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Births to teens in the United States are now concentrated in adolescents at risk due to poverty, a history of foster care, and/or identifying as Black or Latina. These groups are also at elevated risk for exposure to trauma during childhood and to mental health problems related to trauma. This pilot study examined the relationships among trauma history, lifetime traumatic stress symptoms, and current stresses in order to identify common mental health needs in pregnant teens and also looked at their effects on the teen’s level of attachment to her unborn child.
Methods
The study passively recruited teens receiving care from the Nurse Family Partnership program in a large northeastern city and who lived in low income neighborhoods. The obtained sample of 36 teens, ages 15 to 19 (mean age = 17), were predominantly Latina (52%) and Black (39%). Trauma history was measured using the Adverse Childhood Experiences (ACE) measure; lifetime traumatic stress symptoms were assessed by the Trauma Stress Checklist for Children (TSCC); current symptoms were measured using Perceived Stress Scale (PSS), and past or present foster care involvement was self-reported. Data were gathered using individual structured interviews that also asked about social context, relationships, pregnancy health, and the teens’ level of attachment to the unborn child (MAAS).
Findings
The average ACE score in this sample was 3.9, almost at the level (4) indicating high risk for lifetime health and behavioral health problems. Teens who had ever been in foster care had higher average ACE scores (5.5) than those who had not (2.9). Although the TSCC is not a diagnostic instrument, the proportion of teens with “clinically significant” subscale scores was 26% for depression, 25% for post-traumatic stress, 25% for anxiety, 12% for dissociation, and 11% for anger.
As expected, trauma history (the ACE score) was related to the overall score on the TSCC (r = .44) as well as the subscale scores for anger (r = .52), post-traumatic stress (r = .48) and depression (r = .40). ACE scores were also correlated with overall current perceived stress (PSS) as well as to the TSCC subscales for anxiety (r = .55), depression (r = .63, anger (r = .54), PTSD (r = .64) and dissociation (r = .47). ACE scores (r = -.56) and depression symptoms (r = -.33) were inversely related to ratings of satisfaction with the relationship with the father of the baby. However, contrary to expectations, scores on these measures were not significantly related to maternal-fetal attachment. Additional specific findings related to trauma and mental health will be presented.
Implications
Teens in this sample had experienced many different traumas that were related to their lifetime (TSCC) and current (PSS) mental health symptoms. Incorporating trauma-informed mental health care would add an important element to prevention and early intervention programs like the NFP as well as the many other kinds of programs serving pregnant teens. That these factors did not affect maternal-fetal attachment (or self-care in pregnancy) suggests resilience in this group.