Mental health outcomes beyond the post-partum period among adolescent mothers: a systematic review and meta-analysis

Figures & data

Figure 1. PRISMA flow diagram.

Table 1. Characteristics of the included studies.

Study ID	Study design	Country	Participants	Exposure	Mental health outcomes	postpartum (months)
Aitken et al. (2016)	Cohort study	Australia	Household, Income and Labour Dynamics in Australia Survey 4216 women observed over the 13 years categorised within three cohorts for first childbirth: 25–40 years, 20–24 years and younger than 20 years.	Pregnancy. Live births	Mental Component Summary	At least 12 months
Boden et al. (2008)	Longitudinal/ cohort study	New Zealand	Christchurch Health and Development Study Children from Christchurch studied from birth to age 25 – included pregnant, non-pregnant and those mothering. Sample size for adolescent pregnancy whereby participants had full data available on pregnancy and motherhood history, and mental health outcomes from ages 21–25 years represented a cohort of 515 females.	Live birth only – adoptions were not included	Depression (CIDI Scale), anxiety (CIDI Scale), suicidal ideation, suicide attempt, substance dependence	Between 1 and 5 years
Gavin et al. (2011)	longitudinal study	U.S.A.	A 17-year longitudinal study of adolescent mothers Pregnant adolescents aged 17 and younger, unmarried, planning on carrying pregnancy to full term – cohort of 173	Adolescent pregnancy: livebirths and after delivery – does not specify whether any participants had stillbirths etc.	Depressive symptoms (BSI scale), smoking, alcohol/ marijuana use	Factors identified over 17 years of period.
Henretta et al. (2008)	Cohort study	The UK and the U.S.A.	U.S. Health and Retirement Study birth cohort of 1931–1941 4430 American <21 years compared to 21–25, and 25+ years British 1946 Birth Cohort study 1062 English <21 years compared to 21–25, and 25+ years	Pregnancy	Depression (CES-D scale)	The US Study – at the age of 51 and 61 years The UK study – at the age of 53 years
Maughan (1997)	Two cohort studies	UK	British birth cohort studies (the 1946 and 1958 cohorts) 338 Teenagers in 1946 347 Teenagers in 1958 Mothers <20 years compared to older	Pregnancy (small groups of multiple births and illegitimately born children were excluded from the study)	Antisocial behaviour (the Rutter B2 scale), emotional problems (the Rutter B2 scale), other psychiatric disorder/ morbidity	At the age of 36 years
Horwitz et al. (1996)	Cohort	U.S.A.	Young Mother’s Programme between September 1967 and June 1969. Unmarried pregnant women – 154 African American women 13–18 years. Follow-up done at 32–38 years.	Pregnancy Live birth and first birth only	Depression (the DIS Scale)	At least one year
Jaffee (2002)	Cohort study	New Zealand	Dunedin Multidisciplinary Health and Development Study 482 females were assessed at age 26. First birth before age 20; compared to those who first gave birth between ages 20 and 26 and those who had not given birth by age 26	Young adult pregnancy.	Anxiety (the DIS Scale), depression (DIS Scale)	At the age of 26 years
Patel and Sen (2012)	Cohort/ Longitudinal study	U.S.A.	National Longitudinal Survey of Youth 1979 Adolescents 18 or younger from the NLSY79 who had a live birth – 1,310	Pregnancy and live birth	Mental Component Summary, alcohol and marijuana use	Not stated
Taylor (2009)	Longitudinal study	U.S.A.	Wisconsin Longitudinal Study 464 females, 84 males – American adolescents pregnant before the age of 20 – followed from age 18–53 were compared to adult 939 males, 1224 females	Pregnancy	Self-acceptance, depression (the CES-D scale), purpose in life	16–19 years postpartum for the first assessment, 18–35 for the second assessment
