Risk and Protective Factors for Perinatal Well-Being in Low-Income Adolescent Mothers: Results From a Prospective Epidemiological Study of Adolescent Mothers

Background and Purpose: Perinatal depression (PND), affecting approximately 15% of adult mothers, is a leading cause of maternal morbidity and mortality and enduring negative child outcomes including low-birthweight , prematurity, and biological and neurodevelopmental delays. Low-income, minority adolescents have increased prevalence of PND (estimates range from 16-74%), escalating risks for negative maternal and child outcomes.  Prior studies of adolescent mothers based on small, cross-sectional, heterogeneous, and/or isolated samples are problematic. This prospective epidemiological study aimed to assess the point prevalence of antenatal depression (AND) and postpartum depression (PPD) in minority adolescents and to examine the association of social support, adjustment, trauma, and perceived stress on maternal depression status.

Methods: We recruited 212 pregnant adolescents from an urban public prenatal clinic and administered a prospective, longitudinal survey during pregnancy (Time 1) and 6 weeks postpartum (Time 2). Surveys were administered in both English and Spanish. Our survey assessed demographics, SES, depression, stress, social adjustment, and PND. The main outcomes of analyses, AND and PPD, were assessed using the Edinburgh Postnatal Depression Scale. We performed univariate, bivariate, and multivariate analyses using logistic regression to assess prevalence and predictors of AND and PND.

Results: In a diverse sample of adolescents (89.2% racial/ethnic minority), 20% screened positive for AND and 10% screened positive for PPD at six-weeks postpartum. AND was positively associated with poor social adjustment (R=0.45; p<0.001), stress (R=0.36; p<0.01), and trauma (R=0.20; p<0.01) and negatively associated with self-efficacy (R=-0.27; p<0.01) and positive view of pregnancy (R=-0.45; p<0.001). The strongest predictor of PPD was AND (OR of 4.89, p<0.001). PPD was also associated with age (R=0.22; p<0.05), first pregnancy (R=-0.23; p<0.01), social support (R=-0.56; p<0.001), and stress (R=0.35; p<0.01). PPD was negatively associated with positive view of pregnancy (R=-0.27; p<0.001) and involvement of baby’s father (R=-0.32; p<0.001). 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: Significant, malleable risk factors for PND include AND, trauma, stress, social support, social adjustment, self-efficacy, and perception 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. Point prevalence decreased postpartum, and this may be due to transient increased social support following the birth. Following mothers beyond the six-weeks postpartum may be important in identifying PND in high-risk adolescent mothers. Multiple screenings during pregnancy/postpartum are indicated. Results suggest screening should be expanded to assess depression antenatally and past the 6 week postpartum visit.