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Asante HA, Boyetey ST, Essaw E, Nyame CA, Mante B, Dziwornu L, Okyere P. Prevalence and factors associated with antepartum depression among adolescent women in the assin north district of Ghana: a cross-sectional study. BMC Womens Health 2024; 24:276. [PMID: 38711102 DOI: 10.1186/s12905-024-03111-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/23/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Globally, depression is a leading cause of disease-related disability among women. In low-and-middle-income countries (LMICs), the prevalence rate of antepartum depression is estimated to range between 15% and 57% and even higher in adolescent antepartum women. Although a number of studies have shown that depression is common in adolescent pregnancies and has a prevalence rate between 28% and 67% among adolescent mothers, there currently exists no literature on depression among adolescent pregnant women in Ghana. The study aimed to determine the prevalence of antepartum depression and identify the factors associated with it among pregnant adolescent women. METHODS A quantitative cross-sectional study design was adopted by randomly recruiting 220 adolescent pregnant women visiting antenatal clinics in five selected health facilities in five communities in the Assin North District of Ghana. Data were collected using the Edinburgh Postnatal Depression Scale (EPDS). Data analysis was performed using Stata version 14. Both descriptive and inferential analyses were performed. A chi-square analysis was conducted to identify the association between independent and dependent variables. A multivariate logistic regression analysis was carried out to identify the independent variables that were significantly associated with the dependent variable. In all analyses, p-values ≤ 0.05 were deemed statistically significant at a 95% confidence interval. RESULTS The results indicated prevalence of depression was 38.6% using the EPDS cut-off ≥ 13. Respondents who were cohabiting were less likely to experiencing antepartum depression compared to those who were single (AOR = 0.36, 95% CI: 0.20-0.64, p = 0.001). Also, Respondents who had completed Junior High School had a lower likelihood of experiencing antepartum depression compared to those who had no formal education (AOR = 0.19, 95% CI: 0.05-0.76, p = 0.019). Respondents who perceived pregnancy-related items to be costly had higher odds of experiencing antepartum depression (AOR = 2.05, 95% CI: 1.02-4.12, p = 0.042). Lastly, adolescent pregnant women who reported that pregnancy-related items are costly were likely to experience antepartum depression compared to those who did not report such costs (AOR = 2.12, 95% CI: 1.20-3.75, p < 0.001). CONCLUSION The results of this study highlight the importance of a multi-pronged strategy for combating antepartum depression in adolescents and improving the overall health and well-being of pregnant adolescents. Considering that adolescence is a transitional period occasioned by several bio-psycho-social challenges, setting up systems to ensure that young girls are motivated and supported to stay in school will enhance their economic prospects and improve their standards of life while providing psycho-social support will benefit their health and general well-being.
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Affiliation(s)
- Hannah Amoquandoh Asante
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Shadrach Tetteh Boyetey
- Department of Health Policy, Management and Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ebenezer Essaw
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Christopher Amoah Nyame
- Department of Occupational and Environmental Health and Safety, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bertha Mante
- Department of Real Estate and Land Management, University for Development Studies, Tamale, Ghana
| | - Louisa Dziwornu
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Paul Okyere
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Howe K, Stites E, Bassett L, Ewart M, Hammada KA, Sulaiman S, Lony N, Maguek TN. Health and well-being of young mothers displaced by conflict: Experiences from South Sudan and the Kurdistan Region of Iraq. Soc Sci Med 2024; 348:116710. [PMID: 38636208 DOI: 10.1016/j.socscimed.2024.116710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 04/20/2024]
Abstract
Giving birth during adolescence is linked to a variety of negative outcomes, including poor health and well-being. Girls who have been displaced by conflict are at increased risk for becoming young mothers. While prevalence rates and health outcomes have been documented, rarely have the complex personal narratives of early motherhood been examined from the perspectives of mothers themselves, particularly in the Global South. This study relies on in-depth, inductive, narrative analysis of qualitative interviews with 67 young mothers and 10 relatives in South Sudan and the Kurdistan Region of Iraq (KRI) who had been displaced by conflict. This study provides deep insights into the contributing circumstances and consequences of young motherhood from sexual and reproductive health and well-being perspectives, with additional insights on mothering in humanitarian crisis.
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Saleh A, Irwan AM, Latif AI, Syahrul S, Hadju V, Andriani I, Restika I. Implementation of coaching methods to decrease the parenting stress levels among teenage mothers in Indonesia: A quasi-experimental study. Belitung Nurs J 2024; 10:192-200. [PMID: 38690301 PMCID: PMC11056841 DOI: 10.33546/bnj.3071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/01/2023] [Accepted: 02/03/2024] [Indexed: 05/02/2024] Open
Abstract
Background The high rate of early marriage, teenage pregnancy, and teenage mothers increases the prevalence of emotional and mental disorders, depression, parenting stress, and child stunting. Parenting coaching is among the effective ways to overcome parenting stress and improve parents' knowledge, skills, and behaviors, thereby avoiding child stunting. However, studies on parenting coaching are not widely conducted, particularly in Indonesia. Objective This study aimed to present the current status of parenting stress among teenage mothers and assess whether parenting coaching effectively reduces parenting stress among teenage mothers. Methods A quasi-experimental design was used. The participants were randomly selected into two groups: the intervention group receiving parenting coaching intervention and the control group receiving standard education using a leaflet. Data were collected in June 2021 in Takalar Regency, South Sulawesi, Indonesia. Statistical Program for Social Science version 21 (Armonk, NY, USA) was employed for all statistical analyses. Results The parenting coaching intervention had a significant effect on parenting stress (p <0.001), with significant positive changes in knowledge, attitude (p <0.001), behavior (p <0.001), self-efficacy (p <0.001), and maternal function (p <0.001). Additionally, a significant difference in the achievement of z-score values was observed between the intervention and control groups based on Body Weight/Age (BW/A) (p <0.001) and Body Length/Age (BL/A) (p <0.001). However, Body Weight/Body Length (BW/BL) did not show a significant difference in the achievement of z-score (p = 0.34) in the third month. Conclusion Parenting coaching can reduce parenting stress among teenage mothers and improve their knowledge, attitudes, behavior, self-efficacy, and maternal function; hence, this intervention can be used as a reference in the nursing process to reduce parenting stress and prevent child stunting.
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Affiliation(s)
- Ariyanti Saleh
- Faculty of Nursing, Hasanuddin University, Makassar, Indonesia
| | | | | | - Syahrul Syahrul
- Faculty of Nursing, Hasanuddin University, Makassar, Indonesia
| | - Veni Hadju
- Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Irma Andriani
- Faculty of Mathematics and Natural Sciences, Hasanuddin University, Makassar, Indonesia
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Muthelo L, Mbombi MO, Mphekgwana P, Mabila LN, Dhau I, Tlouyamma J, Mashaba RG, Mothapo K, Ntimane CB, Seakamela KP, Nemuramba R, Maimela E, Sodi T. Exploring mental health problems and support needs among pregnant and parenting teenagers in rural areas Of Limpopo, South Africa. BMC Womens Health 2024; 24:236. [PMID: 38614989 PMCID: PMC11015670 DOI: 10.1186/s12905-024-03040-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/21/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Globally, teenage pregnancy is among the most social problems, affecting 21 million adolescents aged 15-19. Due to the increased responsibility of prenatal and postnatal care for their infants without support, pregnant and parenting teenagers, tend to experience mental health problems. Factors contributing to these problems among pregnant and parenting teenagers in rural African settings have hardly received scholarly attention and, therefore, are less understood. The purpose of the study was to explore mental health and challenges among pregnant and parenting teenagers,. METHOD(S) The study adopted a qualitative descriptive, exploratory, and phenomenological design. Purposive sampling was used to select 22 pregnant and parenting teenagers 18 years or older. Data were collected in ten selected clinics within the Demographic Surveillance Systems (HDSS) of DIMAMO and analysed using qualitative content analysis. RESULTS The findings reveal that pregnant and parenting teenagers in rural areas experience various mental challenges such as depression. These challenges are caused by social problems such as stigmatisation, lack of support from families and friends, as well as parenting demands that contribute to poor progress at school or dropouts. Pregnant teens expressed concerns about the lack of spousal support resulting from abandoning their partners. CONCLUSIONS Stress and depression were self-reported as mental problems among participants with various psychosocial implications, such as school dropout and miscarriage. There are various contributing factors to the mental health problems identified among pregnant and parenting teenagers, including inadequate family and spousal support. Access to integrated reproductive, psychosocial, and mental health services could be essential for these pregnant and parenting teenagers, to improve their mental well-being and improve the support system.
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Affiliation(s)
- Livhuwani Muthelo
- Department of Nursing Science, University of Limpopo, SOVENGA, Private Bag X1106, Polokwane, 0727, South Africa.
| | - Masenyani Oupa Mbombi
- Department of Nursing Science, University of Limpopo, SOVENGA, Private Bag X1106, Polokwane, 0727, South Africa
| | - Peter Mphekgwana
- Research Administration and Development, University of Limpopo, SOVENGA, Private Bag X1106, Polokwane, 0727, South Africa
| | - Linneth Nkateko Mabila
- Department of Pharmacy, University of Limpopo, SOVENGA, Private Bag X1106, Polokwane, 0727, South Africa
| | - Inos Dhau
- Department of Geography and Environmental Studies, University of Limpopo, SOVENGA, Private Bag X1106, Polokwane, 0727, South Africa
| | - Joseph Tlouyamma
- Department of Computer Science, University of Limpopo, SOVENGA, Private Bag X1106, Polokwane, 0727, South Africa
| | - Reneilwe Given Mashaba
- DIMAMO Population Health Research Centre, University of Limpopo, SOVENGA, Private Bag X1106, Polokwane, 0727, South Africa
| | - Katlego Mothapo
- DIMAMO Population Health Research Centre, University of Limpopo, SOVENGA, Private Bag X1106, Polokwane, 0727, South Africa
| | - Cairo Bruce Ntimane
- DIMAMO Population Health Research Centre, University of Limpopo, SOVENGA, Private Bag X1106, Polokwane, 0727, South Africa
| | - Kagiso Peace Seakamela
- DIMAMO Population Health Research Centre, University of Limpopo, SOVENGA, Private Bag X1106, Polokwane, 0727, South Africa
| | - Rathani Nemuramba
- DIMAMO Population Health Research Centre, University of Limpopo, SOVENGA, Private Bag X1106, Polokwane, 0727, South Africa
| | - Eric Maimela
- Department of Public Health, University of Limpopo, Private Bag X1106, SOVENGA 0727, Polokwane, South Africa
| | - Tholene Sodi
- Research Chair Mental Health, University of Limpopo, Private Bag X1106, Polokwane, 0727, SOVENGA, South Africa
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Chrisphonte P, Bath E. Overturning Roe v Wade and Planned Parenthood v Casey: An Assault to Reproductive and Racial Justice and the Mental Health of Youth. J Am Acad Child Adolesc Psychiatry 2024; 63:393-395. [PMID: 37678665 DOI: 10.1016/j.jaac.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 07/08/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
On June 24, 2022, the Supreme Court of the United States overturned Roe v Wade and Planned Parenthood v Casey, ending a woman's constitutional right to access abortion. Child and adolescent psychiatrists should be gravely concerned about these decisions. Youth with mental health disorders are an at-risk population. Lack of access to reproductive care, including abortion, will adversely impact the physical and mental health of teens,2 exerting a disproportionate impact on Black and Brown youth, many of whom experience systemic racism and are in systems that leave them structurally vulnerable (ie, in foster care or legal system). These decisions will have a lasting, negative impact on medical, social, and economic outcomes of youth for generations to come. Thus, we make the case that access to reproductive care is a matter of reproductive and racial justice.
