Distress Combined With Poverty Increases Risk for Teen Pregnancy

Pauline Anderson

July 31, 2009

July 31, 2009 — It is easy to assume that the distress experienced by young mothers is caused by their struggles as parents, but a new study suggests that they were already distressed before they got pregnant.

The study found that high distress levels combined with poor family background markedly increase the probability of girls becoming pregnant. It also found that teenage mothers have higher levels of distress than their childless peers and older mothers and that their distress continues into adulthood.

"We're seeing a whole lot of mental-health issues among teenage mothers and, yes, they definitely are at elevated risk for distress, but it doesn’t seem to be caused by the experience of teen childbearing," said lead author Stefanie Mollborn, PhD, assistant professor at the Institute of Behavioral Science at the University of Colorado, in Boulder. "The disadvantaged backgrounds that these girls are coming from seem to be explaining most of what's going on here."

The study appears in the September issue of the Journal of Health and Social Behavior, a quarterly journal of the American Sociological Association.

Psychological Distress

The study used data from the National Longitudinal Study of Adolescent Health, a national survey of students at a representative sample of 80 US high schools and 52 middle schools that began in the mid-1990s. A subsample of these students also completed an extensive in-home interview (wave 1) that was repeated 1 year later (wave 2) and again 6 years later (wave 3). The students' parents were also interviewed.

To analyze psychological distress, researchers used a sample of 5261 female respondents who participated in waves 2 and 3. Students were asked about symptoms associated with depression, such as how easily they could shake off feeling blue or whether they had trouble concentrating. The term depression wasn't used, though, as it is a clinical diagnosis, said Dr. Mollborn.

To analyze effects of teenage childbearing, they looked at 6737 female respondents who participated in waves 2 and 3.

The study also used the Early Childhood Longitudinal Study–Birth Cohort (ECLS-B), a survey of mothers of all infants born in 2001. This survey allowed researchers to compare distress levels of teenage mothers with those of former teenage mothers and mothers who did not give birth as adolescents.

Because of confidentiality concerns, the surveys included only adolescents who were at least 15 years old at the time of giving birth, although in other surveys Dr. Mollborn has used mothers were as young as 11 years old. For this current analysis, she and her colleagues included about 1050 teen moms.

Researchers modified measurements of psychological distress to create a scale ranging from 0 to 3, with a cutoff point of 1.21 on this scale to designate high levels of distress. Adolescents scoring below 1.21 but at least 0.58 on this scale were classified as having moderate distress and those below 0.58 as having low distress.

The study found that teen moms were more distressed than their childless peers. The mean distress level measured at wave 2 of teens who had become mothers by wave 2 was 0.77, compared with 0.59 for teens who still were not mothers by wave 3.

Teen mothers were also more stressed than adults. Their mean distress score at about 9 months' postpartum was 0.56 compared with 0.38 among mothers who had their first birth at ages 20 or older.

Distress Long-Lasting

Further, distress levels for these teenaged mothers appeared to be long-lasting. Data showed that distress levels among mothers who were age 20 years or older at first birth decreased steadily with age, from 0.48 at ages 20 to 24 years to 0.34 at age 35 to 39 years, while postpartum distress levels at the same ages among respondents who were once teen moms actually increased, from 0.52 to 0.57.

"As far out as we could track these women who had given birth as teenagers, which I think was to age 40, they were still showing signs of more distress than other moms," said Dr. Mollborn. "We're not following the same women into middle age, so we can't perfectly get at this, but as best as we can tell from these surveys, it looks like these are folks who are distressed throughout their lives."

There was evidence that teen moms were already distressed before becoming pregnant. Each unit increase in the psychological distress scale measured at wave 1 more than doubled a girl's odds of becoming a teenage mother by wave 3 (OR, 2.08; P < .01).

Distress Combined With Poverty

But distress alone did not account for the increased risk. Using various models to tease out the importance of various risk factors for teen pregnancy, researchers determined that it was distress combined with poverty. One model that predicted probabilities of becoming a teen mom for a "typical" hypothetical respondent showed that at a low level of distress, both high- and low-income respondents were both relatively unlikely to become teen mothers and that the probability for both income categories at moderate levels of distress was 2%. However, at high distress levels, the high-income respondents had a 1% chance of teen childbearing while the poorer respondents' likelihood rose to 5%.

"In the absence of high symptoms of distress, poverty was not predicting teen childbearing, and ditto for distress, so it's the combination of poverty and distress," said Dr. Mollborn. "Each of those things in the absence of the other didn't seem to be putting girls at elevated risk."

Reducing socioeconomic disadvantages through such policies as income supports might help prevent both the distress and poverty that put girls at risk of becoming young moms. "It's really important to understand the causality of this," said Dr. Mollborn. "Addressing some of the root causes like socioeconomic inequalities might be an effective way to start decreasing both mental-health issues among young people and also teenage childbearing."

Compared with many industrialized countries, the United States has a very high teen pregnancy rate, and although it also has higher abortion rates, it has relatively large numbers of teenage mothers, said Dr. Mollborn. She added that the teen birth rate has actually risen 5% in past 2 years. Other research has shown that 1 important reason for this high pregnancy rate is that American teens do not practice contraception consistently, said Dr. Mollborn.

"Excellent Analysis"

Asked for a comment, Larry K. Brown, MD, director of child and adolescent psychiatry research at Rhode Island Hospital and professor at Brown University, in Providence, said the study "is an excellent analysis that's never been done in quite the same way before."

While smaller studies had conflicting results with respect to indicating whether stress existed before a teen pregnancy, this larger study, with its longitudinal data, could show more conclusively that the distress did indeed preexist, said Dr. Brown.

"For me, it also reaffirms something that had been shown in other studies — that young teen mothers were more distressed than nonteenage mothers or older mothers — but never to this degree."

The study was supported by a Council on Research and Creative Work grant at the University of Colorado at Boulder and by the Department of Health and Human Services. No conflict of interest was reported.

J Health Soc Behav. 2009;50:310-326.

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