June 26, 2014 — Summary of "Adolescents, Pregnancy, and Mental Health," Siegel/Brandon, Journal of Pediatric and Adolescent Gynecology, June 2014.
Previous studies have demonstrated the "adverse consequences of perinatal psychopathology" in adults, as well as "links between mental illness and the incidence of adolescent pregnancy," suggesting that "mental illness in the context of adolescent pregnancy is a serious public health concern," according to Rebecca Siegel and Anna Brandon of the University of North Carolina-Chapel Hill.
Siegel and Brandon noted that while research into "the intersection of psychopathology and adolescent pregnancy is limited," the field "has shown growth in the last 2 decades." They conducted a "comprehensive review of what has been learned about psychopathology during adolescent pregnancy and the postpartum period, followed by a discussion of areas for future direction."
The researchers searched electronic databases using the terms "adolescent, pregnancy, postpartum, depression, bipolar disorder, anxiety [and] psychosis" in various combinations, limiting their queries to literature involving individuals ages 21 and under that was published between 1990 and 2013.
Siegel and Brandon reviewed the search results and selected studies that covered at least one of several themes related to adolescent mental illness during pregnancy or the postpartum period, including "prevalence or incidence, comorbidity, psychosocial correlates, birth outcomes, parenting, child outcomes, and psychosocial treatment."
The researchers found 40 articles that met their inclusion criteria, the majority of which were "focused upon depression during pregnancy and the postpartum period." They noted that only two of the studies examined bipolar disorder, two examined anxiety and none focused on psychosis.
A "substantial literature has examined prevalence rates of depression in pregnant and postpartum adolescents," the researchers wrote. They found that rates of depression varied widely across the studies, ranging "between 8% and 47%, possibly due to methodological factors."
The review found that rates of depression in perinatal adolescents "do not appear to differ" from depression rates in adolescents who are not pregnant or postpartum, although one study found a slightly higher rate of suicidal behavior in the perinatal population. However, depression rates among perinatal adolescents were substantially higher than those among perinatal adults, according to the literature.
The review found that comorbidity rates "in perinatal adolescents are estimated at 33% among those experiencing any psychiatric disorder, with research in this area focusing upon substance and alcohol use or smoking." For example, the literature showed that depression is "strongly associated with substance and alcohol use and smoking in postpartum adolescents" and that "bipolar disorder is associated with substance use in pregnant and postpartum adolescents."
The researchers identified evidence of "a strong association between social support and fewer depressive symptoms in perinatal adolescents," although the findings suggest "that it might be adolescents' satisfaction with their social support, or the quality of their social support, rather than the quantity of social support that is associated with depressive symptoms."
"In sum, many psychosocial factors are associated with depression during pregnancy and the postpartum period in adolescents," with perceived "social support" being the one factor that most studies "found was associated with depression," the researchers wrote. In addition, "adolescents' own childhood experiences, self-efficacy, social isolation, body satisfaction, and socioeconomic status" were associated with perinatal depression in adolescents, they found.
Birth and Child Outcomes
Siegel and Brandon found that the literature showed "clear evidence for negative birth and child outcomes among depressed adolescent mothers," including higher rates of preterm deliveries and infants being small for gestational age.
Similarly, the research showed an association between negative childhood outcomes -- such as "problem behavior" and "poorer academic achievement" -- and postpartum depressive symptoms among children of adolescent mothers. Maternal depression also was associated with "harsher parenting behaviors in adolescent mothers," although those parenting styles "may be partially explained by a higher rate of depression, rather than the age of the mothers alone," the researchers wrote.
The researchers found that a "wide variety of psychosocial treatments for depression during pregnancy and the postpartum period in adolescents have been tested, with variable findings." For example, two studies found that "[e]ducational group interventions are successful treatments for adolescent depressive symptoms during pregnancy and the postpartum period," while another study found that "Interpersonal Psychotherapy (IPT)" was beneficial for "depressed, pregnant adolescents."
The researchers noted that just one treatment study "targeted anxiety and stress in perinatal adolescents," and it did not "reduce self-reported anxiety," although it did help reduce "[c]ognitive and affective manifestations of anxiety."
"In conclusion, there is a growing literature considering mental health during adolescent pregnancy and the early postpartum years," with a focus on "symptoms of depression in adolescents," Siegel and Brandon wrote.
However, research "on psychiatric disorders other than depression during pregnancy and the postpartum period in adolescents is ... sorely lacking," they found. The researchers added that there is a need for "future investigations that utilize randomized designs where possible, and study interventions for anxiety and bipolar disorder adapted to the unique characteristics of pregnant and postpartum adolescents."