Risk factors for poor mental health among adolescent mothers in South Africa

Figures & data

Figure 1. Hypothesised risk factors for likely common mental disorder among adolescent mothers affected by HIV clustered according to a socioecological framework.

Figure 2. Prevalence of mental health symptoms among adolescent mothers stratified according to maternal HIV status (n = 1002).

NB. CMD: Common mental disorder(scoring above the cut-off on one or more screen measure for mental health), Mental health comorbidities(experiencing two or more common mental disorders concurrently)

Table 1. Sociodemographic characteristics of adolescent mothers and their children (including hypothesised risk factors for adolescent maternal mental health) stratified according to maternal HIV status (n = 1002).

	M(IQR)/M(SD)/N(%)			X2/t, p-value
	Total sample (n = 1002)	Living with HIV (n = 272)	Not living with HIV (n = 730)
Maternal characteristics
Maternal age (current; years)	18 (17–19)	19 (18–21)	18 (17–19)	175.86, 0.0001
Maternal age at birth of first child (years)	17 (16–18)	17 (16–18)	16 (15–17)	59.64, 0.0001
Has more than one child	88 (8.8%)	54 (19.9%)	34 (4.7%)	57.11, <0.0001
Living in a rural area	290 (28.9%)	68 (25.0%)	222 (30.4%)	2.82, 0.09
Informal housing	219 (22.3%)	67 (25.6%)	152 (21.1%)	2.18, 0.14
In a relationship (current)	659 (66.4%)	192 (71.9%)	467 (64.3%)	5.03, 0.03
Child characteristics
Child age (months)	15 (6–29)	25 (8–39)	13 (5.5–24)	51.34, 0.0001
Child biological sex (female)	488 (48.7%)	137 (50.4%)	351 (48.1%)	0.41, 0.52
Hypothesised risk factors for adolescent maternal mental health
Individual-level factors
Any abuse	45 (4.5%)	15 (5.5%)	30 (4.1%)	0.91, 0.34
Lack of food security	291 (29.0%)	89 (32.7%)	202 (27.7%)	2.45, 0.12
Number of necessities (0–8)	5.22 (2.22)	4.71 (2.33)	5.42 (2.15)	19.08, 0.0001
Lack of access to all basic necessities (8)	807 (80.5%)	227 (83.5%)	580 (79.5%)	2.03, 0.16
No grant receipt	74 (7.4%)	9 (3.3%)	65 (8.9%)	9.07, 0.003
Highest school grade completed	9.63 (1.67)	9.55 (1.87)	9.66 (1.59)	0.94, 0.35
Not in work or education	446 (44.5%)	187 (68.8%)	259 (35.5%)	88.81, <0.0001
Age disparity with father of child (how many years older is the father of the child than the mother?)	4 (2–6)	5 (2–8)	3 (2–5)	20.31, 0.0001
Age disparate relationship (father of child; ≥5 years)	368 (40.1%)	128 (52.0%)	240 (35.8%)	19.82, <0.0001
Interpersonal-level factors
Perceived social support score	13.39 (2.06)	13.22 (2.16)	13.45 (2.02)	1.63, 0.10
Lack of social support	122 (12.2%)	44 (16.2%)	78 (10.7%)	5.59, 0.02
Not supported during pregnancy	179 (17.9%)	51 (18.8%)	128 (17.5%)	0.20, 0.65
Community-level factors
Any exposure to community violence	267 (26.7%)	64 (23.5%)	203 (27.8%)	1.86, 0.17

NB. Missing data: Informal housing n = 981 |In a relationship n = 993 |Age disparate relationship (father of child; ≥5 years[n = 917])

Table 2. Logistic regression models exploring associations between hypothesised risk factors and maternal mental health (n = 1002).

