Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
J Epidemiol Community Health. 2018 Jun;72(6):451-457. doi: 10.1136/jech-2017-209923. Epub 2018 Feb 8.
Teenage mothers are at increased risk for adverse social outcomes and short-term health problems, but long-term impacts on mental health are poorly understood. The aims of our systematic review were to determine the association between teenage pregnancy and mental health beyond the postpartum period, critically appraise the literature's quality and guide future research.
We systematically searched MEDLINE, Embase, PsycINFO, CINAHL, Scopus and Web of Science from inception to June 2017 for peer-reviewed articles written in English or French. Data were collected using a modified Cochrane Data Extraction Form. Study quality was assessed using the Effective Public Health Practice Project critical appraisal tool. Heterogeneity of studies permitted only a qualitative synthesis.
Nine quantitative studies comprising the results from analyses of 11 cohorts met our criteria and were rated as strong (n=5), moderate (n=2) or weak (n=2). Three cohorts found a statistically significant association between teenage pregnancy and poor long-term mental health after adjustment, three found a statistically significant association before but not after adjustment and five did not find a statistically significant association. Studies observed varying degrees of attenuation after considering social context. Studies with statistically significant findings tended to comprise earlier cohorts, with outcomes measured at older ages.
The association between teenage pregnancy and mental health beyond the postpartum period remains unclear. Future studies should employ age-period-cohort frameworks to disentangle effects of normative patterns and stress accumulation. Social factors are important in determining long-term mental health of teenage mothers and should be prioritised in prevention and intervention strategies.
青少年母亲面临着更高的不良社会后果和短期健康问题风险，但对其长期心理健康影响知之甚少。本系统综述的目的是确定青少年怀孕与产后期间心理健康之间的关联，批判性地评估文献质量，并指导未来的研究。
我们系统地检索了 MEDLINE、Embase、PsycINFO、CINAHL、Scopus 和 Web of Science，从开始到 2017 年 6 月，以获取用英语或法语撰写的同行评审文章。使用改良的 Cochrane 数据提取表格收集数据。使用有效公共卫生实践项目批判性评价工具评估研究质量。研究的异质性允许进行定性综合。
有 9 项定量研究包括 11 项队列分析的结果符合我们的标准，并被评为强（n=5）、中（n=2）或弱（n=2）。有 3 个队列在调整后发现青少年怀孕与长期心理健康不良之间存在统计学显著关联，有 3 个队列在调整前发现统计学显著关联，但调整后没有发现统计学显著关联，有 5 个队列没有发现统计学显著关联。在考虑社会背景后，研究观察到不同程度的衰减。具有统计学显著发现的研究往往包含更早的队列，其结果在年龄较大时进行测量。
青少年怀孕与产后期间心理健康之间的关联仍不清楚。未来的研究应采用年龄-时期-队列框架来阐明规范模式和压力积累的影响。社会因素在决定青少年母亲的长期心理健康方面非常重要，应在预防和干预策略中优先考虑。