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Affiliation(s)
| | - Eraka Bath
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, California
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Ronen K, Gewali A, Dachelet K, White E, Jean-Baptiste M, Evans YN, Unger JA, Tandon SD, Bhat A. Acceptability and Utility of a Digital Group Intervention to Prevent Perinatal Depression in Youths via Interactive Maternal Group for Information and Emotional Support (IMAGINE): Pilot Cohort Study. JMIR Form Res 2024; 8:e51066. [PMID: 38306159 PMCID: PMC10873795 DOI: 10.2196/51066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/10/2023] [Accepted: 12/12/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Perinatal depression (depression during pregnancy or the first year postpartum) affects 10%-25% of perinatal individuals, with a higher risk among youths aged <25 years. The Mothers and Babies Course (MB) is an evidence-based intervention for the prevention of perinatal depression, grounded in cognitive behavioral therapy, attachment theory, and psychoeducation. OBJECTIVE We developed a digital adaptation of MB (Interactive Maternal Group for Information and Emotional Support [IMAGINE]) and evaluated it in a pre-post mixed methods pilot among young perinatal people in the United States. METHODS IMAGINE was a structured digital group of up to 7 participants, with scheduled MB content and open discussion for 12 weeks, facilitated by a social worker. Scheduled content included asynchronous SMS text messages, graphics, prerecorded videos, mood polls, and optional weekly synchronous video calls. Eligible participants were pregnant or ≤80 days postpartum, aged 16 to 24 years, had access to a smartphone, spoke English, and had a Patient Health Questionnaire score <10. Participants were recruited throughout the United States from August 2020 to January 2021 through paid social media ads, in-person outreach at clinics, and respondent-driven sampling. Participants completed quantitative questionnaires at enrollment and 3 months, and qualitative interviews at 3 months. We determined uptake, acceptability (by Acceptability of Intervention Measure score), and utility (by use of cognitive behavioral therapy skills). We compared depression symptoms (by Patient Health Questionnaire score), social support (by abbreviated Social Support Behavior score), and perceived stress (by Perceived Stress Score) between enrollment and follow-up by paired 2-tailed t test. RESULTS Among 68 individuals who contacted this study, 22 were screened, 13 were eligible, and 10 enrolled, for an uptake of 76.9%. Furthermore, 4 (40%) participants were pregnant at enrollment. Participants had a median age of 17.9 (IQR 17.4-21.7) years, 6 (67%) identified as Black, 5 (56%) Latinx, and 6 (67%) using Medicaid health insurance. Further, 9 (90%) participants completed follow-up. Among these, the mean acceptability score was 4.3 out of 5 (SD 0.6) and all participants said they would recommend IMAGINE to a friend. Participants reported using a median of 7 of 11 skills (IQR 5-7 skills) at least half the days. We found no significant changes in depression symptoms, perceived stress, or social support. Qualitatively, participants reported one-to-one support from the facilitator, connection with other parents, and regular mood reflection were especially helpful aspects of the intervention. Additionally, participants reported that the intervention normalized their mental health challenges, improved their ability to manage their mood, and increased their openness to mental health care. CONCLUSIONS This pilot study provides promising evidence of the acceptability and utility of IMAGINE among perinatal youths. Our study's small sample size did not detect changes in clinical outcomes; our findings suggest IMAGINE warrants larger-scale evaluation.
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Affiliation(s)
- Keshet Ronen
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Anupa Gewali
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Kristin Dachelet
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Erica White
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - Yolanda N Evans
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States
| | - Jennifer A Unger
- Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, Providence, RI, United States
| | - S Darius Tandon
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
- Center for Community Health, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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Ojeleye OA, Beckie TM, Oruche UM. Psychosocial Factors Associated With Perinatal Anxiety and Perinatal Depression Among Adolescents: A Rapid Review. J Psychosoc Nurs Ment Health Serv 2024; 62:13-22. [PMID: 37646603 DOI: 10.3928/02793695-20230821-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
The current review examined the influence of psychosocial factors on adolescents' perinatal anxiety (PA) and perinatal depression (PND) across geographical regions. Three databases were searched for articles published between 2017 and 2022 and 15 articles were reviewed. We categorized factors into social, cultural, and environmental domains. Social factors included adolescent caregiver trust/attachment, social support, perceived social support, trauma/poly-traumatization, and peer solidarity. Cultural factors included feelings of shame, marital satisfaction, partner's rejection of pregnancy, lack of parental involvement in care, parenting stress, childhood household dysfunction, and adverse childhood events. Environmental factors included neighborhood support, food insecurity, domestic violence, going to church, going out with friends, and sources for obtaining information. Routine assessment of psychosocial factors among perinatal teens is crucial to identify those at higher risk for PA and PND. Further research is necessary to examine the influence of cultural and environmental factors on PA, PND, and perinatal outcomes among adolescents. [Journal of Psychosocial Nursing and Mental Health Services, 62(2), 13-22.].
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Abdul Rahim K, Egglestone NJ, Tsagareli IG, Usmani W, Meherali S, Lassi ZS. Mental health outcomes beyond the post-partum period among adolescent mothers: a systematic review and meta-analysis. Health Psychol Behav Med 2024; 12:2305741. [PMID: 38313449 PMCID: PMC10836488 DOI: 10.1080/21642850.2024.2305741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/08/2024] [Indexed: 02/06/2024] Open
Abstract
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.
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Affiliation(s)
- Komal Abdul Rahim
- Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan
- Dean’s Office, Medical College, Aga Khan University, Karachi, Pakistan
- Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | | | - Wania Usmani
- Public Health Information Development Unit, Torrens University Australia, Adelaide, Australia
| | | | - Zohra S. Lassi
- Adelaide Medical School, Robinsons Research Institute University of Adelaide, Adelaide, Australia
- Faculty of Health and Medical Sciences, School of Public Health, University of Adelaide, Adelaide, Australia
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Kathono J, Nyongesa V, Mwaniga S, Obonyo G, Yator O, Wambugu M, Banerjee J, Breuer E, Duffy M, Lai J, Levy M, Njuguna S, Kumar M. Adolescent perspectives on peripartum mental health prevention and promotion from Kenya: Findings from a design thinking approach. PLoS One 2024; 19:e0290868. [PMID: 38165879 PMCID: PMC10760697 DOI: 10.1371/journal.pone.0290868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/17/2023] [Indexed: 01/04/2024] Open
Abstract
In Kenya, approximately one in five girls aged 15-19 years old are pregnant or already a mother. Adolescent girls and young women experience significant mental health vulnerabilities during the pregnancy and postpartum periods, leading to poor antenatal and postnatal care attendance and inferior infant and maternal health outcomes. Pregnant adolescents often experience stigma and disenfranchisement due to their pregnancy status and at the same time lack access to mental health support within health settings, schools, religious institutions, and communities. This paper presents the results of qualitative interviews embedded within the human-centered design (HCD) process used to adapt the Helping Adolescents Thrive (HAT) program for Kenyan peripartum adolescents including young fathers. This qualitative study used two phases. First, a HAT advisory group participated in a series of four workshops to help identify and articulate mental health promotion needs and deepened the team's understanding of youth-centered thinking. Second, qualitative interviews were conducted with 39 pregnant and parenting adolescents to understand their perspectives on mental health prevention and promotion. Pregnant and parenting adolescents articulated different needs including poor support, stigma, and psychological disturbances. Parenting adolescents reported disturbed relationships, managing motherhood, poor health, and social empowerment. Participants highlighted sources of stress including economic challenges, fear of delivery, strained relationships, rejection, and stigma. Participants described psychological disturbances such as feeling stressed, worthless, withdrawn, and suicidal. Coping mechanisms reported by participants included engaging in domestic activities, hobbies, and social networking. Peers, family and spirituality were identified as important sources of support, as well as school integration, livelihoods, support groups and mentorships. Findings from this study can be used to strengthen and adapt HAT program, policy and practice for mental health prevention and promotion for pregnant and parenting adolescents.
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Affiliation(s)
| | | | | | | | - Obadia Yator
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | | | | | - Erica Breuer
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Malia Duffy
- St Ambrose University, Davenport, Iowa, United States of America
- Health Across Humanity, LLC, Boston, Massachusetts, United States of America
| | - Joanna Lai
- UNICEF Headquarters, New York, NY, United States of America
| | - Marcy Levy
- UNICEF Headquarters, New York, NY, United States of America
| | - Simon Njuguna
- Division of Mental Health, Ministry of Health, Nairobi, Kenya
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, United States of America
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Cooke LM, Moodley S, Paruk L. The profile of adolescent patients presenting to a tertiary maternal mental health clinic. S Afr J Psychiatr 2023; 29:2185. [PMID: 38223306 PMCID: PMC10784263 DOI: 10.4102/sajpsychiatry.v29i0.2185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/13/2023] [Indexed: 01/16/2024] Open
Abstract
Background Between March 2021 and April 2022, there were 90 037 documented adolescent pregnancies in South Africa. Statistics SA reports that this number is growing. Pregnancy places adolescents at greater risk of psychiatry-related morbidity and may have far-reaching consequences for their children. To date, there is no published data describing the patient profile of adolescent pregnancies in Gauteng Province, South Africa. Aim To describe the patient profile (demographics, schooling history and type of accommodation), pregnancy-related factors, substance use habits and contraceptive use in pregnant adolescents seen at a tertiary care maternal mental health clinic (MMHC). Setting The MMHC at Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa. Methods A retrospective file review of all pregnant adolescents referred to the MMHC between January and June 2022. Results The mean age of the patients was 15.2 years; 72% attended school and 97.4% planned to return. Most pregnancies were unplanned (97.9%), wanted (84%) and presented in the second (41.24%) and third (51.55%) trimesters. Most did not report using substances (76.7%). Fifty percent of the participants met the criteria for a major depressive disorder. Repeating a grade was an identifiable risk factor for an increased Edinburgh depression score. An unplanned pregnancy was associated with a higher risk factor assessment. Conclusion Pregnant adolescents represent a vulnerable population group. A greater understanding of this patient profile may inform early psychiatric and psychosocial interventions, improved service delivery and help-seeking behaviour. Contribution This study gives significant insights into the challenges faced, as well as the health and social needs of pregnant adolescents. This contributes to wholistic care and opportunities for early intervention, including awareness of contraceptive use and the risks of substance use and adolescent pregnancy on mental health, benefiting all South African adolescents.
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Affiliation(s)
- Luzaan M Cooke
- Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanushka Moodley
- Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Laila Paruk
- Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Mhango W, Crowter L, Michelson D, Gaysina D. Psychoeducation as an active ingredient for interventions for perinatal depression and anxiety in youth: a mixed-method systematic literature review and lived experience synthesis. BJPsych Open 2023; 10:e10. [PMID: 38088162 PMCID: PMC10755556 DOI: 10.1192/bjo.2023.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/22/2023] [Accepted: 10/14/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Psychoeducation is a common element in psychological interventions for youth depression and anxiety, but evidence about its use with youth perinatally is limited. AIMS This review aims to understand outcomes and mechanisms of psychoeducation for the indicated prevention and treatment of perinatal depression and anxiety in youth. METHOD For this review, we synthesised published quantitative and qualitative evidence. Seven databases (ASSIA, Medline, PubMed, PsycINFO, PsycArticles, Scopus and Web of Science) were searched for studies published before 10 August 2021. We also had consultations with a youth advisory group (N = 12). RESULTS In total, 20 studies met the inclusion criteria. Seven quantitative studies examined multicomponent interventions that included psychoeducation, and one study evaluated psychoeducation as a standalone intervention for postnatal depression. Multicomponent interventions showed significant effects on postnatal depression in two out of six studies, as well as being effective at reducing prenatal anxiety in one study. Standalone psychoeducation for postnatal depression was also effective in one study. Evidence from 12 qualitative studies, corroborated by commentaries from the youth advisory group, suggested that psychoeducation could increase knowledge about symptoms, generate awareness of relevant services and enhance coping. CONCLUSIONS Psychoeducation may be an important foundational ingredient of interventions for perinatal depression and, potentially, anxiety in adolescents and young adults through stimulating help-seeking and self-care.
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Affiliation(s)
- Wezi Mhango
- School of Psychology, University of Sussex, UK; and Department of Psychology, University of Malawi, Malawi
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12
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Meherali S, Rehmani AI, Ahmad M, Adewale B, Kauser S, Lebeuf S, Benoit J, Scott SD. Impact of the COVID-19 pandemic on the sexual and reproductive health of adolescents in Alberta, Canada. Reprod Health 2023; 20:172. [PMID: 37990327 PMCID: PMC10664423 DOI: 10.1186/s12978-023-01712-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE The COVID-19 pandemic led to major service disruptions in the healthcare sector, especially regarding sexual and reproductive health services. However, the impact of the pandemic on Canadian adolescents is relatively unknown. This study aimed to investigate the impacts of the COVID-19 pandemic and associated public health measures on the sexual and reproductive health (SRH) of adolescents in Alberta, Canada. METHODS A qualitative study using an interpretive description (ID) approach and community-based participatory research principles was conducted to capture the subjective experience and perceptions of adolescents and service providers. With the collaboration of the Adolescent Advisory Group and community partners, 18 adolescents and 15 service providers were recruited for the study through purposive sampling. Findings from the qualitative interviews were analyzed using thematic analysis. RESULTS Three major themes emerged from the analysis: (1) COVID-19 SRH experience, (2) barriers to SRH, and (3) adolescent SRH strategies. Our findings highlight numerous barriers and challenges that prevented adolescents from accessing SRH education, products, and services. CONCLUSION The COVID-19 pandemic had a profound impact on the SRH and the well-being of adolescents. Our study reflects the need for diverse SRH strategies to maintain continued access to SRH resources during disruptive events, such as the pandemic.
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Affiliation(s)
- Salima Meherali
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Amyna Ismail Rehmani
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada.
| | - Mariam Ahmad
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Bisi Adewale
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Samar Kauser
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Simone Lebeuf
- Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - James Benoit
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
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Bah HAF, Santos NRD, Costa DO, Carvalho CFD, Martinez VO, Gomes-Júnior EA, Antônio Menezes-Filho J. Environmental neurodevelopment toxicity from the perspective of Bronfenbrenner's bioecological model: a case study of toxic metals. CAD SAUDE PUBLICA 2023; 39:e00202022. [PMID: 37729303 PMCID: PMC10513156 DOI: 10.1590/0102-311xen202022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 06/04/2022] [Accepted: 06/16/2023] [Indexed: 09/22/2023] Open
Abstract
A growing body of literature reports the need for an integrated approach to study the effects of the physical environment on the neurodevelopment of children. Assessment of the true neurotoxicity of pollutants cannot be performed separately from the ecological and multidimensional contexts in which they act. In this study, from the perspective of the Bronfenbrenner's bioecological model, a conceptual model was developed that encompasses the social and biological characteristics of children from the gestational period to childhood, considering exposure to toxic metals. First, we present the toxicity of the main metals and some concept notions that we used in our framework, such as social and structural determinants of health, allostatic load, embodiment, and epigenetic concepts. Then, the main aspects of the Bronfenbrenner's bioecological model, which allow integration of the gene-social relationship in addition to the physical environment, where these metals act, are explained. Finally, we present and discuss the conceptual framework showing how, in real life, biological and social factors may together influence the neurodevelopment of children. Although this model is based on a group of contaminants, it opens new horizons on how environmental sciences, such as neurotoxicology and environmental epidemiology, can articulate with the theoretical models from human sciences to provide a broader approach to study the effects on human neurodevelopment.