Vicary (2001)	Longitudinal Study	U.S.A.	Rural Adolescent Development Study (RAD) – 1995 and Evaluation of Rural Outcomes of Sexuality (EROS) – 1997 Sample size into three categories: Teen mothers that had given birth before/at 18–26 Mothers who had their first child between age of 19–22 and 49 Mothers who had therr first child at 23 or later – 23	Pregnancy and first childbirth (live birth)	Self-image, loneliness, depression (the DI Scale), home stress and satisfaction (the HSSI scale), conflict, managing disagreements (MDS)	Up to 12 years postpartum
Schmidt (2006)	Prospective cohort study	U.S.A./ Colombia	623 adolescent mothers, 18 years or younger, varying in race/ ethnicity who delivered their first child at the University of Texas Medical Branch	Adolescent pregnancy	Depression (the BDI scale)	3, 12, 24 and 48 months postpartum
Walker (2016)	Cohort/ Longitudinal study	U.S.A.	Wave 2 of National Longitudinal Survey of Adolescent Health (Add Health) Adolescents in grades 7–12 in U.S.A. 11–21 years. Adolescent mothers 17 years or younger (67) and adult mothers 18 or older (62) and non-mothers (6499)	Pregnancy and live + no live birth.	Self-control, Self-esteem, depression (CES-D scale)	Not stated
Whitworth (2017)	Longitudinal	U.S.A.	Wave 1 and Wave 4 of the National Longitudinal Study of Adolescent Health (ADD Health) Pregnant U.S.A. adolescents and adults from years 1995 and 2008-16-19-year olds (592) and 20–32-year olds (2306) at their first birth	Pregnancy and live births only	Depression (CES-D scale)	At least 9 months’ postpartum
Kalil (2002)	Longitudinal survey	U.S.A.	990 teenage childbearing women (married and unmarried), adult child bearers (married and unmarried) and married and unmarried non-child bearers.	Pregnancy	Depression (the CES-D scale)	initial survey was conducted at age 14 to 21 in 1979, and analyses on 609 women who had become mothers by 1992
Buckingham-Howes *abstract only (2017)	Cohort/ Longitudinal study	U.S.A.	118 low-income African American adolescent mothers (age not specified – presumed 12–17)	Adolescent pregnancy	Depression (no scale mentioned)	Over 2 years and up to 7 years
Iacobelli et al. (2014)	Case Control	France	Mothers who were less than 18 years old compared to mothers who were 18–29 years old at delivery. 476 mother-infant pairs.	Pregnancy and live birth.	Depression (no scale reported), other psychiatric illness, suicidal attempt, self-intoxication	18 months postpartum
Deal (1998)	Cross-sectional study	U.S.A.	National Center for Health Statistics’ 1988 National Maternal and Infant Health Survey 447 women (15–17 years), 479 women (18–19 years), 870 women (25–34 years)	Pregnancy and live births only	Depression (the CES-D scale)	Average of 17 months postpartum
Li et al. (2021)	Cross-sectional	Bangladesh	From 5 rural and 5 urban hospitals women with their first pregnancy at age 17 or younger will no severe medical conditions. 940 valid participants.	Pregnancy	Suicide attempts	12 months
Mokwena (2016)	Cross-sectional	South Africa	Rural South African women – 56 teenage mothers and 56 non-mothers aged 14–19.	Pregnancy and birth	Anxiety (GHQ Scale), depression (GHQ Scale), somatic symptoms (GHQ Scale), antisocial behaviour (the GHQ Scale), coping strategies (CSS)	Not specified but postpartum 1 year
Stiffman (1987)	Cross-sectional study	U.S.A.	Nationwide programme initiated in 1980 by the Robert Wood Johnson Foundation 1590, 13–18-year-olds adolescents who have become pregnant, those who are sexually active but never have been pregnant, and those who are sexually inactive were compared.	Pregnancy	Anxiety (no scale reported), depression (DIS Scale), conduct disorder (DICA), suicidal ideation, substance dependence	Not stated – no measure of postpartum mental health
Piyasil *abstract only (1998)	Cross-sectional/ comparative	Thailand	Thailand teenage mothers from non-private Rajvithi Hospital aged < or = 18 years of age compared to 20–35-year-old mothers. Sample size not stated.	Pregnancy and livebirths.	Anxiety and depression – measurement not stated	Not sure if these results have a follow-up during the past 1 year postpartum

