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School Connectedness, Mental Health, and Well-Beingof Adolescent MothersLaura F. Romo a & Erum Nadeem ba Gevirtz Graduate School of Education, University of California, Santa Barbara , SantaBarbara, Californiab School of Public Health and Health Services Research Center, University of California, LosAngeles , Los Angeles, CaliforniaPublished online: 13 Oct 2009.

To cite this article: Laura F. Romo & Erum Nadeem (2007) School Connectedness, Mental Health, and Well-Being ofAdolescent Mothers, Theory Into Practice, 46:2, 130-137, DOI: 10.1080/00405840701233040

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THEORY INTO PRACTICE, 46(2), 130–137

Laura F. RomoErum Nadeem

School Connectedness, MentalHealth, and Well-Being ofAdolescent Mothers

In this article, the authors describe recent re-search on risk factors associated with adolescentmothers’ mental health outcomes. They outlinethe consequences associated with three majorrisk factors that impact the teen mother’s ad-justment to her new parental role: lack of socialsupport, caregiver stress, and feelings of lowself-efficacy. The article concludes with specificrecommendations in how school personnel canaddress the mental health and related needs ofteen mothers.

Laura Romo is Assistant Professor at Gevirtz GraduateSchool of Education, University of California, SantaBarbara, Santa Barbara, California.

Erum Nadeem, Ph.D., is a Postdoctoral Fellow atSchool of Public Health and Health Services ResearchCenter, University of California, Los Angeles, Los An-geles, California.

Correspondence should be addressed to Laura F.Romo, UC Santa Barbara Education Department,Phelps Hall 1333, Santa Barbara, CA 93106. E-mail:lromo@education.ucsb.edu

Being a parent for the first time isstressful for adults and adolescents alike.

For adolescent mothers, this stress may be com-pounded by the fact that they are often fromimpoverished, underprivileged backgrounds andare faced with a first time pregnancy and moth-erhood, as well as potential conflicts with anddisconnection from friends and family. The de-mands of parenting may make it difficult foradolescent mothers to continue more age ap-propriate tasks such as emotional and identitydevelopment, friendships with their peers, andnormal adolescent dating relationships (Coley& Chase-Lansdale, 1998). Subsequently, theirhealth and future relationships may be affectedadversely. Many adolescent mothers have el-evated depressive symptomatology and otherforms of psychological distress, especially in theyear following childbirth (Wiemann, Berenson,Wagner, & Landwehr, 1996). Depression ratesamong postpartum teenagers have been reportedas ranging between 16 to 44 percent, significantlyhigher than postpartum adult women and non-pregnant adolescent girls (Miller, 1998). These

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are very meaningful figures considering that ma-ternal depression is a stable predictor of negativeparenting and interaction styles and depressionamong offspring (Hammen & Brennan, 2000).

Although many adolescent mothers and theirchildren fare well, it is important for schools to bemindful of common challenges that, when com-pounded, can lead to negative outcomes. Thisarticle reviews recent literature related to risk fac-tors associated with adolescent mothers’ mentalhealth. We organize the literature around threeprevalent risk factors that can affect the teenmother’s adjustment to the new parental role:lack of social support, caregiver stress, and feel-ings of low self-efficacy. We then outline waysin which schools can address these factors toenhance adolescent well-being. This review de-scribes studies that are most relevant to mentalhealth outcomes of ethnic minority teen moth-ers who are unmarried, not living with a partner,and from socioeconomically disadvantaged back-grounds, because they make up the large majorityof teenage mothers today in the United States.

Risk Factors Associated withAdolescent Mothers’ Mental Health

Lack of Social Support

Several studies conducted with African Amer-icans and Latinas suggest that a close, supportiverelationship with their mothers is a criticalresource for the mental health of adolescentmothers. Emotional and material support fromtheir mothers have been shown to predict pos-itive parenting attitudes, nurturing caregivingskills, lower depression, and higher levels oflife satisfaction among adolescent mothers (Field,Widmayer, Adler, & de Cubas, 1990; Hess, Pa-pas, & Black, 2002; Uno, Florsheim, & Uchino,1998). However, in some cases, as was foundin a sample of low-income African Ameri-can families, older teen mothers and their ownmothers may resent a living situation that im-pinges on their independence, which has negativeconsequences on the quality of their parentingskills (Chase-Lansdale, Brooks-Gunn, & Zam-

sky, 1994). Or, the grandmother’s involvementwith childcare may clash with the adolescentmother’s desire to develop a separate identity andachieve autonomy (Caldwell, Antonucci, & Jack-son, 1998). These conflicts potentially threatenmother-daughter relationship quality, which hasserious implications for the adolescents’ mentalhealth, including increased levels of depres-sive symptomology (Kalil, Spencer, Spieker, &Gilchrist, 1998). As such, it is important that par-ents and adolescents communicate about theseissues. It is not co-residence per se but rather thenature and quality of the family relationship thatrelates to better outcomes for adolescent mothersand their children.

