Background
Postpartum depression is a severe psychological condition that occurs during the puerperium period, potentially leading to disturbances in infant care (American Psychiatric Association, 2013). Distinguishing it from postpartum blues is crucial, as the latter occurs within two weeks after childbirth, while postpartum depression (PPD) can arise anywhere from one month to a year after giving birth. Failure to detect or address postpartum blues adequately can escalate into depression. In some cases, PPD can persist for up to three years after childbirth (Chi et al., 2016). Depression, a common mental disorder, is prevalent among adolescents and teenagers. Disturbingly, projections indicate that by 2030, depression could pose a significant risk of mortality after heart disease (World Health Organization, 2023).
Untreated and prolonged depression can be a significant risk factor for suicide. Shockingly, suicide ranks as the second leading cause of death among adolescents and young adults (World Health Organization, 2023). Among different age groups, mothers who have recently given birth experience the second-highest incidence of depression following adolescence. This higher susceptibility to postpartum depression is notable, with women being three times more likely to develop depression during this period compared to other phases (World Health Organization, 2023).
In Indonesia, there is a concerning trend of early marriages among young girls. A substantial 37.91% of girls get married at 16, and 22.92% get married at 17 (Ministry of Women Empowerment and Child Protection, 2018). Early marriages can contribute to various challenges, including mental health issues, and highlight the importance of providing support and awareness to vulnerable populations. Previous studies have shown that the prevalence of postpartum depression in adult women ranges from 19% to 24% (Nurbaeti et al., 2018, 2019). However, in the United States, adolescent mothers experience postpartum depression at a significantly higher rate—50% higher than mothers who give birth in adulthood (above 20 years) (Haroz et al., 2014). In central Java, Indonesia, the rate of postpartum depression among adolescent mothers was even higher at 60.58% (Rahmadhani & Laohasiriwong, 2020).
Postpartum depression can have consequences, affecting the mother and her child, husband, and family. Mothers experiencing postpartum depression may find it challenging to provide optimal care for their babies due to feelings of powerlessness and an inability to fulfill their responsibilities. Consequently, this can lead to suboptimal hygiene and health conditions for the baby. Additionally, mothers may lack enthusiasm for breastfeeding, potentially disrupting the baby's growth and development (Petzoldt et al., 2016). The mother-baby attachment can also be affected by this depression. Furthermore, postpartum depression can result in weakened childcare and interactions between the mother and child (Brummelte & Galea, 2016), which may have long-term effects on the child's growth and development (Garthus-Niegel et al., 2017; Prady & Kiernan, 2013; Smith-Nielsen et al., 2016).
Numerous studies have extensively investigated risk factors for postpartum depression, primarily focusing on adult mothers. These risk factors include lack of support, anxiety during pregnancy, antenatal depression, stressful life events, poor marital relationships, a history of depression, baby temperament, low socioeconomic status, low self-esteem, unexpected pregnancy, stress related to caring for a baby, maternity blues, and unmarried status (Beck, 2001; O'Hara & McCabe, 2013), as well as breastfeeding difficulties (Chaput et al., 2016; Pope & Mazmanian, 2016). However, there is a lack of adequate research on the factors contributing to postpartum depression among adolescent mothers.
Among adolescent mothers, factors such as interpersonal issues, parenting and infant-related factors, socioeconomic status, stress, and low self-esteem play crucial roles (Kleiber & Dimidjian, 2014). Lack of family support, economic barriers, previous history of depression, and poverty have also been identified as contributing factors (Hipwell et al., 2016; Hymas & Girard, 2019). Nevertheless, some aspects remain understudied, and certain factors are yet to be fully understood. For instance, the influence of Islamic religiosity, social support, and marital relationships are significant among postpartum adolescent mothers, as they are particularly vulnerable to emotional instability during this phase.
