Using two nationally representative, longitudinal data sets, we found that teenage mothers were more distressed than both childless adolescent peers and adult mothers. Contrary to common assumptions, however, their increased psychological distress did not appear to be caused by experiencing teenage childbearing. Rather, teenage mothers’ distress levels were already higher than their peers’ before they became pregnant, and they remained more distressed than others after childbearing, and into early and middle adulthood. This is similar to Booth et al.’s (2008)
finding that trajectories of depressive symptoms for those who experienced early childbearing did not widen or narrow compared to peers who had not formed families.
Just as we found that teenage motherhood did not increase distress, our results also showed that distress did not raise the likelihood of subsequent adolescent childbearing except among teenage girls from poor families. In this group, high distress levels markedly increased the probability of becoming a teenage mother. Among the other groups we tested, the relationship between distress and subsequent teenage childbearing was spurious and caused by underlying factors related to both, such as socioeconomic background, school performance, family structure, and previous sexual experience.
The analyses reported here have several limitations. First, the ECLS-B allowed us to examine levels of postpartum distress among former teenage mothers, but the upcoming wave four of Add Health will provide information about the distress levels of teenage mothers beyond the postpartum period, a period that often poses unique challenges to mothers’ mental health. Second, as noted above, data constraints prohibited us from extending our conclusions to teenage fathers, who represent another vulnerable population in terms of mental health (Heath, McKenry, and Leigh 1995
) but who are currently understudied. Third, although the CES-D scale has been validated across a wide range of populations, there has been considerable debate within the social science community about its and other measures’ utility for investigating mental health as a predictor and outcome (see the June 2002 issue of JHSB
for an extended discussion). Thus, other facets of mental health besides the CES-D would be useful for measuring the intersection of mental health and social consequences for teen mothers.
This study has implications for the adolescent childbearing literature. Our research suggests a parallel between the teen childbearing-distress relationship and the teen childbearing-education relationship. The rarely-examined assumption that becoming a teenage mother creates a high risk of distress, which is similar to the largely debunked supposition that adolescent childbearing causes severely compromised educational outcomes, was not supported in this study. Rather, many teenage mothers experienced long-term psychological distress both before and after having a child, similar to (and potentially even partially caused by or causing) their typically worse educational performance both before and after childbearing. Social disadvantage underlies both teenage childbearing and distress, just as it has been shown to underlie both teenage childbearing and educational outcomes (Ribar 1994
). Understanding the dynamics of the relationship between teenage motherhood and distress is important, and our study contributes to this body of knowledge.
These findings also speak to the broader literatures on selection and causation in mental health and on the causes of social disparities in health outcomes. Empirical evidence on the salience of social disadvantage for understanding health outcomes is strong (Link and Phelan 1995
), and our study provided further support. An array of factors including both socioeconomic status and related phenomena (family structure, school performance, and sexual activity) were important for understanding how social disadvantage is related to psychological distress and teenage childbearing. As researchers from both of these traditions would anticipate, we found that underlying social disadvantage increased psychological distress. Similarly, and as researchers of teenage childbearing have documented in the past, social disadvantage made girls more likely to become adolescent mothers. Our new finding was that the combination of extreme psychological distress and extreme socioeconomic disadvantage was particularly predictive of teenage childbearing. As Lorant et al. (2003)
have suggested, then, the relationship between socioeconomic disadvantage and mental health is complicated, and the two factors can work in tandem.
Perhaps surprisingly, our results did not support the prediction from life course theory that individuals who make a precocious transition to parenthood should suffer mental health consequences. Although the theoretical implication was not borne out, our results are in line with some earlier research that did not find negative consequences of violating transition norms (Settersten 1998
; Settersten 2003
). We do not interpret our findings as identifying a weakness in the theory, especially because our study did not capture other mental health outcomes besides distress that may be affected by violating transition norms. Rather, other processes that have emerged from the life course paradigm besides the violation of transition norms may be more useful for understanding our findings.
For example, two studies that have used the Add Health survey to examine the subjective aspect of aging may be relevant for understanding our findings. Foster, Hagan, and Brooks-Gunn (2008)
showed that young people who perceived themselves to have grown up more quickly than their peers experienced increased psychological distress in young adulthood. Johnson and Mollborn (2009)
found that early hardships (poverty, unsafe or violent environments, and family structure) increased the likelihood of early childbearing and sped up subjective aging. The authors hypothesized that one mechanism through which this occurred was that young people who experienced hardship violated cultural norms conceptualizing childhood and adolescence as being innocent and free of responsibility. Perhaps to deal with this mismatch between what society expected young people to experience and what they actually experienced, they began to perceive themselves as being older. This kind of subjective aging process could also underlie our study’s results, explaining why socioeconomic disadvantage, family structure, and other related factors increased both psychological distress and teenage childbearing. In this account, it would not be the violation of cultural norms about the transition to parenthood, but rather the violation of norms about childhood innocence and freedom from responsibility, that is related to psychological distress.
Our findings suggest that many adolescent girls who reported greater psychological distress were at increased risk of teenage childbearing. Distress was likely a symptom of other underlying problems rather than a direct cause of teenage motherhood, with the exception of poor, highly distressed girls, but it can still be viewed as a “red flag” identifying targets for intervention. Future research should examine whether treating symptoms of distress in teenage girls can decrease rates of subsequent adolescent childbearing, as Kessler et al. (1997)
have suggested. Second, it seems that most teenage mothers are not at risk of increased distress due to childbearing. At the same time, though, they typically start out more distressed than their peers before pregnancy and are more likely to have long-term patterns of psychological distress. Because maternal distress can compromise the outcomes of both mother and child regardless of its cause, distress in teenage mothers should be taken seriously and addressed, and teenage mothers should be considered at risk for depression problems.
All in all, the most compelling policy implication of our findings is that ameliorating social disadvantage may decrease both psychological distress and early childbearing for adolescent girls. This suggestion, that remedying the “upstream” socioeconomic root causes of health problems may be the most efficient way to solve those problems, echoes the work of researchers such as Link and Phelan (1995)
. Reducing socioeconomic disadvantage through policies such as income supports might prevent the complex process we identified of low SES increasing distress, and then compounding the effect of that distress on becoming a teen mother. Future research should explore whether such policy steps could address both of these important public health issues, mental health, and teenage childbearing, simultaneously.