Teen mothers without familial support are alsoat risk for experiencing multiple pregnancies.Approximately 30 to 35 percent of adolescentmothers experience another pregnancy within oneyear of having the first child, and 40 to 50 percenthave another pregnancy within the first two years(Coard, Nitz, & Felice, 2000). These statistics arenoteworthy as the negative consequences of ado-lescent childbearing are compounded when anadolescent has multiple children during her teenyears. While a lack of access to family planninginformation and contraceptives may be at fault,research has identified other contributors to rapidrepeat pregnancies during adolescence, includingthe lack of an intact family structure (Boardman,Allsworth, Phipps, & Lapane, 2006), relation-ship disruptions with mothers (Bull & Hogue,1998), and depression (Gillmore, Lewis, Lohr,Spencer, & White, 1997). These findings point tothe need to help adolescent mothers create andmaintain positive connections with supportivenetworks.

The literature reveals mixed findings aboutthe supportive benefits of a relationship with thebaby’s father or romantic partner. The outcomelargely depends on the circumstances that led upto the pregnancy (e.g., whether the teen motherand baby’s father were already living as a couple,had established a good relationship, or the preg-nancy was intended or unexpected). In general,increased support and positive contact with a ro-mantic partner after the baby is born is associatedwith greater life satisfaction, decreased stress,

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decreased depression, and less negative feelingsabout motherhood (e.g., Milan et al., 2004), allof which have positive effects on the mother-infant relationship. However, recent research alsoindicates that abuse and violence from intimatepartners is not uncommon among teen mothers,with rates as high as 41 percent for teen moth-ers in one urban sample (Leadbeater, Way, &Harmon, 2001). Clearly, partners can be eithera source of support or further strain on adoles-cent mothers and is an area in need of furtherresearch.

Caregiver Stress

Given the increased stress that adolescentmothers face and their potential immaturity asparents, it might be surmised that adolescentswould have more difficulty being good parentsthan adults (Brooks-Gunn & Furstenberg, 1986).Initial research in this area is somewhat inconclu-sive as it has been plagued with methodologicalshortcomings, the most important of which isthe noncomparability of adults and adolescents interms of ethnicity and socioeconomic indicators.It has also been argued that the negative parent-ing associated with teenage childbearing may bea function of exposure to chronic poverty ratherthan the age of the mother (McLoyd, 1998).However, some well-designed studies compar-ing adolescent mothers to adult mothers havefound that adolescent mothers tend to provideless stimulating home environments than adultmothers (Luster & Dubow, 1990), a risk factorfor delays in children’s cognitive functioning andpreparedness for school (McLoyd, 1998). Otherresearch indicates that although adolescent moth-ers are as warm as older mothers, they are oftenless sensitive and responsive to their infants’needs than adult mothers (Culp, Appelbaum,Osofsky, & Levy, 1988; Sommer, Whitman,Borkowski, Schellenbach, Maxwell, & Keogh,1993). These findings suggest there are benefitsto educating adolescents about the intellectualand emotional needs of their infants, and howcaregiver stress can interfere with their levels ofresponsiveness.

Low Self-Efficacy to Succeed

In addition to coping with parenting re-sponsibilities, it is important to enhance teenmothers’ self-efficacy in other domains. Self-efficacy refers to the beliefs in one’s capacityto perform well (Bandura, 1997), and it is pos-itively linked to academic achievement (Pajares,1996). Prior to becoming pregnant, many of theteen mothers were struggling academically, weredisengaged from school, or had learning disabil-ities (Stephens, Wolf, & Batten, 1999). Hence,many adolescent mothers may have doubts abouttheir capability to obtain a high school diploma,a key reason to track closely and support theiracademic progress.

Interestingly, for some teens, having a childcreates an incentive to overcome barriers to suc-cess. In an ethnographic study that explored theresiliency and strengths of adolescent mothers,one motivating factor for an adolescent mother tosucceed (e.g., finish school, become financiallyindependent) was the “rebellious determinationto prove she was not doomed to failure” (Carey,Ratliffe, & Lyle, 1998, p. 347). Pregnant andparenting adolescents report that their drives tosucceed are inspired by their desire to be goodexamples for their children (Shanok & Miller,2005; Way & Leadbeater, 1999). Feelings ofresponsibility and protectiveness over their chil-dren also motivate some pregnant and parentingadolescents to avoid risk behaviors, such as alco-hol and drug use, and violent (fighting) behavior(Kaiser & Hays, 2005; Shanok & Miller, 2005).Thus, enhancing self-efficacy to succeed in aca-demics and other domains can help pregnant andparenting teens maintain resilience in the face ofeducational and economic challenges.