Transitioning to motherhood during adolescence presents unique challenges compared to older mothers, who often lack adequate knowledge, skills, and resources to cope with early motherhood (Van Zyl et al., 2015). The process of attaining motherhood skills may take up to four months after birth for some mothers (Erfina et al., 2019). Adolescent mothers face additional burdens during early motherhood, leading to stress and depression (Mangeli et al., 2017). Hormonal changes during pregnancy and after childbirth, the physical discomfort of delivery, and the responsibility of caring for a child add to the emotional challenges (Ortiz Martinez et al., 2016).
Support from family and others also plays a crucial role in helping adolescents navigate the challenges of motherhood. Less family support has been identified as a contributing factor to postpartum depression in adolescent mothers (Hymas & Girard, 2019). Additionally, the religious and spiritual well-being of a mother can significantly affect her mental state. Lack of religiosity has been linked to depression (Ronneberg et al., 2016) and postpartum depression (Cheadle et al., 2018), while studies on Islamic religiosity remain scarce.
Furthermore, adolescent mothers often depend on support from their spouses and mothers to care for their babies due to their lack of preparedness for childcare (Hymas & Girard, 2019). However, research on postpartum depression among teenage mothers in Indonesia, particularly in West Java, remains limited, with only a few studies investigating this issue. This lack of research emphasizes the need for more comprehensive studies to address the mental health and well-being of postpartum mothers in Indonesia.
Derived from Beck (2001), this research aimed to identify the correlation between Islamic religiosity, social support, marital satisfaction, and postpartum depression experienced by mothers during the postpartum period until their child reaches one year of age in West Java province, Indonesia. This study aimed to contribute valuable knowledge that can potentially improve the well-being and mental health of teenage mothers during their postpartum journey.
The role of nurses and other healthcare professionals is vital in addressing postpartum depression. By incorporating spirituality into their practices, healthcare professionals can facilitate patient compliance and elevate patient expectations (Cheadle et al., 2018). This research aligns with the responsibilities of nursing practitioners in caring for adolescent mothers and comprehending the factors associated with postpartum depression. Moreover, the findings of this study can aid in developing appropriate programs to alleviate postpartum depression among adolescent mothers.
Methods
Study Design
The research utilized a cross-sectional study design and was conducted in two districts in West Java Province, Indonesia. The study took place during the period from July to August 2020. The decision to select West Java as the study site was based on its status as the second-highest province regarding adolescent marriage rates in Indonesia. Furthermore, within West Java province, the districts of Cianjur and Sukabumi were chosen due to their distinction as having the highest rates of adolescent marriages.
Samples/Participants
The sample size for the study was determined using the G*Power calculation, accounting for a 10% potential dropout rate (Kang, 2021). Based on the two independent proportion formulations with p1= 0.35, α = 0.05, and power (β) = 0.80, the minimum required sample size was 183. Considering the 10% dropout rate, the total sample was 201 participants. A total of 203 participants were recruited using cluster sampling, with 101 respondents from the Cianjur district and 102 respondents from the Sukabumi district. The sample; inclusion criteria were as follows: a) Muslim mothers aged 20 years or less, who were in the postpartum period ranging from one month to one year after childbirth, b) mothers with a term pregnancy who delivered a live baby, and c) married mothers. On the other hand, the exclusion criteria were: mothers with existing mental disorders and mothers and their babies currently undergoing treatment in hospitals or health services.
Instruments
Several instruments were used in this study:
Demographic Information
The demographic data utilized in this study comprises information related to both mothers and babies. For mothers, the data includes age, education level, marital status, parity, family income, and the type of childbirth. As for the babies, the information collected includes their gender and birth weight.
The Edinburgh Postnatal Depression Scale (EPDS)
The EPDS was developed by Cox et al. (1987) to assess symptoms of postnatal depression. It has been widely translated and utilized among the Indonesian population (Aadillah & Nurbaeti, 2023; Handini & Puspitasari, 2021; Nurbaeti et al., 2018, 2019). The scale consists of 10 questions, and respondents provide answers on a 4-point scale, with scores ranging from 0 to 3. The total EPDS score can range from 0 to 30. A cut-off score of 12 or higher indicates the presence of postpartum depression symptoms. The EPDS has demonstrated validity and reliability in various studies. The validity of the scale falls within the range of 0.371 to 0.701, and its internal consistency, measured by Cronbach's alpha, was found to be 0.788.
