![[ Visit Client Website ]](images/banner.gif)
Untreated postpartum depression (PPD) places adolescents at risk for chronic depression, poor parenting, and suicide. The purpose of this systematic review was to examine interventions designed to prevent or treat postpartum depression in adolescent mothers.
Methods:
PubMed, MEDLINE, CINHAL and PsycINFO databases were searched. A total of 255 articles were identified; after title and abstract review, 43 articles remained for full text review. Inclusion criteria were: published between 2004 and 2014; randomized controlled trial or quasi-experimental study; English; and assessed interventions for postpartum depression in adolescents, ages 14-19 years. Five articles meeting inclusion criteria were compared using the matrix method to facilitate cross-study comparisons of population, methods, interventions, results, bias, and outcomes.
Results:
The five studies reported interventions provided to 401 adolescents who were pregnant or parenting and at risk for postpartum depression. All studies were conducted in the United States and published between 2004-2014. The majority of the participants were aged 13-19 years old and compromised of various races including; American Indian, African American, Caucasian and Latino and ethnicities including Hispanic and Non-Hispanic. Study settings included a NYC public school, an unidentified urban prenatal clinic, a city in southern USA, an Apache Reservation in Arizona and an unidentified rural public school. The authors used various measurement instruments to assess depression, PPD, self-esteem, maternal gratification, social support and global functioning of participants. The most widely used depression- screening tools were the Center for Epidemiological Studies-Depression Scale (CES-D) with a sensitivity of .95 and specificity of .70 and the Edinburgh Postpartum Depression Scale (EPDS) with a .80 sensitivity and .87 specificity of identifying PPD in adults.
Four of five studies demonstrated improvement in outcomes of prevention of depression and reduction of depressive symptoms. The prevention and treatment interventions differed in each study. The interventions were provided by a variety of healthcare professionals and paraprofessionals. Background information on the qualifications of the person conducting the interventions was not uniformly provided. Two studies were conducted in a group setting and three were conducted in individual sessions.
While most interventions demonstrated improved depression scores in postpartum, one found higher levels of social support increased postpartum depression scores. Other variables that increased postpartum depression were low self-esteem and lower education.
This systematic review identified two distinctly different adolescent depression diagnoses: major depressive episode and postpartum depression. These terms differ from the most current diagnostic terminology: Depressive Disorder, with peripartum onset. Treatment options including pharmacotherapy, psychotherapy, social support and education are effective in treating Depressive Disorder, with peripartum onset. Available pharmacotherapeutic treatment studies did not meet the inclusion criteria therefore medication trials were not included in this systematic review.
Conclusion:
There is a paucity of research focused on interventions to prevent or reduce postpartum depression in adolescents, despite their increased vulnerability. Most participants in interventional studies targeting postpartum depression are adults. There is a lack of pharmacotherapy research studies treating adolescents with postpartum depression. Given the increased incidence of postpartum depression in adolescents compared to their adult counterparts, further research addressing pharmacotherapy treatment modalities is essential.