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Affiliation(s)
- Homègnon Antonin Ferréol Bah
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
- Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Brasil
| | | | | | | | | | | | - José Antônio Menezes-Filho
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
- Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Brasil
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Tung I, Keenan K, Hipwell AE. Adolescent Mothers' Psychological Wellbeing during Pregnancy and Infant Emotional Health. J Clin Child Adolesc Psychol 2023; 52:616-632. [PMID: 34605721 PMCID: PMC8977390 DOI: 10.1080/15374416.2021.1981339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Although many studies have identified risk factors for adolescent pregnancy, much less is known about factors that support pregnant adolescents' psychological wellbeing and offspring outcomes. This study drew on strength-based frameworks to investigate family and neighborhood factors linked to social connectedness that predict psychological wellbeing during adolescent pregnancy and offspring outcomes. METHOD Participants included 135 adolescent mothers (ages 14-21; 90% Black American) assessed annually since childhood as part of a longitudinal study. During preadolescence (ages 11-13), data on contextual stressors and neighborhood support were gathered from participants' caregivers; participants also rated their perceived trust/attachment with caregivers before and during pregnancy. To assess changes in psychological wellbeing, adolescents reported positive and depressed mood before and during pregnancy. A path analysis model tested the prospective associations between family and neighborhood factors, psychological wellbeing during pregnancy, and offspring outcomes (birth outcomes; observed infant positive/negative emotions at age 3-months). RESULTS Positive mood decreased from pre-pregnancy to pregnancy, whereas depressed mood remained stable. Adjusting for pre-pregnancy mood, perceived caregiver trust/attachment during pregnancy was associated with prenatal positive mood. Prenatal positive mood, in turn, reduced risk of preterm birth and indirectly predicted positive infant emotions via birth outcomes. Neighborhood support in preadolescence predicted lower prenatal depressed mood, but depressed mood did not predict infant outcomes beyond positive mood. Contextual life stress was not associated with prenatal mood after adjusting for family and neighborhood support. CONCLUSIONS Findings highlight changes in positive-valence emotions during adolescent pregnancy that may have unique associations with birth outcomes and offspring emotions.
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Affiliation(s)
- Irene Tung
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Kate Keenan
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL
| | - Alison E. Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
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15
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Merriman B, Jarmoc G, van der Rijn M, Pierre-Joseph N. Impact of COVID-19 on Mental Health and Resiliency of Pregnant and Parenting Adolescents and Young Adults: A Qualitative Study. J Pediatr Health Care 2023; 37:484-491. [PMID: 36973102 PMCID: PMC10008786 DOI: 10.1016/j.pedhc.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/25/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION This study aimed to understand the impacts the COVID-19 pandemic has on the mental health and well-being of pregnant and parenting adolescents and young adults (AYA) to identify unique challenges they faced. METHOD Pregnant and parenting AYA from a teen and tot program at a safety-net hospital in the northeast participated in semistructured qualitative interviews. Interviews were audio-recorded, transcribed, and coded. Analysis was conducted using modified grounded theory and content analysis. RESULTS Fifteen pregnant and parenting AYA participated in interviews. Participants were aged 19-28 years (mean age, 22.6). Participants reported adverse mental health experiences, namely increased loneliness, depression, and anxiety, engagement in preventive measures to protect their children's health, positive attitudes toward telemedicine because of efficiency and safety, delayed attainment of personal and professional goals, and increased attitudes of resilience. DISCUSSION Health care professionals should offer expanded screening and support resources to pregnant and parenting AYA during this time.
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Affiliation(s)
- Bridgette Merriman
- Bridgette Merriman, Medical Student, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Grace Jarmoc
- Grace Jarmoc, Medical Student, Boston University Chobanian & Avedisian School of Medicine, Boston, MA.
| | - Madeleine van der Rijn
- Madeleine van der Rijn, Medical Student, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Natalie Pierre-Joseph
- Natalie Pierre-Joseph, Clinical Associate Professor of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
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Merrill KG, Knight L, Nakuti J, Mirembe A, Allen E, Bhatia A, Parkes J, Naker D, Devries KM. The association between violence victimization and subsequent unplanned pregnancy among adolescent girls in Uganda: Do primary schools make a difference? PLOS Glob Public Health 2023; 3:e0001141. [PMID: 37523344 PMCID: PMC10389730 DOI: 10.1371/journal.pgph.0001141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 06/26/2023] [Indexed: 08/02/2023]
Abstract
Violence victimization is a risk factor for adolescent pregnancy in high-income, low violence prevalence countries, but longitudinal data are lacking from settings where violence and adolescent pregnancy are common, including sub-Saharan Africa. We also know little about contextual factors which modify this association. We analyzed data from the Contexts of Violence in Adolescence Cohort (CoVAC) study in Luwero District, Uganda. Primary students in 42 schools completed surveys in 2014 (Wave 1) and 2018 (Wave 2). Our outcome was unplanned pregnancy. Our exposure was violence victimization, including any violence, type of violence (physical, emotional, sexual), perpetrator group (teacher, peer, family member), and polyvictimization. We fit mixed-effects logistic regression models and examined school factors (e.g., connectedness, absenteeism) as effect modifiers, using data from students (n = 3,431) and staff (n = 591) at the 42 schools. 1,449 girls were included in analyses (78% follow-up). At Wave 1, 88% (n = 1,281/1,449) reported any violence (mean age = 12.73, SD = 1.44 years). At Wave 2, 13.9% (n = 201/1,449) reported an unplanned pregnancy. In adjusted models, compared to no violence, significant associations (p<0.05) were observed for any violence (OR = 1.99, 95%CI = 1.03-3.85), physical violence (OR = 1.96, 95%CI = 1.02-3.79), teacher violence (OR = 1.96, 95%CI = 1.01-3.79), peer violence (OR = 2.00, 95%CI = 1.00-4.03), family violence (OR = 2.23, 95%CI = 1.07-4.65), violence from one perpetrator group (OR = 2.04, 95%CI = 1.01-4.15), and violence from three perpetrator groups (OR = 2.21, 95%CI = 0.99-4.95). Sexual and emotional violence were associated in crude but not adjusted analyses. School and peer connectedness modified the association (p<0.05); girls who experienced violence had higher odds of unplanned pregnancy in schools with lower versus higher connectedness. Violence victimization in early adolescence is strongly associated with subsequent unplanned pregnancy among adolescent girls in Uganda but attending schools with more school or peer connectedness attenuated this link. Interventions should seek to reduce violence against girls to prevent unplanned pregnancy. Interventions promoting positive connections to school may be especially important for violence victims.
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Affiliation(s)
- Katherine G Merrill
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Louise Knight
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Elizabeth Allen
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Amiya Bhatia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jenny Parkes
- University College London-Institute of Education, London, United Kingdom
| | | | - Karen M Devries
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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17
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Smiley Y, Manget J, Barber J, Clarence I, Enwerem N, Jolda C, Quinn P, Wesley ZJ, White D, Chokshi B. Social support, resource utilization, and well-being: a survey of adolescent parents in Washington, DC. BMC Public Health 2023; 23:1278. [PMID: 37400757 PMCID: PMC10316559 DOI: 10.1186/s12889-023-16185-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 06/23/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Adolescent parents experience worse health and socioeconomic outcomes compared to older parents. Little is known about the factors that can lead to better health and well-being among teen-headed families. A city-wide collaborative conducted a comprehensive well-being assessment of expectant and parenting teens in Washington, DC. METHODS An online, anonymous survey was conducted with adolescent parents in Washington, DC, using convenience sampling. The survey consisted of 66 questions adapted from validated scales of quality of life and well-being. Descriptive statistics were used to describe the data overall, by subgroups of mother and father, and by subgroups of parent age. Spearman's correlations were utilized to demonstrate associations of social supports with well-being metrics. RESULTS A total of 107 adolescent and young adult parents from Washington, DC, completed the survey; 80% of respondents identified as mothers and 20% as fathers. Younger adolescent parents rated their physical health better compared to older adolescent and young adult parents. Adolescent parents reported accessing various governmental and community-based resources in the preceding 6 months. The most used resources were supplemental food programs, with 35% receiving Supplemental Nutrition Assistance Program benefits and 24% receiving support from the Special Supplemental Nutrition Program for Women, Infants and Children. There was no significant difference in health-related well-being metrics among those who did and did not receive resources. Having higher self-reported social support was positively correlated with higher self-rated physical health, mental health, and well-being, as well as experiencing positive emotions, and was negatively correlated with experiencing negative emotions. CONCLUSION This snapshot of the well-being of expectant and parenting teens in Washington, DC, showed overall positive physical, mental, and emotional health. Greater social support was correlated with better outcomes in these areas. Future work will leverage the multidisciplinary collaborative to translate these findings into policies and programs that meet the needs of this population.
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Affiliation(s)
- Yael Smiley
- Department of General and Community Pediatrics, Children's National Hospital, 111 Michigan Ave, Washington, DC, 20010, USA.
| | - Jaytoya Manget
- Department of General and Community Pediatrics, Children's National Hospital, 111 Michigan Ave, Washington, DC, 20010, USA
| | - John Barber
- Department of Biostatistics and Study Methodology, Children's National Hospital, Washington, DC, USA
| | - Iana Clarence
- District of Columbia Primary Care Association, Washington, DC, USA
| | - Nkechi Enwerem
- Division of Nursing, College of Nursing and Allied Health Sciences, Howard University, Washington, DC, USA
| | - Christiana Jolda
- Department of General and Community Pediatrics, Children's National Hospital, 111 Michigan Ave, Washington, DC, 20010, USA
| | - Patricia Quinn
- District of Columbia Primary Care Association, Washington, DC, USA
| | - Zillah Jackson Wesley
- Division of Nursing, College of Nursing and Allied Health Sciences, Howard University, Washington, DC, USA
| | - Davene White
- Division of Nursing, College of Nursing and Allied Health Sciences, Howard University, Washington, DC, USA
| | - Binny Chokshi
- Department of Pediatrics, Division of Military Child and Family Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Obonyo G, Nyongesa V, Duffy M, Kathono J, Nyamai D, Mwaniga S, Yator O, Levy M, Lai J, Kumar M. Diverse policy maker perspectives on the mental health of pregnant and parenting adolescent girls in Kenya: Considerations for comprehensive, adolescent-centered policies and programs. PLOS Glob Public Health 2023; 3:e0000722. [PMID: 37339107 DOI: 10.1371/journal.pgph.0000722] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 05/04/2023] [Indexed: 06/22/2023]
Abstract
The pregnancy rate in Kenya among adolescent girls is among the highest in the world. Adolescent girls experience increased risk of anxiety and depression during pregnancy and postpartum which can result in poor health outcomes for both mother and baby, and negatively influence their life course. Mental health is often given low priority in health policy planning, particularly in Sub-Saharan Africa (SSA). There is an urgent need to address the treatment gap and provide timely mental health promotion and preventative services, there is a need to focus on the shifting demographic of SSA-the young people. To understand perspectives on policymakers on the mental health prevention and promotion needs of pregnant and parenting adolescent girls, we carried out a series of interviews as part of UNICEF funded helping pregnant and parenting adolescents thrive project in Kenya. We interviewed 13 diverse health and social policy makers in Kenya to understand their perspectives on the mental health experiences of pregnant and parenting adolescent girls and their ideas for optimizing mental health promotion. Six principal themes emerged including the mental health situation for adolescent girls, risk factors for poor mental health and barriers to accessing services for adolescent girls, health seeking behavior effect on maternal and child health outcomes, mental health promotion, protective factors for good mental health, and policy level issues. Examination of existing policies is required to determine how they can fully and effectively be implemented to support the mental health of pregnant and parenting adolescent girls.
