Psychosocial interventions targeting mental health in pregnant adolescents and adolescent parents: a systematic review

Abstract

Background Pregnancy and parenthood are known to be high-risk times for mental health. However, less is known about the mental health of pregnant adolescents or adolescent parents. Despite the substantial literature on the risks associated with adolescent pregnancy, there is limited evidence on best practices for preventing poor mental health in this vulnerable group. This systematic review therefore aimed to identify whether psychosocial interventions can effectively promote positive mental health and prevent mental health conditions in pregnant and parenting adolescents. Methods We used the standardized systematic review methodology based on the process outlined in the World Health Organization’s Handbook for Guidelines Development. This review focused on randomized controlled trials of preventive psychosocial interventions to promote the mental health of pregnant and parenting adolescents, as compared to treatment as usual. We searched PubMed/Medline, PsycINFO, ERIC, EMBASE and ASSIA databases, as well as reference lists of relevant articles, grey literature, and consultation with experts in the field. GRADE was used to assess the quality of evidence. Results We included 17 eligible studies (n = 3245 participants). Interventions had small to moderate, beneficial effects on positive mental health (SMD = 0.35, very low quality evidence), and moderate beneficial effects on school attendance (SMD = 0.64, high quality evidence). There was limited evidence for the effectiveness of psychosocial interventions on mental health disorders including depression and anxiety, substance use, risky sexual and reproductive health behaviors, adherence to antenatal and postnatal care, and parenting skills. There were no available data for outcomes on self-harm and suicide; aggressive, disruptive, and oppositional behaviors; or exposure to intimate partner violence. Only two studies included adolescent fathers. No studies were based in low- or middle-income countries. Conclusion Despite the encouraging findings in terms of effects on positive mental health and school attendance outcomes, there is a critical evidence gap related to the effectiveness of psychosocial interventions for improving mental health, preventing disorders, self-harm, and other risk behaviors among pregnant and parenting adolescents. There is an urgent need to adapt and design new psychosocial interventions that can be pilot-tested and scaled with pregnant adolescents and adolescent parents and their extended networks, particularly in low-income settings.

Understanding Mental Health in the Context of Adolescent Pregnancy and HIV in Sub-Saharan Africa: A Systematic Review Identifying a Critical Evidence Gap

“…As such, the effectiveness of any interventions currently in place is unknown. This finding supports previous research highlighting a lack of prevention interventions targeting mental health among adolescent parents within low and middle income countries [88]. Furthermore, no studies exploring the mental health experience and needs of adolescent fathers living with HIV were identified.…”

Adolescent fathers’ experiences in Indonesia: a qualitative study

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A bioecocultural approach to supporting adolescent mothers and their young children in conflict-affected contexts

“…Unfortunately, the two primary literatures in humanitarian and post-conflict settings that may be useful – on early childhood development and later child and youth development – generally ignore the population of adolescent mothers. A systematic review of interventions to improve the mental health of pregnant adolescents and adolescent parents identified zero studies in LMIC, let alone conflict-affected contexts (Laurenzi et al, 2020). To our knowledge there are only two evaluations of programs to support adolescent mothers from LMIC – one experimental and one nonexperimental.…”