Introduction
Mental health burden in pregnant adolescents in Kenya and SSA
Depression and substance abuse pathogenesis
Perinatal depression and associated risks in adolescence
Method
Study design, sample and setting
Study procedures
Measures
Research designed questionnaire
Perinatal depression screening tool
Depression diagnosis and severity assessment
Alcohol use screening tool
Data analysis
Results
Socio-demographic characteristics of the respondents
Variable | Category | Frequency (N = 212) | Percent (%) |
---|---|---|---|
Age in years | 16 years and below | 34 | 16.0 |
17 years | 72 | 34.0 | |
18 years | 106 | 50.0 | |
Age in years | (Mean, SD, range) | (17.3, 1.92, 14–18) | |
Marital status | Single | 153 | 72.2 |
Married/with partner | 59 | 27.8 | |
Level of education | Primary school | 103 | 48.6 |
Secondary/high school | 109 | 51.4 | |
Current occupation | Student | 33 | 15.6 |
Employed | 33 | 15.6 | |
Unemployed | 146 | 68.9 | |
Religion | Christian | 207 | 97.6 |
Other | 5 | 2.4 | |
Family monthly income (Ksh.) | < 4999 | 67 | 31.6 |
5000–9999 | 98 | 46.2 | |
10,000–34,999 | 44 | 20.8 | |
> 35,000 | 3 | 1.4 | |
Persons living with | Parents | 66 | 31.1 |
Spouse | 57 | 26.9 | |
Friends/alone | 7 | 3.3 | |
Others | 82 | 38.7 | |
Psychological history and psychiatric characteristics of the respondents | |||
Attitude of the father towards the pregnancy | Positive | 87 | 41.0 |
Negative | 78 | 36.8 | |
Ambivalent | 44 | 20.8 | |
Not told about pregnancy | 3 | 1.4 | |
Presence of social support (partner; mother; friend; church etc.) | No | 47 | 22.2 |
Yes | 165 | 77.8 | |
Family member ever been treated for a mental illness, e.g., depression or committed suicide? | No | 181 | 85.4 |
Yes | 31 | 14.6 | |
Age at sexual debut (years) | < 11 | 13 | 6.1 |
11–14 | 44 | 20.8 | |
15–18 | 155 | 73.1 | |
Age at sexual debut | (Mean, SD, range) | (15.3, 1.9, 9–18) | |
Experienced intimate partner violence in pregnancy | No | 198 | 93.4 |
Yes | 14 | 6.6 | |
EPDS categories | Normal | 84 | 39.6 |
Abnormal | 128 | 60.4 | |
EPDS scores | (Mean, SD, range) | (12.3, 7.7, 0–27) | |
BECK depression categories | Normal | 23 | 10.8 |
Mild | 23 | 10.8 | |
Moderate | 56 | 26.4 | |
Severe | 110 | 51.9 | |
BECK depression | (Mean, SD, range) | (29.4, 12.2, 4–60) |
Psychological history and psychiatric characteristics of respondents
Variable | Category | Frequency (N = 212) | Percent (%) |
---|---|---|---|
History of chronic illness | No | 197 | 92.9 |
Yes | 15 | 7.1 | |
Currently on medication | No | 168 | 79.2 |
Yes | 44 | 20.8 | |
Week of gestation of first ANC visit (weeks) | < 12 | 34 | 16.0 |
12–28 | 176 | 83.0 | |
> 28 | 2 | 0.9 | |
Pregnancy unplanned | No | 33 | 15.6 |
Yes | 179 | 84.4 | |
Parity | First pregnancy | 208 | 98.1 |
