While postpartum depression can affect up to 20 percent of mothers, the prevalence of postpartum depression (or related postpartum mood disorders, i.e. postpartum blues or and postpartum psychosis.) for teen mothers is nearly double, "a fact that most people don't even know," says Gloria Malone, a writer, activist, and consultant, who was 15 when she had her daughter. "I was happy but I was tired, overwhelmed, and felt like I had no one to talk to because everyone seemed too busy putting me down…she wrote in a blog post. "I needed someone to talk to and the extreme isolation I felt due to society and people pushing me away and down kept me from finding someone to speak to." The risk of developing a postpartum mood disorder increases if a mother has a weak support system, is experiencing financial instability, or is dealing with an unintended pregnancy—factors which are all statistically more likely for adolescent mothers than adult mothers. In addition, a previous diagnosis of depression or bipolar disorder also increases the risk of postpartum depression. According to the Seleni Institute, a New York City-based nonprofit working to destigmatize and transform mental health and wellness, girls who have a pre-existing mental illness are also three times as likely to give birth as adolescents than their peers who do not have mental health issues. The reason why girls with mental illness are more likely to become mothers needs more research.
Malone, for example, was depressed before she became pregnant, although she "didn't have the words for [her] condition," she says. "Pregnancy and parenting only exacerbated it." Lastly, when teens do become parents, these adversities are further compounded by the stress of parenting and the stigma of early childbearing.
Malone recalls feeling bombarded by messages of hate and disgust. "No one asked me what I needed," she says. In her 20s, she launched teenmomnyc.com, a blog that details her experiences and provides other mothers in New York City with information and resources. Later, she co-founded #NoTeenShame, a social media movement led by seven young mothers that advocates for stigma-free teen pregnancy prevention messaging, LGBTQ-inclusive sexuality education, and equitable access to resources and support for young families. "With teenmomnyc.com, I wanted to tell others like me that it was okay not to be okay, and still be an amazing parent," she says. "#NoTeenShame aims to shine an intersectional spotlight on teen pregnancy and parenting."
While teen mothers, as a group, are at high risk for postpartum mood disorders, those who work with this population know that providing support can help teen moms fight the symptoms. For example, the Seleni Institute's flagship program, the Seleni Institute Teen Initiative (SITI), is "dedicated to improving the likelihood of success in adulthood for teenage mothers by providing critical and evidence-based reproductive and maternal mental health services to pregnant and postpartum teenage girls." SITI provides direct support to teenage girls via free individual psychotherapy, group support in the form of new parent education, and information on the psychological effects of pregnancy and new motherhood. "We want young parents to be proud of their parenting and take ownership of their experience, while also knowing that it's perfectly all right to get support," says Rebecca Benghiat, chief of staff at the Seleni Institute.
In general, there are significant barriers to traditional mental health care for this group of parents, such as cost, social shaming, and new moms lacking time, transportation, and childcare. "Teen mothers also fear losing custody of their children, more so than their adult counterparts," says Megan Stonelake, a psychotherapist who specializes in perinatal mood and anxiety disorders and has worked extensively with adolescent mothers. SITI serves 10 percent of the Seleni Institute's clients, but Benghiat explains that over 10,000 babies are born to women under 18 born in New York City every year. "We hope to reach them all," she says.
Neglecting postpartum mood disorders can have a lasting impact on the health and development of teen mothers and their children. Left untreated, a postpartum mood disorder, aside from affecting the mother's health and interfering with her ability to connect with and care for her baby, is "associated with school dropout, suicide, and substance use. Among adolescent mothers, evidence suggests that depression may prevent them from engaging in health-promoting behaviors for their infants and themselves," according to Maureen Phipps, an OB/GYN at Women and Infants Hospital in Providence, Rhode Island.
Since 2007, Phipps has led a randomized controlled trial called Project REACH (an acronym for Relax, Encourage, Appreciate, Communicate, Help) to evaluate whether the hospital's preventive measures reduce the risk of postpartum depression in adolescent mothers. New parents who are enrolled in the five-year program meet with trained counselors to discuss topics such as "communication, support networks, how to solicit support from friends and family, and goal setting" and receive information about postpartum and infant health.
After phase one of the project, researchers determined that only 12.5 percent of the REACH teens developed postpartum depression, compared to 25 percent of the control teens. "Teen mothers with mental health problems are mostly undertreated," the researchers conclude. "To date, only one published report of two small open-trial pilot studies addressed treatment for depression in pregnant adolescents. Despite the potentially high burden of depression to young women and their families, studies on the prevention of PPD in pregnant adolescents are virtually nonexistent."
Malone's #NoTeenShame campaign also stresses that healthcare professionals who, consciously or unconsciously, vilify teenage pregnancy and teenage parents are doing great harm. "Young moms are undermined at appointments [and] deprived of resources," that can affect their mental health outcomes, Malone explains. "It is harmful to us and our children to treat us without dignity and respect."