Australian adolescents' attitudes and beliefs concerning pregnancy, childbirth and parenthood: the development, psychometric testing and results of a new scale

Longitudinal trajectories and associated risk factors of paternal mental illness in the nine years surrounding the transition to fatherhood

BACKGROUND

The arrival of one's first child is a known risk factor for mental illness, yet investigations on fathers' mental health are limited. We conducted a longitudinal investigation on paternal depression and anxiety in the nine years surrounding the transition to fatherhood.

METHODS

Using a national cohort of French men (CONSTANCES, n = 6299), we investigated the prevalence and associated risk factors of mental illness amongst first-time fathers. Responses to the Center for Epidemiological Studies Depression (CES-D) and 12-item General Health Questionnaire (GHQ-12) scales were used to identify clinically significant symptom scores. Self-declared mental illness was also reported by participants. Group-based modelling was used to identify latent trajectory groups for both measures.

RESULTS

Levels of self-declared anxiety (averaging 4.9 % pre-fatherhood, 7.8 % post) exceeded that of depression (1.9 % pre- fatherhood, 3.3 % post) or other disorders. However, rates of clinically significant symptom scores (17-27 %) were consistently higher. Participants' mental health appeared to worsen from two-years prior to their child's arrival and improve from two-years after. We identified three trajectory groups for fathers' self-declared mental illness: Low stable (90.3 %); Low risk with high temporary increase (5.6 %); and Consistent high risk (4.1 %). Risk factors associated with worsening mental health trajectories were unemployment, not living with one's partner, having had adverse childhood experiences and foregoing healthcare due to financial reasons.

LIMITATIONS

All measures of mental illness relied on participant self-reports and are thus subject to bias.

CONCLUSIONS

This study reveals an important period of heightened psychological vulnerability amongst first-time fathers, emphasising the need for increased and better adapted paternal mental health screening.

Factors Influencing Female Caregivers' Appraisals of Their Preschoolers' Behaviors

INTRODUCTION

This study used the Resiliency Model of Family Stress, Adjustment, and Adaptation to explore family factors associated with primary female caregivers' appraisals of children's behaviors, distortion of their appraisals, and children's risk of having behavioral problems.

METHOD

A cross-sectional, correlational design was used. Data were collected from female caregivers of preschoolers. Instruments measured demographic characteristics, comfort in parenting, appraisal of behaviors, daily and parenting stress, depressive symptoms, social support, ratings of children's behaviors, and distortion in ratings. Analyses included χ² and simultaneous linear regression.

RESULTS

Greater parenting discomfort and daily stress were associated with lower appraisals of children's behaviors. Caucasian race and higher distortion in behavioral ratings were associated with higher risk of behavioral problems. Caregiver's appraisal was associated with daily stress level and parenting comfort.

DISCUSSION

Additional research is needed regarding how these factors affect children's behavior and causes of distorted parental views of children's behaviors.

Motherhood as the Vehicle for Change in Australian Adolescent Women of Preterm and Full-Term Infants

Preterm birth represents an interruption to the normal development of maternal identity and is considered a highly stressful event for adult mothers. However, no research has investigated whether or how preterm birth affects the adolescent mother’s transition to motherhood. The current study aimed to explicate the experience of being a mother for adolescent women who experienced a preterm or term birth in Australia. This Interpretative Phenomenological Analysis Study analyzed interviews with 14 primiparous, English-speaking adolescent mothers (15-19 years; 10 preterm and 4 full term) who participated in three interviews over a 12-month period. Findings suggested few differences in the experience of being a mother due to infant birth status. Instead, the experience of being a mother was fundamentally about transformations to the self. The young women constructed themselves differently as a result of being mothers. Changes included moving away from delinquent behaviors, development of internal resources, growth of a positive view of self, gaining meaning in their lives, and reconciling idealized and actual notions of self and other. This research adds to our understanding of how motherhood shapes the adolescent women’s lives, while also challenging our assumptions about the impact of preterm and full-term birth for adolescent mothers.

Young women's perceptions of the benefits of childbearing: associations with contraceptive use and pregnancy

CONTEXT

High unintended pregnancy rates, and inconsistencies between reported pregnancy intentions and contraceptive behaviors, have been well documented among young U.S. women. Women's beliefs about the benefits of childbearing and motherhood may be related to the apparent disconnect between pregnancy intentions and reproductive outcomes.