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Affiliation(s)
| | | | - Malia Duffy
- Health Across Humanity, LLC, Boston, Massachusetts, United States of America
- Saint Ambrose University, Davenport, Iowa, United States of America
| | - Joseph Kathono
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Nairobi Metropolitan Services, Nairobi, Kenya
| | | | - Shillah Mwaniga
- Nairobi Metropolitan Services, Nairobi, Kenya
- Vrije University, Amsterdam, Netherlands
| | - Obadia Yator
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Marcy Levy
- UNICEF Headquarters, New York, New York, United States of America
| | - Joanna Lai
- UNICEF Headquarters, New York, New York, United States of America
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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O'Flaherty M, Kalucza S, Bon J. Does Anyone Suffer From Teenage Motherhood? Mental Health Effects of Teen Motherhood in Great Britain Are Small and Homogeneous. Demography 2023; 60:707-729. [PMID: 37226980 DOI: 10.1215/00703370-10788364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Teen mothers experience disadvantage across a wide range of outcomes. However, previous research is equivocal with respect to possible long-term mental health consequences of teen motherhood and has not adequately considered the possibility that effects on mental health may be heterogeneous. Drawing on data from the 1970 British Birth Cohort Study, this article applies a novel statistical machine-learning approach-Bayesian Additive Regression Trees-to estimate the effects of teen motherhood on mental health outcomes at ages 30, 34, and 42. We extend previous work by estimating not only sample-average effects but also individual-specific estimates. Our results show that sample-average mental health effects of teen motherhood are substantively small at all time points, apart from age 30 comparisons to women who first became mothers at age 25‒30. Moreover, we find that these effects are largely homogeneous for all women in the sample-indicating that there are no subgroups in the data who experience important detrimental mental health consequences. We conclude that there are likely no mental health benefits to policy and interventions that aim to prevent teen motherhood.
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Affiliation(s)
- Martin O'Flaherty
- Institute for Social Science Research and Australian Research Council Centre of Excellence for Children and Families Over the Life Course, The University of Queensland, Brisbane, Australia
| | - Sara Kalucza
- Department of Sociology and Centre for Demographic and Ageing Research (CEDAR), Umeå University, Umeå, Sweden
| | - Joshua Bon
- School of Mathematical Sciences and Centre for Data Science, Queensland University of Technology, Brisbane, Australia
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Meherali S, Munro S, Puinean G, Salami B, Wong JPH, Vandermorris A, Benoit JRA, Flicker S, Okeke-Ihejirika P, Stroulia E, Norman WV, Scott SD. Co-designing a Sexual Health App With Immigrant Adolescents: Protocol for a Qualitative Community-Based Participatory Action Research Study. JMIR Res Protoc 2023; 12:e45389. [PMID: 36947124 PMCID: PMC10131995 DOI: 10.2196/45389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Canada is one of the world's most ethnically diverse countries, with over 7 million individuals out of a population of 38 million being born in a foreign country. Immigrant adolescents (aged 10 to 19 years) make up a substantial proportion of newcomers to Canada. Religious and cultural practices can influence adolescents' sexual attitudes and behaviors, as well as the uptake of sexual and reproductive health (SRH) services among this population. Adolescence is a time to establish lifelong healthy behaviors. Research indicates an alarming gap in adolescents' SRH knowledge, yet there is limited research on the SRH needs of immigrant adolescents in Canada. OBJECTIVE The purpose of this study is to actively engage with immigrant adolescents to develop, implement, and evaluate a mobile health (mHealth) intervention (ie, mobile app). The interactive mobile app will aim to deliver accurate and evidence-based SRH information to adolescents. METHODS We will use community-based participatory action research to guide our study. This research project will be conducted in 4 stages based on user-centered co-design principles. In Stage 1 (Empathize), we will recruit and convene 3 adolescent advisory groups in Edmonton, Toronto, and Vancouver. Members will be engaged as coresearchers and receive training in qualitative and quantitative methodologies, sexual health, and the social determinants of health. In Stage 2 (Define and Ideate), we will explore SRH information and service needs through focus group discussions with immigrant adolescents. In Stage 3 (Prototype), we will collaborate with mobile developers to build and iteratively design the app with support from the adolescent advisory groups. Finally, in Stage 4 (Test), we will return to focus group settings to share the app prototype, gather feedback on usability, and refine and release the app. RESULTS Recruitment and data collection will be completed by February 2023, and mobile app development will begin in March 2023. The mHealth app will be our core output and is expected to be released in the spring of 2024. CONCLUSIONS Our study will advance the limited knowledge base on SRH and the information needs of immigrant adolescents in Canada as well as the science underpinning participatory action research methods with immigrant adolescents. This study will address gaps by exploring SRH priorities, health information needs, and innovative strategies to improve the SRH of immigrant adolescents. Engaging adolescents throughout the study will increase their involvement in SRH care decision-making, expand efficiencies in SRH care utilization, and ultimately improve adolescents' SRH outcomes. The app we develop will be transferable to all adolescent groups, is scalable in international contexts, and simultaneously leverages significant economies of scale. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/45389.
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Affiliation(s)
| | - Sarah Munro
- University of British Columbia, Vancouver, BC, Canada
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Ajayi AI, Chamdimba E, Sawadogo N, Gitahi N, Tarnagda AM, Ilboudo AK, Munthali A, Thakwalakwa C, Otukpa EO, Ushie BA, Kabiru CW. Socio-ecological factors associated with probable depression among pregnant and parenting adolescent girls: findings from a cross-sectional study in Burkina Faso and Malawi. Reprod Health 2023; 20:38. [PMID: 36882850 PMCID: PMC9990966 DOI: 10.1186/s12978-023-01588-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 02/23/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Pregnant and parenting adolescent girls are at risk of poor mental health because of stigma and social exclusion. Despite one in four girls starting childbearing by the age of 19 in Africa, no study, to the best of our knowledge, has examined the multi-layered factors (individual, family, friends, and neighborhood-related factors) associated with depressive symptoms among pregnant and parenting girls in Africa. Our study contributes to addressing this gap by examining the socio-ecological factors associated with depression symptoms among pregnant and parenting adolescent girls. METHODS Our study adopted a cross-sectional design. Between March and September 2021, we interviewed 980 pregnant and parenting adolescent girls in Ouagadougou, Burkina Faso, and 669 in Blantyre, Malawi. We recruited pregnant and parenting adolescent girls in randomly selected urban and rural enumeration areas in Burkina Faso (n = 71) and Malawi (n = 66). We assessed depressive symptoms using the Patient Health Questionnaire (PHQ-9), which generated an overall score of 27. We considered a score of 10 or more as probable depression. We also obtained information on individual, family, friends, and neighborhood characteristics. We employed logistic regression models to examine the significant factors associated with probable depression among pregnant and parenting adolescent girls. RESULTS The prevalence of probable depression was 18.8% and 14.5% in Burkina Faso and Malawi, respectively. At the individual level, having secondary education was significantly associated with a lower likelihood of probable depression in Malawi (AOR: 0.47; 95% CI 0.27-0.82) but not in Burkina Faso. At the family level, denying paternity (AOR: 3.14; 95% CI 1.34-7.11 in Malawi) and no parental support (AOR: 2.08; 95% CI 1.22-3.55 in Burkina Faso) were associated with higher odds of probable depression. At the community level, perceived neighborhood safety was associated with a lower likelihood of probable depression in Malawi (AOR: 0.74; 95% CI 0.61-0.89) and Burkina Faso (AOR: 0.81; 95% CI 0.73-0.90). Having a safety net within the community was associated with lower odds of probable depression in Burkina Faso (AOR: 0.87; 95% CI 0.78-0.96) but not in Malawi. CONCLUSION Depressive symptoms are common among pregnant and parenting adolescents, suggesting the need to screen them regularly for depression during antenatal and postnatal visits. Factors associated with depression among pregnant and parenting girls operate at multiple levels suggesting a need for multilevel interventions that address all areas of vulnerabilities.
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Affiliation(s)
- Anthony Idowu Ajayi
- Sexual, Reproductive, Maternal, New-born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya.
| | - Elita Chamdimba
- Centre for Social Research, University of Malawi, P. O. Box 280, Zomba, Malawi
| | - Nathalie Sawadogo
- Institut Supérieur des Sciences de La Population, Université Joseph Ki-Zerbo, B.P. 7118, Ouagadougou 03, Burkina Faso
| | - Nyawira Gitahi
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada
| | - Abdoul Moumini Tarnagda
- Institut Supérieur des Sciences de La Population, Université Joseph Ki-Zerbo, B.P. 7118, Ouagadougou 03, Burkina Faso
| | - Abdoul Kader Ilboudo
- Institut Supérieur des Sciences de La Population, Université Joseph Ki-Zerbo, B.P. 7118, Ouagadougou 03, Burkina Faso
| | - Alister Munthali
- Centre for Social Research, University of Malawi, P. O. Box 280, Zomba, Malawi
| | | | - Emmanuel Oloche Otukpa
- Sexual, Reproductive, Maternal, New-born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
| | - Boniface Ayanbekongshie Ushie
- Sexual, Reproductive, Maternal, New-born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
| | - Caroline W Kabiru
- Sexual, Reproductive, Maternal, New-born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
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22
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Abarca D, Allen K, Towson JA, Green KB. Enhancing adolescent parent interactions in communication through facilitative playgroups. J Child Lang 2023:1-16. [PMID: 36632035 DOI: 10.1017/s030500092200071x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Adolescent pregnancy can impact the educational attainment of adolescent mothers and language development of their children. However, support services and interventions can mitigate these risk factors. Adolescent mothers have shown success in implementing various language facilitation strategies (LFS) with their children when coached. We developed a triadic language intervention in a facilitated playgroup context to support adolescent mothers' use of language strategies when interacting with their children. The current pilot study utilized a pre-test, post-test descriptive approach to analyze differences in adolescent mothers' language use and parenting behaviors and their children's language use after participation in facilitated playgroups. All adolescent mothers demonstrated enhanced parenting practices. Changes in mothers' and children's language from pre- to post-test were variable across participants. While this pilot study shows promising evidence of the utility of a triadic intervention situated in playgroups with adolescent families, further research is required to address the limitations of this study.
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Affiliation(s)
- Diana Abarca
- School of Communication Sciences and Disorders, College of Health Professions and Sciences, University of Central Florida, Orlando, Florida, United States of America
| | - Kasey Allen
- School of Communication Sciences and Disorders, College of Health Professions and Sciences, University of Central Florida, Orlando, Florida, United States of America
| | - Jacqueline A Towson
- School of Communication Sciences and Disorders, College of Health Professions and Sciences, University of Central Florida, Orlando, Florida, United States of America
| | - Katherine B Green
- Department of Literacy and Special Education, College of Education, University of West Georgia, Carrollton, Georgia, United States of America
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23
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Whittaker S, Martinez I, Kershaw T. Disparities in healthcare utilization and depression among young mothers: The role of family functioning. Womens Health (Lond) 2023; 19:17455057231199039. [PMID: 37772936 PMCID: PMC10542225 DOI: 10.1177/17455057231199039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/16/2023] [Accepted: 08/15/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Extant research suggests that disparities in healthcare utilization and experiences of mental health disorders such as depression exist across sociodemographic groups. One understudied pathway that may have significant implications for these disparities is the role of family functioning. How families interact, communicate, and adapt may vary, but these relationships remain integral for vulnerable subsets of the population due to their seemingly protective properties. Yet, few studies have examined the relationship between family functioning and health. OBJECTIVE The aim of this study was to explore family functioning as a predictor for healthcare utilization and depression among young mothers and as a moderator of disparities for each of these outcomes. DESIGN/METHODS This analysis uses data from a prospective cohort study which was conducted with 296 pregnant young women recruited from obstetrics clinics in Connecticut between July 2007 and February 2011 and followed 1-year postpartum. Logistic regression models were used to assess family functioning, race/ethnicity, and immigrant status as predictors of healthcare utilization and depression. Family functioning was evaluated as a moderator for both outcomes. RESULTS Black and Latina mothers had decreased odds of using physical healthcare services (odds ratioBlack = 0.13, p < 0.001; odds ratioLatina = 0.31, p = 0.02). Family functioning was associated with decreased odds of using mental healthcare services (odds ratio = 0.97, p = 0.04) and had a protective effect against depression (odds ratio = 0.96, p = 0.003). Family functioning significantly moderated the relationship between immigrant status and physical healthcare utilization, Black race/ethnicity and physical healthcare utilization, and Other race/ethnicity and depression. CONCLUSION Family functioning is a significant factor associated with both healthcare utilization and depression among young mothers. It should be a strongly considered component within healthcare settings to mitigate risks among vulnerable populations.
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Affiliation(s)
- Shannon Whittaker
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Isabel Martinez
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
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24
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Tele A, Kathono J, Mwaniga S, Nyongesa V, Yator O, Gachuno O, Wamalwa D, Amugune B, Cuijpers P, Saxena S, McKay M, Carvajal L, Lai J, Huang KY, Merali Z, Kumar M. Prevalence and risk factors associated with depression in pregnant adolescents in Nairobi, Kenya. Journal of Affective Disorders Reports 2022; 10. [PMID: 36970124 PMCID: PMC10038142 DOI: 10.1016/j.jadr.2022.100424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Background Adolescent parenthood can be associated with a range of adverse outcomes for young mothers such as depression, substance abuse, and posttraumatic stress disorder. Identification of depression and understanding risk factors among pregnant adolescents is important for development of appropriate interventions and programs focused on adolescent mental health. This paper reports on the findings of the prevalence of depression and its associated risk factors among pregnant adolescents in Nairobi, Kenya. Methods We recruited 153 pregnant adolescent (14-18 years) who were accessing maternal health services in one of two Nairobi County primary health care facilities in the cross-sectional survey conducted in 2021. The Patient Health Questionnaire 9 was used to screen for depression. Multivariate Stepwise linear regression modelling was used to identify key predictors of depression. Results Using a cut off of 10 and above on PHQ-9, we found that 43.1% of the respondents were depressed. Depressive symptoms in were independently associated with being in school, experience of intimate partner violence, substance use within the family and having experienced pressure to use substances by family or peers. Limitations Cross-sectional by design and the applications of our findings are limited to settings that are similar to our study population. The PHQ-9 used has not been psychometrically validated locally in this sample. Conclusion We found a high prevalence of depressive symptoms among respondents. These risk factors identified merit further investigation. Comprehensive mental health screening needs to be integrated in primary and community health services on the possible presence of depression.
