Copyright 1990 by the American Psychological Association, Inc. 0021-843X/90/$00.75
Journal of Abnormal Psychology 1990, Vol. 99, No. 1,69-78
Nonpsychotic Postpartum Depression Among Adolescent Mothers Carolyn E. Cutrona
Beth R. Troutman
University of Iowa
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Center for Health Services Research Iowa City, Iowa
This study examined the extent to which childbearing increases vulnerability to clinical depression and depressive symptomatology among primiparous adolescent girls (ages 14 to 18). Childbearing Ss (n = 128) were assessed during pregnancy, 6 weeks postpartum, and 1 year postpartum. Matched nonchildbearing Ss (« = 114) were assessed at corresponding time points. Six weeks postpartum, 6% of the childbearing adolescents met Research Diagnostic Criteria for major depression and 20% for minor depression. These rates were not significantly different from those found for nonchildbearing Ss (4% major depression, 10% minor depression). However, higher rates of somatic symptoms of depression were found among the childbearing Ss than among the nonchildbearing Ss.
delivery. Prevalence estimates range from 33% (Handley, Dunn, Waldon, & Baker, 1980) to 70% (Harris, 1980), depending on diagnostic criteria. The most severe syndrome is postpartum psychosis. Psychotic episodes following childbirth are rare, occurring after 1 to 2 per 1,000 deliveries (Herzog & Detre, 1976; Kendell, Chalmers, & Platz, 1987). The syndrome is highly disabling, with confusion, delusions, and hallucinations prominent symptoms (Brockington et al., 1981; Herzog & Detre, 1976; Protheroe, 1969). A third syndrome, of moderate severity, is nonpsychotic postpartum depression. Although diagnostic criteria vary, a consensus is emerging to limit "postpartum depression" to affective syndromes that arise within 6 months after childbirth and that meet Research Diagnostic Criteria (RDC; Spitzer, Endicott, & Robins, 1978) for a minor depressive episode or RDC or DSMIII-R criteria for a major depressive episode, in the absence of psychotic features (Cutrona, 1982; Kumar &Robson, 1984; O'Hara & Zekoski, 1988). Prevalence estimates based on these or similar diagnostic criteria range from 4.7% (Cutrona, 1983; RDC major depression only) to 14.9% (Kumar & Robson, 1984; RDC major and minor depression, both probable and definite). Given that adolescent pregnancy is most often an unplanned event, that the economic resources of most adolescent mothers are inadequate, and that societal attitudes toward pregnancy among school-aged girls are negative, it is reasonable to expect a higher rate of stress-related postpartum depression among adolescents than among adults. However, in the absence of adequate epidemiologic data for postpartum adolescents, this expectation remains speculative. Furthermore, comparisons to adult postpartum samples are confounded by the greater economic prosperity of older adults, the greater prevalence of married women among adult mothers, and differences in population-wide prevalence of affective disorders between adolescent girls and adult women. This study sought to determine the prevalence of nonpsychotic postpartum depression and the extent to which early childbearing increases the risk for affective disorders among adolescents. No prior studies have been published in which formal
Approximately one million adolescents become pregnant in the United States every year, resulting in more than 470,000 live deliveries to school-aged mothers. In 1986,13% of all deliveries were to women under the age of 20 (National Center for Health Statistics, 1988). Considerable research has documented the adverse economic, educational, and reproductive consequences of adolescent childbearing; however, very little is known about the effect of early childbearing on the mental health of adolescents (Hofferth & Hayes, 1987). Given the large numbers of adolescent women who are bearing and rearing children, the psychological status of this population is of considerable importance from a public health perspective. Not only is the young mother's well-being and ability to function diminished by mental illness, but her behavior also has direct effects on the well-being and development of her offspring (Cohn & Tronick, 1983; Field, 1984; Zekoski, O'Hara, & Wills, 1987). Three distinct syndromes of postpartum psychiatric disorder have been identified by researchers, although no separate diagnostic categories for postpartum affective disorders are included in the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987). The least severe is often termed maternity or baby "blues." Onset is within the first week postpartum, most often on the third or fourth day after delivery. Symptoms consist of transitory tearfulness, dysphoria, anxiety, emotional lability, and sleep disturbance (Pitt, 1973; Yalom, Lunde, Moos, & Hamburg, 1968). Maternity blues are self-limiting, usually showing a significant decrease within 10 days after
This research was supported by Grant RO1-APR000931 from the Office of Population Affairs, Adolescent Pregnancy Programs to Carolyn E. Cutrona. The assistance of Jillene Ferguson, Joan Shepherd, Kathleen Lenihan, Suzanne Bhatt, Desirae Vallier, Margaret Jenkins, Kristin Heiniking, Carol Fate, and Susan Brunkan is gratefully acknowledged. Beth R. Troutman is now at the Department of Psychology, University of Iowa in Iowa City. Correspondence concerning this article should be addressed to Carolyn E. Cutrona, Department of Psychology, University of Iowa, Iowa City, Iowa 52242.