METHODS

Perceived benefits of childbearing and feelings about a potential pregnancy were assessed among 1,377 women aged 15-24 (most of them black or Latina) participating in a longitudinal study in 2005-2008. The women, who were initiating hormonal contraception at public family planning clinics and did not want to become pregnant for one year, were followed for 12 months. Differences in perceived benefits of childbearing by participant characteristics were examined with linear regression, using a new multi-item measure. Cox proportional hazard regression was used to investigate the association of perceived benefits of childbearing with subsequent contraceptive discontinuation and pregnancy.

RESULTS

Perceptions of the benefits of childbearing decreased with increasing age (coefficient, -0.04), and white women perceived fewer benefits to childbearing than blacks (-0.2). As women's perception of the benefits of childbearing increased, their one-year pregnancy rates increased, after demographic characteristics and feelings about a potential pregnancy were controlled for (hazard ratio, 1.2). Benefits of childbearing were not associated with contraceptive discontinuation.

CONCLUSIONS

To better assess pregnancy risk among young women wanting to avoid pregnancy, it may be useful to acknowledge that they hold not only explicit pregnancy desires, but also beliefs about the benefits of childbearing, which may influence sexual behavior and pregnancy.

Factors that adolescent males take into account in decisions about an unplanned pregnancy

Little is known about what factors adolescent males consider important when making decisions concerning the resolution of an unplanned pregnancy with a teenage partner. Young men's influence on pregnancy outcome decisions can play an important part in the subsequent psychological adjustment of the female. The present report draws on data from a larger study with teenage males [Condon, J. T., Corkindale, C. J., Russell, A., & Quinlivan, J. A. (2006). Processes and factors underlying adolescent males' attitudes and decision-making in relation to an unplanned pregnancy. Journal of Youth and Adolescence, 35, 447-458], and extends the findings of that study. Using a 25-item scale embedded in an electronic role-play, data were obtained from 330 male Australian school students on their priorities and concerns in relation to possible outcomes of a partner's pregnancy. Common factors taken into account by almost the entire adolescent sample related to the negative effects of becoming a teenage father. The differences between participants were identified using cluster analysis, which produced three groupings. The majority group was characterised as 'well-balanced' (80.6%), and the two minority groups as 'unwilling/unready' (10.9%) and 'family-centred' (8.5%). Group membership was strongly predictive of the males' final decision regarding the hypothetical pregnancy outcome. Understanding adolescent attitudes and beliefs when faced with this decision may assist practitioners in their guidance of the young couple and help prevent negative psychological sequelae.

`Breaking the Cycle'

Intergenerational explanations are widely available to account for poor health and social outcomes such as those associated with teenage motherhood. Within these explanations, medical journals represent authoritative voices that shape understandings of disadvantage. Teenage motherhood was understood through the metaphor of a `cycle of disadvantage' within this medical literature. Disadvantage is constructed as the result of poor individual choice or family deviance, and the role of the individual and the family in transmitting disadvantage is highlighted. Suggestions for health interventions consequently focus on identifying deviant individuals and families, rather than on ways to address the social context of disadvantage.

Attitudes and behaviours of young Indigenous people in Townsville concerning relationships, sex and contraception: the "U Mob Yarn Up" project

OBJECTIVE

To gain some understanding of the attitudes and behaviours of Indigenous young people in Townsville concerning relationships, contraception and safe sex.

DESIGN

Cross-sectional study using a computer-assisted self-administered survey and single-sex focus group discussions designed by a Young Mums' Group operating on participatory action principles and acting as peer interviewers.

PARTICIPANTS AND SETTING

171 Indigenous students in Years 9-11 at three high schools and 15 residents of a homeless youth shelter in Townsville, Queensland, 27 April - 8 December 2004.

MAIN OUTCOME MEASURES

Self-reported attitudes and behaviour about relationships, sexual intercourse and contraception.

RESULTS

84/183 participants (45.9%) reported past sexual intercourse, with 56.1% commencing intercourse at age 13-14 years. The likelihood of having had sex increased with being male (P=0.001), increasing age, increased perceived sexual activity of peer group (both P=0.000), and drinking alcohol at least weekly (P=0.015). Young women were more likely to report unwanted sexual touching (P=0.031), and less likely to report enjoying sexual intercourse (P=0.001). The main qualitative themes concerned females' reputations, coercion, and denial of female desire. Only 49/80 participants (61.3%) reported always using condoms. The main reasons for not using contraception were "just not thinking about it", shame, and problems with access. Despite having reasonable knowledge about contraception, most lacked the confidence and negotiation skills to communicate with partners about condom use.

CONCLUSIONS

Like teenagers elsewhere, Indigenous teenagers in Townsville are becoming sexually active at a young age, and not practising safe sex reliably. The need to protect their reputations puts young women at risk by not being prepared for safe sex by carrying condoms.