The Revised Dyadic Adjustment Scale (RDAS)
The measurement of marriage satisfaction was carried out using the RDAS Indonesia version. The RDAS was originally developed by Busby et al. (1995), and appropriate permission from the developer was obtained. The scale was translated into the Indonesian language by Wulansari and Setiawan (2019). It comprises 14 items, each with six answer options and a score range of 0-5, except for item number 11, which has five answer options with a score range of 0-4. The cut-off score for the RDAS is 48. A score of 48 or higher indicates a good marital relationship, while a score of 47 or lower suggests distress in the marriage relationship (Ward et al., 2009). Regarding the validity of the RDAS, it has been established to be valid, with scores falling within the range of 0.181 to 0.586. The reliability of the scale, as measured by Cronbach's alpha, was found to be 0.756, indicating good internal consistency.
The Postpartum Support Questionnaire (PSQ)
The PSQ was utilized to assess social support during the postpartum period. The questionnaire was originally developed by Logsdon and McBride (1994), and the researcher obtained permission from the developer before translating it. The PSQ has been translated into Indonesian by Nurbaeti et al. (2018). It comprises 34 items, rated on a scale of 0-7, resulting in a score range of 0 to 238. The cut-off score for the PSQ is 123. A score of 123 or higher indicates good postpartum support, while a score of 122 or lower suggests lower levels of postpartum support. The validity of the PSQ has been established, with scores falling within the range of 0.514 to 0.809. Additionally, Cronbach's alpha reliability test yielded a high value of 0.964, indicating excellent internal consistency.
The Muslim Religiosity Postpartum Questionnaire (MRPQ)
The MRPQ was developed by researchers to measure Islamic religiosity during the postpartum period. The instrument was based on the theories of religiosity by Glock (1962) and El-Menouar (2014) and encompassed five dimensions: belief, ritual practice, devotion, experience and knowledge, and consequences. The religiosity during the postpartum period was captured, including practices such as ‘aqiqah’, caring for babies according to Islamic principles, and postnatal worship.
Initially, 50 items were developed by the researchers, and content validation was carried out with a panel of experts consisting of specialists in Islam, maternity nursing, and midwifery. Based on their input, nine additional items were added, resulting in 59 items rated on a scale of 1 to 4 (1 = not relevant, 2 = item needs revision, 3 = relevant but needs revision, 4 = very relevant). The content validity index (i-CVI) for the 59 items was 0.88, and the scale content validity index (s-CVI) was 0.90, indicating good content validity to proceed with construct validity testing (Zamanzadeh et al., 2015).
For construct validity testing, 102 postpartum mothers were involved, and Confirmatory Factor Analysis (CFA) was used for statistical analysis. The model fit indices (Chi-square = 368.856, df = 333, RMSEA = 0.026, CFI = 0.979, TLI = 0.974) indicated that the model was fit for the data. After estimating and testing the significance of each item's parameter, 29 items were deemed valid (estimate = 1.792 -3.937, p-value < 0.05), while 30 items were found to be invalid (p-value > 0.05). Reliability testing using Cronbach's alpha was then conducted for the final 29-item MRPQ, yielding a good internal consistency with a Cronbach's alpha of 0.724. In this study, the 29-item MRPQ, rated on a 0 – 4 Likert scale, was utilized, resulting in a score range of 0 – 116, with a cut-off score of 84. A score of 84 or higher indicates good Muslim postpartum religiosity, while a score of 83 or lower indicates lower levels of Muslim postpartum religiosity.
