Prenatal and parenting stress on adolescent maternal adjustment: identifying a high-risk subgroup

Parenting Stress Among Adolescent Mothers: An Integrative Literature Review

Adverse maternal and child outcomes are associated with parenting stress. Adolescent mothers may be particularly susceptible to parenting stress because of conflicting parenting and developmental demands. We performed an integrative literature review to identify risk and protective factors for parenting stress, measured by the Parenting Stress Index (PSI), among adolescent mothers. Guided by Belsky's Determinants of Parenting Model (1984) and using Whittemore and Knafl's (2005) five-stage review method, we searched CINAHL, EMBASE, PsycINFO, and MEDLINE databases to identify 786 research articles. After quality appraisal, 26 articles were included. Risk and protective factors were categorized into themes within the context of Belsky's framework, including maternal attributes (e.g. maternal self-efficacy), child characteristics (e.g. child temperament), and contextual influences (e.g. perceived social support). The new conceptual model maps risks, protective factors, and nuanced areas for parenting stress and can guide researchers and clinicians in approaches to prevent and reduce parenting stress among adolescent mothers.

Adverse Childhood Experiences and Complex Post-traumatic Stress in Pregnant Teens: A Pilot Study

INTRODUCTION

Pregnant teens are seen as a group at risk, yet one area that remains understudied is the impact of trauma on their mental health, maternal fetal attachment and pregnancy-related health behavior.

METHODS

A pilot study of urban pregnant teens receiving home visiting services examined trauma exposure, complex traumatic stress, maternal fetal attachment, and health behaviors of pregnancy. The sample (n = 36) was recruited over a period of 20 months from Nurse-Family Partnership of New York City (NFP-NYC) service sites. The teens interviewed completed scales measuring adverse childhood experiences (ACEs), symptoms of complex posttraumatic stress (TSCC), prenatal attachment (MAAS), and pregnancy health behaviors (HPQ-II).

FINDINGS

Over one third of participants reported 4 or more ACEs (36%), and scores on the Trauma Symptom Checklist subscales ranged from a low of 11% for anger to 25% for depression, anxiety and post-traumatic stress. Maternal-fetal attachment was strong and pregnancy health behaviors were positive. The number of ACEs was related to traumatic stress symptoms but not to maternal fetal attachment or health behaviors in pregnancy.

CONCLUSIONS

Pregnant teens with trauma histories could benefit from access to trauma-informed mental health services integrated into the obstetrical or home-visiting services they receive.

Scale for maternity role perceptions

The purpose of this study was to develop and test the psychometric properties of the Maternal Role Perception Scale, a measure of motherhood, based on the perceptions of women. The 5-point Likert draft scale with 61 items was used. The data of 610 mothers were analyzed in the study. In the validity-reliability analysis of the scale, exploratory factor analysis and Cronbach's alpha coefficients were used. As a result of the factor analysis, the scale consists of 28 items and two factors explaining 55.741% of the total variance. The internal consistency coefficient (Cronbach's alpha) of the scale was calculated as 0.952. The Maternity Role Perception Scale (MRPS) is a reliable and valid scale developed for Turkish women. Maternal role is affected by physical, psychological, social status and the life of the woman. It is recommended to apply MRPS on different samples.

From distress to flourishing: towards a strengths-based approach for young mothers

Objective: The current study aims to better understand the predictors of flourishing, as well as the predictors of distress, among first-time Australian mothers in their teens and early 20s in the first year postpartum.Background: Past research has linked early motherhood with poor outcomes for mother and baby. However, other research has demonstrated that disadvantage often precedes early motherhood, rather than results from it, and there has been a consistent body of qualitative research highlighting positive outcomes for young mothers. In this paper, we investigate who is doing well amongst a sample of young mothers.Methods: Through quantitative analysis of survey data of 86 women aged 16-24 years who had transitioned to motherhood in the past 12 months, we investigate the predictors of flourishing, along with postnatal distress.Results: Our findings suggest that this sample of women was doing well, with relatively high scores on flourishing and low scores on distress. As expected, the two constructs were negatively correlated.Conclusion: Whilst self-esteem was a consistent predictor of both distress and flourishing, and acted as a mediating factor, this research also showed that there are unique and independent predictors for distress and flourishing, which can be used to inform tailored programs for young mothers.

