ASSOCIATION BETWEEN POSTPARTUM SUBSTANCE USE AND DEPRESSIVE SYMPTOMS,STRESS, AND SOCIAL SUPPORT IN ADOLESCENT MOTHERS

Objective. Substance use by pregnant teenagers is an important public health problem, but published data on alcohol and illicit drug use by parenting teenagers are virtually nonexistent. This study determined t he prevalence of alcohol and drug use in adolescent mothers in the fir st 4 months postpartum and explored associated psychosocial characteri stics. Methods. Teenagers attending a comprehensive adolescent pregnan cy and parenting program were enrolled consecutively during a routine third trimester prenatal visit. Alcohol use since delivery was determi ned by self-report at 4 months postpartum using an instrument develope d for the 1984 Survey of Drug Abuse Among Maryland Adolescents. Illici t drug use was measured with anonymous quantitative urine drug screens at 2 and 4 months postpartum. Depressive symptoms, stress, and social support were assessed at 2 and 4 months postpartum using validated, s elf-administered instruments. Differences in demographic characteristi cs, peer group influences, and psychosocial variables between substanc e users and nonusers were evaluated. Results. Participants (125/129 el igible) were predominantly African-American, mean age 16.3 years. Comp leted assessments were obtained from 110 at 2 months and 105 at 4 mont hs postpartum. Forty-two percent screened positive for illicit drugs a t a postpartum visit or reported using alcohol since delivering their baby and were classified as substance users. Thirty-one percent of sub jects reported alcohol use since delivery. Marijuana was the most prev alent illicit drug (14%), followed by opiates (5%), and cocaine (4%). When substance users were compared with nonusers, 44% versus 24% score d depressed (P = .02), 62% versus 43% had high stress (P = .04), and 6 2% versus 44% reported a high need for social support (P = .07). Resul ts of logistic regression, after controlling for age, indicated that i llicit substance and/or alcohol use was 3.3 times greater for those wh o were depressed, 2.8 times greater if they reported friends' using il licit drugs, and 6.7 times greater if the adolescent reported smoking cigarettes since delivery. Conclusions. This study indicates that alco hol and drug use are common among this sample of postpartum teenage mo thers and that depression, stress, high support need, and peer group d rug use are associated factors. Although this study cannot determine w hether depression and stress precede or result from use of substances, attention to these factors appears warranted in the care of adolescen t mothers.