The timing of norplant insertion and postpartum depression in teenagers.
BACKGROUND
This study tested the hypothesis that teenagers who have Norplant inserted during the puerperium report more depressive symptoms during the first postpartum year than their peers who do not receive Norplant.


METHODS
We studied the prevalence of depressive symptoms in a group of 212 mothers aged 19 years less, in relation to the timing of Norplant insertion. The participants were divided into 3 groups: 100 (47%) had Norplant inserted during the puerperium (early Norplant users); 72 (34%) had Norplant inserted during the next 10 months (late Norplant users); and 40 (19%) used other contraceptives (40% oral contraceptives; 17% condoms; 43% nothing). Depressive symptoms were measured with the Center for Epidemiologic Studies - Depression Scale. Postpartum depression was defined as a scale score >/=16, 6-12 months after Norplant insertion or delivery. Variables examined as potential confounders were identified a priori from a review of the literature and controlled for in analysis of variance.


RESULTS
At delivery, members of the 3 contraceptive groups did not differ significantly with regard to age, race, parity, educational, marital, or socioeconomic status. Late Norplant users were, however, more apt to have new boyfriends (p =. 03), to rate the support they received from the baby's father as poor (p =.004), and experience depression prior to Norplant insertion (p =.02). Contrary to the study hypothesis, late rather than early Norplant insertion was associated with postpartum depression. Multivariate analyses identified 3 independent predictors of the severity of depressive symptoms at follow-up (depression prior to Norplant insertion, a new boyfriend at delivery, and late Norplant insertion); R(2) = 41.3%.


CONCLUSIONS
Contrary to the study hypothesis, puerperal Norplant insertion did not exacerbate postpartum depression. Delaying Norplant insertion may increase the risk of depression during the first postpartum year, particularly in teenagers with other psychosocial risk factors.
Stevens-Simon
C
C
Department of Pediatrics, Division of Adolescent Medicine, University of Colorado Health Science Center, Denver, Colorado 80218, USA.
Kelly
L
L
Wallis
J
J
D000293:Adolescent; D000704:Analysis of Variance; D003271:Contraceptive Agents, Female / Q000009:adverse effects*; D003863:Depression / Q000139:chemically induced* / Q000517:prevention & control / Q000523:psychology; D019052:Depression, Postpartum / Q000139:chemically induced* / Q000517:prevention & control / Q000523:psychology; D004343:Drug Implants; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016912:Levonorgestrel / Q000009:adverse effects*; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000523:psychology; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012944:Social Support; D013997:Time Factors
D003271:Contraceptive Agents, Female; D004343:Drug Implants; D016912:Levonorgestrel