Adolescent depressive symptoms and subsequent pregnancy, pregnancy completion and pregnancy termination in young adulthood: findings from the victorian adolescent health cohort study

Systematic Review and Meta-Analysis: Adolescent Depression and Long-Term Psychosocial Outcomes

OBJECTIVE

Experiencing depression in adolescence can disrupt important developmental processes, which can have longstanding effects on socioeconomic status and relationships. The objective of this article was to systematically review the evidence examining associations between adolescent depression and adult psychosocial outcomes.

METHOD

Five databases (MEDLINE, Embase, PsycINFO, CINAHL, and ERIC) were searched for articles published from 1980 through March 2017. Eligible articles were peer reviewed, published in English, had prospective cohort study designs, and contrasted adult psychosocial outcomes in those with versus without adolescent depression. Outcomes with sufficient data were pooled using random-effects meta-analyses, with summary measures reported as odds ratios (ORs). A protocol for this review was registered on PROSPERO (CRD42017059662).

RESULTS

Of the 4,988 references screened for inclusion, 31 articles comprising 136 analyses were included for review. Twenty-four cohorts were represented. Seventy-seven analyses across 10 outcomes were meta-analyzed, with remaining analyses summarized narratively. Meta-analyses suggested that adolescent depression was associated with outcomes including, but not limited to, failure to complete secondary school (OR 1.76, 95% CI 1.29-2.39), unemployment (OR 1.66, 95% CI 1.29-2.14), and pregnancy/parenthood (OR 1.38, 95% CI 1.06-1.81).

CONCLUSION

This review demonstrates that adolescent depression is associated with a myriad of adult psychosocial outcomes. Many are linked and can lead to the propagation of difficulties across the lifespan. These findings can have important implications for encouraging the provision of targeted mental health care early in development to improve life chances.

Adolescent mental health and behavioural predictors of being NEET: a prospective study of young adults not in employment, education, or training

BACKGROUND

Young adults who are not in employment, education, or training (NEET) are at risk of long-term economic disadvantage and social exclusion. Knowledge about risk factors for being NEET largely comes from cross-sectional studies of vulnerable individuals. Using data collected over a 10-year period, we examined adolescent predictors of being NEET in young adulthood.

METHODS

We used data on 1938 participants from the Victorian Adolescent Health Cohort Study, a community-based longitudinal study of adolescents in Victoria, Australia. Associations between common mental disorders, disruptive behaviour, cannabis use and drinking behaviour in adolescence, and NEET status at two waves of follow-up in young adulthood (mean ages of 20.7 and 24.1 years) were investigated using logistic regression, with generalised estimating equations used to account for the repeated outcome measure.

RESULTS

Overall, 8.5% of the participants were NEET at age 20.7 years and 8.2% at 24.1 years. After adjusting for potential confounders, we found evidence of increased risk of being NEET among frequent adolescent cannabis users [adjusted odds ratio (ORadj) = 1.74; 95% confidence interval (CI) 1.10-2.75] and those who reported repeated disruptive behaviours (ORadj = 1.71; 95% CI 1.15-2.55) or persistent common mental disorders in adolescence (ORadj = 1.60; 95% CI 1.07-2.40). Similar associations were present when participants with children were included in the same category as those in employment, education, or training.

CONCLUSIONS

Young people with an early onset of mental health and behavioural problems are at risk of failing to make the transition from school to employment. This finding reinforces the importance of integrated employment and mental health support programmes.

The Mental Health Status and Intellectual Ability of Unwed Mothers Dwelling in Korean Shelter Homes

Although many unwed mothers have issues concerning mental health and intellectual ability, little research has focused on their mental and cognitive status. Due to the public stigma attached to unwed mothers in South Korea, they tend to conceal their status and are less likely to seek psychiatric and psychological help. In this context, this study aims to assess the current status of their mental health and intellectual characteristics. A total of 48 unwed mothers from two shelter homes in South Korea agreed to participate in the study. We compared the mental health status of these unwed mothers with that of the general female population. Unwed mothers were more likely than those of the general female population to have mood disorders, post traumatic stress disorder (PTSD), alcohol and nicotine use disorders, and attention-deficit hyperactivity disorder (ADHD). Among the 48 unwed mothers, 20 (41.7%) had an IQ of less than 70, and the mean IQ (78.31) was significantly lower than the normalized mean IQ of the general female population. This study confirmed that unwed mothers dwelling in Korean shelter homes are more likely than the general female population to have mental disorders.

Early parenting: the roles of maltreatment, trauma symptoms, and future expectations

The psychosocial determinants of early parenting are still not well understood. The current study used data on 115 girls in the Capella Project, who were followed longitudinally for the first 18 years of life. Potential predictors of early parenting assessed were child maltreatment, trauma symptoms, and girls' expectations for their socioeconomic outcomes. Cox regression survival analyses were conducted to predict time to the birth of first child. Significant unique predictors of early parenting included neglect, anxiety, low depression, and low expectations of going to college. Practice and research implications of these findings include the importance of neglect for risk of early parenting, the importance of ongoing trauma symptoms in youth, and the potentially protective influence of expectations of going to college.

Social and emotional adjustment following early pregnancy in young Australian women: a comparison of those who terminate, miscarry, or complete pregnancy

PURPOSE

To compare social and emotional adjustment including educational attainment and substance use in women who had a child, pregnancy termination, or miscarriage by young adulthood.

METHODS

Data were from a population-based longitudinal study of the health and well-being of 1,943 young Australians (Victorian Adolescent Health Cohort Study) followed from 15 to 24 years of age. The sample was restricted to female participants and based on pregnancies reported by age 24 years. Analyses were adjusted for early teenage depressive symptoms, cigarette smoking, alcohol use, cannabis use, and parent socioeconomic context.

RESULTS

A total of 208 pregnancies (in 170 women) were reported from a sample of 824 young women by 24 years of age. Compared with those who had never been pregnant, those who had a child had lower tertiary education completion and a higher risk of nicotine dependence; those who terminated a pregnancy were more commonly single and had a higher risk of smoking and alcohol use as well as nicotine and alcohol dependence; and those who had a miscarriage had a higher risk of depressive symptomatology and binge drinking as well as nicotine and cannabis dependence.

CONCLUSIONS

Young women who have been pregnant by their mid-twenties report a range of difficulties in social and emotional adjustment that vary across the different pregnancy outcomes. Broad-based psychosocial health care is essential not only for young women whose pregnancies proceed to live birth, but also for those whose pregnancies end with miscarriage or induced abortion.