Data Collection
The research preparation involved several steps, including obtaining ethical approval, securing research venue permits, reproducing questionnaires, and training enumerators. One research assistant and eight enumerators (four in each district) were enlisted to assist with the research. The research assistant was a lecturer in the Nursing Program in Sukabumi, while the enumerators were local residents and nursing students from Sukabumi and Cianjur districts. A one-day training was conducted in each study setting to ensure that the research assistant and enumerators had a unified understanding of the research's purpose and data collection methods.
Data collection commenced after obtaining ethical approval, and research permits from the District Health Offices of Cianjur and Sukabumi. Each district was divided into three Public Health Centers. Potential respondents were identified from the Public Health Clinic data, and their phone numbers were obtained. Eligible respondents were contacted by phone and invited to participate in the study, with a mutually agreed-upon time for a home visit.
The enumerators visited the respondents’ homes to collect the data while adhering to health protocols due to the COVID-19 pandemic. An online platform was used for data collection, but due to limitations in its use, respondents were required to be physically present during the data collection process. To ensure confidentiality, respondents were not accompanied by their husbands, relatives, friends, or family members while completing the questionnaires. Health protocols were strictly followed throughout the data collection process to safeguard the well-being of all involved parties.
Data Analysis
Univariate analysis was employed for descriptive variables, while bivariate analyses were conducted using the Chi-square test. Significant variables identified in the bivariate analysis were further subjected to multivariate analysis using the multiple logistic stepwise method.
Ethical Considerations
The study obtained ethics approval from Universitas Islam Negeri Syarif Hidayatullah Jakarta (No. Un.01/F.10/KP.01.1/KE.SP/07.08.018/2020, approved on 20 July 2020). Before proceeding, researchers and enumerators explained the study’s purpose, goals, potential benefits, and instructions on completing the questionnaire to the participants. Informed consent was obtained from the participants, signifying their willingness to participate in the study.
Results
Characteristics of the Respondents
Table 1 displays the characteristics of the respondents. The age of the respondents ranged from 14 to 20 years, with a mean age of 19.08 (SD = 1.191). Regarding the education level of the mothers, 33% had completed basic school, 48.3% had attended junior school, and 18.7% had completed high school. Additionally, 95.6% of the mothers were housewives, while 4.4% were working mothers. The family income of the respondents varied between IDR 100,000 (equivalent to US$ 8.5) and IDR 4,000,000 (US$ 285), with a mean income of IDR 1,562,686.57 (SD = 777,126,596). Among the respondents, 63.1% identified their husbands and parents as meaningful individuals, 29.6% identified only their husbands, and 7.4% identified only their parents. Moreover, 92.6% of the mothers were primiparas, while 7.4% already had two children. As for pregnancy planning, 59.1% of the mothers had planned pregnancies, and 40.9% had unplanned pregnancies. Regarding childbirth, 99% of the mothers had normal deliveries, while only 1% gave birth through C-sections. Among the mothers, 95.6% did not experience any complications during childbirth, while 4.4% faced complications such as bleeding. Regarding the gender of the babies born, 59.1% were male, and 40.9% were female. The babies' weights at birth ranged from 1400 grams to 4000 grams, with a mean weight of 2,913.05 grams (SD = 400,049).