	Any common mental disorder
	Model 1		Model 2		Model 3		Model 4		Model 5
	OR (95% CI)	p	AOR (95%CI)	p	AOR (95%CI)	p	AOR (95%CI)	p	AOR (95%CI)	p
Sociodemographic factors
Maternal age at birth of first child (years)	0.99 (0.87–1.12)	0.82	1.01 (0.88–1.16)	0.91	0.98 (0.84–1.14)	0.77	0.98 (0.84–1.14)	0.77	0.96 (0.82–1.12)	0.66
Maternal HIV	1.53 (1.02–2.27)	0.04	1.34 (0.85–2.12)	0.21	1.18 (0.73–1.91)	0.52	1.12 (0.67–1.87)	0.66	1.23 (0.75–2.11)	0.39
Child age (months)	1.01 (1.00–1.02)	0.006	1.01 (1.00–1.02)	0.14	1.01 (1.00–1.02)	0.10	1.01 (1.00–1.03)	0.07	1.01 (0.99–1.02)	0.14
More than one child	1.92 (1.10–3.34)	0.02	1.60 (0.82–3.13)	0.17	1.30 (0.64–2.63)	0.47	1.16 (0.56–2.42)	0.69	1.28 (0.61–2.66)	0.51
In a relationship (current)	0.96 (0.65–1.43)	0.85	0.90 (0.60–1.34)	0.60	0.94 (0.61–1.47)	0.80	0.94 (0.60–1.48)	0.80	0.94 (0.59–1.48)	0.79
Living in a rural area	0.64 (0.41–0.97)	0.05	0.66 (0.42–1.05)	0.08	0.72 (0.43–1.20)	0.20	0.81 (0.48–1.35)	0.42	0.91 (0.53–1.53)	0.70
Informal housing	1.17 (0.76–1.81)	0.48	1.06 (0.68–1.65)	0.81	0.88 (0.54–1.43)	0.60	0.82 (0.50–1.36)	0.45	0.76 (0.46–1.27)	0.30
Individual level factors
Any abuse	3.81 (1.99–7.30)	<0.0001	-	-	3.17 (1.52–6.56)	0.002	2.83 (1.33–5.98)	0.007	2.54 (1.20–5.40)	0.01
Lack of food security	1.06 (0.71–1.60)	0.77	-	-	0.94 (0.59–1.49)	0.80	0.84 (0.52–1.35)	0.46	0.86 (0.53–1.40)	0.54
Lack of access to basic necessities	0.97 (0.61–1.55)	0.91	-	-	1.05 (0.62–1.80)	0.86	0.96 (0.55–1.65)	0.87	0.94 (0.55–1.64)	0.84
No grant receipt	1.38 (0.72–2.64)	0.33	-	-	1.41 (0.70–2.87)	0.34	1.55 (0.75–3.19)	0.23	1.50 (0.73–3.09)	0.27
Not in work or education	1.79 (1.22–2.61)	0.003	-	-	1.70 (1.07–2.68)	0.02	1.62 (1.01–2.58)	0.05	1.57 (0.98–2.52)	0.06
Age disparate relationship	1.35 (0.93–1.96)	0.11	-	-	1.11 (0.73–1.70)	0.61	1.21 (0.79–1.86)	0.38	1.22 (0.79–1.88)	0.38
Interpersonal level factors
Lack of social support	4.28 (2.75–6.65)	<0.0001	-	-	-	-	3.88 (2.37–6.36)	<0.0001	4.09 (2.48–6.74)	<0.0001
Not supported during pregnancy	1.52 (0.97–2.38)	0.06	-	-	-	-	1.31 (0.80–2.17)	0.29	1.42 (0.85–2.36)	0.18
Community factors
Exposure to community violence	2.08 (1.41–3.06)	<0.0001	-	-	-	-	-	-	2.09 (1.33–3.27)	0.001
			R^2 = 0.02		R^2 = 0.05		R^2 = 0.09		R^2 = 0.11

Common mental disorder (scoring above the cut-off on one or more screen measure for mental health) |Model 1.Univariate model |Model 2. Multivariate model including all sociodemographic factors listed |Model 3. Multivariate model including all sociodemographic and individual- level factors listed| Model 4. Multivariate model including all sociodemographic, individual-, and interpersonal- level factors listed|Model 5. Multivariate model including all sociodemographic, individual-, interpersonal- and community- level factors listed