Depression in former school-age mothers and community comparison subjects

Mental health outcomes beyond the post-partum period among adolescent mothers: a systematic review and meta-analysis

Background

Adolescence is the most crucial part of life. The vulnerability of adolescent mothers is even more pronounced and can affect various health aspects. While they suffer from social and emotional stresses shortly after giving birth, the long-term effect after the post-partum period of adolescent pregnancy on the mental outcomes holds prime importance. Thus, this systematic review aims to ascertain the association between adolescent pregnancy on mental health outcomes.

Methods

The search strategy was run in June 2023 on databases including PubMed, CINAHL, Scopus, Psych Info, and Embase . Quality assessment of the studies was done using the National Institute of Health (NIH)'s National Heart, Lung and Blood Institute (NHLBI) tool for observational studies. For studies that measured similar outcomes, a meta-analysis was conducted.

Findings

The search strategy yielded 21 results from all databases and cross-referencing. Of these, all except for one (case-control) were cross-sectional and cohort studies. The pooled analysis found a significant association between adolescent pregnancy and depression (RR 1.34; 95% CI 1.05, 1.72, 6 studies, heterogeneity: Chi2 P 0.01; I2 = 60%); however, no association was found in anxiety (RR 1.05; 95% CI 0.26, 4.14, 2 studies; heterogeneity: Chi² P = 0.0003; I2 = 93%) and suicidal ideation (RR 3.21; 95% CI 0.17, 59.33; 3 studies; heterogeneity: Chi2 P < 0.00001; I2 = 98%).

Implication

These findings suggest that the mental health needs of adolescent mothers must be addressed and innovative and effective interventions that support and address the mental health needs of adolescent mothers are needed to improve their mental health.

Effectiveness of an Attachment-Based Intervention Program in Promoting Emotion Regulation and Attachment in Adolescent Mothers and their Infants: A Pilot Study

This pilot study examined the effectiveness of an attachment-based intervention program, PRERAYMI, based on video technique, psychological counseling and developmental guidance in improving the style of interaction and emotion regulation of adolescent mothers and their infants after 3 and 6 months of intervention. Analyses revealed that adolescent mothers who participated in the intervention (vs. control group adolescent mothers) increased their Sensitivity and reduced their Controlling style after both 3 and 6 months of treatment. Infants who participated in the intervention (vs. control group infants) increased their Cooperative style and reduced their Passive style from 3 to 9 months. Moreover, the intervention group dyads (vs. control group dyads) increased the amount of time spent in affective positive coordination states (matches), decreased the amount of time spent in affective mismatches, and had a greater ability to repair mismatches from 3 to 9 months. Furthermore, the intervention group dyads (vs. control group dyads) increased the amount of time spent in reciprocal involvement in play with objects from 3 to 9 months. The quality of maternal attachment did not affect the intervention effect.

Motherhood in adolescent mothers: maternal attachment, mother-infant styles of interaction and emotion regulation at three months

Early motherhood is considered a risk factor for an adequate relationship between mother and infant and for the subsequent development of the infant. The principal aim of the study is to analyze micro-analytically the effect of motherhood in adolescence on the quality of mother-infant interaction and emotion regulation at three months, considering at the same time the effect of maternal attachment on these variables. Participants were 30 adolescent mother-infant dyads compared to 30 adult mother-infant dyads. At infant 3 months, mother-infant interaction was video-recorded and coded with a modified version of the Infant Caregiver Engagement Phases and the Adult Attachment Interview was administered to the mother. Analysis showed that adolescent mothers (vs. adult mothers) spent more time in negative engagement and their infants spent less time in positive engagement and more time in negative engagement. Adolescent mothers are also less involved in play with their infants than adult mothers. Adolescent mother-infant dyads (vs. adult mother-infant dyads) showed a greater duration of negative matches and spent less time in positive matches. Insecure adolescent mother-infant dyads (vs. insecure adult mother-infant dyads) demonstrated less involvement in play with objects and spent less time in positive matches. To sum up adolescent mother-infant dyads adopt styles of emotion regulation and interaction with objects which are less adequate than those of dyads with adult mothers. Insecure maternal attachment in dyads with adolescent mothers (vs. adult mother infant dyads) is more influential as risk factor.

Predictors of Parenting and Infant Outcomes for Impoverished Adolescent Parents

Adolescent mothers and their children are at risk for a myriad of negative outcomes. This study examined risk and protective factors and their impact on a sample (N=172) of impoverished adolescent mothers. Multiple regression analyses revealed that depressed adolescent mothers report higher levels of parenting stress, and that their children are more at risk for maltreatment and are developmentally behind other babies. In addition, adolescent mothers with restricted social support have babies who are at higher risk for maltreatment. Finally, mothers who were older during pregnancy were more likely to stay in school. Implications for program development are discussed.

Stability of maternal depressive symptoms among urban, low-income, African American adolescent mothers

BACKGROUND

Maternal depressive symptomatology is an important public health issue with negative consequences for both mothers and infants.