One previous pregnancy | 4 | 1.9 | |
Is pregnancy wanted? | No | 40 | 18.9 |
Yes | 172 | 81.1 |
Obstetric history of the respondents
Variable | Category | Frequency (N = 212)a | Percent (%) |
---|---|---|---|
Living with anyone who is a problem drinker or alcoholic or who uses street drugs | No | 173 | 81.6 |
Yes | 39 | 18.4 | |
Ever consumed alcohol at any time in your life? | No | 119 | 56.1 |
Yes | 93 | 43.9 | |
Age at first consumption (N = 92), years | < 11 | 7 | 7.6 |
11–14 | 24 | 26.1 | |
15–18 | 61 | 66.3 | |
Currently consuming alcohol | No | 155 | 73.1 |
Yes | 57 | 26.9 | |
Consumption at a hazardous level (N = 57) | No | 41 | 71.9 |
Yes | 16 | 28.1 | |
Alcohol dependence (N = 57) | No | 18 | 31.6 |
Yes | 39 | 68.4 | |
Audit scores | (Mean, SD, range) | (2.5, 5.6, 0–34) | |
Alcohol-related harm is already being experienced | No | 155 | 73.1 |
Yes | 57 | 26.9 | |
Ever been pressured into using alcohol or other substances by your friends or peers? | No | 140 | 66.0 |
Yes | 72 | 34.0 | |
Currently or have you ever smoked Cigarettes? | No | 207 | 97.6 |
Yes | 5 | 2.4 | |
Ever used any other psychoactive substance | No | 194 | 91.5 |
Yes | 18 | 8.5 |
Alcohol use by the respondents
Variable | Category | Overall | Depression | OR (95% CI) | Group differences | |
---|---|---|---|---|---|---|
No | Yes | |||||
Live with anyone who is a problem drinker or alcoholic or who uses street drugs | No | 173 (81.6) | 43 (24.9) | 130 (75.1) |
Reference
| (χ2(1,212) = 5.52; P = 0.019) |
Yes | 39 (18.4) | 3 (7.7) | 36 (92.3) | 3.97 (1.16–13.54) | ||
Ever consumed alcohol at any time in your life? | No | 119 (56.1) | 32 (26.9) | 87 (73.1) |
Reference
| (χ2(1,212) = 4.31; P = 0.038) |
Yes | 93 (43.9) | 14 (15.1) | 79 (84.9) | 2.08 (1.03–4.17) | ||
Age at first consumption, years | < 11 | 7 (7.6) | 0 (0.0) | 7 (100.0) |
Reference
| (χ2(2,92) = 1.30; P = 0.522) |
11–14 | 24 (26.1) | 4 (16.7) | 20 (83.3) | UD | ||
15–18 | 61 (66.3) | 9 (14.8) | 52 (85.2) | UD | ||
Currently consuming alcohol | No | 155 (73.1) | 38 (24.5) | 117 (75.5) |
Reference
| (χ2(1,212) = 2.70; P = 0.101) |
Yes | 57 (26.9) | 8 (14.0) | 49 (86.0) | 1.99 (0.87–4.57) | ||
Audit scores | Normal | 184 (86.8) | 43 (23.4) | 141 (76.6) |
Reference
| (χ2(1,212) = 2.29; P = 0.130) |
Abnormal | 28 (13.2) | 3 (10.7) | 25 (89.3) | 2.54 (0.73–8.83) | ||
Consumption at a hazardous level | No | 41 (71.9) | 6 (14.6) | 35 (85.4) |
Reference
| (χ2(1,57) = 0.04; P = 0.835) |
Yes | 16 (28.1) | 2 (12.5) | 14 (87.5) | 1.20 (0.22–6.68) | ||
Alcohol dependence | No | 18 (31.6) | 6 (33.3) | 12 (66.7) |
Reference
| (χ2(1,57) = 8.12; P = 0.004) |
Yes | 39 (68.4) | 2 (5.1) | 37 (94.9) | 9.25 (1.64–52.06) | ||
Alcohol-related harm is already being experienced | No | 155 (73.1) | 39 (25.2) | 116 (74.8) |