| Characteristics | n | % | Mean (SD), Min-Max |
|---|---|---|---|
| Mother Information | |||
| Age (year) | 19.08 (1.191), 14 - 20 | ||
| Education level | |||
| Basic School | 67 | 33.0 | |
| Junior School | 98 | 48.3 | |
| High School | 38 | 18.7 | |
| Working status | |||
| Housewife | 194 | 95.6 | |
| Working | 19 | 4.4 | |
| Family income (IDR) | 1,562,686.57 (777,126.60), 100,000 - 4,000,000 | ||
| Live with | |||
| Husband | 60 | 29.6 | |
| Parents | 15 | 7.4 | |
| Husband and Parent | 128 | 63.1 | |
| Number of children | |||
| 1 | 188 | 92.6 | |
| 2 | 15 | 7.4 | |
| Pregnancy planning | |||
| Yes | 120 | 59.1 | |
| No | 83 | 40.9 | |
| Types of childbirth | |||
| Normal | 201 | 99.0 | |
| C-section | 2 | 1.0 | |
| Complications during childbirth | |||
| Yes | 9 | 4.4 | |
| No | 194 | 95.6 | |
| Baby Information | |||
| Current baby gender | |||
| Boy | 120 | 59.1 | |
| Girl | 83 | 40.9 | |
| Baby birth weight (grams) | 2,913.05 (400.05), 1,400 – 4,000 |
Description of Islamic Religiosity, Social Support, and Marriage Satisfaction
Table 2 presents a description of the variables in this study. Islamic religiosity had a mean score of 125.33 (SD = 13.202), ranging from 92 to 150. Social support had a mean score of 122.69 (SD = 53.551), ranging from 7 to 233. Marital relationships had a mean score of 50.88 (SD = 8.781), ranging from 14 to 65. Based on the mean value as a cut-off score due to a normal distribution of data (skewness value for Islamic religiosity = -0.404; and social support = -0.244), and the median value as a cut-off score for marital relationships (skewness value = -1.097), the results of the distribution of Islamic religiosity frequency, social support, and marital relations were obtained. A total of 92 mothers (45.3%) had sufficient religiosity, and 111 mothers (54.7%) had good religiosity. A total of 90 mothers (44.3%) were known to lack social support during the postpartum period, while 113 mothers (55.7%) had the perception of getting a lot of social support. Ninety-three mothers (45.8%) stated that they were less satisfied with their marriage, and as many as 110 mothers (54.2%) were satisfied with their marriage.
| Variable | Mean | Median | SD | Min | Max |
|---|---|---|---|---|---|
| Islamic religiosity | 125.33 | 127 | 12.20 | 92 | 150 |
| Social support | 122.69 | 127 | 53.55 | 7 | 233 |
| Marriage satisfaction | 50.88 | 52 | 8.78 | 14 | 65 |
Postpartum Depression in Adolescent Mothers
Postpartum depression had a mean score of 9.50 (SD = 5.163), with scores ranging from 0 to 25. Using a cut-off score of 12, it was found that 35.96% of adolescent mothers had symptoms of PPD.
Association between Islamic Religiosity, Social Support, Marital Satisfaction, and Postpartum Depression
Out of the 73 mothers who experienced symptoms of postpartum depression, 46.6% had a sufficient level of religiosity, while 53.4% had a good level of Islamic religiosity. The results indicated no significant correlation between Islamic religiosity and PPD in adolescent mothers (p = 0.778). Regarding social support, 42.5% of mothers who experienced postpartum depression reported receiving less support. The findings showed that social support was not significantly related to postpartum depression in adolescent mothers (p = 0.688). However, when analyzing odds, it revealed an estimated value of 1.126 with a 95% CI of 0.631-2.008. This implies that mothers perceiving a lack of support during the postpartum period tended to experience postpartum depression 1.13 times (0.6-2) more than those who felt supported.
On the other hand, 60.3% of mothers who expressed dissatisfaction with their marriage also experienced symptoms of postpartum depression. The statistical analysis demonstrated a significant association between marital satisfaction and PPD in adolescent mothers (p = 0.002). The Odds Ratio returned a value of 0.399 (95% CI = 0.221 – 0.718), indicating that respondents dissatisfied with their marriage were at a 0.399 times higher risk of experiencing postpartum depression than those who perceived satisfaction with their marriage (Table 3).
| Variable | Depression | X2 | p | OR 95% of the CI | |||
|---|---|---|---|---|---|---|---|
| Yes | No | ||||||
| n | % | n | % | ||||
| Islamic Religiosity | |||||||
| Enough | 34 | 46.6 | 58 | 44.6 | 0.072 | 0.778 | 0.924 (0.520 - 1.643) |
| Good | 39 | 53.4 | 72 | 55.4 | |||
| Social Support | |||||||
| Less | 31 | 42.5 | 59 | 45.4 | 0.161 | 0.688 | 0.399 (0.221 - 0.718) |
| Good | 42 | 57.5 | 71 | 54.6 | |||
| Marriage Satisfaction | |||||||
| Less | 44 | 60.3 | 49 | 37.7 | 9.60 | 0.002 | 1.126 (0.631 - 2.008) |
| Good | 29 | 39.7 | 81 | 62.3 | |||
Additionally, a covariate analysis was conducted considering maternal and infant characteristics. The analysis revealed significant relationships between PPD and factors such as education, family income, the number of children, and the weight of the baby at birth (Table 4).