METHODS

This study examined prevalence and patterns of depressive symptoms among 181 urban, low-income, first-time, African American adolescent mothers recruited from urban hospitals following delivery. Follow-up evaluations were conducted at 6 (N=148; 82%) and 24 (N=147; 81%) month home visits. Depressive symptoms were measured with Beck Depression Inventory (BDI).

RESULTS

Half of mothers (49%) had BDI scores >9 at baseline, with significant correlations between BDI scores across all visits (r=0.28-0.50). Depressive symptom trajectories analyzed using group-based trajectory modeling revealed three trajectories of depressive symptoms: Low (41%), Medium (45%), and High (14%). The high depressive symptom group reported lower self-esteem, more negative life events, and lower parenting satisfaction than the low and moderate depressive symptoms groups.

LIMITATIONS

Depressive symptoms were self-reported and not verified with a clinical interview. Findings are limited to urban, low-income, African American adolescent mothers and may not be generalizable to other populations.

CONCLUSIONS

The high prevalence and relative stability of depressive symptoms through 2years of parenting suggest the need for early identification and treatment of maternal depressive symptoms. Brief screening for maternal depressive symptoms conducted during pediatric well-child visits is a feasible and effective method for identifying mothers with depressive symptoms, however, screening measures can not differentiate between high and low levels of depressive symptoms. Brief intervention may be an effective treatment for mothers with mild symptoms of depression; mothers with moderate to severe symptoms may require more intensive intervention.

Barriers to depression treatment in low-income, unmarried, adolescent mothers in a southern, urban area of the United States

This study explored barriers to depression treatment in low-income, unmarried, adolescent mothers in a southern, urban area of the United States. The authors utilized a phenomenological approach and focus group methodology. Participants (n = 9) were enrolled in a teen parent program, an option of the public school system. The metaphor of a merry-go-round emerged from the data and represented the ups and downs that the adolescent mothers experience as they struggle to adjust to the role of mother. Their knowledge of postpartum depression and depression treatment occurred in the context of their demographics and their desire to create a family for their baby, their fears, and surprise at the reality of mothering. Childbirth education for adolescent mothers should include information on depression and the process of depression treatment.

Risk factors for young adult substance use among women who were teenage mothers

Teenage mothers may not "mature out" of substance use during young adulthood, and this non-normative trajectory of use may contribute to negative outcomes for teenage mothers and their offspring. Pregnant teenagers (age range=12-18 years; 68% Black) were recruited from a prenatal clinic and interviewed about their substance use, and subsequently re-interviewed six and ten years later (n=292). Consistent with the literature, early tobacco and marijuana use were risk factors for young adult use. Other substance use, peer adolescent use and mental health indicators were more important than race and socioeconomic status (SES) in determining which teenage mothers would use tobacco, engage in binge drinking, and use marijuana as young adults. However, race and SES were significant predictors of quitting tobacco use and marijuana use by the 10-year follow-up. Depression was associated with both persistent tobacco use and marijuana use in teenage mothers. These results illustrate the long-term consequences of teenage childbearing and identify modifiable risk factors for later health risks that should be addressed among younger mothers.

Early motherhood and subsequent life outcomes

BACKGROUND

Early motherhood has been linked with a number of adverse outcomes, including mental health difficulties and barriers to completing educational qualifications and workforce participation. The present study examined the extent to which these linkages could be explained by the influence of social, family, and background factors that were associated with early motherhood.

METHODS

Data were gathered as part of the Christchurch Health and Development Study, a 25-year longitudinal study of a birth cohort of New Zealand children. Information was obtained on: (a) the history of pregnancy and parenthood for female participants over the period 15-21 years; (b) measures of DSM-IV mental disorders and suicidal behaviour over the interval 21-25 years; (c) measures of educational achievement over the interval 21-25 years; (d) measures of welfare dependence, workforce participation, and income over the interval 21-25 years; and (e) childhood, family and related confounding factors.

RESULTS

Early motherhood was associated with higher levels of mental health disorders, lower levels of educational achievement, higher levels of welfare dependence, lower levels of workforce participation, and lower income. Control for confounding factors reduced the associations between early motherhood and later mental health disorders to statistical non-significance. However, the associations between early motherhood and later educational achievement and economic circumstances persisted after control for potentially confounding factors.

CONCLUSIONS

The findings suggest that early motherhood puts young women at risk for educational underachievement and poorer economic circumstances. The linkages between early motherhood and later mental health difficulties can largely be accounted for by childhood, family, and related circumstances that occurred prior to parenthood.

Adolescent Motherhood and Postpartum Depression

Adolescent mothers undergo unique personal and social challenges that may contribute to postpartum functioning. In this exploratory investigation completed within a risk and resilience framework, 149 adolescent mothers, ages 15 to 19, who participated in school-based teen parents' programs, completed measures of parental stress (social isolation and role restriction), maternal competence, weight/shape concerns, and depression. The sample was quite diverse, and no ethnic differences in base rate levels of the variables were detected. Regression analyses indicated that social isolation, maternal competence, and weight/shape concerns predicted unique variance associated with depression level. The findings are discussed in light of future work and the continued need to inform prevention and treatment programs for young mothers.