Reference
| (χ2(1,212) = 4.07; P = 0.044) |
Yes | 57 (26.9) | 7 (12.3) | 50 (87.7) | 2.40 (1.01–5.73) | ||
Ever been pressured into using alcohol or other substances by your friends or peers | No | 140 (66.0) | 36 (25.7) | 104 (74.3) |
Reference
| (χ2(1,212) = 3.91; P = 0.048) |
Yes | 72 (34.0) | 10 (13.9) | 62 (86.1) | 2.15 (1.00–4.63) | ||
Currently or have ever smoked cigarettes | No | 207 (97.6) | 46 (22.2) | 161 (77.8) |
Reference
| (χ2(1,212) = 1.42; P = 0.234) |
Yes | 5 (2.4) | 0 (0.0) | 5 (100.0) | UD | ||
Have you ever used any other psychoactive substance/s | No | 194 (91.5) | 42 (21.6) | 152 (78.4) |
Reference
| (χ2(1,212) = 0.00; P = 0.955) |
Yes | 18 (8.5) | 4 (22.2) | 14 (77.8) | 0.97 (0.30–3.09) |
Overall (N = 212) | Not depressed (N = 84) | Depressed (N = 128) | ||||
---|---|---|---|---|---|---|
n (%) | (95% CI) | n (%) | (95% CI) | n (%) | (95% CI) | |
Currently consuming alcohol (N = 212) | ||||||
Yes | 57 (26.9) | (20.8–32.5) | 15 (17.9) | (10.7–27.4) | 42 (32.8) | (25.0–40.6) |
Ever consumed alcohol (N = 212) | ||||||
Yes | 93 (43.9) | (37.3–50.5) | 30 (35.7) | (25.0–46.4) | 63 (49.2) | (40.6–57.8) |
Age at which it was first taken (N = 91), years | ||||||
< 11 | 6 (6.6) | (2.2–12.1) | 1 (3.6) | (0.0–10.7) | 5 (7.9) | (1.6–14.3) |
11–14 | 24 (26.4) | (17.6–36.3) | 6 (21.4) | (7.1–35.7) | 18 (28.6) | (17.5–39.7) |
15–18 | 61 (67.0) | (57.1–75.8) | 21 (75.0) | (57.1–89.3) | 40 (63.5) | (50.8–74.6) |
Type of alcohol (N = 91) | ||||||
Beer, wine or bottled spirits | 59 (64.8) | (54.9–74.7) | 19 (67.9) | (50.0–85.7) | 40 (63.5) | (50.8–74.6) |
Local brews | 29 (31.9) | (22.0–41.8) | 8 (28.6) | (10.7–46.4) | 21 (33.3) | (22.2–44.4) |
Both beer, wine and local brews | 3 (3.3) | (0.0–7.7) | 1 (3.6) | (0.0–10.7) | 2 (3.2) | (0.0–7.9) |
How often do you have a drink containing alcohol? (N = 212) | ||||||
Never | 155 (73.1) | (73.1–67.5) | 69 (82.1) | (82.1–73.8) | 86 (67.2) | (67.2–57.8) |
Monthly or less | 35 (16.5) | (16.5–11.3) | 9 (10.7) | (10.7–4.8) | 26 (20.3) | (20.3–13.3) |
2–4 times a month | 12 (5.7) | (5.7–2.8) | 5 (6.0) | (6.0–1.2) | 7 (5.5) | (5.5–2.3) |
2–3 times a week | 8 (3.8) | (3.8–1.4) | 1 (1.2) | (1.2–0.0) | 7 (5.5) | (5.5–2.3) |
4 or more times a week | 2 (0.9) | (0.9–0.0) | 0 (0.0) | (0.0–0.0) | 2 (1.6) | (1.6–0.0) |
Audit scores (N = 57) | ||||||
0–7 normal | 29 (50.9) | (38.6–63.2) | 10 (66.7) | (40.0–93.3) | 19 (45.2) | (31.0–59.5) |
8 and above-harmful and hazardous use | 28 (49.1) | (36.8–61.4) | 5 (33.3) | (6.7–60.0) | 23 (54.8) | (40.5–69.0) |
Alcohol dependence (N = 57) | ||||||
Yes | 39 (68.4) | (56.2–78.9) | 6 (40.0) | (20.0–66.7) | 33 (78.6) | (66.7–90.5) |
Alcohol-related harm already being experienced (N = 57) | ||||||