| Variable | X2/t | p |
|---|---|---|
| Level of education | 6.245 | 0.012* |
| Working status | 0.028 | 0.867 |
| Family income | 9.128 | 0.003* |
| Number of children | 4.064 | 0.044* |
| Types of childbirth | 1.134 | 0.287 |
| Childbirth complications | 0.294 | 0.587 |
| The current baby's gender | 0.302 | 0.583 |
| Baby birth weight | 103.708 | 0.0001* |
Note: *significant level (<0.05)
The subsequent analysis shown in Table 5 involved conducting a multiple logistic regression to assess the variable of marital satisfaction and the significant covariate variables. In stage 1 of the analysis, the Nagelkerke R2 was found to be 0.168, the -2 log-likelihood was 238.689, and the Lemeshow significance test yielded a value of 0.979. Among the covariate variables, income (p = 0.010), the number of children (p = 0.027), and marital satisfaction (p = 0.002) showed significant associations with PPD. On the other hand, education (p = 0.24) and the baby's weight at birth (p = 0.912) were not significantly associated with PPD. Therefore, education and the baby's weight at birth were not considered in the logistical regression test at a later stage, as indicated by the Lemeshow test of significance (p = 0.87) confirming the model’s fit. It can be concluded that marital satisfaction (p = 0.001), family income (p = 0.001), and the number of children (p = 0.026) were significantly correlated with PPD. The income and the number of children were found to influence PPD in teenage mothers, alongside marital satisfaction. The odds ratio for income was 0.362, indicating that low-income mothers had a 0.362 times higher chance of experiencing PPD in comparison to other adolescent mothers.
| Variable | B | SE | Wald | df | p | Exp(B) | 95% CI for Exp(B) | |
|---|---|---|---|---|---|---|---|---|
| Lower | Upper | |||||||
| Constant | 1.031 | 0.877 | 1.380 | 1 | 0.240 | 2.803 | ||
| Family income | -1.122 | 0.348 | 10.401 | 1 | 0.001 | 0.326 | 0.165 | 0.644 |
| Number of children | 1.303 | 0.583 | 4.989 | 1 | 0.026 | 3.680 | 1.173 | 11.547 |
| Marriage satisfaction | -1.007 | 0.314 | 10.261 | 1 | 0.001 | 0.365 | 0.197 | 0.676 |
Note: -2 Log Likelihood = 240.178 | Nagelkelke R2 = 0.159 | Lemeshow test sig.= 0.870
Discussion
The results indicated that 35.96% of adolescent mothers in the study had symptoms of postpartum depression. This highlights the ongoing concern regarding mental health issues ((Falgas-Bague et al., 2023). The prevalence of postpartum depression in this study surpassed previous research conducted on postpartum mothers aged above 21 years (Aadillah & Nurbaeti, 2023; Nurbaeti et al., 2018, 2019). Furthermore, the results align with a study conducted in the United States, suggesting that the rate of depression in adolescent mothers is higher than that in adult mothers during the postpartum period (Haroz et al., 2014).
The findings showed that the status of Islamic religiosity among the respondents was almost balanced, with 46.6% of mothers having sufficient Islamic religiosity and 53.4% having a good level of Islamic religiosity. However, the statistical analysis indicated no significant association between Islamic religiosity and PPD in adolescent mothers. This result was consistent with previous research (Akbarzadeh et al., 2015; Handelzalts et al., 2020). The role of religiosity in an individual's life was closely linked to the function of religion. Religion was a source of mental support, aiding individuals in problem-solving (Ronneberg et al., 2016). Moreover, religion played a crucial role in social life, preventing crime-related behaviors and maintaining marital stability. From a psychological perspective, engaging in religious rituals or practices provided a sense of tranquility and well-being (Haryanto, 2016).
