Background
Methods
Search strategy and process
Selecting primary studies
Inclusion criteria: | |
• Studies exploring as a primary research question or objective mental health and wellbeing experiences of young mothers (age under 20 at time of pregnancy, and under 25 at the time of the research) in pregnancy and the post-natal period (up to one year after birth). | |
• Studies where primary evidence from young mothers foregrounds their mental health and wellbeing experiences in pregnancy and the postnatal period (up to one year after birth). | |
• Studies which employ qualitative methods (pure or mixed methods) of data collection and analysis | |
• Studies from OECD countries. | |
Exclusion criteria: | |
• Studies with young mothers who were over the age of 20 at the time of pregnancy or over the age of 25 at data collection. | |
• Studies where the views of young mothers (under the age of 20) are included but not separately identified or reported. | |
• Studies with young women on pregnancy termination. | |
• Studies which exclusively investigate the experience of pharmacological or service development interventions for mental health problems. | |
• Studies without a primary focus on mental health and wellbeing in the research question or study aims or primary evidence from young mothers’ accounts. | |
• Studies that discuss issues related to mental health and wellbeing (i.e. stigma or violence) but where no connection is explicitly referred to in study aims or in participants’ accounts. | |
• Studies with quantitative methods of data collection and analysis. | |
• Qualitative data with no verbatim quotes. | |
• Reviews, opinion pieces/commentaries, theses and dissertations, non-peer reviewed journal articles, reports, conference abstracts. | |
• Studies from non-OECD countries. |
Reading, data extraction and quality appraisal approach
Determining how the studies are related
Process of translating studies
Synthesis process
Results
Outcome of study selection
The synthesis papers: characteristics
Source paper and country | -Young women sample N -Age range -Pregnant/parenting stage (where provided) | -Ethnicity (as defined by papers) -Children’s details -Mental health status (where provided) | Aims | Qualitative methods | Reported data analysis |
---|---|---|---|---|---|
(Lesser et al., 1999) [40] USA | N = 15; ‘adolescents’ Parenting: 2 years postpartum Sample of ‘adolescents’ not defined in terms of age but quotations from young women age 17 (n = 1); age 18 (n = 5) | N = 11 Latina; n = 3 African-American; n = 1 Caucasian. N = 8 had one child; n = 4 were pregnant with their second child; n = 3 had two children. Reported symptoms of depression either during pregnancy or postpartum, measured by the Center for Epidemiologic Studies Depression Scale (n = 14) or reported a history of suicide attempt(s) within the past year (n = 1) | To provide a description of the affective component of depressed adolescents’ maternal role by eliciting young mothers’ perceptions of their maternal roles and their experiences of depression. | Ethnographic interviews, 2 h long conducted | Content analysis |
(Clemmens, 2002) [41] USA | N = 20, age 16–18 Parenting: 1–11 months postpartum | 9 African American; 8 Hispanic; 3 White All had one child Depressive symptoms | To address the phenomenon of depression from the perspective of adolescent mothers. Explore their memories of feeling depressed after the birth of their babies. | In depth face to face interviews, 15–45 min (20 mins average) | Descriptive phenomenological design (Colaizzi, 1978) |
(Renker, 2002) [42] USA | N = 40; age 18–20 Pregnant or parenting Average age for conception for the current pregnancy was 18. | N = 17 African American; N = 18 White; N = 5 teens Hispanic, American Indian, or mixed racial background. | To explore adolescents’ experiences of abuse in the year before and during pregnancy. | Structured and focused interviews 30–90 min | Generalized qualitative approach blended content/thematic analysis. (Creswell, 1994) |
(Kennedy, 2005) [43] USA | N = 10; age 16–20 Pregnant or parenting | N = 7 Mexican American; n = 3 African American. | To explore urban adolescent mothers’ experiences with community violence; witnessing parental violence, familial physical abuse, and partner violence; their methods of coping and resistance. | Individual, open-ended interviews (45–90 min) | Grounded Theory (Strauss & Corbin, 1990) |