Abbreviations: BDI: Beck Depression Inventory; BSI: Brief Symptom Inventory; CES-D: Centre for Epidemiological studies Depression Scale; CIDI: Composite International Diagnostic Interview; CSS: Coping Strategy Scale; DI: Depression Inventory; DICA: Diagnostic Interview for Children and Adolescents; DIS: Diagnostic Interview Schedule; GHQ: General Health Questionnaire; HSSI: Home Stress and Satisfaction Indexes; MCS: mental component summary; NR: Not Reported; MDS: Managing Disagreements Scale; SIQYA: Self-image Questionnaire for Young Adults; UCLA-LS: UCLA Loneliness Scale.

Table 2. Outcomes Reported in the Included Studies.

Study ID	Maternal Mental Health Outcomes
	Self-acceptance	Self-control	Self-esteem	Self-image	MCS	Loneliness	Anxiety	Depression	Somatic symptoms	Antisocial behaviour	Conduct disorders	Emotional problems
Aitken et al. (2016)					X
Boden et al. (2008)							X (CIDI)	X (CIDI)
Buckingham-Howes *abstract only (2017)								X (NR)
Deal (1998)								X (CES-D)
Gavin et al. (2011)								X (BSI)
Henretta et al. (2008)								X (CES-D)
Horwitz et al. (1996)								X (DIS)
Iacobelli et al. (2014)								X (NR)
Jaffee (2002)							X (DIS)	X (DIS)
Kalil 2002 (2002)								X (CES-D)
Li et al. (2021)
Maughan 1997 (1997)										X (Rutter B-2 Scale)		X (Rutter B-2 Scale)
Mokwena et al. (2016)							X (GHQ) & insomnia	X (GHQ)	X (GHQ)	X (GHQ)
Patel 2012 (2012)					X
Piyasil *abstract only (1998)							X (NR)	X (NR)
Schmidt et al. (2006)								X (BDI)
Stiffman et al. (1987)							X (NR)	X (DIS)			X (DICA)
Taylor (2009)	X							X (CES-D)
Vicary 2001 (2001)				X		X		X (DIS)
Walker 2016 (2016)		X	X					X (CES-D)
Whitworth (2017)								X (CES-D)

Table 2. Continued.

Study ID	Maternal Mental Health Outcomes
	coping strategies	other psychiatric disorder /morbidity	Home stress and satisfaction	Conflict	Managing disagreements	Purpose in life	Suicidal ideation	Suicide attempt	Substance dependence	Smoking	Alcohol, Marijuana use	Self-intoxication
Aitken et al. (2016)
Boden et al. (2008)							X	X	X
Buckingham-Howes *abstract only (2017)
Deal (1998)
Gavin et al. (2011)										X	X
Henretta et al. (2008)
Horwitz et al. (1996)
Iacobelli et al. (2014)		X						X				X
Jaffee (2002)
Kalil 2002 (2002)
Li et al. (2021)								X
Maughan 1997 (1997)		X
Mokwena et al. (2016)	X (CSS)
Patel 2012 (2012)											X
Piyasil *abstract only (1998)
Schmidt et al. (2006)
Stiffman et al. (1987)							X		X
Taylor (2009)						X
Vicary 2001 (2001)			X (HSSI)	X	X (MDS)
Walker 2016 (2016)
Whitworth (2017)

Abbreviations: BDI: Beck Depression Inventory; BSI: Brief Symptom Inventory; CES-D: Centre for Epidemiological studies Depression Scale; CIDI: Composite International Diagnostic Interview; CSS: Coping Strategy Scale; DI: Depression Inventory; DICA: Diagnostic Interview for Children and Adolescents; DIS: Diagnostic Interview Schedule; GHQ: General Health Questionnaire; HSSI: Home Stress and Satisfaction Indexes; MCS: mental component summary; NR: Not Reported; MDS: Managing Disagreements Scale; SIQYA: Self-image Questionnaire for Young Adults; UCLA-LS: UCLA Loneliness Scale.

Table 3. Quality assessment of the included studies.

