Exploring Differences Between Adolescents and Adults With Perinatal Depression—Data From the Expanding Care for Perinatal Women With Depression Trial in Nigeria

Abstract

Background: Depression is common among women in the perinatal period. Although pregnancy and motherhood among adolescents are global public health issues, little is known about how adolescents differ from adults in the occurrence and correlates of perinatal depression.Methods: Data were derived from a cluster randomized controlled trial of psychosocial interventions for perinatal depression in primary maternal care in Nigeria (the Expanding Care for Perinatal Women with Depression trial). Adolescents and adult participants recruited during pregnancy and followed up till 6-month postpartum were compared: proportions with depression [screening positive to depression on the Edinburgh Postnatal Depression Scale (score ≥ 12) and meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria using the short form of the Composite International Diagnostic Interview]; adjustment and attitude to pregnancy and motherhood (using the Maternal Adjustment and Maternal Attitudes scale); and parenting skills (measured on Infant–Toddler version of the Home Inventory for Measurement of the Environment). Infant and fetal growth were assessed by measures of weight and head circumference at birth and upper mid-upper arm circumference (MUAC) at 6 months.Results: Of 8,580 adults screened, 6.9% had major depression compared with 17.7% of 772 screened adolescents (p < 0.001). Adolescents had significantly poorer adjustment and attitudes to pregnancy, lower mean fetal gestational age at birth, and a smaller mean baby’s birth weight. At 6-month postpartum, there were no significant differences in the rates of remission from depression between adolescent and adult women (Edinburgh Postnatal Depression Scale score <6). Adolescent mothers continued to have poorer maternal attitudes and parenting skills indicated by significantly lower scores on the Infant–Toddler version of the Home Inventory for Measurement of the Environment responsivity and involvement subscales. Infants of adolescent mothers had a higher rate of undernutrition (defined as MUAC < 12.5 cm) compared with those of adult mothers: 14.8 and 6.3%, respectively (p = 0.008), with the mean MUAC remaining significantly lower for infants of adolescent mothers after adjusting for their lower birth weight (p = 0.04).Conclusion: Perinatal depression is more common and is associated with poorer maternal attitudes and parenting skills in adolescents compared with those in adults. Evidence from this exploratory study suggests that in improving outcomes in infants of adolescent mothers with perinatal depression, depression treatment may need to be supplemented with specific approaches to improve parenting skills.

Impact of maternal mental health interventions on child-related outcomes in low- and middle-income countries: a systematic review and meta-analysis

“…MMH components included education surrounding selfesteem and/or problem-solving (Aracena et al, 2009;Tripathy et al, 2010;Le Roux et al, 2013;Le Roux et al, 2014;Tomlinson, 2014;Rotheram-Borus et al, 2014b;Tomlinson et al, 2015;Tomlinson et al, 2016a;Tomlinson et al, 2016b;Gureje et al, 2019;Oladeji et al, 2019), strengthening social networks (Rotheram-Borus et al, 2014a, Rotheram-Fuller et al, 2018Nabulsi et al, 2019;Rotheram-Borus et al, 2019), provision of social, psychological and emotional support (Villar et al, 1992;Cooper et al, 2009;Tripathy et al, 2010;Murray et al, 2015;Nabulsi et al, 2019), cognitive-behavioural strategies (Le Roux et al, 2013;Le Roux et al, 2014;Rotheram-Borus et al, 2014a;Rotheram-Borus et al, 2014b;Tomlinson, 2014;Tomlinson et al, 2015;Karamoozian and Askarizadeh, 2015;Tomlinson et al, 2016a;Tomlinson et al, 2016b, Rotheram-Fuller et al, 2018Fuhr et al, 2019;Rotheram-Borus et al, 2019;Sikander et al, 2019), alcohol use prevention (Le Roux et al, 2013;Rotheram-Borus et al, 2014b;Tomlinson, 2014;Rotheram-Borus et al, 2014a;Tomlinson et al, 2015…”

Stigma and utilization of treatment for adolescent perinatal depression in Ibadan Nigeria

“…The occurrence of PD among adolescents complicates their unique age-and development-related challenges and thus demands services attuned to the unique needs of this age group. Evidence from Nigeria suggests that children of adolescent mothers with depression have poorer outcomes [21]. However, Nigeria, like other low resource nations of the region, lacks adequate numbers of trained care providers as well as appropriate infrastructure to support high quality primary maternity care for adolescents [31].…”

Responding to the challenge of Adolescent Perinatal Depression (RAPiD): protocol for a cluster randomized hybrid trial of psychosocial intervention in primary maternal care

“…Using a clinician-administered structured interview, rates of 16% for major depressive disorder during pregnancy, 20% at 6 weeks postpartum, and 26% at 1 year postpartum have been reported [6]. Although widely variable, the reported rates of perinatal depression suggest that the problem may be higher than that commonly found among perinatal adults [7,8].…”

“…More than in adults, adolescent perinatal depression is associated with other unique consequences such as increased risk of further pregnancy in adolescence, the use of aggressive parenting behaviors, stunting and cognitive delays in the infants, preschool problem behavior, poorer school performance, and higher levels of psychopathology in the child at 14 years of age [6,10]. Many of these consequences reflect poorer adjustment to motherhood and poorer parenting skills [8].…”

“…While the pattern of recovery from perinatal depression by the participating adolescents was similar to that of adults, the adolescents nevertheless performed worse than adults at the 6month outcome on indices of parenting skills. Specifically, adolescent mothers were rated significantly lower on overall scores on the Home Inventory for Measurement of the Environment, Infant-Toddler version (HOME-IT) [16], as well as on the subscale scores of responsivity and involvement [8].…”