Young women's experience of adolescent marriage and motherhood in Jordan

Adolescent pregnancy and early motherhood are associated with poor social and physical outcomes. This study explored the experiences of marriage and motherhood among Jordanian young women. A descriptive qualitative design was employed. Participants (n = 15, age 15-37 years) who had experienced adolescent marriage and motherhood and who lived in eastern Amman, the capital of Jordan, were selected via snowball sampling. Data were collected by tape-recorded face-to-face interviews and analysed thematically. Five themes were identified: lost opportunities for personal development, learning to be submissive and indecisive, uncertainty toward cultural norms, ambivalent feelings toward a maternal role and empowering oneself to face life demands. The findings indicate that the experience of marriage and motherhood among Jordanian adolescents was mostly negative; they felt that they had been deprived of their rights, respect and the experience of being a young person. Additionally, they felt that the transition into motherhood was very difficult, and that they were prematurely forced into adult social roles and responsibilities, which caused them to experience numerous challenges. Adolescent mothers are a vulnerable group that should be better targeted by prevention and intervention measures.

"It has been a long journey from first knowing": narratives of unplanned pregnancy

Unplanned pregnancies come with risks of various health and financial consequences for women. Understanding such experiences is vital to aiding women in this health context; however, there is little research in this vein, particularly for college-aged young women. Narratives of unplanned pregnancy may help to shed light on the experiences of these women, leading to greater understanding and more congruent and helpful support communication, prevention, and education resources. The present study aimed to identify themes in unplanned pregnancy narratives. Stories for women who had continued their pregnancies differed from those of women who did not continue their pregnancies, and overall, narratives seemed to work toward positively reappraising and making sense of the experience, especially in terms of autonomy, as well as seeking affirmation and support for decisions made. Implications of these results will be discussed in terms of future narrative work in the unplanned pregnancy context.

The relationship between parental stress and postpartum depression among adolescent mothers enrolled in a randomized controlled prevention trial

Given the high co-occurrence of depression and parental stress among adolescent mothers, we evaluated the relationship between parental stress and postpartum depression among primiparous adolescent mothers. We conducted an observational analysis among a cohort of 106 adolescent mothers at 289 postpartum visits who were enrolled in a randomized controlled trial to prevent postpartum depression. Parental stress was measured using the Parenting Stress Index, short form. The Structured Clinical Interview for DSM-IV Childhood Diagnoses was administered to assess for postpartum depression; subthreshold depression was assessed using the Children's Depression Rating Scale, revised version. Generalized estimating equations were utilized to assess the relationship of parental stress on postpartum depression during the first 6 months postpartum. We present adjusted odds ratios (AOR) controlling for study arm, age, born in the United States, prior history of depression, and number of study visits. The median age was 16 years, 53% were Latina, and 16% reported a past history of depression. Nineteen adolescents (19%) were diagnosed with postpartum depression and 25% experienced high levels of parental stress through 6 months postpartum. Adolescent mothers who reported higher levels of parental stress were at significantly increased risk for postpartum depression [AOR 1.06 (95% CI 1.04-1.09); p < 0.0001]. High levels of parental stress predicted subsequent postpartum depression when assessing parental stress at visits prior to a depression diagnosis to determine whether we could establish a temporal association [AOR 1.06 (95% CI 1.02-1.09); p < 0.01]. Parental stress was also a risk factor for subthreshold depression [AOR 1.04 (95% CI 1.01-1.07); p < 0.01]. Parental stress was a significant risk factor for developing both postpartum depression as well as subthreshold depression among adolescent mothers. Interventions that target a reduction in parental stress may lead to less depression severity among primiparous adolescent mothers.