In summary, various risk factors, such as lackof social support, caregiver stress, and feelingsof low self-efficacy impact the teen mother’sadjustment to the new parental role and mayhave long-term negative consequences. Yet, it theaccumulation of risk factors that predicts neg-ative life outcomes for adolescent mothers, notthe presence of any one risk factor alone. Onlya subset of young mothers will experience ex-treme hardship, such as dealing with depression,

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substance use, poverty, and partner violence, is-sues that require intervention from mental healthprofessionals.

The Role of Schools in AddressingMental Health Risks

In this section, we outline ways that schoolscan enhance the well-being of adolescent moth-ers. We advocate that the best approach toimproving adolescent mother’s mental health in-volves working simultaneously on multiple issues(e.g., mental health care, caregiver skills, socialand academic support). Although we generalizeresearch findings in this section to all ado-lescents, one should keep in mind that somerecommendations may be more relevant to partic-ular ethnic groups and less to others. There is no“one size fits all” model, and schools need to beattuned to the beliefs, values, and practices of thelocal community in all of the services and sup-ports that they provide. For example, Latina adultand adolescent mothers report turning to familymembers during stressful times more than otherethnic groups do, are more open to advice fromothers regarding childrearing issues, and allowextended family more involvement in childcare(Becerra & de Anda, 1984; Fuller, Holloway, &Liang, 1996). Hence, schools may find that in-creased family involvement in childcare enhanceswell-being for this group of adolescent moth-ers, especially those from immigrant households(Nadeem & Romo, in press). On the other hand,for African American adolescents, and particu-larly for those who are older, coresidence maybe stressful and even have negative consequenceson infant parenting styles for both the teen moth-ers and the grandmothers (Chase-Lansdale et al.,1994).

Enhancing Adolescents’ Self-Efficacyto Succeed

The preponderance of evidence paints a verygrim picture of adolescent educational outcomes,but the news is not all bad. Many adolescentmothers are able to complete high school, and

by their mid to late twenties, they are often ableto earn wages that equal their peers who didnot have children in their teenage years (Fos-ter, Jones, & Hoffman, 1998; Hoffman, Foster,& Furstenberg, 1993). This trend may be at-tributed to the fact that we as a society areadapting to the needs of adolescent mothers byproviding greater access to and support for edu-cation. Nevertheless, 25 percent of teen mothersnever become economically self-sufficient and30 percent do not finish high school (Whit-man, Borkowski, Keogh, & Weed, 2001), leavingmany adolescents unprepared and noncompeti-tive for future employment. Given that financialstrain is directly linked to depressive symptomsin teen mothers (Kalil & Danziger, 2000), posi-tive mental health outcomes are dependent uponachieving educational success.

To enhance academic motivation and achieve-ment, Batten and Stowell (1999) recommend thatschool personnel incorporate flexibility into theschool day and instructional practices. For ex-ample, teens may feel defeated when they arerepeatedly late to school or have to miss classesand assignments due to childcare issues or med-ical appointments. To avoid dropping out ofschool, parenting teens would benefit from classschedules that allow for early dismissal or late ar-rival. It may also be beneficial to combine schoolattendance with home tutoring and make-up as-signments that allow teens with parenting andhealth issues to miss school. Summer programsand partial crediting systems can help teens makeup instructional time. Finally, it is especially criti-cal that teen parents have positive perceptions ofthe school environment. Messages that conveylow educational expectations from teachers (e.g.,being advised not to take “smart” classes) nega-tively impact adolescent mothers’ confidence tosucceed academically (Kalil, 2002).

In addition to academic self-efficacy, schoolscan play a role in promoting mothering com-petence. Adolescent mothers who are moreknowledgeable about child development and whohold more realistic parenting expectations seemto be better adjusted and more successful par-ents. They provide their children with a higherquality home environment, and their children

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perform better on cognitive assessments andshow fewer behavior problems years later (Be-nasich & Brooks-Gunn, 1996). Understandinghow caregiver behaviors impact cognitive andlanguage development may motivate teen moth-ers to interact and play with their infants incognitively stimulating ways (e.g., monitor thechild’s gaze behavior, follow in on the child’s in-terests instead of redirecting attention to otherobjects). Although it is beyond the scope ofthe current review to address outcomes forteen fathers, caregiver support programs shouldalso engage adolescent fathers, with sensitiv-ity to the relationship dynamics between theparents.