69
70
BETH R. TROUTMAN AND CAROLYN E. CUTRONA
diagnostic procedures were used to assess the mental health of childbearing adolescents. Furthermore, appropriate comparison groups of nonchildbearing adolescents have frequently been lacking in prior studies. In this study, a closely matched sample of nonpregnant adolescents was followed over time and assessed at the same intervals as the pregnant/childbearing sample. This allowed estimates of the degree to which early childbearing increases the risk to adolescents of significant affective disorders in the months following delivery.
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Depression Among Adolescents It is now generally accepted that adult RDC and DSM-IIIR criteria should be used to diagnose major and minor depression in adolescents (Kashani & Simonds, 1979; Strober, Green, & Carlson, 1981; Welner, Werner, & Fishman, 1979), but only recently have there been studies that applied these diagnostic criteria in determining the prevalence of depressive syndromes among adolescents. In a study of 14-16-year-olds, a point prevalence of 4.7% for DSM-III major depression was found by Kashani et al. (1987). Studies indicate a lifetime prevalence for major depression of about 7% for adolescents (boys and girls combined), with a somewhat higher lifetime prevalence of 10% for female adolescents (Deykin, Levy, & Wells, 1987; Kashani etal., 1987). Estimates based on self-report measures of depression suggest that subsyndromal depressive symptoms are widespread among adolescents. Using adult cutoff scores for depression on the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961), 22% to 49% of adolescents are classified as depressed (Friedrich, Reams, & Jacobs, 1982; Kaplan, Nussbaum, Skomorowsky, Shenker, & Ramsey, 1980; Ten, 1982). The rate of depression for adolescent girls (44%) falls toward the top of this range (Gibbs, 1985). Although these figures suggest high rates of depressive symptoms in adolescents, researchers have cautioned against assuming that high scores on self-report measures of depressive symptomatology are equivalent to diagnoses of depression (Oliver & Simmons, 1984).
Postpartum Depression Among Adolescents Clinical reports suggest that depressive symptoms are quite widespread among adolescent mothers (Fraiberg, 1982; Group for the Advancement of Psychiatry, 1986). However, no empirical studies have examined the prevalence of rigorously diagnosed postpartum depression in adolescents. In a cross-sectional study that compared the BDI scores of pregnant (n = 62), parenting (n = 63), and nonchildbearing (n = 60) adolescent girls, all of whom were enrolled in reentry or alternative high school programs, no significant differences were found among the three groups (Barth, Schinke, & Maxwell, 1983). Mean scores on the BDI ranged from 8.8 (nonchildbearing control subjects) to 10.2 (pregnant subjects). However, length of time since delivery was not reported for the parenting group, and some of the childbearing participants probably were beyond the 6-month postpartum period. Studies of adolescent mothers in the years following delivery suggest that they commonly experience depressive symptoms
during their children's early years. For example, 59% of adolescent mothers of 1- to 3-year-olds met the adult cutoff score for depression on the CES-D in a study by Colletta (1983). Another study indicated that mothers who had first given birth during adolescence experienced more frequent feelings of sadness when their children were first graders than did those mothers who were older when they first gave birth (Brown, Adams, & Kellam, 1981). The current study sought to estimate the prevalence of diagnosable depression among childbearing adolescents during pregnancy, postpartum, and 1 year after delivery and to compare these rates with those of closely matched, nonchildbearing adolescents to determine the extent to which early childbearing increases risk for affective disorders among adolescent females. Participants in both the childbearing and nonchildbearing groups were assessed on multiple occasions that corresponded to the childbearing adolescents' second or third trimester of pregnancy, 6 weeks postpartum, and 12 months after the infant's birth. The 12-month follow-up was included to determine the relative rates of recovery from depression that occurred in the context of childbirth and outside of that context.
