Posted by Maryjo M. Oster, Self-Sufficiency Research Clearinghouse Staff

Evidence suggests that most mental health problems and disorders begin during adolescence. These issues frequently go undetected, and consequently untreated, until adulthood. Recent estimates suggest that one in five teenagers has a diagnosable mental health disorder, yet fewer than half of these adolescents receive treatment for their conditions. Often, youth report not even being aware of such services. Moreover, an estimated 40 to 60 percent of children who do receive mental health treatment drop out before completing their treatment plans. The reason for drop out among children and adolescents can be due to factors related to the adolescent, caregiver, or the family. For example, children with externalizing behavior problems are more likely to end treatment prematurely. Similarly, family factors such as being from a low-income, single-parent families or families with individuals who also experience mental illnesses are more likely to drop out early.  

Adolescent mothers are twice as likely as adult mothers to experience depression. Other research has revealed a statistically significant association between conduct problems (e.g., Oppositional Defiant Disorder) and later risk of teenage pregnancy. There are a variety of barriers associated with  accessing mental health care for adolescents, including (but not limited to) stigma, financial limitations, concerns about confidentiality, lack of flexibility in appointment scheduling, limited training for providers on adolescent mental health, and lack of adequate health insurance coverage. The presence of mental health problems and difficulties in accessing care for these problems can be further compounded when an adolescent is expectant or parenting.

Adolescent pregnancy and the development of mental health disorders share many of the same risk factors. For example, low income and educational attainment are associated with both the development of a mental health disorder and adolescent pregnancy. However, other psychosocial factors through the life course may complicate the association between adolescent pregnancy and mental health. Nevertheless, acknowledgement and understanding of the unique mental health needs of young parents, as well as identification of resources that can meet these needs, are good for young parents, their children, and the communities in which they reside.

Teen parents must adjust to their new role as parents while simultaneously navigating adolescent development. Young parents also often face economic struggles and social stigma. Researchers theorize these unique contextual factors and stressors contribute to the onset of negative mental health symptoms and disorders. Substance abuse is also more common among young parents than adult parents and their non-pregnant/parenting peers. Though research suggests that most adolescent mothers reduce or refrain from using substances during pregnancy, they often resume use following childbirth and continue using drugs or alcohol into adulthood.

Screening is key in providing for the mental health of young parents. The American Academy of Pediatrics recommends mental health screening of mothers at pediatricians’ offices during child well visits. Primary care providers can also conduct this type of routine screening during the young parents’ office visits. In order for screening to be effective, both types of providers need adequate training in working with this population (i.e., adolescents more generally, young parents in particular) as well as with mental health issues. However, to be effective, screening must be accompanied by plans to help adolescents access the treatment and services they need after a positive screen.

Prevention and intervention can also take place within doctors’ offices, as well as in schools and homes. Though not all programs for expectant and parenting young people have been designed or evaluated specifically with mental health outcomes in mind, many show promise based on their positive outcomes in other areas, like reduced repeat pregnancy, increased likelihood of high school graduation, and less time receiving public assistance (i.e., welfare). For example, the “teen-tot” model establishes a comprehensive care team for both teen parents and their children that provides medical, case management, social work, and mental health services into integrated appointments at a doctor’s office. The interdisciplinary team provides services directly and connects young parents to additional resources in the community.

Alternatively, mental health services for expectant young parents and those with children can be delivered in their natural environments. One example of these programs is the Nurse-Family Partnership, which serves low-income unmarried mothers (approximately half of which are adolescents) through regular in-home visits by nurses both before and after the birth of the mother’s first child. However, the outcomes of home visiting programs are effected by parental depression, and studies have shown that home visitors are not always equipped to address maternal depression, which may reduce the effectiveness of the intervention. The Healthy Families Massachusetts intervention examined the impact of home visitors trained to provide referrals and resources for women over 16 years old experiencing depression and found that mothers visited by trained home visitors were more likely to be assessed for depression and more likely to have child maltreatment incidents reported. Thus, it is critical that service providers that work with young parents have sufficient training to identify and address adolescent mental health issues and to link them to appropriate services in the community.

Models and programs that address the barriers specific to adolescents (and adolescent parents in particular) will likely have the most success in identifying those in need of services and providing those services to them.

The SSRC Library contains numerous evaluation reports and stakeholder resources on mental care, including:

• Depression in Washington’s female TANF population: Prevalence, DSHS screening, and treatment:  This study highlights the increased likelihood of depression among women receiving TANF compared to women with children in the general population.
• Maternal depressive symptoms and low literacy as potential barriers to employment in a sample of families receiving welfare: Are there two-general implications?: This article details the impact of maternal depression on the mother’s employment and the child’s development.
• Patterns of depression among adolescent mothers: Resilience related to father support and home visiting programs: This article provides longitudinal evidence of the association between maternal depression phases and satisfaction with support from the child’s father as well as enrollment in home visiting programs.
• The role of the family and family-centered programs and policies: This policy analysis highlights evidence of family-centered programs and policies such as home visiting programs that improve the health and developmental outcomes of children through improved parenting.
• Evaluation of public health nurse visiting program for a pregnant and parenting teens: This study evaluates the program Pregnant and Parent Team Program. The study found that adolescent parents who participated in this had both improved parenting skills and were more self-sufficient. 
• Maternal depression in home visitation: A Systematic Review: This systematic review evaluates the impact of maternal depression severity on home visiting nurses. The study found that home visiting nurses often lack the skills to assess or reduce maternal depression.
• Limiting home visiting effects: Maternal depression as a moderator of child maltreatment: This randomized controlled design study compared the impact of training home visiting nurses to address maternal depression and report child maltreatment among mothers who recently had a child. The study found that the trained home visiting nurses were more likely to recommend resources for women facing maternal depression and report instances of child maltreatment.

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