Cross-sectional and cohort studies
Study ID	1	2	3	4	5	6	7	8	9	10	11	12	13	14	Overall
Aitken et al. (2016)	Y	Y	Y	Y	Y	Y	Y	NA	Y	Y	Y	NA	Y	Y	High
Boden (2008)	Y	Y	Y	Y	Y	Y	Y	NA	Y	Y	Y	NA	Y	Y	High
Gavin (2011)	Y	Y	Y	Y	Y	Y	Y	NA	Y	N	Y	NA	Y	Y	High
Henretta (2008)	Y	Y	Y	Y	Y	Y	Y	NA	Y	N	Y	NA	Y	Y	High
Maughan (1997)	Y	Y	Y	Y	Y	Y	Y	NA	Y	Y	Y	NA	Y	Y	High
Horwitz et al. (1996)	Y	Y	Y	Y	Y	Y	Y	NA	Y	N	Y	NA	Y	Y	High
Jaffee (2002)	Y	Y	Y	Y	Y	Y	Y	NA	Y	Y	Y	NA	Y	Y	High
Patel (2012)	Y	Y	Y	Y	Y	Y	Y	NA	Y	Y	Y	NA	Y	Y	High
Taylor (2009)	Y	Y	Y	Y	Y	Y	Y	NA	Y	Y	N	NA	Y	Y	Moderate
Vicary (2001)	Y	Y	Y	Y	Y	Y	Y	NA	Y	Y	Y	NA	Y	Y	High
Schmidt et al. (2006)	Y	Y	Y	Y	Y	N	Y	NA	Y	N	Y	NA	Y	Y	Low
Walker and Holtfreter (2016)	Y	Y	Y	Y	Y	Y	Y	NA	Y	N	Y	NA	NA	Y	Moderate
Whitworth (2017)	Y	Y	Y	Y	Y	Y	Y	NA	Y	Y	Y	NA	Y	Y	High
Kalil (2002)	Y	Y	Y	Y	Y	Y	Y	NA	Y	Y	Y	NA	NA	Y	High
Buckingham-Howes et al. *abstract only (2017)	Y	Y	NA/ N	NA/ N	N/ NA	Y	Y	NA	Y	Y	Y/ PARTIALLY	NA	NA	N/ NA	N/A
Deal (1998)	Y	Y	Y	Y	Y	Y	Y	NA	Y	N	Y	NA	Y	Y	Moderate
Li et al. (2021)	Y	Y	Y	Y	Y	N	Y	N	Y	N	Y	N	Y	Y	Low
Mokwena (2016)	Y	Y	Y	Y	Y	N	Y	N	N	N	N	N	Y	N	Low
Stiffman (1987)	Y	Y	Y	Y	Y	N	N/A	N	Y	No	Y	N	Y	N	Low
Piyasil *abstract only (1998)	Y	Y	NA	N/ NA	N/ NA	Y	N/ NA	NA	Y	N/ NA	N/ NA	NA	NA	N/ NA	N/A
Case-Control Studies
Iacobelli 2014 (2014)	Y	Y	Y	Y	Y	Y	Y	N	N	N	N	N	N	-	Low

Figure 2. Adolescent pregnancy and depression.

Table 4. Adolescent pregnancy and mental health outcomes.

Outcomes	Estimate (RR/MD)	95% Confidence Interval	Studies	Heterogeneity
Depression (overall)	1.46	[1.16, 1.84]	5	Chi^2 P = 0.25; I^2 = 23%
CIDI: Composite International Diagnostic Interview	2.17	[1.43, 3.28]	n = 1	NA
CES-D: Centre for Epidemiological studies Depression Scale	1.27	[0.95, 1.70]	n = 1	NA
DIS: Diagnostic Interview Schedule	1.05	1.05 [0.26, 4.14]	n = 2	Chi^2 P = 0.0003; I^2 = 93%
Not reported	1.50	[0.88, 2.54]	n = 2	Chi^2 P = 0.45; I^2 = 0%
Mean Depression Scores
CES-D: Centre for Epidemiological studies Depression Scale	0.76	[0.52, 0.99]	n = 3	Chi^2 P = 0.27; I^2 = 25%
Anxiety (overall)	1.05	[0.26, 4.14]	2	Chi^2 P = 0.0003; I^2 = 93%
CIDI: Composite International Diagnostic Interview	2.10	[1.28, 3.43]	n = 1	NA
Not reported	0.52	[0.29, 0.91]	n = 1	NA
Mental Component Summary	−0.21	[−1.77, 1.35]	n = 2	Chi² P = 0.02; I² = 73%
Somatic Symptoms
General Health Questionnaire	−2.20	[−3.99, −0.41]	n = 1	NA
Antisocial behaviour
(Rutter B-2 Scale)	3.11	[2.50, 3.87]	n = 1	NA
Conduct Disorder
DIS: Diagnostic Interview Schedule	0.90	[0.82, 0.99]	n = 1	NA
Emotional problems
(Rutter B-2 Scale)	1.63	[1.21, 2.20]	n = 1	NA
Other psychiatric disorder/ morbidity	1.54	[1.17, 2.03]	n = 2	Chi^2 P = 0.32; I^2 = 1%
Suicidal ideation	1.77	[0.51, 6.14]	n = 2	Chi^2 P = 0.0001; I^2 = 93%
Suicidal attempts	3.21	[0.17, 59.33]	n = 3	Chi^2 P < 0.00001; I^2 = 98%
Substance Dependence	1.12	[0.60, 2.10]	n = 2	Chi^2 P = 0.22; I^2 = 34%
Self-intoxication	5.00	[1.10, 22.70]	n = 1	NA
Smoking	0.69	[0.56, 0.86]	n = 1	NA
Alcohol/ Marijuana use	0.26	[0.19, 0.37]	n = 1	NA
Mean Alcohol/ Marijuana use	−0.03	[−0.10, 0.04]	n = 1	NA

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Data availability statement

All data used from primary studies asre within the manuscript.

Ethics statement

Institutional Review Board Statement: Not applicable.