Method Participants Participants were 128 pregnant adolescents (mean age = 16.8 years, SD = 1.1) and 114 nonpregnant, matched adolescent control subjects (mean age = 16.9 years, SD = 1.6) who had never given birth. Pregnant subjects were recruited from a number of different sources. Staff members at five state-funded Maternal and Child Health Clinics, two educational programs for adolescent mothers, and one university hospital in the state of Iowa identified young women who were the appropriate age for participation (14-18 years) and who were pregnant with their first child. Five pregnant subjects were identified by friends who were already enrolled in the study. In addition, a subject who was initially chosen as a control but became pregnant prior to her first interview participated as a pregnant subject. Pregnant adolescents were excluded from the study for the following reasons: refused to participate (17%); gave birth prior to first interview (9%); lived more than 200 miles from the University of Iowa or planned to move outside this radius (5%); could not be located (4%); and planned to release the baby for adoption (3%). Thus, 63% of the pregnant adolescents identified participated in the study. Age was the only information obtained from individuals who were approached but who either refused or were not accepted into the study. Participants and nonparticipants did not differ significantly on age, K201) = 0.14, ns. The nonpregnant comparison group was recruited using the acquaintance-control technique. Pregnant subjects were asked to provide the names of five female acquaintances who were within 2 years of themselves in age, had not previously given birth to a child, and were not currently pregnant. This method of recruiting control subjects has been used in a number of epidemiologic studies (Kleinbaum, Kupper, & Morgenstem, 1982; MacMahon, Pugh, & Ipsen, 1960; O'Hara, Zekoski, Philips, & Wright, 1990). The young woman who was most similar to the pregnant subject in age and marital status was selected from those named and sent a letter describing the study and how she was selected. An interviewer then contacted her to describe the study further and invite her participation. For each pregnant subject, potential control subjects were contacted until either a control subject was selected or there were no more potential control subjects from which to choose. Eighty-four percent of the potential control subjects contacted participated in the study. No significant age differences were found between
POSTPARTUM DEPRESSION AMONG ADOLESCENTS
.05. Finally, more control than childbearing subjects lived with their parents, x\ 1, N = 242) = 27.79, p < .001.
Table 1 Demographic Characteristics ofChildbearing and Comparison Adolescents
Characteristic
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Age Grade Vocabulary score Mother's education Father's education Mother's occupation Father's occupation Number of siblings Nonwhite Enrolled in school Residing with parents Married Parents divorced Parent deceased
Childbearing (n=128)
Comparison (n=114)
M
SD
M
SD
16.8 10.6' 7.5 11.8 11.5 28.7 28.2 2.4
1.1 1.4 2.3 1.8 2.2 13.1 14.8 2.4
16.9 11.1" 7.6 11.9 11.7 27.2 30.6 2.9
1.5 1.3 2.5 2.5 2.7 13.4 14.8 2.8
10.3% 56.3%' 49.2%a 20.5%' 56.1% 14.8%"
71
11.4% 79.8%b 82.4%b 1.8%b 40.2% 6.1%b
Note. Different superscripts across rows indicate statistically significant differences between groups.
