies on paternal mental health in the context of high-risk pregnancy particularly when there is a risk of fetal loss are scarce, and further investigation is needed to understand the extent and nature of psychiatric symptoms in this group ( 24 ). Given the undeniable influence of maternal mental health on the psychological well-being and emotional support provided by their husbands, and recognizing that women undergoing high-risk pregnancies have a heightened need for emotional support, this study aims to examine the psychological symptoms in husbands of women with high-risk pregnancies. Although prior studies have noted depressive symptoms among these partners, comparative evidence between high-risk and low-risk groups remains limited ( 18 - 24 ). By comparing these symptoms with those in husbands of women experiencing low-risk pregnancies, the study seeks to identify the psychological challenges faced by this group and to create a foundation for addressing and improving the mental health of both pregnant women and their husbands. The findings can also provide practical insights for healthcare providers and midwives, encouraging the integration of paternal mental health screening and support into routine prenatal care to enhance family health outcomes during pregnancy. Materials and Methods Study design This case-control study was conducted to compare depression and anxiety in husbands of women with high-risk and low-risk pregnancies. The study took place between 2023 and November 2024 in the hospitals affiliated with Babol University of Medical Sciences (Ayatollah Rohani and Yahyanejad Hospitals). Participants and sampling The principal investigator attended obstetrics clinics and gathered information on women with high-risk pregnancies from the Babol Pregnancy Mental Health Registry (BPMHR) (www.register.mubabol.ac.ir). Pregnant women with high-risk or low-risk pregnancies were recruited from the high-risk maternity wards of Babol University hospitals. After evaluating the inclusion and exclusion criteria for both the case and control groups, the investigator established contact with the pregnant women and obtained the phone numbers of their husbands. During a phone interview with the husbands of women in the high-risk group, eligibility criteria were assessed. For eligible participants, a demographic questionnaire and the Brief Symptom Inventory-18 (BSI18) were sent via an online link through the registry system (porsline®), delivered to their smartphones via SMS. Procedure All participants were fully informed about the study’s objectives and methods, and then signed the informed consent form. The inclusion criteria were as follows: i. Husbands of pregnant women with high-risk pregnancies, ii. Both the woman and her husbands must be over 18 years old, iii. Both husbands must have at least primary education, iv. They must have a smartphone to complete the questionnaires, and v. Both the woman and her husbands must consent to participate in the study. The inclusion criteria for the control group (low-risk pregnancies) were as follows: i. Husbands of women with low-risk pregnancies, ii. Matched with the case group by age, gestational age, and education level through frequency matching, and iii. The husbands must also consent to participate in the study. They should have at least primary education and own a smartphone. The exclusion criteria included: i. Lack of consent, ii. Presence of severe psychiatric disorders (e.g., bipolar disorder, psychosis) in the husbands of pregnant women as reported by the individual, and iii. Patients with incomplete information. A total of 200 eligible fathers were approached for the study. Of these, 160 participants (80 in each group) completed the questionnaires and met the inclusion criteria, resulting in a response rate of 80%. The sample size was determined based on the following formula and reference articles ( 25 ): ( z 1 - α 2 + z 1 - β ) 2 x ( 2 σ 1 2 ) ( µ 1 - µ 2 ) 2 α = 0.05 Z 1-α/2 =1.96 β=0.20 → 1-β =0.80 Z1-β=0.84 ∆=2.2 σ=4.8 ( 1.96 + 0.84 ) 2 ( 2 x 4.8 ) ( 2.2 ) 2 = 75 In this regard, the means and standard deviations of the "BSI-18 Questionnaire" in the two groups of a study of women hospitalized with high-risk pregnancies were con sidered to be (10.5 ± 4.8) and (13.27 ± 4.8), respectively ( 25 ). Assuming a significance level of 0.05, a power of 80%, and equal numbers in each group, the minimum sam ple size required in each group was determined to be 80 individuals. Based on a significance level of 0.05, a power of 80%, a standard deviation of 4.8, and an expected mean difference of 2.2, the required sample size was estimated to be approximately 75 participants per group. Accounting for a potential 10% attrition rate, the final sample size was in creased