Table 2.
Estimates and correlates identified in quantitative evaluations of mental health among pregnant adolescents and young women in sub-Saharan Africa (N = 8).
| Author, year published, Country | Study design, sample size | Estimates and correlates identified | Key findings | Conclusions about gaps in mental health service Delivery | Bioecological level(s) identified |
|---|---|---|---|---|---|
| Ayamolowo et al. (2019), Nigeria2 | Cross-sectional study; 13–19 year old pregnant and breastfeeding adolescents (N = 120) | Moderate perceived social support: 54·2% Low perceived social support: 1 2·5% Severe depression: 10·0% Correlation between respondents' level of social support and depression at r=- 0·510, P=<0·0001 |
Significant association between perceived social support and development of depression among population. | Need for community health information, education and programs to support and reduce negative mental health outcomes among the population. | Individual |
| Babafemi et al. (2012), Nigeria3 | Cross-sectional study; 13–19 year old pregnant and breastfeeding adolescents; N = 300 (N = 150 pregnant, N = 150 postpartum) | Depression and anxiety: During pregnancy: 27·3% After pregnancy: 59·0% After childbirth and now: 13·7% Poor psychosocial support during pregnancy: 35·7% Poor psychosocial support during breastfeeding: 16·7% Generally, 49·3% who received poor psychosocial support either during pregnancy or breastfeeding also experienced poor health while 17·7% who got good psychosocial support at those times also experienced good health. |
Health and psychosocial problems of adolescent pregnancy include low education, poverty, limited job opportunities, depression, and high blood pressure |
Attention of nurses, health education, conventional education, economic status etc. correlate to increased health status and ability of the pregnant adolescent to cope with pregnancy related stress | Individual |
| Dare et al. (2016), Nigeria7 | Cross-sectional study; 13–18-year-old pregnant adolescent girls and young women (AGYW); N = 100 (N = 33 pregnant; N = 67 never pregnant) |
Depression (n = 31, 93·9%); Substance abuse (n = 28, 84·8%); School dropout (n = 24, 72·7%); Abandonment by friends (n = 24, 72·7%); Rejection by parents/relatives (n = 22, 66·7%); Rejection by church/mosque (n = 17, 51·5%); Stigmatization by the community (n = 22, 66·7%); Suicide attempts (n = 18, 54·5%)” |
Poverty is a major factor causing adolescent pregnancy |
Need for sex education in schools, improved access to health services and staff who understand adolescents and their needs |
Individual Microsystem |
| Govender et al. (2020), South Africa6 | Cross-sectional study 13–19 year old pregnant and postpartum adolescents; N = 326 | Depressive symptoms (EPDS ≥13): 11·7% Among pregnant adolescents: 15·9% Among postpartum adolescents: 8·8% Experiences of physical, sexual, and verbal abuse were associated with risk of depression (p<0·05) |
Prevalence of antenatal depression is higher than postpartum depression. Physical violence, verbal abuse, and absence of partner support associated with antenatal and postpartum depression. | Need to integrate MH needs and MH screening into reproductive health program packages. | Microsystem |
| Kimbui et al. (2018), Kenya10 | Cross-sectional study; 14–18-year-old pregnant AGYW N = 212 (N = 106 16–17 years old, N = 106 18 years old) |
Depressive symptoms (EPDS: ≥8): 60·4%; Severe depression (BDI): 51·9%; Currently consuming alcohol: 26·9%; “Of the 110 pregnant adolescents who were severely depressed, 39 were currently consuming alcohol.” |
Suggested correlation between depression and substance abuse in adolescents | Need to develop culturally relevant systemic interventions for the population. | Individual |
| Oladeji et al. (2019), Nigeria14 | Cohort study; N = 9352 (N = 772 pregnant adolescents ≤19 years old, N = 8580 adult pregnant women) | Depression (EPDS score ≥ 12): 17·7% (15–19 year olds). 6·9% (≥19 year olds, 0·082) Adjustment and attitudes to pregnancy (mean MAMA score): 21·8% (15–19 year olds). 19·8% (≥19 year olds, <0·001) |
Perinatal depression more common and associated with poorer maternal attitudes and parenting skills in pregnant adolescents than in pregnant adults | Need to supplement depression interventions in pregnancy to improve parenting skills. | Microsystem |
| Osok et al. (2018, 2), Kenya16 | Cross-sectional study; N = 176 pregnant adolescents (age 15–18) |
Mild-to-severe depressive symptoms (score ≥5): 78·4%;Severe depressive symptoms (score ≥15): 15·9%;Correlates of depressive symptoms:
|
Risk factors for depression include: having experienced an adverse event or extremely stressful life context, living with HIV/AIDS, absence of support from the partner or family and being a younger adolescent | Need to integrate WHO's Mental Health Treatment Gap Action Program (known as WHO mhGAP) in the healthcare settings for pregnant adolescents | Individual Microsystem Exosystem |
| Wong et al. (2017), South Africa18 | Cross-sectional study; N = 625 (18–24 year old postpartum AGYW, ≥25 year old postpartum women) | Depression: 11% Self-harming thoughts: 6% (18–24 year olds: 11%; >24 year olds: 4%, p-value= 0·002) Risky alcohol use: 16% Alcohol-related harm: 21% (18–24 year olds: 37%; >24 year olds: 20%, p-value= 0·02) |
Young HIV-infected pregnant women more likely to report depressive symptoms and self-harming thoughts compared to older women with the youngest women reported the highest levels of alcohol-related harm | Need for interventions for the population | Individual |