Yes | 51 (89.5) | (80.7–96.5) | 13 (86.7) | (66.7–100.0) | 38 (90.5) | (81.0–97.6) |
Hazardous alcohol use (N = 57) | ||||||
Yes | 16 (28.1) | (15.8–40.4) | 3 (20.0) | (0.0–40.0) | 13 (31.0) | (16.7–45.2) |
Multivariate analyses and logistic regression model
Levels of depression | Group differences | ||||
---|---|---|---|---|---|
Normal (N = 23) | Mild (N = 23) | Moderate (N = 56) | Severe (N = 110) | ||
Currently consuming alcohol | |||||
No | 18 (11.6) | 20 (12.9) | 46 (29.7) | 71 (45.8) | (χ2(3,212) = 9.0; P = 0.030) |
Yes | 5 (8.8) | 3 (5.3) | 10 (17.5) | 39 (68.4) | |
Frequency of consumption | |||||
Never | 18 (11.6) | 20 (12.9) | 46 (29.7) | 71 (45.8) | (χ2(12,212) = 14.7; P = 0.256) |
Monthly or less | 2 (5.7) | 2 (5.7) | 7 (20.0) | 24 (68.6) | |
2 to 4 times a month | 3 (25.0) | 0 (0.0) | 2 (16.7) | 7 (58.3) | |
2 to 3 times per week | 0 (0.0) | 1 (12.5) | 1 (12.5) | 6 (75.0) | |
> 4 times a week | 0 (0.0) | 0 (0.0) | 0 (0.0) | 2 (100.0) | |
Audit scores | |||||
Normal | 22 (12.0) | 21 (11.4) | 52 (28.3) | 89 (48.4) | (χ2(3,212) = 7.1; P = 0.069) |
Abnormal | 1 (3.6) | 2 (7.1) | 4 (14.3) | 21 (75.0) | |
Alcohol-related harm is already being experienced | |||||
No | 19 (12.3) | 20 (12.9) | 45 (29.0) | 71 (45.8) | (χ2(3,212) = 8.9; P = 0.031) |
Yes | 4 (7.0) | 3 (5.3) | 11 (19.3) | 39 (68.4) | |
Alcohol dependence | |||||
No | 3 (16.7) | 3 (16.7) | 3 (16.7) | 9 (50.0) | (χ2(3,57) = 9.7; P = 0.021) |
Yes | 2 (5.1) | 0 (0.0) | 7 (17.9) | 30 (76.9) | |
Hazardous alcohol consumption | |||||
No | 5 (12.2) | 1 (2.4) | 8 (19.5) | 27 (65.9) | (χ2(3,57) = 4.6; P = 0.201) |
Yes | 2 (0.0) | 2 (12.5) | 2 (12.5) | 12 (75.0) | |
Ever consumed alcohol at any time in your life | |||||
No | 15 (12.6) | 17 (14.3) | 35 (29.4) | 52 (43.7) | (χ2(3,212) = 8.2; P = 0.043) |
Yes | 8 (8.6) | 6 (6.5) | 21 (22.6) | 58 (62.4) | |
Age at which it was consumed, years | |||||
< 11 | 0 (0.0) | 0 (0.0) | 3 (42.9) | 4 (57.1) | (χ2(6,92) = 3.2; P = 0.782) |
11–14 | 2 (8.3) | 2 (8.3) | 4 (16.7) | 16 (66.7) | |
15–18 | 6 (9.8) | 3 (4.9) | 14 (23.0) | 38 (62.3) | |
Type of alcohol have you consumed in the past | |||||
Beer, wine or bottled spirits | 4 (6.8) | 4 (6.8) | 10 (16.9) | 41 (69.5) | (χ2(6,91) = 4.8; P = 0.566) |
Local brews | 4 (13.8) | 1 (3.4) | 9 (31.0) | 15 (51.7) | |
Both beer, wine and local brews | 0 (0.0) | 0 (0.0) | 1 (33.3) | 2 (66.7) | |
Ever been pressured into using alcohol or other substances by your friends or peers | |||||
No | 17 (12.1) | 19 (13.6) | 47 (33.6) | 57 (40.7) | (χ2(3,212) = 21.4; P < 0.001) |
Yes | 6 (8.3) | 4 (5.6) | 9 (12.5) | 53 (73.6) |
Variable | Category | OR (95% CI) | AOR | 95% CI | P-value |
---|---|---|---|---|---|
Marital status | Single | 3.61 (1.82–7.17) | 0.16 | (0.01–3.87) | 0.260 |
Married/with partner |
Ref.