to 80 participants per group. Assuming some attri tion during the study, 100 questionnaires were distributed. Instruments Demographic questionnaire A sociodemographic questionnaire was used to describe the characteristics of the participants for women in terms of age, education, place of residence, pregnancy history, medical history and for men in terms of age, education, place of residence, medical history. The brief symptom inventory BSI-18 is an 18-item questionnaire that evaluates three symptoms: depression, anxiety, and somatization. It also measures the overall psychological distress index. Each subscale score ranges from 0 to 24, and the total score ranges from 0 to 72. The cutoff for symptoms in each subscale (depression, anxiety, and somatization) is a score ≤ 4, while the cutoff for the total score is ≤ 10. For women, the cutoff is 4 ≤ for depression, 6 ≤ for anxiety, and 5 ≤ for somatization. Additionally, the cutoff for the total score in women is 13 ≤. In the Iranian version of this questionnaire, the validity is 0.81 and the reliability is 0.90 ( 26 ). Ethical considerations The research proposal for this study was approved by the Ethics Committee in Research at Babol University of Medical Sciences (IR.MUBABOL.HRI.REC.1402.176). Confidentiality and protection of participants’ privacy were ensured, and the obtained information was kept confidential. The research results will be disclosed without mentioning the names or personal details of the individuals involved. Statistical analysis The data were analyzed using SPSS version 22 (IBM Corp., Armonk, NY, USA). Descriptive analysis was conducted using means and standard deviations (for quantitative variables) and frequencies and proportions (for qualitative variables). The formal normality tests were conducted. Based on these observations, the data were considered approximately normally distributed, and the use of t tests and linear regression analyses was deemed appropriate. To examine the desired relationships, t tests and chi-square tests were employed. Additionally, linear regression analysis with multiple variables was used to examine predictors of depression and anxiety symptoms. Variables for inclusion in the multivariate linear regression models were selected based on their significance in univariate analysis (P<0.01), as well as their clinical relevance as reported in previous literature. A significance level of 0.05 was considered. Results According to Table 1, 160 participants took part in this study (80 in the high-risk pregnancy group and 80 in the lowrisk pregnancy group). Most individuals in both groups were older than 30 years. In the high-risk pregnancy group, 55.0% of men and 57.5% of women had less than a high school diploma. The pregnant women in both high-risk and low-risk groups showed no significant differences in terms of age, gestational age, education, occupation, and psychiatric history, and were well-matched. Similarly, the spouses of the pregnant women in both the low-risk and high-risk groups showed no significant differences in demographic characteristics such as age, education, occupation, and psychiatric history, and were also well-matched. Table 1. Demographic characteristics of the two study groups Variable High-risk pregnancy Low-risk pregnancy P value* Men Women Men Women Men Women Age (Y) <30 32 (40.0) 19 (23.8) 34 (42.5) 20 (25.0) 0.500 0.436 >30 48 (60.0) 61 (76.3) 46 (57.5) 60 (75.0) Education High school 46 (57.5) 44 (55.0) 41 (52.5) 48 (60.0) 0.263 0.316 University 34 (42.5) 36 (45.0) 39 (48.8) 32 (40.0) Job Employee 8 (10.0) 30 (37.5) 12 (15.0) 27 (33.8) 0.237 0.371 Nonemployee 72 (90.0) 50 (62.5) 68 (85.0) 53 (66.3) Past history of psychiatric illness Yes 6 (7.5) 4 (5.0) 8 (10.0) 2 (2.5) 0.390 0.341 No 74 (92.5) 76 (95.0) 72 (90.0) 78 (97.5) Age (Y) 32.71 ± 6.11 36.76 ± 7.20 31.73 ± 5.31 36.03 ± 6.13 0.187 0.152 Open in a new tab Data are presented as mean ± SD or n (%). * ; t test was used to compare the mean scores of Age between the two groups (husbands of women with high-risk and low-risk pregnancies), while chi-square tests were applied to compare categorical variables such as educational level, job, and past history of psychiatric illness. The results of the analysis of the frequency of anxiety and depression in the husbands of pregnant women in the two study groups are shown in Table 2. In the comparison of depression scores, husbands of women with high-risk pregnancies had significantly higher depression levels compared to husbands of women with low-risk pregnancies (P=0.038). In the comparison of anxiety scores between the two groups, a statistically significant difference was found (P<0.001). Additionally, the total psychological distress score was significantly higher in the husband’s of