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25
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Gilbert CS, Xaverius PK, Tibbits MK, Sappenfield WM. Refreshing the Perinatal Periods of Risk: A New Reference Group and Nationwide Large-County-Level Analyses. Matern Child Health J 2022; 26:2396-2406. [PMID: 36183285 DOI: 10.1007/s10995-022-03561-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The Perinatal Periods of Risk approach (PPOR) is designed for use by communities to assess and address the causes of high fetal-infant mortality rates using vital records data. The approach is widely used by local health departments and their community and academic partners to inform and motivate systems changes. PPOR was developed and tested in communities based on data years from 1995 to 2002. Unfortunately, a national reference group has not been published since then, primarily due to fetal death data quality limitations. METHODS This paper assesses data quality and creates a set of unbiased national reference groups using 2014-2016 national vital records data. Phase 1 and Phase 2 analytic methods were used to divide excess mortality into six components and create percentile plots to summarize the distribution of 100 large US counties for each component. RESULTS Eight states with poor fetal death data quality were omitted from the reference groups to reduce bias due to missing maternal demographic information. There are large Black-White disparities among reference groups with the same age and education restrictions, and these vary by component. PPOR results vary by region, maternal demographics, and county. The magnitude of excess mortality components varies widely across US counties. DISCUSSION New national reference groups will allow more communities to do PPOR. Percentile plots of 100 large US counties provide an additional benchmark for new communities using PPOR and help emphasize problem areas and potential solutions.
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Affiliation(s)
- Carol S Gilbert
- CityMatCH and the Division of Child Health Policy, Department of Pediatrics, University of Nebraska Medical Center, 982155, Nebraska Medical Center, Omaha, NE, USA.
| | - Pamela K Xaverius
- Maternal and Child Health Center of Excellence in Education, Science, and Practice, Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA.,Research and Scholarly Activity, University of Health Sciences and Pharmacy in St. Louis, 1 Pharmacy Place, St. Louis, MO, USA
| | - Melissa K Tibbits
- Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - William M Sappenfield
- The Chiles Center, College of Public Health, University of South Florida, Tampa, FL, USA
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26
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Scholl CC, Trettim JP, Böhm DM, Molina ML, Soares MC, Dias NDC, Reyes IDPS, de Matos MB, Justo JMRDM, Pinheiro RT, Quevedo LDA. Are adolescents more likely to have antenatal anxiety disorders than adult women? A comparison between two samples. J Affect Disord 2022; 316:50-55. [PMID: 35932938 DOI: 10.1016/j.jad.2022.07.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/25/2022] [Accepted: 07/30/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The literature reports that teenage pregnancy is considered a risk factor for anxiety disorders (ADs). However, research on this topic is limited. This study aimed to investigate if pregnant adolescents presented a greater likelihood of having ADs by comparing two samples of pregnant women in a southern city of Brazil. We also observed the prevalence rates of antenatal ADs among adolescents and adult women. METHODS In this cross-sectional study, we evaluated 1852 women from two different studies: 995 pregnant adolescents attending prenatal care in the public health system (convenience sample) and 857 pregnant women from a population-based study. We used the Mini International Neuropsychiatric Interview (MINI Plus) to assess antenatal ADs, using the Social Anxiety Disorder (SAD) and Generalized Anxiety Disorder (GAD) modules. The primary aim of this study was tested through multivariate analysis using Poisson regression. RESULTS The prevalence of ADs was 11.0 % among pregnant adolescents and 13.8 % among adult pregnant women. Both samples presented similar rates of ADs (p = 0.065). In the adjusted analysis, maternal age did not predict antenatal ADs (PR = 0.97; p = 0.853). LIMITATIONS Considering the particularities of each study where the samples came from, it was not possible to include other ADs such as panic disorder or phobias. CONCLUSIONS Our findings suggest that pregnancy in adolescence does not increase the likelihood of antenatal ADs. However, we emphasize the importance of an adequate psychological screening and care in pregnancy in order to prevent possible psychiatric disorders.
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Affiliation(s)
- Carolina Coelho Scholl
- Catholic University of Pelotas (UCPel), Rua Gonçalves Chaves, 377, 411 C, 96015-560 Pelotas, RS, Brazil
| | - Jéssica Puchalski Trettim
- Catholic University of Pelotas (UCPel), Rua Gonçalves Chaves, 377, 411 C, 96015-560 Pelotas, RS, Brazil
| | - Denise Müller Böhm
- Catholic University of Pelotas (UCPel), Rua Gonçalves Chaves, 377, 411 C, 96015-560 Pelotas, RS, Brazil
| | - Mariane Lopez Molina
- Catholic University of Pelotas (UCPel), Rua Gonçalves Chaves, 377, 411 C, 96015-560 Pelotas, RS, Brazil; Educational Anhanguera Faculties Rio Grande, Av. Rheingantz, 91, Parque Residencial Coelho, 96202-110 Rio Grande, RS, Brazil
| | - Mariana Carret Soares
- Catholic University of Pelotas (UCPel), Rua Gonçalves Chaves, 377, 411 C, 96015-560 Pelotas, RS, Brazil
| | - Natália da Costa Dias
- Catholic University of Pelotas (UCPel), Rua Gonçalves Chaves, 377, 411 C, 96015-560 Pelotas, RS, Brazil
| | | | - Mariana Bonati de Matos
- Catholic University of Pelotas (UCPel), Rua Gonçalves Chaves, 377, 411 C, 96015-560 Pelotas, RS, Brazil
| | | | - Ricardo Tavares Pinheiro
- Catholic University of Pelotas (UCPel), Rua Gonçalves Chaves, 377, 411 C, 96015-560 Pelotas, RS, Brazil
| | - Luciana de Avila Quevedo
- Catholic University of Pelotas (UCPel), Rua Gonçalves Chaves, 377, 411 C, 96015-560 Pelotas, RS, Brazil.
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27
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Smiley Y, Silberholz E, Bekele E, Brodie N. Caregiver stress and social determinants of health in key populations: immigrant parents, parents of children with medical complexity, and adolescent parents. Curr Opin Pediatr 2022; 34:521-530. [PMID: 35993274 DOI: 10.1097/mop.0000000000001163] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To examine the five domains of social determinants of health - economic stability, education access, healthcare access and quality, neighborhood and built environment, and social and community context - and how these relate to caregiver stress in under-resourced populations. RECENT FINDINGS Socioeconomic and family factors are increasingly understood as drivers of child health. Caregiver stress can impact family stability and child wellbeing. Immigrant parents, caregivers of children with medical complexity, and adolescent parents experience stressors due to the unique needs of their families. These groups of parents and caregivers also face various challenges identified as social determinants of health. Interventions to mitigate these challenges can promote resilience, care coordination, and community-based supports. SUMMARY Current research describes caregiver stress in key populations, how caregiver stress affects children, and approaches to minimize and mitigate these effects. Pediatric providers can implement best practices to support families who are navigating stress due to caregiving and social determinants of health.
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Affiliation(s)
- Yael Smiley
- Division of General and Community Pediatrics, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Elizabeth Silberholz
- Division of General Pediatrics, Boston Children's Hospital; Harvard Medical School, Boston, Massachusetts, USA
| | - ElShadey Bekele
- Division of General and Community Pediatrics, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Nicola Brodie
- Division of General and Community Pediatrics, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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28
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Moltrecht B, de Cassan S, Rapa E, Hanna JR, Law C, Dalton LJ. Challenges and opportunities for perinatal health services in the COVID-19 pandemic: a qualitative study with perinatal healthcare professionals. BMC Health Serv Res 2022; 22:1026. [PMID: 35962401 PMCID: PMC9372985 DOI: 10.1186/s12913-022-08427-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/03/2022] [Indexed: 11/15/2022] Open
Abstract
Background Perinatal healthcare professionals (PHCPs) provide essential support to all parents in the perinatal period, including young parents aged 16–24, who are at an increased risk of morbidity and mortality. Little is known about the impact of COVID-19 restrictions on the provision of perinatal services, and on perinatal healthcare professionals, caring for young parents in the UK. Methods A UK based qualitative study using semi-structured interviews with perinatal healthcare professionals (n = 17). Data were analysed using thematic analysis. Results Two themes were identified describing perinatal healthcare professionals’ perceptions of providing care to young parents during the pandemic. Perinatal healthcare professionals perceived that young parents’ needs were amplified by the pandemic and that pandemic-related changes to the service, such as the use of telemedicine to replace face-to-face interactions, did not manage to successfully mitigate the increased feelings of anxiety and isolation experienced by young parents. Concerns were raised by perinatal healthcare professionals that these changes reduced young parent’s access to vital support for themselves and their child and may contribute to exacerbating pre-existing inequalities. Conclusions This study provides insight into the impact of the COVID-19 pandemic on the provision of perinatal care to young parents. Perinatal mental health professionals felt these negative impacts could be overcome by using a blended approach of technology and face-to-face interactions allowing regular contact with young parents and facilitating the exchange of vital information, while maintaining access to opportunities for social interactions with other parents. Findings from this study could be used to future-proof services against further COVID-19 restrictions.
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Affiliation(s)
- Bettina Moltrecht
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK.,Evidence-Base Practice Unit, University College London, London, N1 9JH, UK.,Centre for Longitudinal Studies, University College London, London, WC1H 0NU, UK
| | - Simone de Cassan
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
| | - Elizabeth Rapa
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
| | - Jeffrey R Hanna
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, BT9 7BL, UK
| | - Clare Law
- Centre for Early Child Development, Blackpool Better Start (NSPCC), Blackpool, UK
| | - Louise J Dalton
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK.
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29
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Cluxton-Keller F, Hegel MT. A Video-Delivered Family Therapeutic Intervention for Perinatal Women with Clinically Significant Depressive Symptoms and Family Conflict: Indicators of Feasibility and Acceptability (Preprint). JMIR Form Res 2022; 6:e41697. [PMID: 36194458 PMCID: PMC9579927 DOI: 10.2196/41697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/02/2022] [Accepted: 09/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Variation in family therapeutic intervention fidelity has an impact on outcomes. The use of video conferencing technology can strengthen therapist fidelity to family therapeutic interventions. Objective This article explores indicators of feasibility and acceptability for a video-delivered family therapeutic intervention for perinatal women with depressive symptoms and family conflict. The objectives of this article are to describe indicators of feasibility, including therapist fidelity to the intervention and technological factors that relate to implementation of the intervention, as well as indicators of acceptability for participants of the intervention. Methods The data included in this article are from an ongoing randomized trial of the Resilience Enhancement Skills Training (REST) video-delivered family therapeutic intervention. Participant recruitment and data collection are still underway for this clinical trial. Of the 106 participants who are currently enrolled in this study, 54 (51%) have been randomized to receive REST from May 2021 through July 2022. Currently, 2 therapists are delivering the intervention, and the training procedures for therapists are summarized herein. Therapist fidelity to the family therapeutic intervention was assessed in 67 audio recorded sessions. The training procedures were summarized for use of video conferencing technology by therapists and the 54 study participants. Knowledge of the video conferencing technology features was assessed in therapists and study participants by the number of attempts required to use the features. Participant responsiveness to the intervention was assessed by the percentage of attended sessions and percentage of complete homework assignments. Results To date, both therapists have demonstrated high fidelity to the family therapeutic intervention and used all video conferencing technology features on their first attempt. The current participants required 1 to 3 attempts to use 1 or more of the video conferencing technology features. About 59% (n=32) of the current participants immediately accessed the features on the first attempt. Our results show that perinatal women attended all sessions, and their family members attended 80% of the sessions. To date, participants have completed 80% of the homework assignments. Conclusions These early findings describe indicators of the feasibility and acceptability of the video-delivered family therapeutic intervention for use with this high priority population. Upon completion of recruitment and data collection, a subsequent article will include a mixed methods process evaluation of the feasibility and acceptability of the video-delivered family therapeutic intervention. Trial Registration ClinicalTrials.gov NCT04741776; https://clinicaltrials.gov/ct2/show/NCT04741776
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Affiliation(s)
- Fallon Cluxton-Keller
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Mark T Hegel
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
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30
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Foss S, Gustafsson HC, Berry OO, Hipwell AE, Werner EA, Peterson BS, Monk C. Associations between childhood maltreatment, poor sleep, and prenatal distress in pregnant adolescents. Dev Psychopathol 2022; 34:764-73. [PMID: 33551015 DOI: 10.1017/S0954579420002163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Childhood maltreatment (CM) is a known risk factor for adolescent pregnancy. Sleep disturbances and psychological distress, both common negative sequelae of CM, often co-occur during pregnancy, although directionality remains unclear. Furthermore, little is known about how CM affects sleep-distress associations during pregnancy. In pregnant adolescents, we examined: (a) whether there are significant predictive associations from CM to sleep quality and distress and (b) bidirectional influences of distress and sleep quality. Healthy pregnant adolescents (n = 204) were recruited before or during the 2nd trimester. CM was assessed at enrollment; sleep quality and distress were assessed in the 2nd and 3rd trimesters. Hypotheses were tested using path analysis. Findings revealed that CM was associated with worse 2nd trimester sleep quality and distress (β = .19, p < .05 for sleep; β = .30, p < .001 for distress). Higher levels of 2nd trimester distress were associated with lower 3rd trimester sleep quality (β = .19, p < .05). Findings provide novel information about (a) associations from CM to prenatal mood and sleep in pregnant adolescents, and (b) sleep-distress directionality over the course of pregnancy. These results have implications for better understanding the ways in which CM potentially exerts influences later in life, and for targeting interventions to address physical and mental health during pregnancy.