Course of depression and anxiety symptoms during the transition to parenthood for female adolescents with histories of victimization

The aim of the current study was to increase understanding of how victimization history impacts the longitudinal course of depression and anxiety in a sample of 55 adolescents emerging into parenthood. Adolescents were interviewed about their victimization experiences during their second trimester of pregnancy, and interviews were subsequently classified according the Maltreatment Classification Scale (Barnett, Manly, & Cicchetti, 1993). Adolescents reported on their symptoms of depression and anxiety prenatally and 6 and 12 months postpartum. Growth curve modeling revealed that, on average, there was a steady linear decline in depression and anxiety symptoms across the transition to parenthood, with a rate of change of 25% and 20%, respectively, from the prenatal assessment to 12 months postpartum. Sexual abuse history attenuated the likelihood of a decrease in depressive symptoms over time. Neglect history was associated with higher prenatal levels of anxiety, as well as a steeper decline in anxiety symptoms over time. Future research is needed to determine the role of poly-victimization in predicting the onset and change of depression and anxiety symptoms. Findings from the current study have the potential to aid in the design of preventative and intervention efforts to reduce risks of mental health difficulties in adolescent parents.

Social support communication in unplanned pregnancy: support types, messages, sources, and timing

Pregnancy is a time of uncertainty and stress for many women, and these aspects are compounded for those facing unplanned pregnancies. Social support communication is considered a vital part of healthy outcomes in pregnancy but is largely unexplored in the unplanned pregnancy context, particularly for college-aged young women. The present study aimed to identify various dimensions of social support in unplanned pregnancy for this population, including support types desired and enacted, sources of support, support types helpful in various stages of this health experience, and message strategies used in helpful support communication. Results of an online semi-structured survey exploring message content and these other elements were analyzed through qualitative and quantitative content analysis as well as statistical analysis. Nurturing support, specifically network support, was found to be most desired in this health context, and the message strategies found in the most helpful support messages differed according to support type. Source and timing of support were also factors in the most helpful types of support in this context. Implications of these results will be discussed in terms of future research in social support in the unplanned pregnancy context.

Family and relationship influences on parenting behaviors of young parents

PURPOSE

Assess the influence of relationship and family factors during pregnancy on parenting behavior 6 months postpartum among low-income young parents.

METHODS

Some 434 young expectant couples were recruited from obstetrics clinics during pregnancy and followed 6 months postpartum. Using a series of general estimating equations to control for the correlated nature of the data, we assessed the influence of relationship factors (e.g., relationship satisfaction, attachment) and family factors (e.g., family functioning, family history) during pregnancy on parenting (e.g., parenting involvement, time spent caregiving, parenting experiences, and parenting sense of competence) 6 months postpartum controlling for covariates.

RESULTS

Relationship functioning related to parenting involvement, caregiving, parenting experiences, and parenting sense of competence. In addition, several family factors related to parenting. Mother involvement during childhood was related to more parenting involvement, parenting positive experiences, and parenting sense of competence. History of being spanked as a child related to less time spent caregiving and less positive life change from being a parent. Further, gender significantly moderated the associations between relationship and family factors and parenting behavior. Male parenting behavior was more influenced by relationship and family factors than female parenting.

CONCLUSIONS

This study suggests the importance of relationship and family contexts for parenting behaviors of young mothers and fathers, highlighting the potential utility of involving both young mothers and fathers in parenting programs, and developing interventions that focus on strengthening young parents' romantic relationships and that address negative parenting experienced during childhood.

Qualitative evaluation of the Teenage Mothers Project in Uganda: a community-based empowerment intervention for unmarried teenage mothers

Background

A large proportion of unmarried teenage mothers in Uganda face physical, psychological, and social problems after pregnancy and childbirth, such as obstetric complications, lack of education, and stigmatisation in their communities. The Teenage Mothers Project (TMP) in Eastern Uganda empowers unmarried teenage mothers to cope with the consequences of early pregnancy and motherhood. Since 2000, 1036 unmarried teenage mothers, their parents, and community leaders participated in economic and social empowerment interventions. The present study explored the changes resulting from the TMP as well as factors that either enabled or inhibited these changes.

