title: Association between postpartum substance use and depressive symptoms, stress, and social support in adolescent mothers.
abstract: 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 the prevalence of alcohol and drug use in adolescent mothers in the first 4 months postpartum and explored associated psychosocial characteristics.
  
  
  METHODS
  Teenagers attending a comprehensive adolescent pregnancy and parenting program were enrolled consecutively during a routine third trimester prenatal visit. Alcohol use since delivery was determined by self-report at 4 months postpartum using an instrument developed for the 1984 Survey of Drug Abuse Among Maryland Adolescents. Illicit 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, self-administered instruments. Differences in demographic characteristics, peer group influences, and psychosocial variables between substance users and nonusers were evaluated.
  
  
  RESULTS
  Participants (125/129 eligible) were predominantly African-American, mean age 16.3 years. Completed assessments were obtained from 110 at 2 months and 105 at 4 months postpartum. Forty-two percent screened positive for illicit drugs at a postpartum visit or reported using alcohol since delivering their baby and were classified as substance users. Thirty-one percent of subjects reported alcohol use since delivery. Marijuana was the most prevalent illicit drug (14%), followed by opiates (5%), and cocaine (4%). When substance users were compared with nonusers, 44% versus 24% scored depressed (P = .02), 62% versus 43% had high stress (P = .04), and 62% versus 44% reported a high need for social support (P = .07). Results of logistic regression, after controlling for age, indicated that illicit substance and/or alcohol use was 3.3 times greater for those who were depressed, 2.8 times greater if they reported friends' using illicit drugs, and 6.7 times greater if the adolescent reported smoking cigarettes since delivery.
  
  
  CONCLUSIONS
  This study indicates that alcohol and drug use are common among this sample of postpartum teenage mothers and that depression, stress, high support need, and peer group drug use are associated factors. Although this study cannot determine whether depression and stress precede or result from use of substances, attention to these factors appears warranted in the care of adolescent mothers.
authors.affiliation: University of Maryland School of Medicine, Department of Family Medicine, Baltimore, USA.
authors.forename: B
authors.initials: B
authors.lastname: Barnet
authors.forename: A K
authors.initials: AK
authors.lastname: Duggan
authors.forename: M D
authors.initials: MD
authors.lastname: Wilson
authors.forename: A
authors.initials: A
authors.lastname: Joffe
mesh_terms: D000293:Adolescent; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000523:psychology; D019052:Depression, Postpartum / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000523:psychology*; D015995:Prevalence; D012944:Social Support; D012959:Socioeconomic Factors; D013315:Stress, Psychological; D019966:Substance-Related Disorders / Q000453:epidemiology*