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31
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Chokshi B, Pukatch C, Ramsey N, Dzienny A, Smiley Y. The Generational Trauma Card: A Tool to Educate on Intergenerational Trauma Transmission. Journal of Loss and Trauma 2022. [DOI: 10.1080/15325024.2022.2091315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Binny Chokshi
- Department of Pediatrics, Division of Military Child and Family Health, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Catherine Pukatch
- Department of Pediatrics, Children’s National Hospital, Washington, District of Columbia, USA
| | - Natasha Ramsey
- Department of Adolescent Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Alexa Dzienny
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Yael Smiley
- Department of Pediatrics, Children’s National Hospital, Washington, District of Columbia, USA
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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32
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Grégoire-Briard F, Harrison MA, Webster R, Fleming N. Frequency of unscheduled visits to the Obstetrical Triage Assessment unit by pregnant adolescents in an urban Canadian Center compared to a matched cohort of pregnant women. J Obstet Gynaecol Can 2022; 44:1061-1066. [PMID: 35752406 DOI: 10.1016/j.jogc.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES People from marginalized and vulnerable populations present more frequently for unscheduled, emergency obstetrical services at labour and delivery triage units. Based on our clinical experience, pregnant adolescents visit the obstetrical triage assessment units (OTAU) more often than adults do. This study was designed to assess this phenomenon by quantifying and describing the frequency of unscheduled visits to the OTAU by pregnant adolescents (age <20 y) compared with a matched cohort of adult pregnant patients (age ≥20 y). METHODS A retrospective database review was performed for data on all adolescent patients that delivered at our institution at ≥20 weeks gestation between January 1, 2013, and December 31, 2017. Adolescent pregnant patients were matched in a 1:1 ratio with adult pregnant patients. Demographic and clinical characteristics as well as the number of visits to the OTAU were recorded. RESULTS A total of 160 adolescent pregnant patients visited the OTAU during the study period. The mean number of visits to the OTAU by adolescents was 2.77 ± 2.40 compared with 1.96 ± 1.80 visits in the adult cohort (P = 0.0001). Adolescents were 63% more likely than adults to access triage services (incidence rate ratio [IRR] 1.63; 95% CI 1.09-2.44, P = 0.017). Diagnosis of a mental health condition was the only identified risk factor for accessing OTAU, irrespective of age (IRR 1.64; 95% CI 1.05, 2.55, P = 0.029). CONCLUSIONS Adolescent pregnant patients tend to visit the OTAU on an unscheduled basis more often than do adult patients. The presence of a mental health condition was identified as an important predictor of unscheduled visits to OTAUs for adolescent patients.
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Affiliation(s)
- Florence Grégoire-Briard
- Division of Pediatric and Adolescent Gynecology, Department of Surgery, Children's Hospital of Eastern Ontario
| | - Mary-Ann Harrison
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Richard Webster
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Nathalie Fleming
- Division of Pediatric and Adolescent Gynecology, Department of Surgery, Children's Hospital of Eastern Ontario; University of Ottawa, Department of Obstetrics and Gynecology, Ottawa, Canada; Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Canada
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Jack SM, Duku E, Whitty H, Van Lieshout RJ, Niccols A, Georgiades K, Lipman EL. Young mothers' use of and experiences with mental health care services in Ontario, Canada: a qualitative descriptive study. BMC Womens Health 2022; 22:214. [PMID: 35672725 PMCID: PMC9172978 DOI: 10.1186/s12905-022-01804-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 05/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background Despite the high prevalence of mental health issues among young mothers, their subsequent needs for mental health care support does not correlate with their access and use of services. The purpose of this study, grounded in the experiences of young mothers living in Ontario, Canada, was to describe their experiences of using mental health services during the perinatal period, and to identify the attributes of services and professionals that influenced their decision to engage with mental health services.
Methods As the qualitative component of a sequential explanatory mixed methods study, the principles of qualitative description informed sampling, data collection, and analysis decisions. In-depth, semi-structured interviews were conducted with a purposeful sample of 29 young mothers (≤ 21 years) who met diagnostic criteria for at least one psychiatric disorder, and who were ≥ 2 months postpartum. Interview data were triangulated with data from ecomaps and a sub-set of demographic data for this purposeful sample from the survey conducted in the quantitative study component. Qualitative data were analyzed using both conventional content analysis and reflexive thematic analysis; the subset of survey data extracted for these 29 participants were analyzed using descriptive statistics. Results Young mothers identified the need to have at least one individual, either an informal social support or formal service provider who they could talk to about their mental health. Among participants deciding to seek professional mental health support, their hesitancy to access services was grounded in past negative experiences or fears of being judged, being medicated, not being seen as an active partner in care decisions or experiencing increased child protection involvement. Participants identified organizational and provider attributes of those delivering mental health care that they perceived influenced their use of or engagement with services. Conclusion Organizations or health/social care professionals providing mental health services to young pregnant or parenting mothers are recommended to implement trauma-and violence-informed care. This approach prioritizes the emotional and physical safety of individuals within the care environment. Applying this lens in service delivery also aligns with the needs of young mothers, including that they are actively listened to, treated with respect, and genuinely engaged as active partners in making decisions about their care and treatment.
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Affiliation(s)
- Susan M Jack
- School of Nursing, McMaster University, HSC 3H48B, 1280 Main St. West, Hamilton, ON, L8S 4L8, Canada.
| | - Eric Duku
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Heather Whitty
- Institute for Innovation and Implementation, School of Social Work, University of Maryland Baltimore, Baltimore, USA
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Alison Niccols
- Ron Joyce Children's Health Centre, Hamilton, ON, Canada
| | - Katholiki Georgiades
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Ellen L Lipman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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Kotoh AM, Sena Amekudzie B, Opoku-Mensah K, Baku EA, Glozah FN. Pregnant adolescents' lived experiences and coping strategies in peri-urban district in Southern Ghana. BMC Public Health 2022; 22:901. [PMID: 35513816 DOI: 10.1186/s12889-022-13318-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 04/14/2022] [Indexed: 11/28/2022] Open
Abstract
Background Adolescence, a transition period from childhood to adulthood forms the foundation of health in later life. The adolescence period which should have been characterised by good health is often marred with life-threatening and irreparable consequences of public health concern. Teen pregnancy is problematic because it could jeopardise adolescents’ safe transition to adulthood which does not only affect adolescents, but also their families, babies and society. There is ample evidence about the determinants and effects of teen pregnancy, but it is fragmented and incomplete, especially in Sub-Sahara Africa. This study presents pregnant adolescents’ voices to explain significant gaps in understanding their lived experiences and coping strategies. Methods This narrative inquiry, involved in-depth interviews with 16 pregnant adolescents, who were recruited from a peri-urban district in Southern Ghana using purposive and snowball techniques in health facilities and communities respectively. The audio recorded interviews were transcribed verbatim and analysed manually using content analysis. Results Many pregnant adolescents are silent victims of a hash socio-economic environment, in which they experience significant financial deprivation, parental neglect and sexual abuse. Also, negative experiences of some adolescent girls such as scolding, flogging by parents, stigmatisation and rejection by peers and neighbors result in grieve, stress and contemplation of abortion and or suicide. However, adolescents did not consider abortion as the best option with regard to their pregnancy. Rather, family members provided adolescents with critical support as they devise strategies such as avoiding people, depending on God and praying to cope with their pregnancy. Conclusion Adolescent pregnancy occurred through consensual sex, transactional sex and sexual abuse. While parents provide support, pregnant adolescents self-isolate, depend on God and pray to cope with pregnancy and drop out of school. We recommend that the Ministries of Education and Health, and law enforcement agencies should engage community leaders and members, religious groups, non-governmental organisations and other key stakeholders to develop interventions aimed at supporting girls to complete at least Senior High School. While doing this, it is also important to provide support to victims of sexual abuse and punish perpetrators accordingly.
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Barker LC, Brown HK, Bronskill SE, Kurdyak P, Austin PC, Hussain-Shamsy N, Fung K, Vigod SN. Follow-up after post-partum psychiatric emergency department visits: an equity-focused population-based study in Canada. Lancet Psychiatry 2022; 9:389-401. [PMID: 35430003 DOI: 10.1016/s2215-0366(22)00099-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Emergency department visits for a psychiatric reason in the post-partum period represent an acute need for mental health care at a crucial time, but little is known about the extent of timely outpatient follow-up after these visits or how individual and intersecting social determinants of health influence this outcome. This study aimed to examine outpatient mental health care follow-up by a physician in the 30 days after an individual attended the emergency department for a psychiatric reason in the post-partum period and understand how social determinants of health affect who receives follow-up care. METHODS In this population-based cohort study, routinely collected health data from Ontario, Canada were accessed through ICES to identify all post-partum individuals whose sex was listed as female on their health card and who had attended an emergency department in Ontario before the COVID-19 pandemic for a psychiatric reason. Individuals admitted to hospital at the time of the emergency department visit, who died during the visit, or who left without being seen were excluded from the study. Ethnicity data for individuals were not collected. The primary outcome was the proportion of individuals with any outpatient physician (psychiatrist or family physician) visit for a mental health reason within 30 days of the index emergency department visit. Family physician mental health visits were identified using a validated algorithm for Ontario Health Insurance Plan-billed visits and mental health diagnostic codes for community health centre visits. We examined the associations between social determinants of health (age, neighbourhood income, community size, immigration, neighbourhood ethnic diversity) and who received an outpatient mental health visit. We used modified Poisson regression adjusting for the other social determinants of health, clinical, and health services characteristics to examine independent associations with follow-up, and conditional inference trees to explore how social determinants of health intersect with each other and with clinical and health services characteristics in relation to follow-up. FINDINGS We analysed data collected between April 1, 2008, and March 10, 2020, after exclusions we identified 12 158 people who had attended the emergency department for a psychiatric reason in the post-partum period (mean age 26·9 years [SD 6·2]; range 13-47); 9848 individuals lived in an urban area, among these 1518 (15·5%) were immigrants and 2587 (26·3%) lived in areas with high ethnic diversity. 5442 (44·8%) of 12 158 individuals received 30-day follow-up. In modified Poisson regression models, younger age, lower neighbourhood income, smaller community size, and being an immigrant were associated with a lower likelihood of follow-up. In the CTREE, similar variables were important, with several intersections between social determinants of health and between social determinants of health and other variables. INTERPRETATION Fewer than half of emergency department visits for a psychiatric reason in the post-partum period were followed by timely outpatient care, with social-determinants-of-health-based disparities in access to care. Improvements in equitable access to post-emergency department mental health care are urgently needed in this high-risk post-partum population. FUNDING Department of Psychiatry, University of Toronto; Canadian Institutes of Health Research.
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Affiliation(s)
- Lucy C Barker
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada
| | - Hilary K Brown
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Scarborough Campus, Department of Health & Society, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada
| | - Susan E Bronskill
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada
| | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Peter C Austin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada
| | - Neesha Hussain-Shamsy
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada
| | | | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada.
