More than 400,000 adolescent girls will give birth in the United States each year, and about one in four of them will experience postpartum depression (PPD).
"Adolescent postpartum depression is a critical problem of great public health significance. Rates of depression among new adolescent mothers are significantly higher than adult postpartum women and non-perinatal adolescents," explained Maureen G. Phipps, MD, MPH, interim chief of obstetrics and gynecology, director of research with Women & Infants Hospital of Rhode Island, and associate professor of obstetrics and gynecology at The Warren Alpert School of Medicine at Brown University.
Dr. Phipps leads a team addressing this situation through research. After developing a preventive intervention called Project REACH (Relax, Encourage, Appreciate, Communicate, Help) to reduce the risk of PPD in adolescent mothers, the team recently launched a five-year study to evaluate the program. The study is sponsored by the National Institute for Mental Health through a five-year, $2.8-million grant.
"The current Project REACH proposal builds on the foundation of our National Institute of Mental Health-funded treatment development project and pilot study in which we were able to demonstrate a reduction in cases of depression within six months postpartum," Dr. Phipps said. "We believe our current study will show that Project REACH is effective in reducing the risk for developing postpartum depression in adolescent mothers."
The danger of PPD in adolescents
Evidence suggests that PPD prevents adolescent mothers from engaging in healthy behaviors both for themselves and their infants. Untreated depression is associated with dropping out of school, suicide and substance use.
"Depression in the postpartum period puts adolescent mothers and their children at risk during an already challenging time in their lives and may be a major cause of poor outcomes for these young mothers and their children," Dr. Phipps explained.
In addition, there is increasing evidence that untreated PPD is related to poor maternal-infant attachment and child development. The children of adolescents have a higher risk of behavior disorders, cognitive and social deficits and hospitalization for unintended injuries.
A new approach
In a health care environment where effective programs targeting the prevention of PPD in adolescents are non-existent, the research team carefully evaluated and refined Project REACH to integrate into a prenatal care program for teens. This way, the expectant mothers are given the tools they need before symptoms of PPD ever strike. Such a prevention-based approach has distinct advantages over postpartum screening and treatment for existing PPD.
"Waiting until the postpartum period leaves adolescent mothers and their infants vulnerable," Dr. Phipps said. "Many teens with PPD may not seek care and, therefore, will be unrecognized, untreated or undertreated. In contrast, Project REACH optimizes prevention by being accessible and appealing to adolescents."
The core elements of Project REACH mirror the principles of interpersonal psychotherapy (IPT), the framework of which focuses on risk factors related to PPD that clinicians and patients can potentially change. This includes strengthening social relationships and encouraging the teens to ask for support.
Project REACH is delivered in five one-hour prenatal sessions with a postpartum booster session. In addition to discussion, there are videos, role-playing exercises, and homework. Sessions cover areas such as expectations about motherhood, stress management, "baby blues" versus depression, development of a support system, identifying and resolving interpersonal conflict, communication skills, healthy relationships, goal setting and psychosocial resources for new mothers.
If shown to be effective, Project REACH has the potential for broad integration into a prenatal care program, Dr. Phipps said. Further, results from the Project REACH study will inform interventions to prevent PPD and help caregivers understand the association between adolescent maternal depression and maternal-child bonding and healthy behavior.