control participants and those who chose not to participate, /(137) = 0.80, ns. No control subject could be recruited for 14 of the 128 childbearing subjects who completed the first interview. At the time of the first interview, informed consent for participation was obtained from both the subject and her legal guardian. Subjects were paid $ 15 per interview for their participation. Demographic characteristics of the pregnant and nonpregnant comparison groups are shown in Table 1. A broad range of socioeconomic levels were represented among participants' families. The majority of the families, however, were of lower socioeconomic status (SES) as reflected by a mean revised Duncan Socioeconomic Index (Stevens & Featherman, 1980) of 28.2 (SD = 14.8). Approximately one third of the participants came from cities of greater than 100,000 population (although none were from cities of 500,000 or greater), and the remaining participants came from smaller cities, towns, or rural areas. Ninety percent of the participants were White, 10% were Black, and less than 1% were from other ethnic groups, reflecting the racial composition of the state of Iowa. As shown in Table 1, the two samples were highly similar on age, parents' education, parents' SES, family size, and racial background. They differed significantly on number of years of school completed, {(241) = 2.48, p < .05. The pregnant girls had completed an average of 10.6 years and the nonpregnant comparison group had completed an average of 11.1 years of school. However, the two groups did not differ significantly on vocabulary subtest scores of the Wechsler Intelligence Scale for Children-Revised (WISC-R; Wechsler, 1974; administered to participants under age 17) or the Wechsler Adult Intelligence Scale-Revised (WAIS-R; Wechsler, 1981). These scores have been shown to correlate highly with overall intelligence (Wechsler, 1974, 1981). Thus, the difference in years of education appears to be related to the higher drop-out rate among the pregnant adolescents rather than a difference in intellectual ability. Significantly more of the comparison group participants (79.8%) than of those in the pregnant group (56.3%) were currently enrolled in school. The two groups also differed significantly on marital status, whether or not they resided with their parents, and whether either parent was deceased. More of the pregnant participants were married, *2(1, N = 240) = 18.52, p < .001, and more of them had experienced the death of a parent x2( I, N = 240) = 4.56, p
Journal of Abnormal Psychology 1990, Vol. 99, No. 1,69-78
Nonpsychotic Postpartum Depression Among Adolescent Mothers Carolyn E. Cutrona
Beth R. Troutman
University of Iowa
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Center for Health Services Research Iowa City, Iowa
This study examined the extent to which childbearing increases vulnerability to clinical depression and depressive symptomatology among primiparous adolescent girls (ages 14 to 18). Childbearing Ss (n = 128) were assessed during pregnancy, 6 weeks postpartum, and 1 year postpartum. Matched nonchildbearing Ss (« = 114) were assessed at corresponding time points. Six weeks postpartum, 6% of the childbearing adolescents met Research Diagnostic Criteria for major depression and 20% for minor depression. These rates were not significantly different from those found for nonchildbearing Ss (4% major depression, 10% minor depression). However, higher rates of somatic symptoms of depression were found among the childbearing Ss than among the nonchildbearing Ss.