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Vasconcelos A, Bandeira N, Sousa S, Pereira F, Machado MDC. Adolescent pregnancy in Sao Tome and Principe: a cross-sectional hospital-based study. BMC Pregnancy Childbirth 2022; 22:332. [PMID: 35428214 PMCID: PMC9013095 DOI: 10.1186/s12884-022-04632-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 03/21/2022] [Indexed: 11/11/2022] Open
Abstract
Background Pregnancy starts early in Sao Tome and Principe (STP) and rates of adolescent pregnancy increased 16% in recent years reaching a 27.3% prevalence. This study aimed to understand the pregnant adolescents’ characteristics and factors associated to early childbearing in STP. Methods A cross-sectional hospital-based study was undertaken in Hospital Dr. Ayres de Menezes between 2016 and 2018 with a randomly selected total sample size of 518 mothers. Mothers’ clinical records and interviews were used to collect relevant data. The results among adolescent girls 19 years of age and younger (n=104) were compared to adult mothers (n=414). A subgroup analysis of adolescent pregnant girls was also conducted. Statistically significance was considered at a p-value ≤0.05. Data were analysed using SPSS software. Results The study revealed that 20.1% were adolescent mothers. Pregnancy at a very early age (≤15) was experienced by 7.7%. The characteristics founded to be positively associated with adolescent pregnancy were: 1) being single (OR 0.39, 95% CI=0.2–0.6, p≤0.001); 2) having a relationship with the baby´s father for a period of less than one year (OR 0.16, 95% CI=0.09-0.3, p≤0.001); 3) lack of the baby´s father support (OR 0.41, 95% CI=0.2–0.7, p=0.002); 4) not using a contraceptive method (OR 0.33, 95% CI=0.2–0.5, p≤0.001), and 5) inappropriate knowledge concerning the identification of the newborn’s danger signs (OR 15.7, 95% CI= 9–26, p≤0.001). Comparing pregnancy at very early age (≤15) to late (>18 and ≤19) adolescents, main differences were that previous contraceptives were not used at all in girls ≤15 years compared to 9.8% of late childbearing subgroup. Conclusions Unfavourable factors linked to adolescent pregnancies were absence of a contraceptive method, getting pregnant in the early first months of one relationship and to be single. Gap age difference between adolescents’ partners, polygamous sexual relationships, previous abortion and having already other living children were also identified. Adolescents also had inappropriate knowledge of the identification of the newborns’ danger signs. Before being sexually active, adolescents critically need sexual and reproductive health information provided by a healthy community and through school programmes on sexual education. Schools should promote girl’s empowerment and awareness and, at the same time, reinforce boy’s role in fatherhood and shared responsibilities. The government should work on the prevention of early sexual initiation, as well as on improving family planning programmes to protect them from pregnancy with special focus for the very early adolescent girls. None of these goals can be achieved if the government doesn’t, simultaneously, improve educational and economic opportunities for girls.
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Moltrecht B, Dalton LJ, Hanna JR, Law C, Rapa E. Young parents' experiences of pregnancy and parenting during the COVID-19 pandemic: a qualitative study in the United Kingdom. BMC Public Health 2022; 22:523. [PMID: 35300654 PMCID: PMC8927525 DOI: 10.1186/s12889-022-12892-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/17/2022] [Indexed: 12/21/2022] Open
Abstract
Young parents (aged 16–24 years) in the perinatal period are at an increased risk of poor mental health especially during the COVID-19 pandemic, due to multiple risk factors including social and economic instability. COVID-19 related restrictions had profound implications for the delivery of perinatal care services and other support structures for young parents. Investigating young parents’ experiences during the pandemic, including their perceived challenges and needs, is important to inform good practice and provide appropriate support for young parents. Qualitative interviews were conducted with young parents (n = 21) during the COVID-19 pandemic in the United Kingdom from February – May 2021. Data were analysed using thematic analysis. Three key themes were identified to describe parents’ experiences during the COVID-19 pandemic. Parents reported specific COVID-19 related anxieties and stressors, including worries around contracting the virus and increased feelings of distress due to uncertainty created by the implications of the pandemic. Parents described feeling alone both at home and during antenatal appointments and highlighted the absence of social support as a major area of concern. Parents also felt their perinatal care had been disrupted by the pandemic and experienced difficulties accessing care online or over the phone. This study highlights the potential impact of the COVID-19 pandemic on young parents, including their mental wellbeing and the perinatal support they were able to access. Insights from this study can inform the support and services offered to families going forward. Specifically, the findings emphasise the importance of (a) supporting both parents during perinatal appointments, (b) providing parents with mental health support early on and (c) finding ways to facilitate communication pathways between professionals and parents.
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Affiliation(s)
- Bettina Moltrecht
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Evidence-Base Practice Unit, University College London, London, N1 9JH, UK.,Centre for Longitudinal Studies, University College London, London, WC1H 0NU, UK
| | - Louise J Dalton
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Jeffrey R Hanna
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, BT9 7BL, UK
| | - Clare Law
- Centre for Early Child Development, Blackpool Better Start (NSPCC), Blackpool, UK
| | - Elizabeth Rapa
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
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Huda MM, O'Flaherty M, Finlay JE, Edmed S, Mamun AA. Partner's characteristics and adolescent motherhood among married adolescent girls in 48 low-income and middle-income countries: a population-based study. BMJ Open 2022; 12:e055021. [PMID: 35264355 PMCID: PMC8915377 DOI: 10.1136/bmjopen-2021-055021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The objective of this study was to examine the prevalence of adolescent motherhood among married adolescent girls and its associations with their partners' characteristics in low-income and middle-income countries (LMICs). DESIGN Population-based study. PARTICIPANTS 54 285 ever married (or lived with a partner) adolescent girls (15-19 years old) were including in prevalence analysis. However, partner characteristics were assessed in a subsample of 24 433 adolescent girls who were married (or living with a partner) at the time of interview. SETTINGS Data from the latest available Demographic and Health Survey round during 2010-2018 in 48 LMICs across different geographic regions. RESULTS The overall prevalence of adolescent motherhood was 73.98% (95% CI 70.96 to 78.10) among married adolescent girls in this study. In the pooled analysis, statistically significant and positive associations were observed between adolescent motherhood and partners' desire for more children (adjusted marginal effect (AME): 2.34, 95% CI 1.21 to 3.47) and spousal age gap (AME: 1.67, 95% CI 0.30 to 3.04 for three plus age gap). However, no statistically significant association was observed between adolescent motherhood and partners' education (AME: -0.36, 95% CI -1.77 to 1.05 for primary education) and partners' agricultural occupation (AME: 1.07, 95% CI -0.17 to 2.32). Overall, there was significant variation in the associations across countries; however, the positive associations persisted between adolescent motherhood and partners' desire for more children and spousal age gap in most of the studied countries. CONCLUSIONS Our findings may inform policymakers about the importance of incorporating partners of married adolescent girls into the existing birth control programmes to delay age at first birth among married adolescents in LMICs. More attention should be given to the married adolescent girls who have older partners, and efforts to discourage marriages with much older partners may have a secondary benefit of reducing adolescent motherhood in LMICs.
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Affiliation(s)
- M Mamun Huda
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
- The ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Queensland, Australia
| | - Martin O'Flaherty
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Queensland, Australia
| | - Jocelyn Edwina Finlay
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Shannon Edmed
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Queensland, Australia
| | - Abdullah Al Mamun
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Queensland, Australia
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Ghahremani T, Magann EF, Phillips A, Ray-griffith SL, Coker JL, Stowe ZN. Women's Mental Health Services and Pregnancy: A Review. Obstet Gynecol Surv 2022; 77:122-9. [DOI: 10.1097/ogx.0000000000000994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Huda MM, Finlay JE, O'Flaherty M, Al Mamun A. Transition in social risk factors and adolescent motherhood in low- income and middle- income countries: Evidence from Demographic and Health Survey data, 1996-2018. PLOS Glob Public Health 2022; 2:e0000170. [PMID: 36962188 PMCID: PMC10021223 DOI: 10.1371/journal.pgph.0000170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 04/13/2022] [Indexed: 11/19/2022]
Abstract
Understanding the dynamics of social risk factors in the occurrence of adolescent motherhood is vital in designing more appropriate prevention initiatives in low-income and middle-income countries (LMICs). We aimed this study to examine the transition of social risk factors and their association with adolescent motherhood in LMICs since the initiation of the MDGs. We analysed 119967 adolescent girls (15-19 years) from 40-nationally representative Demographic Health Surveys in 20 LMICs that had at least two surveys: a survey in 1996-2003(baseline, near MDGs started) and another in 2014-2018(endline). Adolescent motherhood (having a live birth or being pregnant before age 20) was the outcome of interest, whereas social risk factors including household wealth, girls' level of education, and area of residence were the exposures. The association between adolescent motherhood and the social risk factors, as well as changes in the strength of the association over time were observed using multilevel logistic regression analysis. On an average, the proportion of adolescent mothers without education decreased by -15·61% (95% CI: -16·84, -14·38), whereas the poorest adolescent mother increased by 5·87% (95% CI: 4·74, 7·00). The national prevalence of adolescent motherhood remained unchanged or increased in 55·00% (11/20) of the studied countries. Comparing baseline to endline, the overall adjusted odds ratio (AOR) of adolescent motherhood increased for both poorest (AOR = 1·42, 95% CI: 1·28, 1·59) and rural residences (AOR = 1·09, 95% CI: 1·01, 1·17), and decreased, but not statistically significant for the low level of education (AOR = 0·92, 95% CI: 0·84, 1·01 for no education). Our study concludes that social risk factors of the adolescent mother had shifted in different directions during MDGs and SDGs eras, and adolescent mothers remained more disadvantaged than non-mothers in LMICs. Efforts need to be enhanced to improve adolescent girls' education. Intervention should be prioritised in disadvantaged communities to delay adolescent first birth and prevent adolescent motherhood in LMICs.
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Affiliation(s)
- M Mamun Huda
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Queensland, Australia
| | - Jocelyn E Finlay
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Martin O'Flaherty
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Queensland, Australia
| | - Abdullah Al Mamun
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Queensland, Australia
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Zisman-Ilani Y, Buell J, Mazel S, Hennig S, Nicholson J. Virtual Community Engagement Studio (V-CES): Engaging Mothers With Mental Health and Substance Use Conditions in Research. Front Psychiatry 2022; 13:805781. [PMID: 35782439 PMCID: PMC9240264 DOI: 10.3389/fpsyt.2022.805781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
Active engagement of community stakeholders is increasingly encouraged in behavioral health research, often described as a co-production approach. Community stakeholders (e.g., patients, providers, policy makers, advocates) play a leading role together with research investigators in conducting the various phases of research, including conceptualization, design, implementation, and the interpretation and dissemination of findings. The concept of co-production has promising benefits for both the target population and the research outcomes, such as producing person-centered interventions with greater acceptability and usability potential. However, it is often the case that neither researchers nor community members are trained or skilled in co-production methods. The field of behavioral health research lacks tools and methods to guide and promote the engagement of diverse stakeholders in the research process. The purpose of this methods paper is to describe the Virtual Community Engagement Studio (V-CES) as a new method for engaging vulnerable populations like mothers with mental health and substance use conditions in research. We piloted the method in collaboration with the Maternal Mental Health Research Collaborative (MMHRC), focusing on one of the most vulnerable, under-researched populations, mothers coping with mental health and/or substance abuse disorders. Our pilot included mothers and providers who work with them as Community Experts to inform all phases of research design and implementation, and the interpretation and application of findings. The aim of this article is to describe the V-CES as a powerful tool that supports the engagement of mothers with mental health and/or substance use disorders and other community stakeholders in research, to provide examples of its use, and to make recommendations for future use, based on lessons learned. The V-CES toolkit is available for use with this target population as well as others.
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Affiliation(s)
- Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States.,Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Jennifer Buell
- Institute for Behavioral Health Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Shayna Mazel
- Institute for Behavioral Health Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Shannon Hennig
- Maternal Mental Health Research Collaborative, Calgary, AB, Canada
| | - Joanne Nicholson
- Institute for Behavioral Health Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
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Affiliation(s)
- Yael Smiley
- Children's National Hospital, Washington, DC, USA.,George Washington University, Washington, DC, USA
| | | | | | - Binny Chokshi
- Children's National Hospital, Washington, DC, USA.,George Washington University, Washington, DC, USA
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Nannini S, Tung I, Northrup JB, Stepp SD, Keenan K, Hipwell AE. Changes in severity of depression and borderline personality disorder symptoms from pregnancy to three years postpartum in adolescent mothers. J Affect Disord 2021; 294:459-463. [PMID: 34325165 PMCID: PMC8410668 DOI: 10.1016/j.jad.2021.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/30/2021] [Accepted: 07/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The transition to motherhood is associated with the emergence or exacerbation of symptoms of emotional distress disorders for many women. Although adolescence is a developmental period of increased risk for mood disorders and emotion dysregulation among women, little is known about changes in emotional distress across the early postpartum years among adolescent mothers. We tested the hypothesis that symptoms of depression and borderline personality disorder (BPD) would differ between pregnant and non-pregnant adolescents, and that these differences would be maintained in the three years following delivery. METHODS Data were drawn from the longitudinal Pittsburgh Girls Study: 307 adolescent mothers (14-18 years) and 307 never-pregnant adolescents, matched on age, race and household receipt of public assistance, self-reported severity of depression and BPD across four years. RESULTS There were no group differences on depression severity during or after pregnancy. However, compared with their non-pregnant peers, pregnant adolescents reported more severe BPD symptoms even after comorbid depression symptoms were accounted for, and this group difference was sustained during the following three years. LIMITATIONS Findings are based on a community sample rather than a clinical sample, which may have limited the severity of symptoms captured. CONCLUSIONS Findings suggest that adolescent mothers are a high-risk group for BPD symptoms during and after pregnancy, highlighting pregnancy as a critical window of opportunity to reduce morbidity among young mothers and potential negative effects on the next generation.
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Affiliation(s)
- Sierra Nannini
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Irene Tung
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | | | - Stephanie D. Stepp
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA,Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Kate Keenan
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago
| | - Alison E. Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, Corresponding author: Alison E. Hipwell PhD, ClinPsyD. Department of Psychiatry, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA 15213.
