Self-esteem, stressful life events, social support, and postpartum depression in adolescent mothers in Thailand

Adolescent pregnancy is an important social and public health problem in Thailand accounting for 13.0% of all pregnancies annually. In Thailand, premarital relations and pregnancy out of marriage are considered very dishonorable and bring great shame upon the family.; Research in countries other than Thailand reveals that adolescent pregnancy is associated with postpartum depression. Self-esteem, stressful life events, and social support have been found to be associated with postpartum depression but primarily in adult mothers in western countries. A few studies have examined the relationships of these three factors in adolescent mothers but not in nonwestern countries such as Thailand.; This cross-sectional, prospective, correlational study, therefore focused on adolescent mothers in Thailand in order to examine the: (1) relationships between self-esteem and stressful life events with postpartum depression, (2) moderating effect of social support on postpartum depression, and (3) effects of maternal characteristics (age, education, parity, marital status, family income, employment status, and unintended pregnancy) on postpartum depression. A convenience sample of 119 adolescent mothers, ages 14 to 19, was recruited from three hospitals of two provinces, Khon Kaen and Udonthani, of Thailand. Participants completed a self-report questionnaire containing measures of self-esteem (Rosenberg, 1965), stressful life events (Norbeck, 1984), social support (MSPSS, Zimet, et al, 1988), postpartum depression (CES-D, Radloff, 1977), and demographic questionnaires at six weeks postpartum.; Of the total adolescent mothers, 54.6% had a score of 16 or greater indicating a high level of depressive symptoms, with 21% of the total sample scoring 23 or greater indicating the need for psychiatric referral. When controlling for maternal characteristics, only self-esteem and negative stressful life events were significant predictors of postpartum depression (beta = -.368, p < .000 and beta = .451, p < .000, respectively). All independent variables explained 43.4% (adjusted) of the variance in overall postpartum depression. Postpartum depression was common among Thai adolescent mothers but that self-esteem and social support were high at six weeks postpartum. There is a need to identify adolescent mothers who have low self-esteem and experience high negative stressful life events because they are at increased risk for postpartum depression.