women with high-risk pregnancies compared to those with low-risk pregnancies (P=0.018). Table 2. Comparison of the frequency of depression, anxiety, somatization, and psychological distress (based on BSI-18 cut-off scores) between high-risk and low-risk pregnancy groups Variable Pregnancy P value * * High-risk (n=80) Low-risk (n=80) Depression 0.038 No 27 (33.7) 39 (48.8) Yes 53 (66.3) 41 (51.2) Anxiety 0.001 No 28 (35.0) 53 (66.3) Yes 52 (65.0) 27 (033.7) Somatization 0.033 No 68 (85.0) 65 (81.2) Yes 12 (15.0) 15 (18.8) Psychological distress 0.018 No 41 (51.2) 55 (68.7) Yes 39 (48.8) 25 (31.3) Open in a new tab Data are presented as n (%). The cutoff point for symptoms in each of the depression subcomponents is ≤4, anxiety is ≤6, somatization is ≤5, and the cutoff point for the total score is ≤13 and ** ; Chi-square tests. The comparison of depression and anxiety levels based on demographic characteristics ( Table 3 ) showed that only among individuals with education levels higher than a high school diploma (P=0.049), a statistically significant difference in depression levels was observed between the two study groups. However, for other demographic characteristics, there was no significant difference in depression levels between the two groups. Additionally, anxiety levels were significantly higher in patients compared to healthy individuals across all demographic categories. Table 3. Comparison of depression and anxiety mean scores across demographic characteristics between two study groups Group Variable High-risk pregnancy Low-risk pregnancy P value * Depression Age (Y) <30 5.50 ± 2.98 6.09 ± 4.92 0.731 >30 5.66 ± 4.80 4.14 ± 4.14 0.051 Job Employee 4.83 ± 4.29 4.25 ± 2.83 0.550 Nonemployee 6.12 ± 4.63 4.49 ± 4.87 0.086 Education High school 5.09 ± 4.70 4.31 ± 5.05 0.448 University 6.30 ± 4.26 4.56 ± 2.80 0.540 Past history of psychiatric illness 8.00 ± 6.68 7.00 ± 0.00 0.784 Anxiety Age (Y) <30 8.50 ± 2.98 6.63 ± 4.92 0.286 >30 6.89 ± 5.08 4.24 ± 4.16 0.001 Job Employee 7.23 ± 4.14 4.44 ± 3.23 0.007 Nonemployee 7.14 ± 5.20 4.64 ± 4.80 0.013 Education High school 6.20 ± 4.93 4.04 ± 5.10 0.042 University 8.36 ± 4.43 5.37 ± 2.64 0.001 Past history of psychiatric illness 11.25 ± 3.09 3.00 ± 4.24 0.049 Open in a new tab Data are presented as mean ± SD. * ; t test was used to compare continuous variables (mean symptom scores) between groups. The impact of the studied variables (independent) on predictors of depression and anxiety symptoms was assessed using multivariate linear regression, as shown in Table 4. The results indicated that with the presence of the variables of high-risk pregnancy and a history of high-risk pregnancy, the level of depression in the husbands of women with high-risk pregnancies was significantly higher (P<0.001). Specifically, having a history of high-risk pregnancy in women was a predictor of depression in their husbands. Additionally, the results showed that with the inclusion of the variables of education level and high-risk pregnancy, the level of anxiety in the husbands of women with high-risk pregnancies was significantly higher (P<0.001). This suggests that having a university education and a high-risk pregnancy are predictors of anxiety in the husbands of pregnant women. Table 4. Predictors of depressive and anxiety symptoms in spouses of pregnant women with high-risk pregnancies Predictors Depression Anxiety P value Beta 95.0% CI for B P value Beta 95.0% CI for B Lower Bound Upper Bound Lower Bound Upper Bound Age (Y) 30< * vs. ≥30 0.013 -2.047 1.734 0.870 0.111 0.512 3.406 0.146 Education University * vs. high school 0.103 -0.534 2.382 0.213 0.185 0.258 3.278 0.022 Risk of pregnancy High-risk pregnancy * vs. low-risk pregnancy 0.195 0.300 3.142 0.018 0.293 1.259 4.240 <0.001 History of high-risk pregnancy history Yes * vs. No 0.214 0.559 4.107 0.010 0.116 0.488 3.188 0.149 Open in a new tab * ; Multivariate linear regression. Dependent variable: Depression and anxiety and CI; Confidence interval. Discussion This study aimed to compare symptoms of depression and anxiety in the husbands of women with high-risk and low-risk pregnancies. One of the key findings of this study revealed that anxiety levels were significantly higher in the husbands of women with high-risk pregnancies compared to those with low-risk pregnancies. This conclusion is supported by several studies that highlight the psychological impact of high-risk pregnancies, not only on the mother but also on their husbands. Furthermore, this finding indicates that high-risk pregnancies directly affect the mental health of the husbands of pregnant women, as the stressful conditions and concerns about the health of the mother and fetus contribute to greater anxiety in these individuals. Such anxiety may stem