(Stevens, 2006) [44] USA | N = 18, age 15–21 Parenting – at least 3 months postpartum | N = 6 Black; n = 7 White; n = 3 Black/White/Indian; n = 1 Black/White/Mexican; Mexican/White n = 1 Age of children: 0–3 months n = 2; 3–6 months n = 3; 6–9 months n = 3; 9–12 months n = 1; 12–24 months n = 5; 2–4 years n = 6 | To explore how adolescent women who are parenting describe what “being healthy” means to them and how they define their own health needs. | Ethnographic methods Including in-depth interviews and participant observation, photovoice | Participants’ views /meanings of health as described in interviews and narratives of photographs (ethnographic and photovoice) |
(Shanok & Miller, 2007) [45] USA | N = 42; age 13–19 39 pregnant; 3 parenting | N = 18 Hispanic; n = 19 Black; n = 4 Black and Hispanic, n = 3 undisclosed Subsection with depressive symptoms | To explore the nature of the participants’ depression and the factors that helped them to feel better. | Mixed methods. Analysis of therapy sessions with participants | Inductive qualitative analysis LeCompte and Schensul (1999) |
(Erdmans & Black, 2008) [46] USA | N = 27; average age 20, Parenting Average age 17 years old when they had their first child | 12 White, 9 Puerto Rican, 5 African American, and 1 biracial (White and Puerto Rican). | To listen to victims of child abuse tell their life histories to better understand the trajectories linking child sexual abuse to adolescent motherhood. | Two face to face interviews, 1.5–2 h | Life story method (Bertaux & Kohli, 1984) |
(Meadows-Oliver, 2009) [47] USA | N = 8; age 18–19 Pregnant (n = 2); parenting (n = 5) | N = 7 African-American, n = 1 Latina. N = 4 one child; n = 4 two children – ages between 7 months to 5 years. N = 2 pregnant at time of interview | To explore the lived experience of homeless adolescent mothers’ caring for their children while living in a shelter? | 1:1 face to face interviews lasting 20–30 min | Phenomenological approach (Colaizzi, 1978) |
(Kulkarni, 2009) [48] USA | N = 24, age 18–22 Parenting Age at first pregnancy 14–16 n = 19; 17–18 n = 5 | African American n = 9; Asian n = 1; European American n = 4; Mexican/Mexican American n = 10 Number of children 1 n = 18; 2–3 n = 6 | To explore the effects of IPV on their adolescent mothers’ important relationships. | Semi structured interviews 35 mins to 2 h with n = 24; second interviews with n = 15 | ‘Qualitative analysis’ (Miles and Huberman, 1994) |
(Brown, Brady & Letherby, 2011) [49] UK | N = 9; age 16+ Parenting (1–5 years) Age range time of giving birth 13–18 years. | Children age 1–5 years | To explore a range of issues pertinent to young women’s lack of agency, disempowerment and experiences of power, control and domestic violence with reference to intimate and familial relationships. | In-depth, semi-structured interviews 1–2 h | Grounded theory “style” (Glaser & Strauss, 1967) |
(Smith & Roberts, 2011) [50] UK | N = 13 under age of 25 at interview Parenting | N = 5 White British; n = 3 Mixed race; n = 2 Black British; n = 1 Indian; n = 1 Caribbean; n = 1 Black African | To explore the experience of being a young parent and some of the influences on their sexual and reproductive behaviours in young mothers from a variety of socioeconomic backgrounds. | Semi structured interviews | Thematic analysis (Braun and Clarke, 2006) |
(Crawford et al., 2011) [51] USA | N = 24, age 16–19 at baseline Pregnant or parenting | Data not provided for the sub sample of those interviewed for qualitative research. | To follow a sample of young homeless females over a 3-year period as they moved from late adolescence into early adulthood informed by in-depth interviews with a subsample. | Semi structured interviews of 1 h | Thematic coding |
(Boath et al., 2013) [52] UK | N = 15; age 17–19 Parenting - first time mothers with babies under the age of one. Age range at the time of giving birth 16 to 18 years (mean 16.9). | Children under age of one Identified by their health visitor as suffering from postpartum depression following clinical assessment. | To elicit the experiences of teenage mothers with postpartum depression and to further explore those factors associated with depression in younger mothers. | 40 min – 1.5 h face-to-face semi-structured interviews | Thematic framework analysis (Ritchie & Spencer, 1994) |
(Herrman, 2013) [53] USA | N = 26; age 14–18 N = 22 16–39 weeks pregnant; n = 4 parenting | N = 7 Hispanic; N = 10 African American; N = 6 White; N = 3 mixed origins Children age 1–3 months. | To provide a voice to young mothers about their thoughts and perceptions of TDV within the context of their relationships and experiences in pregnancy and parenting. | Semi structured focus groups | Qualitative coding of typologies (Rubin and Rubin, 2005) |