Methods

Semi-structured interviews (N = 23) were conducted with former teenage mothers , community leaders, and project implementers, and lifeline histories were obtained from former teenage mothers (N = 9). Quantitative monitoring data regarding demographic and social characteristics of teenage mother participants (N = 1036) were analysed.

Results

The findings suggest that, overall, the TMP seems to have contributed to the well-being of unmarried teenage mothers and to a supportive social environment. It appears that the project contributed to supportive community norms towards teenage mothers’ position and future opportunities, increased agency, improved coping with early motherhood and stigma, continued education, and increased income generation by teenage mothers. The study findings also suggest limited change in disapproving community norms regarding out-of-wedlock sex and pregnancy, late active enrolment of teenage mothers in the project (i.e., ten months after delivery of the child), and differences in the extent to which parents provided support.

Conclusions

It is concluded that strengths of the community-based TMP seem to be its socio-ecological approach, the participatory planning with community leaders and other stakeholders, counselling of parents and unmarried teenage mothers, and the emphasis on education and income generation. The project can improve by earlier active participation of unmarried pregnant adolescents and increased support for parents.

Canadian adolescent mothers' perceptions of influences on breastfeeding decisions: a qualitative descriptive study

BACKGROUND

There is increased recognition of the importance of breastfeeding at a national level as evidenced by the increased number of Canadian mothers initiating breastfeeding. However, adolescent mothers (<19 years), compared to all other mothers, have lower rates of breastfeeding initiation and duration. The purpose of this study was to examine the facilitating influences and barriers to initiating, and continuing breastfeeding, as perceived by adolescent mothers in Durham Region, Ontario, Canada.

METHODS

The principles of interpretive description guided this qualitative study. A purposeful, homogenous sample of 16 adolescent mothers (15-19 years) were recruited to complete individual, semi-structured, face-to-face interviews. Conventional content analysis was used to code data, identify concepts and synthesize them into overall themes.

RESULTS

Adolescent mothers in this study expressed that the decision to breastfeed was made prenatally and while partner and family member opinions about breastfeeding initiation were influential, the decision was made independently. Mothers were primarily motivated to initiate breastfeeding due to the health benefits for the infant. Lower breastfeeding duration rates were found among mothers who decided to only "try" breastfeeding when compared to the mothers who committed to breastfeeding. Influences on continued breastfeeding included: 1) the impact of breastfeeding on social and intimate relationships; 2) the availability of social support; 3) the physical demands of breastfeeding; 4) mothers' knowledge of breastfeeding practices and benefits; and 5) mothers' perceived sense of comfort in breastfeeding.

CONCLUSIONS

The results of this study provide health care providers new conceptual insight and understanding of the factors that influence adolescents' decisions to "try" breastfeeding and to continue providing breastmilk to their infants. Professional implications drawn from this study include active engagement of adolescents in the pre and postnatal periods, including early assessment of potential barriers surrounding breastfeeding decisions. This early professional interaction highlights the professional as a form of support, and allows for sharing of evidence-informed breastfeeding information and practical breastfeeding skills. Inclusion of adolescents' positive social support networks should be emphasized in professional breastfeeding support. Motivational interviewing is a promising prenatal strategy to influence behavior change and reduce ambivalence in decision-making about breastfeeding, creating opportunities for health care providers to tailor interventions.

Mothers' experiences in the Nurse-Family Partnership program: a qualitative case study

Background

Few studies have explored the experiences of low income mothers participating in nurse home visiting programs. Our study explores and describes mothers' experiences participating in the Nurse-Family Partnership (NFP) Program, an intensive home visiting program with demonstrated effectiveness, from the time of program entry before 29 weeks gestation until their infant's first birthday.