from concerns such as the possibility of preterm labor, the risk of miscarriage, the need for special care, or financial challenges related to additional healthcare expenses. This finding is consistent with previous studies. For example, the research by Petersen and Quinlivan ( 27 ) showed that the husbands of women at risk for preterm labor experienced significantly higher levels of anxiety compared to the husbands of women with normal, low-risk pregnancies. This result is also supported by the findings of Rao et al. ( 8 ), which indicated that anxiety levels were considerably higher in the husbands of women facing serious pregnancy complications. Additionally, research suggests that the presence and support of a husbands during pregnancy can significantly impact mental health outcomes ( 28 ). In cases where women face high-risk pregnancies, the stress associated with their condition often translates into increased anxiety for their husband’s, as they share the emotional burden of potential complications. In contrast, supportive husbands involvement has been shown to reduce this anxiety to some extent, although the inherent stressors of high-risk situations may still lead to heightened anxiety levels among husband’s ( 29 ). These findings may be interpreted through the lens of modern psychological frameworks such as the emotion regulation model ( 30 ), which highlights the role of coping capacities in managing stress. In the context of high-risk pregnancies, husbands may face ongoing emotional strain due to uncertainty, perceived lack of control, and fear of medical complications. When adaptive emotion regulation strategies—such as problem-solving or cognitive reframing—are not effectively employed, individuals may experience psychological distress, including anxiety and depression. These insights underscore the importance of integrating paternal mental health support into prenatal care, particularly in high-risk contexts. The results of the study showed that the frequency of depression symptoms was significantly higher in the husbands of women with high-risk pregnancies compared to those with low-risk pregnancies. This suggests that husbands of women with high-risk pregnancies are at greater risk for depression. One possible explanation for this could be the psychological pressure caused by the high-risk pregnancy, which can lead to feelings of hopelessness, helplessness, and anxiety about the future. This finding aligns with some previous studies, while it differs from others. For example, the study by Mohammadpour et al. ( 31 ) found that depression in the husbands of women with high-risk pregnancies was higher due to the psychological pressures they faced. In contrast, Wang et al. ( 32 ) showed that fathers' depression increased after the birth of their child when faced with pregnancy complications, but there were no significant changes during the pregnancy period. This discrepancy in results may be related to cultural differences and the social conditions of the participants. In societies where traditional gender roles place greater emphasis on men's economic and supportive responsibilities, the psychological pressures from high-risk pregnancies may affect depression differently. Additionally, men who have adequate social and emotional support may be less likely to experience depression. In societies where traditional gender roles dictate that men are primarily responsible for economic support, the psychological stress related to high-risk pregnancies may be exacerbated. This stress could lead to higher rates of depression among men who feel inadequate in fulfilling these roles, especially if they lack sufficient social support. However, men with strong social and emotional support networks are generally less prone to depression, which suggests that supportive systems can protect against the psychological stress related to traditional gender role expectations ( 33 ). Another important finding was that high-risk pregnancy is a strong predictor of increased levels of depression and anxiety in the husbands of pregnant women. These findings highlight the psychological pressures resulting from high-risk pregnancies, which are transferred to husbands due to concerns about the health of both the mother and the fetus. This result is consistent with previous studies. For instance, one study found that husbands of women at risk for preterm birth experienced significantly higher levels of anxiety compared to the husbands of women with low-risk pregnancies ( 27 ). This clearly demonstrates that high-risk pregnancy conditions, such as the possibility of preterm birth, can directly lead to increased anxiety in husbands. Furthermore, a meta-analysis found that husbands of women with serious pregnancy complications