|
Ref.
| |||
Highest level of education | Primary school | 0.53 (0.27–1.03) | 0.68 | (0.29–1.57) | 0.368 |
Secondary |
Ref.
|
Ref.
| |||
Occupation | Student | 2.70 (0.77–9.42) | 5.12 | (1.19–22.00) |
0.028
|
Employed | 0.47 (0.21–1.06) | 0.45 | (0.16–1.30) | 0.142 | |
Unemployed |
Ref.
|
Ref.
| |||
Family monthly income | < 4999 |
Ref.
|
Ref.
| ||
5000–9999 | 0.41 (0.18–0.94) | 0.22 | (0.09–0.56) |
0.002
| |
10,000–34,999 | 0.60 (0.22–1.66) | 0.60 | (0.20–1.79) | 0.361 | |
> 35,000 | 0.31 (0.03–3.78) | 2.00 | (0.14–29.25) | 0.614 | |
Persons living with | Parents |
Ref.
|
Ref.
| ||
Spouse | 0.35 (0.16–0.80) | 0.41 | (0.02–8.44) | 0.562 | |
Friends/alone | 0.56 (0.10–3.21) | 0.73 | (0.09–6.04) | 0.766 | |
Others | 1.60 (0.64–3.98) | 1.00 | (0.38–2.62) | 0.994 | |
History of chronic illness | No |
Ref.
|
Ref.
| ||
Yes | α (0.00–) | 4.35 | (0.66–28.48) | 0.125 | |
Currently on any medication | No |
Ref.
|
Ref.
| ||
Yes | 0.44 (0.21–0.91) | 1.54 | (0.58–4.05) | 0.384 | |
Pregnancy unplanned | No |
Ref.
|
Ref.
| ||
Yes | 2.88 (1.30–6.36) | 3.41 | (1.19–9.80) |
0.023
| |
Pregnancy wanted | No | 6.53 (1.51–28.20) | 3.24 | (0.83–12.74) | 0.092 |
Yes |
Ref.
|
Ref.
| |||
Attitude of the father towards the pregnancy | Positive |
Ref.
|
Ref.
| ||
Negative | 9.83 (3.61–26.77) | 8.72 | (2.88–26.37) |
< 0.001
| |
Ambivalent | 5.25 (1.88–14.63) | 4.26 | (1.35–13.45) |
0.013
| |
Not told | 1.35 (0.12–15.42) | 0.29 | (0.01–6.67) | 0.436 | |
Presence of social support | No | 5.17 (1.53–17.51) | 1.48 | (0.48–4.58) | 0.496 |
Yes |
Ref.
|
Ref.
| |||
Age at sex debut | Mean (SD) | 0.73 (0.58–0.92) | 0.70 | (0.55–0.89) |
0.003
|
Live with anyone who is a problem drinker or alcoholic or who uses street drugs | No |
Ref.
|
Ref.
| ||
Yes | 3.97 (1.16–13.54) | 1.23 | (0.42–3.55) | 0.706 | |
Ever consumed alcohol at any time in life | No |
Ref.
|
Ref.
| ||
Yes | 2.08 (1.03–4.17) | 1.15 | (0.41–3.26) | 0.787 | |
Alcohol-related harm being experienced | No |
Ref.
|
Ref.
| ||
Yes | 2.40 (1.01–5.73) | 1.08 | (0.32–3.70) | 0.901 | |
Ever used any other psychoactive substance | No |
Ref.
|
Ref.
| ||
Yes | 0.97 (0.30–3.09) | 3.21 | (1.31–7.88) |
0.011
|