Methods

A qualitative case study approach was implemented. A purposeful sample of 18 low income, young first time mothers participating in a pilot study of the NFP program in Hamilton, Ontario, Canada partook in one to two face to face in-depth interviews exploring their experiences in the program. All interviews were digitally recorded and transcribed verbatim. Conventional content analysis procedures were used to analyze all interviews. Data collection and initial analysis were implemented concurrently.

Results

The mothers participating in the NFP program were very positive about their experiences in the program. Three overarching themes emerged from the data: 1. Getting into the NFP program; 2. The NFP nurse is an expert, but also like a friend providing support; and 3. Participating in the NFP program is making me a better parent.

Conclusions

Our findings provide vital information to home visiting nurses and to planners of home visiting programs about mothers' perspectives on what is important to them in their relationships with their nurses, how nurses and women are able to develop positive therapeutic relationships, and how nurses respond to mothers' unique life situations while home visiting within the NFP Program. In addition our findings offer insights into why and under what circumstances low income mothers will engage in nurse home visiting and how they expect to benefit from their participation.

Comparison of adolescent, young adult, and adult women's maternity experiences and practices

BACKGROUND AND OBJECTIVE

Pregnant adolescents face unique challenges. Understanding the experiences, knowledge, and behaviors of adolescents during the pregnancy and postpartum periods may contribute to improvement of their maternity care. The purpose of this study was to compare the maternity experiences, knowledge, and behaviors of adolescent, young adult, and adult women by using a nationally representative sample.

METHODS

This study used data from the Canadian Maternity Experiences Survey (N = 6421). The weighted proportions of each variable were calculated by using survey sample weights. Logistic regression was used to estimate odds ratios. Bootstrapping techniques were used to calculate variance estimates for prevalence and 95% confidence intervals.

RESULTS

Adolescents and young adults were more likely to experience physical abuse in the previous 2 years, initiate prenatal care late, not take folic acid before or during pregnancy, have poor prenatal health behaviors, have a lower cesarean delivery rate, have lower breastfeeding initiation and duration rates, experience more stressful life events, experience postpartum depression symptoms, and rate their infant's health as suboptimal than adult women. Adolescents were more likely to rate their own health as suboptimal.

CONCLUSIONS

Adolescents have unique needs during pregnancy and postpartum. Health care professionals should seek to provide care in a manner that acknowledges these needs.

Risk and protective factors associated with postnatal depression in Mexican adolescents

We explored factors associated with postnatal depression and further evaluated whether any of these risk and protective factors are specific for adolescent mothers. Data concerning depression levels, family and individual factors were collected in a cross-sectional study which surveyed 298 women in Monterrey, N.L., Mexico. Mean maternal age was 24.64 years, and 27.18% of the mothers were between 14 and 19 years old. Prevalence of postnatal depression was higher in adolescents (16.05%) than in adult mothers (14.29%) but, on average, this difference was not significant. The association between individual factors and postnatal depression for both adult and adolescent mothers was explored. Our results revealed that social support is significantly associated with less possibility of postnatal depression in both groups, and that this effect is stronger for adolescents (OR=0.81) than for adults (OR=0.92). For the sample as a whole postnatal depression was associated with lower levels of education, reported fear during labor and living with partner. We also found that having a girl greatly increased the possibility of postnatal depression. We conclude that social support is a protective factor associated with postnatal depression, especially for adolescents.

