Bumps in the road on the journey through pregnancy - young mums and mental health
Discovering you are pregnant can trigger many feelings and emotions - joy, bewilderment and anxiety, in what can be one of the biggest moments of a woman’s life.
But for some mums-to-be these natural initial reactions, both positive and negative, can run deeper and be linked to more serious problems, or exacerbate pre-existing mental health problems.
Mental health issues are more prevalent in young people aged 16-24 than in any other age group, with 75% of mental health problems experienced during adult life commencing before the age of 25. Young women in particular are at the highest risk of common mental health problems, such as self-harm and post-traumatic stress disorder (PTSD) compared with boys, in what appears to be a global phenomenon. Yet there’s been very little research on the mental health of young expectant mums at a time of life where they may be particularly vulnerable.
Research conducted so far in this cohort has almost exclusively focused on adolescents under 19 who have depression - to the exclusion of other mental illnesses. This represents a real gap in the literature, which our study aims to address.
In our research, funded by NIHR Programme Grants for Applied Research, we evaluated 545 expectant mums in London in the early stages of pregnancy, and aimed to compare the prevalence of mental health problems in young women aged between 16 and 25 years compared to older women aged 25 years and older. We also aimed to compare the associated risk factors of mental disorders between these two age groups.
What are our key findings?
- 67.2% of pregnant young women had a mental disorder
This included depression, anxiety disorders, obsessive compulsive disorder (OCD)) and post-traumatic stress disorder (PTSD) compared to 21.2% in women aged 25 years or older
- 25% of young pregnant women had an anxiety disorder
Young women had especially high rates of anxiety disorders - specifically social phobia
- Young pregnant women were more likely to have low levels of social support than pregnant women aged 25 years or over
This included being single, living in poverty, homelessness or living in emergency accommodation. Young women were also more likely to be unemployed or unable to work, and to have an unplanned pregnancy
- Young women had a six-fold increased risk of having a common mental disorder in early pregnancy than women aged 25 years or over
This was often associated with living alone and lifetime experience of abuse
- 8.9% of young pregnant women reported lifetime experience of abuse
This included sexual abuse 20.6%, and partner abuse 19.5%.
We show a shockingly high prevalence of mental disorders in young pregnant women aged 16 to 24 years compared with women aged 25 years or older. In comparison to previous research that has focused primarily on postnatal depression, we find young women experience a broad range of mental health problems during early pregnancy, with anxiety disorders being particularly prevalent.
Vulnerability is not limited to pregnant teenagers
The majority of young women in our study had limited or no access to key sources of support – for example they were out of education and employment, living alone, or, even more startlingly, more than a quarter of the young women in this cohort were homeless or living in emergency accommodation. This is at a time of life where women may be in particular need of support to navigate early adult life, as well as to care for her unborn child. Secondly, this age group also experienced concerning rates of abuse, and these figures are likely to be an underrepresentation due to known underreporting on this subject.
This isn’t limited to under 19s, and is particularly relevant to those in their early 20s. These findings come at a time of increasing discussion about mental illness during childhood and adolescence, and their associated risk factors, including social environment, education, family, violence and instability. These factors are still extremely present to those in their early 20s. And such factors, specifically low social support and abuse, are associated with common mental health problems in young pregnant women.
Healthcare services need to target young pregnant women
These findings have important implications: healthcare services must target resources to pregnant women under 25, paying particular attention to those in their early 20s - not just to those in their teens. We also highlight the need for an interdisciplinary approach to be taken to address problems in this population. This approach - frequently talked about in the field of global mental health where low cost, scalable solutions to healthcare policy and services are frequently discussed - is becoming increasingly relevant to women in both high-income and low and middle-income countries. Early pregnancy, where women approach services for perinatal care, provides a unique opportunity to implement integrated identification and intervention programmes for mental health care and for women experiencing abuse. Alongside this, we must also provide societal and community interventions to address insecure housing, employment and social networks in this population, which may improve women’s mental health. The recent announcement of increased funding for perinatal services in the UK provides an opening to put these much needed services into practice to improve outcomes for mothers and their children at what can be a challenging time of a woman’s life.
Dr Lockwood Estrin’s paper is available to read online: Young pregnant women and risk for mental disorders: findings from an early pregnancy cohort
Find out more about the study: Well-being in pregnancy in an inner city maternity service
More blogs by Dr Lockwood Estrin:
Further information on Women's Mental Health Research at King’s College London is available on the university’s website.
Follow Institute of Psychiatry, Psychology & Neuroscience on Twitter @SWMH_IoPPN
The views and opinions expressed in this blog are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health and Social Care.