By Diana Mahoney, New England Bureau. Share your thoughts and suggestions at cpnews@elsevier.com
Depression in adolescent mothers is linked to an increased risk of rapid subsequent pregnancy, and these findings should come as no surprise.
In a secondary analysis of data drawn from two consecutive longitudinal risk reduction interventions, Dr. Beth Barnet and her colleagues in the department of family and community medicine at the University of Maryland, Baltimore, discovered that depressive symptoms were associated with a 44% increase in risk of subsequent pregnancy among 269 predominantly African American and low income teens.
The study included 297 pregnant adolescents aged 12–18 who received prenatal care at one of five community-based prenatal sites. At enrollment, the teens underwent a baseline structured interview and were randomly assigned to a subsequent pregnancy prevention intervention or to a usual-care control. Research staff administered structured follow-up questionnaires at 1 and 2 years post partum.
Of the 269 teens who completed at least one of the follow-up questionnaires, 46% had depressive symptoms at baseline, the authors reported in the March issue of the Archives of Pediatric and Adolescent Medicine. Of the 245 teens who completed 2 years of follow-up, 120 experienced a subsequent pregnancy within 2 years of childbirth. Of the 24 who were followed for only 1 year, 9 had a subsequent pregnancy during that time, they wrote (Arch. Pediatr. Adolesc. Med. 2008;162:246–52).
“The hazard ratio of subsequent pregnancy was significantly greater among the 112 teens with baseline depressive symptoms,” the authors wrote, noting that the increased risk remained significant even after adjustment for possible confounders, including age, education, Medicaid status, exposure to violence, substance use, and relationship with the baby's father.
This study is the first to demonstrate with longitudinal data that depressive symptoms precede subsequent pregnancy in adolescent mothers and might be a determinant of this. However, in context of the following data on depression and adolescent mothers, the results could have been predicted:
▸ Depression is a well-known nonsexual antecedent of teen pregnancy. In a recent national study using longitudinal data from more than 4,000 middle school and high school students, depressive symptoms in boys and girls were predictive of subsequent sexual risk behavior, including condom nonuse at last sex, birth control nonuse at last sex, and multiple sexual partners (Pediatrics July 2006;118:189–200).
▸ Depression is common among adolescents. According to the 2001 Youth Risk Behavior Survey of more than 13,000 students, 28% of U.S. high school students reported severe depressive feelings (MMWR 2002;51[SS04]:1–64). In a 2005 report of the results from the Office of Applied Studies' National Survey on Drug Use and Health, the lifetime prevalence of depression among adolescents was estimated to be 14% (http://www.oas.samhsa.gov/p0000016.htm#2k4
▸ Rates of postpartum depression in adolescent mothers are significantly higher than those seen in adult mothers. According to the results of a recent integrative review of the literature on postpartum depression in adolescent mothers by pediatric nurse practitioner Vanessa Reid of New London, Conn., the prevalence of postpartum depression among women of all ages is estimated to be between 20% and 28% during the immediate postpartum period, compared with rates between 53% and 56% among adolescents (J. Pediatr. Health Care 2007;21:289–98).
▸ Rates of postpartum depression among African American adolescents are nearly twice as high as those observed in white adolescents, according to the result of a 1998 report on the National Maternal and Infant Health Survey (Am. J. Public Health 1998;88:266–70).
Without a doubt, the odds are clearly stacked against adolescent mothers and, by default, their offspring. Multiple studies examining the impact of maternal depressive symptoms on offspring have shown that depression can interfere with a mother's ability to provide emotional and psychological support and attachment, as well as proper and adequate nutrition and physical care, for her infant, according to Ms. Reid.
“The results of studies that examined the relationship between maternal depressive symptoms and child outcomes revealed negative feeding interactions, negative or less positive interaction behaviors, child problem behaviors in preschool, and general pediatric complications, including lower weight, shorter length, and smaller head circumference,” Ms. Reid said.
In addition, “repeat adolescent pregnancy and birth are associated with poorer pregnancy outcomes, less educational attainment, lower future income, and greater dependence on public assistance,” wrote Dr. Barnet and her colleagues. “Children born into families with short interpregnancy intervals are exposed to increased parenting stress and negative parenting behaviors.”
Numerous interventions have attempted to reduce rapid subsequent pregnancy in adolescents, but “none that I am aware of have specifically targeted depression,” Dr. Barnet said. Instead, many such efforts have focused on such factors as access to contraceptives, education, and social support. The outcomes have been disappointing, she said.