Kumar Manasi, Huang Keng-Yen, Othieno Caleb, Wamalwa Dalton, Madeghe Beatrice, Osok Judith, Kahonge Simon Njuguna, Nato Joyce, McKay Mary McKernon
Department of Psychiatry, University of Nairobi, PO Box 47074, Nairobi 00100, Kenya.
Department of Public Health and Child and Adolescent Psychiatry, New York University, New York, NY 10016, USA.
Glob Soc Welf. 2018 Mar;5(1):11-27. doi: 10.1007/s40609-017-0102-8. Epub 2017 Oct 25.
The key objective of this paper is to provide a phenomenological account of the mental health challenges and experiences of adolescent new mothers. We explore the role of social support and the absence of empathy plays in depression among pregnant adolescents. The project also collected data on the adolescents' caregiving environment which includes the adolescents' mothers, their partners, the community, and health care workers, as well as feedback from staff nurses at the maternal and child health centers. The caregivers provide additional insight into some of the barriers to access of mental health services and pregnancy care, and the etiology of adolescents' distress.
The interviews were conducted in two health facilities of Kariobangi and Kangemi's maternal and child health (MCH) centers that cover a huge low-income and low-middle-income formal and informal settlements of Nairobi. A grounded theory approach provided a unique methodology to facilitate discussion around adolescent pregnancy and depression among the adolescents and their caregivers. Our interviews were cut across four samples with 36 participants in total. The sample 1 comprised of eight pregnant adolescents who screened positive for depression in Kariobangi, sample 2 were six caregivers from both sites, and sample 3 were 22 new adolescent mothers from both sites. After individual interviews, we carried out one focused group discussion (FDG) in order to understand the cross-cutting issues and to gather some consensus on key issues, and the sample 4 were 20 community health workers, health workers, and nurses from both sites. We had one FGD with all health facility-based workers to understand the cross-cutting issues. The interviews in sample 1 and 2 were individual interviews with pregnant and parenting adolescents, and their caregivers. All our adolescent participants interviewed in sample 1 were screened for depression. Individual interviews followed the FGD.
Pregnant and parenting adolescents faced several adversities such as social stigma, lack of emotional support, poor healthcare access, and stresses around new life adjustments. We highlighted a few useful coping mechanisms and strategies that these adolescents were thinking to reduce their stress. Primary social support for pregnant and parenting teens comes from the adolescent's mother. The external family and male partners provide negligible support in the rearing of the child. While the mother's reactions to the daughters' pregnancy were empathetic sometimes, absence of food and resources made the mother distant and constraint in lending support. For those adolescents who were living with partners, in their new mother role, they had to negotiate additional challenges such as solutions to everyday childcare responsibilities and other family duties. The health care workers and community health workers confirmed that adolescent mothers have multiple needs, but there is a lack of holistic approach of service, and that their own training and capacities were very limited.
Our paper highlights several individual stakeholder-related and system-level barriers in the MCH primary care setting that affect delivery of psychosocial support for pregnant adolescent. We have identified these knowledge, practice, and institutional gaps that need addressing through careful community and health service staff engagement using implementation strategies that are effective in low-resource settings. Pregnant adolescents are highly vulnerable group and mental health services needs to be understood better.
本文的关键目标是对青少年初产妇的心理健康挑战及经历进行现象学描述。我们探讨社会支持的作用以及缺乏同理心在怀孕青少年抑郁中所起的作用。该项目还收集了青少年的照料环境数据，其中包括青少年的母亲、她们的伴侣、社区和医护人员，以及母婴健康中心护士的反馈。照料者提供了一些关于获得心理健康服务和孕期护理的障碍以及青少年苦恼病因的额外见解。
访谈在卡里奥班吉和坎格米母婴健康（MCH）中心的两个医疗机构进行，这些机构覆盖了内罗毕大量的低收入和中低收入正式及非正式定居点。扎根理论方法提供了一种独特的方法，以促进围绕青少年怀孕和抑郁问题在青少年及其照料者之间展开讨论。我们的访谈涉及四个样本，总共36名参与者。样本1由在卡里奥班吉抑郁筛查呈阳性的8名怀孕青少年组成，样本2是来自两个地点的6名照料者，样本3是来自两个地点的22名青少年初产妇。在个体访谈之后，我们进行了一次焦点小组讨论（FDG），以了解贯穿各领域的问题并就关键问题达成一些共识，样本4是来自两个地点的20名社区卫生工作者、卫生工作者和护士。我们与所有医疗机构的工作人员进行了一次焦点小组讨论，以了解贯穿各领域的问题。样本1和2中的访谈是对怀孕及育儿青少年及其照料者的个体访谈。样本1中所有接受访谈的青少年参与者都进行了抑郁筛查。个体访谈在焦点小组讨论之后进行。
怀孕及育儿青少年面临着诸多困境，如社会污名、缺乏情感支持、难以获得良好的医疗保健以及新生活调整带来的压力。我们强调了这些青少年为减轻压力而考虑的一些有用的应对机制和策略。怀孕及育儿青少年的主要社会支持来自青少年的母亲。外部家庭和男性伴侣在孩子抚养方面提供的支持微乎其微。虽然母亲对女儿怀孕的反应有时是有同理心的，但缺乏食物和资源使母亲在提供支持时变得冷漠且有所限制。对于那些与伴侣生活在一起的青少年，作为初为人母的角色，她们必须应对额外的挑战，比如解决日常育儿责任和其他家庭事务。医护人员和社区卫生工作者证实，青少年母亲有多种需求，但缺乏全面的服务方法，而且他们自身的培训和能力非常有限。
我们的论文强调了母婴初级保健环境中几个与个体利益相关者及系统层面相关的障碍，这些障碍影响了为怀孕青少年提供心理社会支持。我们已经确定了这些知识、实践和机构方面的差距，需要通过在资源匮乏环境中有效的实施策略，谨慎地让社区和卫生服务人员参与来加以解决。怀孕青少年是高度脆弱的群体，心理健康服务需要得到更好的理解。