delivery. Prevalence estimates range from 33% (Handley, Dunn, Waldon, & Baker, 1980) to 70% (Harris, 1980), depending on diagnostic criteria. The most severe syndrome is postpartum psychosis. Psychotic episodes following childbirth are rare, occurring after 1 to 2 per 1,000 deliveries (Herzog & Detre, 1976; Kendell, Chalmers, & Platz, 1987). The syndrome is highly disabling, with confusion, delusions, and hallucinations prominent symptoms (Brockington et al., 1981; Herzog & Detre, 1976; Protheroe, 1969). A third syndrome, of moderate severity, is nonpsychotic postpartum depression. Although diagnostic criteria vary, a consensus is emerging to limit "postpartum depression" to affective syndromes that arise within 6 months after childbirth and that meet Research Diagnostic Criteria (RDC; Spitzer, Endicott, & Robins, 1978) for a minor depressive episode or RDC or DSMIII-R criteria for a major depressive episode, in the absence of psychotic features (Cutrona, 1982; Kumar &Robson, 1984; O'Hara & Zekoski, 1988). Prevalence estimates based on these or similar diagnostic criteria range from 4.7% (Cutrona, 1983; RDC major depression only) to 14.9% (Kumar & Robson, 1984; RDC major and minor depression, both probable and definite). Given that adolescent pregnancy is most often an unplanned event, that the economic resources of most adolescent mothers are inadequate, and that societal attitudes toward pregnancy among school-aged girls are negative, it is reasonable to expect a higher rate of stress-related postpartum depression among adolescents than among adults. However, in the absence of adequate epidemiologic data for postpartum adolescents, this expectation remains speculative. Furthermore, comparisons to adult postpartum samples are confounded by the greater economic prosperity of older adults, the greater prevalence of married women among adult mothers, and differences in population-wide prevalence of affective disorders between adolescent girls and adult women. This study sought to determine the prevalence of nonpsychotic postpartum depression and the extent to which early childbearing increases the risk for affective disorders among adolescents. No prior studies have been published in which formal
Approximately one million adolescents become pregnant in the United States every year, resulting in more than 470,000 live deliveries to school-aged mothers. In 1986,13% of all deliveries were to women under the age of 20 (National Center for Health Statistics, 1988). Considerable research has documented the adverse economic, educational, and reproductive consequences of adolescent childbearing; however, very little is known about the effect of early childbearing on the mental health of adolescents (Hofferth & Hayes, 1987). Given the large numbers of adolescent women who are bearing and rearing children, the psychological status of this population is of considerable importance from a public health perspective. Not only is the young mother's well-being and ability to function diminished by mental illness, but her behavior also has direct effects on the well-being and development of her offspring (Cohn & Tronick, 1983; Field, 1984; Zekoski, O'Hara, & Wills, 1987). Three distinct syndromes of postpartum psychiatric disorder have been identified by researchers, although no separate diagnostic categories for postpartum affective disorders are included in the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987). The least severe is often termed maternity or baby "blues." Onset is within the first week postpartum, most often on the third or fourth day after delivery. Symptoms consist of transitory tearfulness, dysphoria, anxiety, emotional lability, and sleep disturbance (Pitt, 1973; Yalom, Lunde, Moos, & Hamburg, 1968). Maternity blues are self-limiting, usually showing a significant decrease within 10 days after
This research was supported by Grant RO1-APR000931 from the Office of Population Affairs, Adolescent Pregnancy Programs to Carolyn E. Cutrona. The assistance of Jillene Ferguson, Joan Shepherd, Kathleen Lenihan, Suzanne Bhatt, Desirae Vallier, Margaret Jenkins, Kristin Heiniking, Carol Fate, and Susan Brunkan is gratefully acknowledged. Beth R. Troutman is now at the Department of Psychology, University of Iowa in Iowa City. Correspondence concerning this article should be addressed to Carolyn E. Cutrona, Department of Psychology, University of Iowa, Iowa City, Iowa 52242.
69
70
BETH R. TROUTMAN AND CAROLYN E. CUTRONA
diagnostic procedures were used to assess the mental health of childbearing adolescents. Furthermore, appropriate comparison groups of nonchildbearing adolescents have frequently been lacking in prior studies. In this study, a closely matched sample of nonpregnant adolescents was followed over time and assessed at the same intervals as the pregnant/childbearing sample. This allowed estimates of the degree to which early childbearing increases the risk to adolescents of significant affective disorders in the months following delivery.
