Adolescent mother's depression after the birth of their babies: weathering the storm

Adolescence, Fall, 2002 by Donna A. Clemmens

INTRODUCTION

Adolescent motherhood continues to be a common and complex phenomenon in the Western world, accounting for almost 500,000 births annually in the United States (Ventura, Curtin, & Mathews, 2000). Although the U.S. birth rate for adolescents giving birth before the age of nineteen has consistently declined since 1991, it still remains five times higher than in all other developed countries (MacFarlane, 1997). A recent review of national infant health data revealed that as many as 48% of adolescent mothers experience depressive symptoms (Deal & Holt, 1998), compared to 13% in adult mothers (O'Hara & Swain, 1996). Depression affects the adolescent mother's capacity to form and maintain relationships. This often results in her disengagement from mother-child interaction, and interferes with the attentiveness and nurturance needed by her infant to develop securely (Colletta, 1983; Gelfand & Teti, 1990; Hubbs-Tait et al., 1996). Adolescent mothers identified as depressed are at increased risk of future psychopatholo gy (Leadbeater et al., 1996), with additional deleterious effects on their children's lives.

For many adult mothers, the experience of depression in the postpartum period is devastating (Affonso et al., 1993; Beck, 1993, 1996). Depressive mood disorders observed in the postpartum period include psychosis, depression, panic disorder, and obsessive-compulsive behavior. Mothers whose postpartum depression has gone undiagnosed feel confused and "fear they are losing their minds" (Beck, 1993, P. 44). Postpartum depression has been linked to mothers' failure to respond to infant cues, and to detrimental relationships with children resulting in their poor cognitive and emotional development (Beck, 1995, 1998).

The assumption that adolescents as a group present with similar symptoms to those of adults has influenced the identification and description of depression in adolescent mothers (Leadbeater & Linares, 1992; Wilcox et al., 1998). Yet adolescent depression as a whole remains underrecognized, with a large number of adolescents going undiagnosed because they do not meet the DSM-IV criteria for depression (Lewinsobn, Rhode, & Seeley, 1998). Studies that examine the unique nature of depression in adolescents have been lacking (Petersen et al., 1992). Given the severity of outcomes associated with postpartum depression and the largely unknown nature of the phenomenon in adolescent mothers, further study, particularly of symptom presentation, is called for. This study addressed the phenomenon of adolescent mothers' depression after the birth of their babies from the viewpoint of the adolescent mothers.

Review of the Literature

Concern for the welfare of adolescent mothers and their children has resulted in a plethora of research over the past quarter of a century. The focus has been on understanding both the correlates of positive outcomes (Arenson, 1994; Censullo, 1994; Diehl, 1997; SmithBattle, 1995; SmithBattle & Leonard, 1998) and the factors associated with negative outcomes (Leadbeater, Bishop & Raner, 1996; Lesser, Koniak-Griffin, & Anderson, 1999). Adolescent mothers whose experiences are associated with adverse outcomes include those mothers who develop depressive symptoms during their postpartum period. A wide discrepancy in reported rates of depression in adolescent mothers presents a somewhat fragmented picture of the phenomenon, with rates ranging from 6% to 68% over the first year following childbirth (Chen, 1996; Colletta, 1983; Hudson, Elek, & Campbell-Grossman, 2000; Leadbeater & Linares, 1992; McHenry, Browne, Kotch, & Symons, 1990; Troutman & Cutrona, 1990). Troutman and Cutrona (1990) and Lillich (1990) claimed that depressive symptomatology might not be a unique response to birth in adolescent or adult mothers, and accounted for only 6% to 10% of the adolescent motherhood population. In contrast, Deal and Halt (1998) reported that 48% of almost 1000 adolescent mothers surveyed had depressive symptoms.

While depressive symptoms in adolescent mothers postpartum have been identified in studies, they were described and defined differently by the various researchers, using a variety of instruments and cut-off scores, sometime between the birth of infants and three years postpartum, and with different symptom presentation. The depression screening instruments included the Beck Depression Inventory (BDI), the Center for Epidemiological Studies Depression Scale (CES-D), the Reynolds Adolescent Depression Scale (RADS) and the Edinburgh Postnatal Depression Scale (EPDS). These instruments were often used inappropriately to diagnose postpartum depression (PPD), with no corroborating clinical diagnosis. Additionally, the validity of using the BDI in screening for postpartum depression has been questioned, since it shows decreased sensitivity and specificity in identifying PPD in adult mothers (Whiffen & Gotlib, 1993; Beck, 1992). While Troutman and Cutrona (1990) reported higher rates of somatic symptoms among their s ample, Chen (1996) found higher levels of cognitive-affective symptoms. Leadbeater and Linares (1992) found that although somatic symptoms declined over the course of the postpartum period, the reported rates of cognitive-affective symptoms were still high enough to meet the cut-off score criteria for depression. We are left with a conflicting picture of depressive symptoms in adolescent mothers in the postpartum period.