Depressive Symptoms and Resilience among Pregnant Adolescents: A Case-Control Study

Background. Data regarding depression and resilience among adolescents is still lacking. Objective. To assess depressive symptoms and resilience among pregnant adolescents. Method. Depressive symptoms and resilience were assessed using two validated inventories, the 10-item Center for Epidemiologic Studies Short Depression Scale (CESD-10) and the 14-item Wagnild and Young Resilience Scale (RS), respectively. A case-control approach was used to compare differences between adolescents and adults. Results. A total of 302 pregnant women were enrolled in the study, 151 assigned to each group. Overall, 56.6% of gravids presented total CESD-10 scores 10 or more indicating depressed mood. Despite this, total CESD-10 scores and depressed mood rate did not differ among studied groups. Adolescents did however display lower resilience reflected by lower total RS scores and a higher rate of scores below the calculated median (P < .05). Logistic regression analysis could not establish any risk factor for depressed mood among studied subjects; however, having an adolescent partner (OR, 2.0 CI 95% 1.06-4.0, P = .03) and a preterm delivery (OR, 3.0 CI 95% 1.43-6.55, P = .004) related to a higher risk for lower resilience. Conclusion. In light of the findings of the present study, programs oriented at giving adolescents support before, during, and after pregnancy should be encouraged.

Effects of group prenatal care on psychosocial risk in pregnancy: results from a randomised controlled trial

Few interventions have succeeded in reducing psychosocial risk among pregnant women. The objective of this study was to determine whether an integrated group prenatal care intervention already shown to improve perinatal and sexual risk outcomes can also improve psychosocial outcomes compared to standard individual care. This randomised controlled trial included pregnant women ages 14-25 from two public hospitals (N = 1047) who were randomly assigned to standard individual care, group prenatal care or integrated group prenatal care intervention (CenteringPregnancy Plus, CP+). Timing and content of visits followed obstetrical guidelines, from 18-week gestation through birth. Each 2-h group prenatal care session included physical assessment, education/skills building and support via facilitated discussion. Using intention-to-treat models, there were no significant differences in psychosocial function; yet, women in the top tertile of psychosocial stress at study entry did benefit from integrated group care. High-stress women randomly assigned to CP+ reported significantly increased self-esteem, decreased stress and social conflict in the third trimester of pregnancy; social conflict and depression were significantly lower 1-year postpartum (all p-values < 0.02). CP+ improved psychosocial outcomes for high-stress women. This 'bundled' intervention has promise for improving psychosocial outcomes, especially for young pregnant women who are traditionally more vulnerable and underserved.

Young mother-father dyads and maternal harsh parenting behavior

OBJECTIVE

This study examined whether the age of parents predicted maternal harsh parenting behavior, specifically whether younger mothers might be at higher risk than older mothers, and which paternal characteristics might be associated with maternal parenting behavior.

METHODOLOGY

This study used data from the Fragile Families and Child Wellbeing (FFCW) study. In the present study, the authors examined a subsample of families for which complete data were available on all variables that were used in the analyses (n=1,597). Based on the parents' age at the time of the child's birth, mother-father age-dyad types were classified, and selected paternal factors were used to examine their association with maternal harsh parenting behavior. Psychological aggression, physical aggression, and self-reports of spanking were used as proxies for maternal harsh parenting behavior.

RESULTS

Multivariate analyses indicated that adolescent mothers, regardless of how old their partners were, were at higher risk for harsh parenting behavior than older adult mothers. Regarding paternal factors, paternal coercion against mother and the fathers' use of spanking were significantly associated with all three proxies for maternal harsh parenting behavior. Fathers' employment was a risk factor for maternal physical aggression.

CONCLUSION

This study supported findings from previous studies that younger mothers may indeed be at greater risk for harsh parenting behavior. It is critical, therefore, that they acquire appropriate parenting behavior and develop a healthy relationship with their children. Additional studies, both cross-sectional and longitudinal, are needed to involve their partners (i.e., their child's father) in order to shed light on ways of preventing harsh parenting behavior and examining the role of fathers in maternal parenting behavior.

PRACTICE IMPLICATIONS

The present study calls for more attention to sex education and intervention programs in school and health care settings as important components of prevention services. Practitioners need to better understand the concept of harsh parenting behavior in order to work with young parents and prevent future physical child abuse. Policy makers should support these efforts and research should be done that engages both mothers and fathers and seeks to enhance and modify existing programs for youths.