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Depression Among Adolescents It is now generally accepted that adult RDC and DSM-IIIR criteria should be used to diagnose major and minor depression in adolescents (Kashani & Simonds, 1979; Strober, Green, & Carlson, 1981; Welner, Werner, & Fishman, 1979), but only recently have there been studies that applied these diagnostic criteria in determining the prevalence of depressive syndromes among adolescents. In a study of 14-16-year-olds, a point prevalence of 4.7% for DSM-III major depression was found by Kashani et al. (1987). Studies indicate a lifetime prevalence for major depression of about 7% for adolescents (boys and girls combined), with a somewhat higher lifetime prevalence of 10% for female adolescents (Deykin, Levy, & Wells, 1987; Kashani etal., 1987). Estimates based on self-report measures of depression suggest that subsyndromal depressive symptoms are widespread among adolescents. Using adult cutoff scores for depression on the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961), 22% to 49% of adolescents are classified as depressed (Friedrich, Reams, & Jacobs, 1982; Kaplan, Nussbaum, Skomorowsky, Shenker, & Ramsey, 1980; Ten, 1982). The rate of depression for adolescent girls (44%) falls toward the top of this range (Gibbs, 1985). Although these figures suggest high rates of depressive symptoms in adolescents, researchers have cautioned against assuming that high scores on self-report measures of depressive symptomatology are equivalent to diagnoses of depression (Oliver & Simmons, 1984).
Postpartum Depression Among Adolescents Clinical reports suggest that depressive symptoms are quite widespread among adolescent mothers (Fraiberg, 1982; Group for the Advancement of Psychiatry, 1986). However, no empirical studies have examined the prevalence of rigorously diagnosed postpartum depression in adolescents. In a cross-sectional study that compared the BDI scores of pregnant (n = 62), parenting (n = 63), and nonchildbearing (n = 60) adolescent girls, all of whom were enrolled in reentry or alternative high school programs, no significant differences were found among the three groups (Barth, Schinke, & Maxwell, 1983). Mean scores on the BDI ranged from 8.8 (nonchildbearing control subjects) to 10.2 (pregnant subjects). However, length of time since delivery was not reported for the parenting group, and some of the childbearing participants probably were beyond the 6-month postpartum period. Studies of adolescent mothers in the years following delivery suggest that they commonly experience depressive symptoms
during their children's early years. For example, 59% of adolescent mothers of 1- to 3-year-olds met the adult cutoff score for depression on the CES-D in a study by Colletta (1983). Another study indicated that mothers who had first given birth during adolescence experienced more frequent feelings of sadness when their children were first graders than did those mothers who were older when they first gave birth (Brown, Adams, & Kellam, 1981). The current study sought to estimate the prevalence of diagnosable depression among childbearing adolescents during pregnancy, postpartum, and 1 year after delivery and to compare these rates with those of closely matched, nonchildbearing adolescents to determine the extent to which early childbearing increases risk for affective disorders among adolescent females. Participants in both the childbearing and nonchildbearing groups were assessed on multiple occasions that corresponded to the childbearing adolescents' second or third trimester of pregnancy, 6 weeks postpartum, and 12 months after the infant's birth. The 12-month follow-up was included to determine the relative rates of recovery from depression that occurred in the context of childbirth and outside of that context.
Method Participants Participants were 128 pregnant adolescents (mean age = 16.8 years, SD = 1.1) and 114 nonpregnant, matched adolescent control subjects (mean age = 16.9 years, SD = 1.6) who had never given birth. Pregnant subjects were recruited from a number of different sources. Staff members at five state-funded Maternal and Child Health Clinics, two educational programs for adolescent mothers, and one university hospital in the state of Iowa identified young women who were the appropriate age for participation (14-18 years) and who were pregnant with their first child. Five pregnant subjects were identified by friends who were already enrolled in the study. In addition, a subject who was initially chosen as a control but became pregnant prior to her first interview participated as a pregnant subject. Pregnant adolescents were excluded from the study for the following reasons: refused to participate (17%); gave birth prior to first interview (9%); lived more than 200 miles from the University of Iowa or planned to move outside this radius (5%); could not be located (4%); and planned to release the baby for adoption (3%). Thus, 63% of the pregnant adolescents identified participated in the study. Age was the only information obtained from individuals who were approached but who either refused or were not accepted into the study. Participants and nonparticipants did not differ significantly on age, K201) = 0.14, ns. The nonpregnant comparison group was recruited using the acquaintance-control technique. Pregnant subjects were asked to provide the names of five female acquaintances who were within 2 years of themselves in age, had not previously given birth to a child, and were not currently pregnant. This method of recruiting control subjects has been used in a number of epidemiologic studies (Kleinbaum, Kupper, & Morgenstem, 1982; MacMahon, Pugh, & Ipsen, 1960; O'Hara, Zekoski, Philips, & Wright, 1990). The young woman who was most similar to the pregnant subject in age and marital status was selected from those named and sent a letter describing the study and how she was selected. An interviewer then contacted her to describe the study further and invite her participation. For each pregnant subject, potential control subjects were contacted until either a control subject was selected or there were no more potential control subjects from which to choose. Eighty-four percent of the potential control subjects contacted participated in the study. No significant age differences were found between
POSTPARTUM DEPRESSION AMONG ADOLESCENTS
.05. Finally, more control than childbearing subjects lived with their parents, x\ 1, N = 242) = 27.79, p < .001.
