Research That Matters (January 17 - 20, 2008)

Purpose: Rates of perinatal depression in adolescents are almost twice as high as rates in adult pregnant women and non-pregnant adolescents. Prevalence of perinatal depression in adolescents is estimated to be between 16% and 44%. Adolescent mothers face significant social and economic challenges, which can be exacerbated by amplified and persistent depressive symptoms. Given that depression is a treatable disorder, and the negative impact of prerinatal depression is compounded during adolescence, there is a need for research on effective treatments for perinatal depression. Meta-analytic studies and reviews of clinical trials have begun to identify effective treatment for depression among non-pregnant adolescents and perinatal adult women. Treatment of adolescent perinatal depression has not been examined. Methods. The main objective of this meta-analysis is to evaluate the efficacy of existing interventions for perinatal adolescents in reducing maternal depressive symtpomatology. Database searches of Cochrane DSR, ACP Journal Club, DARE, CCTR, MEDLINE, PSYLIT, and Social Work Abstracts in combination with citation list searches and personal approaches completed by two reviewers were used to identify eligible studies. All studies that tested an intervention with adolescents during the perinatal period with an outcome that measured depression or emotional wellbeing were sought for the purpose of this review. Data were analyzed using the Comprehensive Meta-Analysis software (Bornstein & Rothstein, 1999). Standardized mean differences were calculated for continuous outcome data and rate differences was calculated for dichotomous outcome data. Separate analyses were conducted for each class of data. Results. The review reports the efficacy of existing interventions in reducing depression and depressive symtomatology in perinatal adolescents. Of the 7 interventions analyzed, 2 reported significant positive effect sizes, 3 interventions reported marginally positive effects, and 2 interventions reported marginally negative effects. In studies using continuous data grouped by type of intervention, public health nurse care (.47, p < .05) and intensive home visiting (.43, p < .05) had significant positive effect sizes. Comprehensive care (.13, p = .72) and parent training (.12, p = 71) had small effect sizes that were not significant (95% confidence intervals). In studies with dichotomous outcomes, comprehensive care (.01, p = .80) has a marginal positive effect that was not significant. Conclusions. Little intervention evidence exists to guide practice with pregnant and postpartum adolescents. Few existing interventions for pregnant and postpartum adolescents measure depression and, in those that do, few specifically target perinatal depression. Interventions that measure perinatal depression show few significant effects in reducing perinatal depression in this high risk group and those that do show only small effects. No recommendations regarding best practices for adolescents with perinatal depression can be made based on the existing evidence. If policy and practice are to be guided by evidence, additional research will need to focus on increased testing of interventions specifically targeting perinatal depression in adolescent mothers.