This prospective epidemiological study aimed to estimate the prevalence of PND in adolescents and identify associated risk factors to inform targeted interventions and policies to improve outcomes in this vulnerable population.
Methods: We recruited 250 pregnant adolescents from an urban public prenatal clinic and administered a prospective, longitudinal survey at two time points (prenatal and postpartum). Our survey assessed demographics, SES, depression, stress, and social adjustment. Depression was measured using the Edinburgh Postnatal Depression Scale (EPDS). We performed univariate, bivariate, and multivariate analyses using logistic regression to assess prevalence and predictors of PND.
Results: In a diverse sample of adolescents (28.7% Black, 55.3% Latina), 22.9% screened positive for antenatal depression (AND) and 12.5% screened positive at the six-week postpartum (PPD) visit. AND was positively associated with poor social adjustment (R=0.47; p<0.001), stress (R=0.38; p<0.01), and trauma (R=0.31; p<0.05) and negatively associated with self-efficacy (R=-0.44; p<0.001) and positive view of pregnancy (R=-0.52; p<0.001). The strongest predictor of PPD was AND (OR of 4.25, p<0.05). PPD was also associated with age (R=0.22; p<0.05), first pregnancy (R=-0.22; p<0.05), poor social support (R=0.50; p<0.001), and stress (R=0.38; p<0.01). Conversely PPD was negatively associated with positive view of pregnancy (R=-0.26; p<0.05) and involvement of baby's father (R=-0.24; p<0.05). The multiple logistic regression model predicting AND was significant (p<0.001, pseudo-R2=0.43). The strongest predictor in the model was social adjustment (OR 1.14, p<0.05). The postpartum logistic regression model was also significant (p<0.001, pseudo-R2=0.5490).
Conclusion and Implications: This study represents the largest prospective study of adolescent PND identified to date. The strongest predictor of adolescent PPD is AND. Significant, malleable risk factors for PND include trauma, stress, social support, social adjustment, self-efficacy, and view of pregnancy. These factors should be targeted in prevention and intervention efforts. Point prevalence rates fell within the expected range antenatally but not at 6-weeks postpartum. This may be due to increased support following the birth of the baby. Following these mothers beyond the routine six-week postpartum visit may be important identifying high-risk adolescent mothers with PPD and multiple screenings during pregnancy and postpartum are called for. Results suggest screening postpartum under the US Department of Health and Human Services' Early Childhood Comprehensive Systems program should be expanded to assess depression antenatally. Early detection and treatment of PND can lead to significant improvements in outcomes for adolescent mothers and their children.