Table 1 Demographic Characteristics ofChildbearing and Comparison Adolescents
Characteristic
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Age Grade Vocabulary score Mother's education Father's education Mother's occupation Father's occupation Number of siblings Nonwhite Enrolled in school Residing with parents Married Parents divorced Parent deceased
Childbearing (n=128)
Comparison (n=114)
M
SD
M
SD
16.8 10.6' 7.5 11.8 11.5 28.7 28.2 2.4
1.1 1.4 2.3 1.8 2.2 13.1 14.8 2.4
16.9 11.1" 7.6 11.9 11.7 27.2 30.6 2.9
1.5 1.3 2.5 2.5 2.7 13.4 14.8 2.8
10.3% 56.3%' 49.2%a 20.5%' 56.1% 14.8%"
71
11.4% 79.8%b 82.4%b 1.8%b 40.2% 6.1%b
Note. Different superscripts across rows indicate statistically significant differences between groups.
control participants and those who chose not to participate, /(137) = 0.80, ns. No control subject could be recruited for 14 of the 128 childbearing subjects who completed the first interview. At the time of the first interview, informed consent for participation was obtained from both the subject and her legal guardian. Subjects were paid $ 15 per interview for their participation. Demographic characteristics of the pregnant and nonpregnant comparison groups are shown in Table 1. A broad range of socioeconomic levels were represented among participants' families. The majority of the families, however, were of lower socioeconomic status (SES) as reflected by a mean revised Duncan Socioeconomic Index (Stevens & Featherman, 1980) of 28.2 (SD = 14.8). Approximately one third of the participants came from cities of greater than 100,000 population (although none were from cities of 500,000 or greater), and the remaining participants came from smaller cities, towns, or rural areas. Ninety percent of the participants were White, 10% were Black, and less than 1% were from other ethnic groups, reflecting the racial composition of the state of Iowa. As shown in Table 1, the two samples were highly similar on age, parents' education, parents' SES, family size, and racial background. They differed significantly on number of years of school completed, {(241) = 2.48, p < .05. The pregnant girls had completed an average of 10.6 years and the nonpregnant comparison group had completed an average of 11.1 years of school. However, the two groups did not differ significantly on vocabulary subtest scores of the Wechsler Intelligence Scale for Children-Revised (WISC-R; Wechsler, 1974; administered to participants under age 17) or the Wechsler Adult Intelligence Scale-Revised (WAIS-R; Wechsler, 1981). These scores have been shown to correlate highly with overall intelligence (Wechsler, 1974, 1981). Thus, the difference in years of education appears to be related to the higher drop-out rate among the pregnant adolescents rather than a difference in intellectual ability. Significantly more of the comparison group participants (79.8%) than of those in the pregnant group (56.3%) were currently enrolled in school. The two groups also differed significantly on marital status, whether or not they resided with their parents, and whether either parent was deceased. More of the pregnant participants were married, *2(1, N = 240) = 18.52, p < .001, and more of them had experienced the death of a parent x2( I, N = 240) = 4.56, p