Early motherhood and harsh parenting: the role of human, social, and cultural capital

OBJECTIVE

This study examined the role of maternal human, social, and cultural capital in the relationship between early motherhood and harsh parenting behavior.

METHODS

This study used data from the Fragile Families and Child Wellbeing (FFCW) Study. Harsh parenting behaviors by mothers who were 19 years or younger at birth of the focal child (n=598) were compared with that of adult mothers 26 years or older (n=1,363). Measures included: For harsh parenting behavior, three proxies were created from the Parent to Child version of the Conflict Tactics Scales (CTS-PC) and self-reports of maternal spanking. For maternal human capital, education, employment, and depression were used. For maternal social capital, expected-social support, paternal support, and lone caregiver status were included. For maternal cultural capital, religious attendance and attachment to race/ethnic heritage were used.

RESULTS

Multivariate analyses indicated that adolescent motherhood has a significant impact on all three harsh parenting behavior outcomes even after controlling for demographic and maternal capital characteristics. Working since the birth of the focal child, depression scores, paternal support, expected-social support, and attendance at religious services made independent contributions to the prediction of harsh parenting behavior.

CONCLUSIONS

Findings emphasize the importance of the prevention of adolescent motherhood and suggest intervention strategies for reducing the risk of maternal harsh parenting behavior. Further study is necessary to examine the complicated relationships among maternal capital and parenting. One method may be to focus on the development of measures of maternal capital, notably measures of expectations regarding and perceptions of received capital.

PRACTICE IMPLICATIONS

Findings from this study have implications for social work practice, particularly for the prevention of adolescent pregnancy and intervention with adolescent mothers and their children. First, the study calls for more recognition of school social work and intervention programs in school settings as important components of prevention services. Second, the importance of identifying fathers and helping them become involved and connected with their young families are highlighted. Finally, practitioners should become more aware of the role of culture in young families as the effect of cultural capital on parenting behavior becomes better understood.

Investigating the relationship between teenage childbearing and psychological distress using longitudinal evidence

The high levels of depression among teenage mothers have received considerable research attention in smaller targeted samples, but a large-scale examination of the complex relationship between adolescent childbearing and psychological distress that explores bidirectional causality is needed. Using the National Longitudinal Study of Adolescent Health (Add Health) and the Early Childhood Longitudinal Study--Birth Cohort, we found that teenage mothers had higher levels of distress than their childless adolescent peers and adult mothers, but the experience of teenage childbearing did not appear to be the cause. Rather teenage mothers' distress levels were already higher than their peers before they became pregnant, and they remained higher after childbearing and into early and middle adulthood. We also found that distress did not increase the likelihood of adolescent childbearing except among poor teenagers. In this group, experiencing high levels of distress markedly increased the probability of becoming a teenage mother Among nonpoor teenage girls, the relationship between distress and subsequent teenage childbearing was spurious.

Identifying postpartum depression: are 3 questions as good as 10?

BACKGROUND

Postpartum depression is the most common medical problem that new mothers face. Anxiety is a more prominent feature of postpartum depression than of depression that occurs at other times in life. Routine, universal screening significantly improves detection in primary health care settings. Thus, an ultrabrief scale that could be incorporated into a general health survey or interview would be useful.

OBJECTIVE

We tested the hypothesis that, during the first 6 postpartum months, the 3-item anxiety subscale of the Edinburgh Postpartum Depression Scale is a better ultrabrief depression screener than 2 Edinburgh Postpartum Depression Scale questions that are almost identical to the widely used Patient Health Questionnaire.

METHODS

A cohort of 199 14- to 26-year-old participants in an adolescent-oriented maternity program completed the Edinburgh Postpartum Depression Scale at well-child visits during the first 6 postpartum months. Three subscales of the Edinburgh Postpartum Depression Scale were examined as ultrabrief alternatives: the anxiety subscale (3 items; Edinburgh Postpartum Depression Scale-3), the depressive symptoms subscale (7 items; Edinburgh Postpartum Depression Scale-7), and 2 questions that resemble the Patient Health Questionnaire (Edinburgh Postpartum Depression Scale-2). The reliability, stability, and construct validity of the Edinburgh Postpartum Depression Scale and 3 subscales were compared. Criterion validity was assessed by comparison with a score of >/=10 on the full, 10-item Edinburgh Postpartum Depression Scale.