Increasing Social Support

Today, shared caregiving between mothers andadolescent daughters is common, given recentpolicies which require that adolescent mothersmust live with a guardian to receive finan-cial assistance (U.S. House of Representatives,1996). As mentioned, for the most part such anarrangement where there is increased family in-volvement in childcare enhances well-being forteen mothers. In cases when co-residence is detri-mental due to highly strained mother-daughterrelationships, referrals to professional counselingservices may be needed for resolving conflicts.Interventions that provide training for mothersand daughters to communicate openly and ef-fectively may improve family functioning andadolescent parenting.

Some researchers also highlight the impor-tance of increasing social support from schoolpersonnel (e.g., Kalil, 2002). Adolescent moth-ers must perceive that teachers, counselors, andschool psychologists are available, interested,and supportive of their problems (Kalil, 2002).These perceptions are especially critical in theabsence of a positive family social support net-work. Additionally, because many teen mothersfeel isolated and stigmatized when raising theirchildren (Rothenberg & Weissman, 2002), a teenmother peer support group facilitated by a schoolpsychologist can provide aid and support, andcreate a venue that teens can rely on to discuss

parenting challenges and solutions. Adolescentmothers with higher levels of peer support, andhence less social isolation, appear to be lessprone to living in the fear or threat of partnerviolence (Sussex, 2005).

Reducing Caregiver Stress

Comprehensive programs in which teen moth-ers receive a range of services are most successfulin reducing stressors associated with teenageparenting. The California School Age FamiliesEducation (Cal-SAFE) program, administered bythe California Department of Education, is oneexample. It is designed to provide support ser-vices for pregnant or parenting teens to improveacademic achievement and skills, and to providequality child care for their children. Programsoperate in local high schools, where teens cancomplete their academic requirements towardsearning a high school diploma. Congruent sup-port services include on-site childcare centers(at the high school) where teens also get handson, supervised experience in caring for chil-dren. Pregnant and parenting teens are alsoprovided with vocational counseling and helplinking to other community health services. Inessence, these programs provide a wholly inte-grated support system to help adolescent motherssuccessfully juggle the dual roles of high schoolstudent and mother.

On an individual level, schools can integratethe needs of adolescent mothers in their existingstructures or provide outside referrals. Currently,there are about 1500 comprehensive school basedhealth centers in 43 states and the District ofColumbia (Center for Health and Health Care inSchools, 2003). In line with the recommendationsof the President’s New Freedom Commission onMental Health to expand school mental healthprograms (Hogan, 2003), 83 percent of schoolsreport providing case management for studentswith emotional problems, and nearly half ofall schools work with a community-based or-ganization to provide mental health or socialservices to students (Brenner, Martindale, &Weist, 2000).

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Raising Awareness Among Staff of MentalHealth Needs

As is evident, many adolescent mothers re-main at high risk for psychological distress,especially depression. In a recent longitudinalstudy conducted with 623 adolescent mothersfrom diverse ethnic backgrounds, the researchersfound that over 50 percent of adolescent moth-ers experienced moderate to severe depressivesymptomatology during the 12 months post-partum period (Schmidt, Weimann, Rickert, &Smith, 2006), with its highest prevalence at three-months postpartum. For some mothers, especiallyMexican-American adolescents, these depressivesymptoms persisted up to four years later, high-lighting the importance of training school staff tobe mindful of this risk. Schools should educatetheir staff about the symptoms of clinical depres-sion to improve the likelihood of early screening,early identification, and referral to appropriatemental health services. In tandem with these ef-forts, staff should be equally attuned to signs ofintimate partner violence and equipped to pro-vide necessary resources and referrals to combatsituations of abuse.

Conclusion

In conclusion, adolescent mothers remain athigh risk for psychological distress. The goodnews is that school administrators, counselors,and teachers are poised to make a difference.The ability of schools to be responsive to theneeds of adolescent mothers has profound long-term implications. Teen mothers who attend orgraduate from high school are more likely to en-roll in parent education classes, have increasedknowledge of child development and parent-child interaction skills (Kaiser & Hays, 2005),are more nurturant caregivers (Hess, Papas, &Black, 2002), have higher educational aspirations(Leadbeater, 1996), and, very importantly, expe-rience less depression, less anxiety, and higherself-esteem (Weed, Keogh, & Borkowski, 2000)compared to adolescents who do not attend orgraduate from high school. It is important that

schools consider these research findings in shap-ing intervention programs to attend to the psy-chological needs of their pregnant and parentingadolescents.

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er 2

014