Depressive symptoms, stress, and social support in pregnant and postpartum adolescents

Objective: To assess prospectively the incidence and course of depressive symptoms among pregnant and postpartum adolescents and explore the roles of stress and social support as influencing factors. Methods: Pregnant teenagers attending a comprehensive adolescent pregnancy and parenting program were enrolled during their third trimester of pregnancy and followed up through 4 months post partum. Depressive symptoms and social support were measured with validated, self-administered instruments during the third trimester and at 2 and 4 months post partum. Stress was measured during the prenatal and postpartum periods. Results: Study participants (N=125) were predominantly black (93%) and were aged 12 to 18 years. Completed assessments were obtained from 114 subjects at 2 months post partum and 108 at 4 months. Forty-two percent had significant depressive symptoms in the third trimester, with 36% and 32% having scores that indicated depression at 2 and 4 months post partum. Stress levels increased significantly from the third trimester to the postpartum period (P<.01) and were positively associated with depressive symp toms. Receiving social support from the adolescent's mother or the infant's father, especially in the postpartum period, was significantly associated with lower rates of depression. Reporting conflict with the infant's father was strongly associated with increased rates of depressive symptoms. Conclusions: Results indicate that depressive symptoms are common among pregnant teenagers and postpartum adolescents. Stress and social support appear to be important mediators. Identifying those teenagers with high stress and conflict and low levels of support will help identify those who are at particular risk for depressive symptoms.