How Can We Help Teen Mothers Avoid and Cope With Postpartum Depression?
By Rachel Walden — April 25, 2013
Although there is a fair amount of information and research available on postpartum depression in general, very little of it seems to focus specifically on the needs or care of teen mothers.
A pilot study published in the American Journal of Obstetrics and Gynecology in March attempts to fill in this gap — and it shows some promising results.
First, the authors explain why the risks of PPD in teens are important:
PPD puts adolescent mothers and their children at risk during an already challenging time in their lives, and this hardship may be a major determinant of poor outcomes for these young mothers and their children. Untreated, depression is associated with school dropout, suicide, and substance use. Among adolescent mothers, evidence suggests that depression may prevent them from engaging in health-promoting behaviors for their infants and themselves.
The study is based on a randomized controlled trial of the REACH program (Relax, Encourage, Appreciate, Communicate, Help), which is designed to help expectant mothers develop stress management and other skills. The program was offered as structured therapy during pregnancy, followed by a postpartum “booster” session.
Participants in the therapy group used interpersonal therapy to work on effective communication skills, conflict management, improving their social support systems and building healthy relationships, and goal setting. They, as well as the control group, received a handbook of typical pregnancy and postpartum/newborn health information. A total of 106 teens age 17 or younger and without pre-existing mental health issues were randomized to the therapy or control groups.
The researchers looked for major depressive episodes within the six months after birth. Although only 12.5 percent of the REACH teens developed postpartum depression, compared with 25 percent of the control teens, the results were not statistically significant, as the study was fairly small and very few teens (19) overall developed postpartum depression. A larger study may be needed to better determine the utility of the program.
Despite a lack of clear effect, the study highlights a need for further investigation into the postpartum mental health needs of teens. As the authors explain:
Although validated treatments for adolescent depression exist and include interpersonal therapy, cognitive behavioral therapy, and antidepressant medication, teen mothers with mental health problems are mostly under treated. To date, only one published report of 2 small open-trial pilot studies addressed treatment for depression in pregnant adolescents. Despite the potentially high burden of depression to young women and their families, studies on the prevention of PPD in pregnant adolescents are virtually nonexistent.
Another lesson learned in this study was that teens preferred individual therapy sessions over the planned group sessions, so sessions were adjusted to be one-on-one. The researchers also took care to specifically design the REACH program to be culturally appropriate for a diverse group of racial and ethnic backgrounds.
This study makes an extremely important contribution to our understanding of teen moms and their post-partum needs. It shows, elegantly, how multiple interventions can come together to improve the mental health of the mom. These interventions will improve the baby’s wellbeing as well.
The scheme developed for this research is complex.
There are two SIMPLE things practitioners can do for teen moms.
One is to ASK about depression symptoms in EVERY post-partum teen.
The other is to provide an SSRI to teen moms who are depressed*.
Many studies have shown that a mom with treated depression is a better mom; her baby benefits from mom’s being treated.
Two SSRIs are on the $4 list at most pharmacies: Prozac and Celexa. These drugs are safe to both mom and nursing baby.
*Practitioners should also ask about post-partum anxiety. A very recent study showed that post-partum anxiety is even more prevalent than post-partum depression. Thankfully post-partum anxiety also responds to the same simple, low cost SSRIs!
Agreed, the study above is a much-needed area of investigation and a great contribution to our understanding of PPD in teen moms.
Teen moms are at HUGE risk for PPD. See of these known risk factors apply to your average teen mother:
-The pregnancy was unplanned or unwanted.
-She has a weak support system.
-She has recent experience of stressful events during the past year.
-She is having problems in her relationship with her significant other.
-She is having financial problems.
-She has experienced early mother-child separation (for example, giving the baby up for adoption).
-She had a negative birth experience. (Most complications of pregnancy are MUCH more common in teen pregnancies and, of course, people, even obstetrical professionals, can act “judgy” or superior to teen moms.)
-She has a history of depression, either during pregnancy or at other times.
This is why we need to be on the lookout. The negative outcomes associated with PPD for both mothers and babies can be very grave. As the last poster pointed out, this is why it’s so important to screen for and treat PPD in teens.
Studies show that most OBs and primary care providers caring for mothers during the postpartum period are too busy to use the scientifically-proven screening test(s) for PPD in a busy office, if they even do at all. This leaves new moms and their babies out in the cold, often until it gets *really bad* or sometimes until it’s too late. And sometimes PPD is never diagnosed and mother and baby suffer for months or years from the fallout.
Recent studies have investigated the utility of having providers use a one-question screening tool to detect PPD. The best question to date has proven to be, “When you try to sleep while the baby is sleeping, can you?” It turns out that of the 10 questions on the Edinburgh Postnatal Depression Scale (the tool providers who screen most often use), the most predictive one is about the inability to sleep. If more providers would take the time to use even a single, proven question (not just, “Are you depressed?”…it’s not that predictive and many women don’t answer honestly), think what good it would do.
I agree with the last poster that treatment with an antidepressant (and other pschotropic drugs, if needed in addition) is really, really important for mom and baby. But so are programs like REACH. I’m wondering what other programs and tool are out there for teen moms who don’t have access to REACH.
Something to research.
An important topic that is not brought up very often about a marginalized group of people – teen moms. Thank you for this post.