experienced significantly higher levels of anxiety and depression ( 8 ), which aligns well with the current study’s findings. Additionally, a study in Iran showed that husbands of women with high-risk pregnancies are more vulnerable to depression and anxiety due to concerns about their spouse's health ( 31 ). Another important finding was that demographic variables, such as education level and previous experience of high-risk pregnancies, were significantly related to the levels of anxiety and depression in husbands. Specifically, having an education level higher than high school and previous experience of high-risk pregnancies were associated with increased anxiety levels in the husbands. These findings align with previous research. For example, a study showed that husbands of individuals with higher education (above high school) exhibited higher levels of anxiety ( 34 ). This finding suggests that higher educational attainment might be related to increased awareness or concerns about pregnancy risks, potentially leading to higher anxiety. Additionally, husbands who had previously experienced high-risk pregnancies also exhibited higher levels of anxiety and depression. This can be attributed to their previous experiences, which likely influenced their perceptions and emotional responses during subsequent pregnancies ( 35 ). These findings underscore the importance of paying greater attention to the mental health of husbands of pregnant women, especially in high-risk pregnancy cases, and highlight the necessity of providing supportive interventions and counseling for this group. This study has significant clinical and practical implications. The findings can inform the development and integration of mental health screening protocols for the spouses of women with high-risk pregnancies in obstetric and midwifery settings. Incorporating mental health assessments into routine prenatal care can enable midwives, obstetricians, and healthcare providers to identify psychological distress early in expectant fathers and offer timely interventions. By addressing the emotional needs of both partners, these measures can help improve maternal emotional support, enhance family stability, and potentially contribute to better pregnancy outcomes. At the system level, these results highlight the importance of training maternity care teams in recognizing and managing paternal mental health issues, which can lead to more holistic and family-centered prenatal care models. Such practical steps could include administering brief mental health screening tools during prenatal visits, offering referral pathways to counseling services, and providing psychoeducational sessions or supportive resources tailored for expectant fathers. This study has several limitations that should be acknowledged. First, the cross-sectional design restricts the ability to draw causal inferences between high-risk pregnancies and psychological symptoms in husbands. Second, the study was conducted in a specific cultural and regional context in northern Iran, which may limit the generalizability of the findings to other populations and healthcare systems. Third, the analysis included only a limited number of demographic and psychological covariates. Important factors such as perceived social support, economic status, and prior mental health history were not assessed and may influence the outcomes. Future studies should consider longitudinal designs, diverse cultural settings, and a broader set of psychological and contextual variables. Conclusion The results of this study showed that husbands of women with high-risk pregnancies experienced significantly higher levels of depression and anxiety compared to the control group. A history of high-risk pregnancy in the wife was found to be a significant predictor of psychological symptoms in the husbands. Acknowledgments The authors thank the husbands of pregnant women who participated in the study. The Deputy of Research of Babol University of Medical Sciences approved and supported the study (Grant No.724134501). Author’s Contributions. M.F., A.Gh.; Conceptualization, Methodology, Software, Writing-reviewing, and Editing. H.S; Data curation and Conceptualization. H.A.-R.; Conceptualization and Writing-original draft preparation. A.Gh., S.M.M.; Supervision, Visualization, and Investigation. Z.G.; Methodology and Analysis of data. S.M.M.; Software and Validation. All authors read and approved the final manuscript. Footnotes Conflict of Interest: Hajar Adib-Rad and Mahbobeh Faramarzi are reviewers and editors for this journal. They did not participate in any capacity related to the peer review of this manuscript, nor were they involved in editorial decisions. 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