(Aparicio et al., 2015) [54] USA | N = 6; age 19–22 Parenting, mothers in foster care Age 14 to 17 years at the time of their first pregnancy. | n = 5 African American; n = 1 Latina, born in the U.S. Three participants had one child, one participant had two children, and one participant had three children. | To explore the lived experience of motherhood among teen mothers in foster care with a history of maltreatment. To inform teenage pregnancy prevention and to elucidate practices to give teenage mothers in foster care and their children the very best start possible in cases where a birth occurs. | Three in-depth interviews for each participant 1–2 weeks apart | Interpretative Phenomenological Analysis (IPA) |
(Kinser & Masho, 2015) [55] USA | N = 17; mean age: 17.5 +/− 1.3 years Pregnant | N = 17 African American | To evaluate pregnant, AA adolescents’ perceptions of depression and stressful experiences and assess feasibility and acceptability of adjunctive/ complementary, non-pharmacologic stress and depression management strategies for this underserved population. | Qualitative interviews using nontherapeutic focus groups | Content analysis with phenomenological overtones (Sandelowski, 2000) |
(Leese, 2016) [56] UK | N = 12; age 16–19 Parenting | – | To capture young mothers’ journeys to understand the reality of individual and collective experiences within cultural context of support group (Flick 2009). | Ethnographic narrative interviews and participant and non-participant observation collected over year | Thematic analysis Gomm (2008) |
(Fortier & Foster, 2017) [57] Canada | N = 10; age 21–25 Parenting Conception age 13–19 | All identified as Anglophone and Caucasian | To understand better the experiences of young mothers with subsequent pregnancy and motherhood in Canada’s capital. | Semi structured depth phone interviews av. 60 mins | Qualitative content analysis (Elo and Kyngäs 2008) |
(Bledsoe et al., 2017) [58] USA | N = 20; age 14–20 Pregnant | 46.5% African American; 46.5% Latina. Pregnant: average gestational age 16.85 weeks (SD = 4.63) 6 prior depression diagnosis; 1 bipolar; 1 mood disorder,1 panic disorder | To address knowledge gaps regarding the experience of U.S. low-income, minority, depressed pregnant adolescent women’s perceptions of pregnancy, depression, and help-seeking. | In depth, semi structured interviews and questionnaire | Descriptive qualitative approach |
Outcome of relating studies: how studies relate to each other
Outcome of translation and synthesis process
Line of argument | Synthesis 3rd order interpretations (or themes) | List of 15 translated 2nd order constructs (sub-themes) | Definition (translation) of the 2nd order construct | Papers that include the 2nd order constructs |
---|---|---|---|---|
Individual bodies | Embodied trauma: Deep imprints | ‘Living with violence’ [43] | Interpersonal violence in YW’s lives impacts physically and mentally. Violence is tolerated due to low self-esteem and as a familiar pattern in lives. | |
‘Crying out for help’ [42]: Traumatic after effects of childhood | Abusive, conflictual, violent relationships from childhood contribute to later depression as trauma which has been suppressed resurfaces. Suicidal attempts and self-destructive behaviour linked to childhood abuse; women propelled into intimate relationships early. Abandonment and loss also involved in complex traumatic histories. | |||
Stress and overwhelm: Weight on shoulders | ‘Carrying all the stress’ [54]: emotionally and physically draining | Stress in pregnancy; stress of being pulled between adolescent and mothering roles and having to adapt to responsibility is emotionally and physically draining; stress of children acting out; stress of living circumstances. | ||
Stress: ‘increasing the risk’ [53] | Stress of pregnancy and motherhood raises risk of violence, depression and suicidal attempts and leads to fatigue and overwhelm. | |||
Not just hormones: Depression darkness | Depression impact on the ‘transition into motherhood’ [56] | Post-natal depression is present, difficult and, for some mothers, causes difficulty parenting | ||
Difficulty of identifying and ‘explaining the unexplainable’ [41] of depression | Depression figured as blinding and feels like explaining something unexplainable. YW interpret it as stress or relate it to life events, relationships and circumstances. | |||
Relational influences | Held together: support, conflict and isolation | ‘Circle of support’ [54]: sustaining and protecting | Family or wider circles of support can provide validation and increase esteem and lessen stress of pregnancy. Adult relationships can be enabling, provide sense of new pathways and help YW seek help for m/health issues. | |