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Kolemen AB, Akyuz E, Toprak A, Deveci E, Yesil G. Evaluation of the parents' anxiety levels before and after the diagnosis of their child with a rare genetic disease: the necessity of psychological support. Orphanet J Rare Dis 2021; 16:402. [PMID: 34583726 PMCID: PMC8480067 DOI: 10.1186/s13023-021-02046-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 09/19/2021] [Indexed: 12/31/2022] Open
Abstract
Background The diagnosis of the rare genetic diseases has great importance in treating multisystemic conditions, preventing potential complications, and estimating disease risk for family members. The duration of obtaining genetic test results is varies. The demand to learn the diagnosis of a possible untreatable illness involves a struggle between uncertainty and a lifetime chronic disease. The current uncertainty of their child's condition and the long wait for a diagnosis may increase the parents' anxiety level and cause difficulties in the continuation of diagnostic procedures in some families. This study aimed to investigate the prediagnosis and postdiagnosis anxiety levels of parents who have a child with a rare genetic disease. Method The parents in this study, mothers or fathers, admitted their children to the Bezmialem Vakıf University Medical Genetics Clinic due to a suspected rare genetic disease (n = 40). Researchers created “The Sociodemographic Questionnaire” and used it to analyze the parents' sociodemographic status. In addition, they used the State-Trait Anxiety Inventory (STAI) to determine the anxiety levels of the parents. Results The state anxiety levels of parents decreased significantly after learning the diagnosis. However, there was no statistically significant decrease observed in trait anxiety levels. Conclusion Data from this study revealed that informing parents about their child's disease and properly explaining to them the expected difficulties might help to reduce their anxiety levels. Psychological support for parents is necessary to reduce their long-term stress, thus increasing the patient's compliance with treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-02046-2.
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Affiliation(s)
- Ayse B Kolemen
- Department of Medicine, Bezmialem Vakıf University Faculty of Medicine, Istanbul, Turkey
| | - Enes Akyuz
- Department of Biophysics, Saglık Bilimleri University Faculty of International Medicine, Istanbul, Turkey
| | - Ali Toprak
- Department of Biostatistics and Medicine Informatics, Division of Basic Medical Sciences, Bezmialem Vakıf University Faculty of Medicine, Istanbul, Turkey
| | - Erdem Deveci
- Department of Psychiatry, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Gozde Yesil
- Department of of Medical Genetics, Istanbul University Faculty of Medicine, Istanbul, Turkey.
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Amjad S, Adesunkanmi M, Twynstra J, Seabrook JA, Ospina MB. Social Determinants of Health and Adverse Outcomes in Adolescent Pregnancies. Semin Reprod Med 2021; 40:116-123. [PMID: 34500474 DOI: 10.1055/s-0041-1735847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The association between adolescent childbearing and adverse maternal and birth outcomes has been well documented. Adverse adolescent pregnancy outcomes are associated with substantial risk of long-term morbidities for the young mother and their newborns. Multiple levels of social disadvantage have been related to adverse pregnancy outcomes among adolescent mothers. Patterns of cumulative social adversity define the most marginalized group of adolescents at the highest risk of experiencing adverse maternal and birth outcomes. Using a social determinants of health (SDOH) framework, we present an overview of the current scientific evidence on the influence of these conditions on adolescent pregnancy outcomes. Multiple SDOH such as residence in remote areas, low educational attainment, low socioeconomic status, and lack of family and community support have been linked with increased risk of adverse pregnancy outcomes among adolescents. Based on the PROGRESS-Plus equity framework, this review highlights some SDOH aspects that perinatal health researchers, clinicians, and policy makers should consider in the context of adolescent pregnancies. There is a need to acknowledge the intersectional nature of multiple SDOH when formulating clinical and societal interventions to address the needs of the most marginalized adolescent in this critical period of life.
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Affiliation(s)
- S Amjad
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - M Adesunkanmi
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - J Twynstra
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada
| | - J A Seabrook
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada.,Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Children's Health Research Institute and Lawson Health Research Institute, London, Ontario, Canada
| | - M B Ospina
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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46
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Bieleninik Ł, Lutkiewicz K, Cieślak M, Preis-Orlikowska J, Bidzan M. Associations of Maternal-Infant Bonding with Maternal Mental Health, Infant's Characteristics and Socio-Demographical Variables in the Early Postpartum Period: A Cross-Sectional Study. Int J Environ Res Public Health 2021; 18:8517. [PMID: 34444265 PMCID: PMC8392040 DOI: 10.3390/ijerph18168517] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 01/25/2023]
Abstract
(1) Background: There is a continuing discussion concerning the impact of preterm birth on Maternal-Infant bonding with inconsistent results. The large burden of preterm births calls for research to evaluate the impact of it on material psychological outcome in the early postpartum period. Thus, the aim of this study was to evaluate the relationship between maternal postpartum bonding with maternal mental health, socio-demographical factors, and child's characteristics. (2) Methods: A cross-sectional study design was used. In total, 72 women (a mean age of 31.44 years old) of preterm infants (mean gestational age = 33.54; range 24-36) filled out socio-demographic questionnaires, Postpartum Bonding Questionnaire (PBQ), Edinburgh Postpartum Depression Scale (EPDS), Postpartum Depression Screening Scale (PDSS), Generalized Anxiety Disorder Assessment (GAD-7), and Parental Stress Scale (PSS) 1-3 days post-delivery; (3) Results: The results analyses have shown positive correlations between the overall result of maternal postpartum bonding with stress (p < 0.01), maternal educational level (p < 0.01), maternal age (p < 0.05) and the number of children (p < 0.01). However, there were no significant relationships between other investigated variables. The results of linear regression have revelated the important role of the overall scores in experience of stress among mothers (explaining 49% of the variability). The mediating role of maternal stress on maternal postpartum bonding was not found. That relationship of maternal postpartum bonding and maternal stress was not moderated through socio-demographic variables. (4) Conclusions: In this study mothers of prematurely born children had a good level of Maternal-Infant bonding. Maternal stress was found to be a predictor of maternal postpartum bonding among the tested variables. Surprisingly, the study results did not show significant relationships between maternal postpartum bonding and maternal mental health (depression and anxiety).
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Affiliation(s)
- Łucja Bieleninik
- Department of Clinical and Health Psychology, Faculty of Social Sciences, Institute of Psychology, University of Gdańsk, 80-309 Gdańsk, Poland; (K.L.); (M.B.)
- GAMUT—The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre, 5838 Bergen, Norway
| | - Karolina Lutkiewicz
- Department of Clinical and Health Psychology, Faculty of Social Sciences, Institute of Psychology, University of Gdańsk, 80-309 Gdańsk, Poland; (K.L.); (M.B.)
| | - Mariusz Cieślak
- Faculty of Educational Sciences, Institute of Psychology, University of Lodz, 91-433 Lodz, Poland;
| | - Joanna Preis-Orlikowska
- Division of Obstetrics, Division of Neonatology, Department of Perinatology, Faculty of Medicine, Medical University of Gdańsk, 80-214 Gdańsk, Poland;
| | - Mariola Bidzan
- Department of Clinical and Health Psychology, Faculty of Social Sciences, Institute of Psychology, University of Gdańsk, 80-309 Gdańsk, Poland; (K.L.); (M.B.)
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47
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DeMarco N, Twynstra J, Ospina MB, Darrington M, Whippey C, Seabrook JA. Prevalence of Low Birth Weight, Premature Birth, and Stillbirth Among Pregnant Adolescents in Canada: A Systematic Review and Meta-analysis. J Pediatr Adolesc Gynecol 2021; 34:530-537. [PMID: 33727190 DOI: 10.1016/j.jpag.2021.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
Although most studies show that adolescent pregnant women are at a higher risk for adverse birth outcomes, there has been limited research examining this relationship in Canada. This systematic review and meta-analysis investigated the prevalence of low birthweight (LBW), preterm birth (PTB), and stillbirth in Canadian adolescent women compared to adult women. Studies were included if they were primary research and included a sample of adolescent mothers (≤19 years) and adult mothers (≥20 years) who gave birth to singleton infants in Canada. Birth outcomes must have been measured consistently in at least 3 studies for inclusion. Comprehensive electronic literature searches were conducted from database inception until August 2020 in 5 databases. Random effects meta-analysis models were used to estimate pooled odds ratios (pOR) for LBW, PTB, and stillbirth between adolescent and adult pregnant women. Outcomes reported included PTB (8 studies), LBW (6 studies), and stillbirth (3 studies). Compared to adult mothers, adolescent mothers had a 56% increase in the prevalence of LBW (pOR 1.56, 95% confidence interval [CI] 1.24, 1.97), a 23% increase in PTB (pOR 1.23, 95% CI 1.06, 1.42), a 20% increase in stillbirth (pOR 1.20, 95% CI 1.05, 1.37). Heterogeneity, as assessed by I2, was high for LBW and PTB and was low for stillbirth. A subgroup analysis did not remove the high heterogeneity, and some studies did not adjust for confounding variables and were missing information on sociodemographic and behavioral factors. Future research is needed to investigate the mechanisms surrounding these differences by maternal age.
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Affiliation(s)
- Natalie DeMarco
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada
| | - Jasna Twynstra
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Maria B Ospina
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Marissa Darrington
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada
| | - Caroline Whippey
- Beryl Ivey Library, Brescia University College, London, Ontario, Canada
| | - Jamie A Seabrook
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada; Department of Paediatrics, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; Human Environments Analysis Laboratory, Western University, London, Ontario, Canada.
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48
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Markin RD, McCarthy KS, Hayes JA. Young pregnant clients in college or university counselling centres: Environmental and symptom experiences. Couns Psychother Res 2021. [DOI: 10.1002/capr.12445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Kevin S. McCarthy
- Chestnut Hill College Philadelphia USA
- Perelman School of Medicine University of Pennsylvania Philadelphia USA
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Weiss SJ, Leung C. Maternal depressive symptoms, poverty, and young motherhood increase the odds of early depressive and anxiety disorders for children born prematurely. Infant Ment Health J 2021; 42:586-602. [PMID: 34021614 PMCID: PMC8453766 DOI: 10.1002/imhj.21924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Children born preterm, compared to term, are at risk for behavioral problems. However, the prevalence and predictors of internalizing disorders among children born preterm are unclear. The purpose of this study was to identify the prevalence of depressive and anxiety disorders at 2 years of age among children born preterm and determine the extent to which poverty, maternal depressive symptoms, or young motherhood increase the likelihood of these disorders. Mothers and their infants (N = 105) were recruited from two neonatal intensive care units affiliated with a major U.S. university. A sociodemographic questionnaire, the Patient Health Questionnaire‐9, and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition scale scores from the Preschool Child Behavior Checklist were used to measure primary variables. We examined mothers’ family satisfaction and quality of caregiving as well as children's degree of prematurity, morbidity, gender, cognitive functioning, and motor function as covariates. Fifteen percent of children met criteria for an anxiety disorder and another 15% for depression. Maternal depressive symptoms increased the odds of children developing both anxiety and depression, whereas young motherhood was associated with child anxiety and poverty with child depression. Results indicate the need for mental health assessment of children born preterm during their first 2 years of life and the importance of early therapeutic and tangible support to vulnerable mothers and children.
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Affiliation(s)
- Sandra J. Weiss
- Department of Community Health SystemsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Cherry Leung
- Department of Community Health SystemsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
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50
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MacLean JR, Wetherall K. The Association between HIV-Stigma and Depressive Symptoms among People Living with HIV/AIDS: A Systematic Review of Studies Conducted in South Africa. J Affect Disord 2021; 287:125-137. [PMID: 33780828 DOI: 10.1016/j.jad.2021.03.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND People living with HIV/AIDS (PLWHA) are at increased risk of stigma and mental illness, and this appears to be a particular issue in South Africa, which is home to 19% of the world's HIV-positive population. This paper aims to systematically review the literature investigating the relationship between HIV-stigma and depressive symptoms among PLWHA in South Africa. METHODS A keyword search of four bibliographic databases (CINAHL, Ovid MEDLINE, PsycINFO, and Web of Science) and two grey literature websites was conducted. The quality of eligible studies was assessed using established criteria. RESULTS Fourteen quantitative studies were included in the review. PLWHA in South Africa experience high levels of HIV-stigma and depressive symptoms. All forms of stigma were found to be associated with depressive symptoms amongst PLWHA. Prospective findings were mixed, with one study finding that stigma did not predict depressive symptoms over 36 months, and another that depressive symptoms predicted stigma 12 months later, suggesting a potentially bidirectional relationship. Females and young adults may be particularly vulnerable to HIV-stigma and its negative psychological effects. Some support was found for the moderating role of social support in the relationship between stigma and depressive symptoms across different sub-populations. LIMITATIONS Few studies conducted prospective analyses or tested mediation/moderation. CONCLUSIONS Despite limitations, this study highlights the importance of understanding the mechanisms underlying HIV-stigma across different sub-populations in South Africa. This may lead to more effective and context-specific interventions to combat adverse mental health outcomes.
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Affiliation(s)
- Jack R MacLean
- Institute of Health and Wellbeing, University of Glasgow, 1055 Great Western Road, Glasgow G12 0XH, UK
| | - Karen Wetherall
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, 1055 Great Western Road, University of Glasgow, G12 0XH, UK.
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