Why lightning strikes twice: postpartum resumption of sexual activity during adolescence

PURPOSE

To describe the circumstances surrounding the postpartum resumption of sexual activity in a cohort of teenage mothers. The goal was to shed new light on the reasons why teenagers who have just given birth put themselves at risk for conception.

METHODS

A racially and ethnically diverse group of 267 poor, predominantly unmarried, primiparous, 13-21 year olds was enrolled consecutively at delivery and followed through the third postpartum month. The primary outcome measure was weeks postpartum at resumption of sexual activity, further categorized as protected or unprotected. The analysis controlled for factors thought to influence the postpartum resumption of sexual activity among adult couples and the use of contraception during adolescence. The Kaplan-Meier method was used to estimate the time to end point and Cox proportional-hazards regression analysis to compute relevant relative risks (RR).

RESULTS

By the end of the third postpartum month, 58% of the teenagers had had sexual intercourse and the majority (80%) used contraception when they did so. The median time to first coitus, 10.7 weeks, was unrelated to contraceptive use but was significantly shorter among teenagers who lived with their boyfriends (RR: 2.4; 95%CI: 1.7-3.4) and those who delivered prior to term (RR: 2.1; 95%CI: 1.3-3.6). The analysis revealed that the teenagers who did not use contraception at first postpartum sexual intercourse exhibited more theorized risk factors for conception than those who did and those who remained sexually abstinent.

CONCLUSIONS

This new empirical evidence that coital activity resumes soon after delivery should dispel the normative belief that contraception is unnecessary during the puerperium. Early contraceptive vigilence may also decrease the frequency and rapidity with which teen mothers conceive, as the differences in the prevalence of teen pregnancy risk factors we uncovered suggest that decisions about using contraception (not sexual intercourse) determine the risk of rapid repeat conception. Teens with live-in boyfriends and premature babies are especially apt to benefit from the new information in this report as they resume sexual activity sooner than their peers and are less apt to use contraception when they do so.

Anxiety and depression in fathers in teenage pregnancy

OBJECTIVE

It is recognized that pregnant teenagers have higher levels of psychological symptomatology compared to older pregnant women. However, there are limited data on fathers in the setting of teenage pregnancy. The aim of this study was to compare levels of psychological symptomatology in fathers in the setting of teenage as compared to non-teenage pregnancy.

METHOD

A cross-sectional cohort study was undertaken. Data from interviews with consecutive fathers in the setting of teenage (Teenage) and non-teenage (Control) pregnancy were compared during the antenatal period. Subjects were interviewed to obtain information covering demographic and family information, the Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire-28 (GHQ-28).

RESULTS

Significantly more fathers in the setting of teenage pregnancy met the case criteria for HADS-A and HADS-D subscales compared to older fathers. They had significantly higher GHQ-28 totals and all subscale scores and were more likely predictive of a young age of death compared to older fathers. However, formal contact with psychiatric services was similar between groups. Interestingly, 14% of fathers in the setting of teenage pregnancy reported losing their own father as a child. In multivariate analysis, a high HADS score was significantly associated with younger age of onset of fatherhood and exposure to domestic violence as a child, whereas having their own father alive was significantly protective against a high HADS score.

CONCLUSION

Fathers, in the setting of teenage pregnancy, have unrecognized psychological symptomatology and require services along with teenage mothers.

The First-Time Fathers Study: a prospective study of the mental health and wellbeing of men during the transition to parenthood

OBJECTIVE

In comparison to its female counterpart, the transition of men to parenthood has been relatively neglected in previous research. The present paper argues that men may have gender-specific risk factors for perinatal psychological distress and may manifest distress in ways different from women. The prime objective of this research was to document changes in psychological, relationship and lifestyle parameters in a cohort of first time fathers from pregnancy to the end of the first postnatal year. The present paper reports on these changes.

METHOD

Three hundred and twelve men were assessed at 23 weeks of pregnancy and followed up at 3, 6 and 12 months postnatally, using a battery of self-report questionnaires covering psychological symptom levels, lifestyle variables and relationship/sexual functioning. Two hundred and four men completed all four assessments.

RESULTS

The men exhibited highest symptom levels in pregnancy with general, through small, improvement at 3 months and little change thereafter. Lifestyle variables showed small changes over the first postnatal year. Sexual functioning appeared to deteriorate markedly from pre-pregnancy levels with only minimal recovery by the end of the first year. The results highlight that the majority of men anticipated return of sexual activity to pre-pregnancy levels; however, this failed to eventuate.