RESULTS

A total of 41 mothers (20.6%) met study criteria for referral for evaluation of depression (Edinburgh Postpartum Depression Scale-10 score >/= 10). The Edinburgh Postpartum Depression Scale-3 exhibited the best screening performance characteristics, with sensitivity at 95% and negative predictive value at 98%. It identified 16% more mothers as depressed than the Edinburgh Postpartum Depression Scale did. The performance of the Edinburgh Postpartum Depression Scale-2 was markedly inferior, with sensitivity at 48% to 80%. Moreover, the Edinburgh Postpartum Depression Scale-2 was unreliable for mothers who had not been depressed in the past.

CONCLUSION

The brevity, reliability, and operating characteristics of the Edinburgh Postpartum Depression Scale-3 make it an attractive postpartum depression screening tool for primary health care settings in which the goal is to detect depression, not to assess its severity. Validation by diagnostic psychiatric interview is needed.

Negotiating the transition from adolescence to motherhood: coping with prenatal and parenting stress in teenage mothers in Mulago hospital, Uganda

Background

Adolescence is a transitional stage from childhood to adulthood that is characterized by physical, physiological, psychosocial and behavioral changes that are influenced to a large extent by the age, culture and socialization of the individual. To explore what adolescent mothers perceive as their struggles during the period of transition from childhood to parenthood (through motherhood) and to describe strategies employed in coping with stress of pregnancy, motherhood and parenthood.

Methods

Longitudinal qualitative study involving twenty two in-depth interviews and six focus group discussions among pregnant adolescents who were followed from pregnant to delivery, from January 2004 to August 2005. Participant were selected by theoretical sampling and data was analyzed using grounded theory.

Results

Overall, young adolescents reported more anxiety, loss of self esteem (when they conceived), difficulty in accessing financial, moral and material support from parents or partners and stigmatization by health workers when they sought care from health facilities. Three strategies by which adolescent mothers cope with parenting and pregnancy stress that were described as utilizing opportunities (thriving), accommodating the challenges (bargaining and surviving), or failure (despairing), and varied in the extent to which they enabled adolescents to cope with the stress.

Conclusion

Adolescents on the transition to motherhood have variable needs and aspirations and utilize different strategies to cope with the stress of pregnancy and parenthood.

Effects of polychlorinated biphenyls on maternal odor conditioning in rat pups

Polychlorinated biphenyls (PCBs) are pervasive environmental contaminants that can have damaging effects on physiologic, motoric and cognitive function. Results from studies on PCBs and behavior have shown that exposure can alter learning and memory processes and that these shifts in cognitive abilities can be related to changes in hormonal and neural function. Little experimentation has been done on the impact of exposure to PCBs on social and emotional development. Previous work has shown that exposure to PCBs in children can alter play behavior. Importantly, exposure to PCBs has been found to change aspects of maternal-offspring interactions in rodents. The present study examined the impact of PCBs on maternal odor conditioning in rat pups 12-14 days of age. A modified version of the conditioned place preference paradigm was used that incorporated a maternal-associated odor cue (lemon scent) as the conditioned stimulus. PCBs significantly depressed the preference for the maternal-associated cue but did not impair discrimination for a novel odor. These effects could arise due to changes in the social dynamics between the dam and offspring after co-exposure to PCBs. For example, dams exposed to PCBs during gestation have been found to show elevated grooming directed towards pups exposed to PCBs. This change in maternal care can have dramatic effects on behavioral and hormonal systems in the developing rat pup. In conclusion, perinatal PCBs alter important social behaviors of both the mother and pup, and these alterations could have long-lasting effects on behavioral, cognitive and emotional development.