‘Interpersonal disputes and conflict’ [58] | Conflict in relationships with partners, family members or other people, and emotional violence or controlling relationships are also trigger for stress and depression as well as for homelessness. | |||
‘Left behind’ [41]: social isolation | Despite some sources of support, YW feel social isolation from a sense of abandonment by partners (in particular); friends or family due to being a young mother; or because YW have chosen to stay away from bad influences or violent relationships. Result of isolation or sense of abandonment or exclusion may be a sense of depression, loneliness and suicidal thoughts. | |||
Socio-economic insecurity | Unstable foundations: Ground beneath feet | Impact of ‘housing instability’ [58] on mental health and wellbeing | Housing instability and/or homelessness and/or tumultuous living conditions impact development and transition to motherhood. Living circumstances lead to or seen as factor in depression. | |
Impact of ‘socioeconomic stress’ [44] on mental health and wellbeing | Economic stressors mean YW do not have what need to live healthy lives; poverty primary factor in depression and increased stress, leads to feelings of despair. | |||
Social surveillance | Surveilled and judged: Head down | Impact of ‘stigma and perceptions of being judged’ [52] on help seeking for mental health | Mental health is seen as a stigmatised or judged issue, which, along with the stigma and judgement associated with being a teenage mum, prevents help seeking, and is hidden from HCPS, as YW try to present themselves as good mothers. | |
Impact of ‘stigma and perceptions of being judged’ [52] on emotional life world | Judgement from the public or community about being a young, single mother adds to stress, and contributes to depression and to social exclusion. Impact of stigma and perceptions of being judged has a negative impact on emotional wellbeing. | |||
Narrative reparation | Empowerment and resilience: Breaking cycles and managing impressions | ‘Light in the darkness’ [54]: reparation and empowerment of motherhood | Repairing childhood wounds, positive changes in mental health and wellbeing in becoming a mother including increased motivation, feelings of love for children, opportunity to return to education, positive maternal behaviours, breaking cycles. Pregnancy provides a point to move on from harmful behaviours. | |
‘Impression management’ [56] | Young women present stories, in a positive light in order to avoid the ‘stigma’ attached to teenage motherhood and mental illness. |
Individual bodies
Embodied trauma: deep imprints
Stress and overwhelm: Weight on shoulders
Nobody, gives me a hand with her. Where can I go for support, because as soon as I came out of hospital I just come home and I thought, what a life and what have I got at this age …[52], (p. 361).
Not just hormones: depression darkness
Nobody has ever told me what it is really [postpartum depression] … I just sit here sometimes and I am crying for no reason, but I could have detected it earlier if someone had explained to me what your first symptoms were, but nobody told me [52], (p. 361).
Relational influences
Held together: support, conflict and isolation
The friends that I used to have, I don’t have. So, that is another reason why I am depressed because they say, ‘Oh!’ I can’t go out with them or hang out with them no more so they are not going to hang with me or call me anymore. I honestly have no friends. And you know, it’s a lot of things because people look at me now differently because they see me carrying a baby [41], (p. 559).
Socio-economic insecurity
Unstable foundations: ground beneath feet
I didn’t want my child to grow up like how I grew up, like from place to place and people neglecting them or, you know, and things like that. I just wanted him to grow with a normal childhood like a child should [54], (p. 48).
Social surveillance
Surveilled and judged: head down
I don’t know what the health visitors are like, or if they are going to say things or twist things round to say that I can’t cope. The thing is, with health visitors they’re scared of them going to social services, which is the main concern, that’s why people don’t speak out about postnatal depression, they keep things bottled up [52], (p. 356).
Narrative reparation
Empowerment and resilience: breaking cycles and managing impressions
So I guess instead of saying teen moms are smarter, I should say they are stronger. .. It’s like you are in a race with someone who’s not pregnant or doesn’t have kids, in the same race with them, running the same amount of time, but theirs is maybe 5 miles, and mine is maybe 10 … that’s the way I see it. I′m running a lot more, but we’re still in the same spot [40], (p. 141).