CONCLUSIONS

Pregnancy, rather than the postnatal period, would appear to be the most stressful period for men undergoing the transition to parenthood. The results suggest that the most important changes occur relatively early in pregnancy. Thereafter, lack of change (rather than change) is the most noteworthy feature. These men appeared to be ill-prepared for the impact of parenthood on their lives, especially in terms of the sexual relationship. Further research to determine the timing and trigger of stress in pregnancy is recommended.

Teenage mother's predictions of their support levels before and actual support levels after having a child

OBJECTIVES

To evaluate to what extent teenage mothers are able to predict their postnatal support networks in the antenatal period, and the extent to which support correlates with depressive symptomatology and social class.

DESIGN

A prospective cohort study.

SETTING

Teenage antenatal clinic.

PARTICIPANTS

Teenage mothers (n=124) aged less than 18 years.

INTERVENTION

Women were surveyed in the antenatal period and again 6 months postpartum about their anticipated and actual levels of support using the Maternal Social Support Index. The questionnaire covered key issues involved in discharge planning such as the availability of help with household tasks, emergency respite, and communication. Subjects also completed social class data and the Edinburgh Postnatal Depression Scale.

MAIN OUTCOME MEASURE

Ability of pregnant teenagers to predict postnatal support and correlation of support with social class and depressive symptomatology.

RESULTS

The key finding was that teenage mothers significantly overestimated their support networks in the antenatal period compared to the reality experienced 6 months postpartum (P=0.0001). Dissatisfaction was most marked in the communication and daily activity support subscales. The level of support at 6 months postpartum correlated significantly with the Edinburgh Postnatal Depression score (P=0.0001) and with social class (P=0.017).

CONCLUSION

Services for teenage mothers that provide assistance with communication and daily support activities are required to help overcome the discrepancies between idealization and reality. Poor support correlates with depressive symptomatology and social class.

The First-Time Fathers Study: a prospective study of the mental health and wellbeing of men during the transition to parenthood

OBJECTIVE

In comparison to its female counterpart, the transition of men to parenthood has been relatively neglected in previous research. The present paper argues that men may have gender-specific risk factors for perinatal psychological distress and may manifest distress in ways different from women. The prime objective of this research was to document changes in psychological, relationship and lifestyle parameters in a cohort of first time fathers from pregnancy to the end of the first postnatal year. The present paper reports on these changes.

METHOD

Three hundred and twelve men were assessed at 23 weeks of pregnancy and followed up at 3, 6 and 12 months postnatally, using a battery of self-report questionnaires covering psychological symptom levels, lifestyle variables and relationship/sexual functioning. Two hundred and four men completed all four assessments.

RESULTS

The men exhibited highest symptom levels in pregnancy with general, through small, improvement at 3 months and little change thereafter. Lifestyle variables showed small changes over the first postnatal year. Sexual functioning appeared to deteriorate markedly from pre-pregnancy levels with only minimal recovery by the end of the first year. The results highlight that the majority of men anticipated return of sexual activity to pre-pregnancy levels; however, this failed to eventuate.

CONCLUSIONS

Pregnancy, rather than the postnatal period, would appear to be the most stressful period for men undergoing the transition to parenthood. The results suggest that the most important changes occur relatively early in pregnancy. Thereafter, lack of change (rather than change) is the most noteworthy feature. These men appeared to be ill-prepared for the impact of parenthood on their lives, especially in terms of the sexual relationship. Further research to determine the timing and trigger of stress in pregnancy is recommended.

Current priorities for adolescent sexual and reproductive health in Australia

The sexual health needs of teenagers differ from those of adults. Young sexually active teenagers are at high risk of Chlamydia trachomatis genital infection and its complications. Teenage pregnancy continues to be a problem in Australia. Current preventive strategies and clinical services in this domain of adolescent health in Australia are deficient. Australia can learn from the innovative and effective strategies developed in various countries for preventing high-risk sexual behaviours in teenagers.

Nursing care for pregnant adolescents

Although the physical care of pregnant adolescents is similar to that required by adult women, adolescents have additional unique needs. Adolescents often need more support and extensive teaching during pregnancy and the postpartum. Moreover, adolescents often have fewer life experiences than do adult women, making them less able to cope with the life changes they are experiencing related to pregnancy and birth. Nonjudgmental and developmentally appropriate interactions are essential to the care of pregnant adolescents. This article explores nursing care for the physical, emotional, and educational needs of adolescents during the prenatal, intrapartum, and postpartum periods.