Religious doctrines and practices, including prayers, served as self-relaxation, fostering self-reflection and generating a sense of inner well-being. Belief in God instilled faith and immense strength in individuals, offering them spiritual resilience to overcome mental hardships and alleviate fears, anxieties, and worries. In today's world, where material pursuits dominate people's attention, there is an increasing need for spirituality. The purpose of material possessions and the intense competition often lead to significant mental stress, making individuals vulnerable to various psychological issues, such as anxiety and depression. Embracing religiosity helps people avoid idleness, frenzy, and cognitive impairments, allowing them to improve themselves continuously. Furthermore, religion promotes personality stability, mental clarity, resilience, emotional balance, and overall mental well-being (Cheadle et al., 2018; Haryanto, 2016).
Interestingly, the results indicated that 42.5% of participants lacked support. However, in our study, social support was not significantly associated with PPD in adolescent mothers. Although this study did not show statistical significance, examining the odds ratio results revealed an estimated value of 1.126 with a 95% CI of 0.631-2.008. This implies that mothers lacking support tended to have PPD 1.126 times more than mothers with good support. This could be attributed to cultural factors but was significantly correlated in the third month after childbirth when the family's involvement in supporting the mother after birth is prominent. This finding aligns with previous studies conducted in Indonesia (Aadillah & Nurbaeti, 2023; Nurbaeti et al., 2018, 2019) but contradicts findings from studies in other countries (Easterbrooks et al., 2016; Falah-Hassani et al., 2016; Nilsen et al., 2013; Phipps et al., 2013).
Easterbrooks et al. (2016) reported that adolescents who received less support tended to have higher depressive symptoms during adolescence. Families or relatives may be more attuned to recognizing the triggers or fluctuations in mood that occur before or throughout adolescent pregnancy. Hence, family support is crucial. Early recognition of PPD symptoms by family members can lead to timely intervention and help-seeking for the new mother. Additionally, Nilsen et al. (2013) suggested that for adolescents with limited interpersonal skills, perceived and factual social support from significant individuals may serve as a buffer against depressive symptoms.
The findings revealed that 60.3% of respondents expressed dissatisfaction with their marriage. Moreover, the study found a significant association between marital satisfaction and PPD in adolescent mothers, which aligns with several previous studies. Mothers dissatisfied with their marriage tended to experience PPD (Lee & Hwang, 2015; Yakupova & Liutsko, 2021; Yusuff et al., 2015). Low marital satisfaction consistently emerged as a contributing factor to PPD among mothers in Asian countries.
Interestingly, Odinka et al. (2018) reported that 33.3% of mothers in Nigeria experienced moderate to severe symptoms of PPD related to dissatisfaction in their marriage. Similarly, Matinnia et al. (2017) mentioned in their publication that poor marital satisfaction was a potential risk factor for PPD. Nurbaeti et al. (2018) conducted a study in Indonesia and found a negative relationship between marriage satisfaction and postnatal depression. Mothers with low marital satisfaction were more susceptible to high EPDS scores. Another study in South Jakarta, Indonesia (Nurbaeti et al., 2019) revealed a negative and significant relationship between marital satisfaction and postnatal depression, indicating that mothers with low marital satisfaction were more prone to depression than those with high marital satisfaction. Furthermore, Duan et al. (2020) found that marital satisfaction impacted both depressive mothers and couples.
The mother's relationship with her partner plays a significant role in improving her emotional well-being. Several studies have highlighted the connection between poor marital relationships and low marital satisfaction with pregnancy and postnatal depression. For instance, research in Russia indicated that marital dissatisfaction during prenatal and postpartum periods can contribute to postpartum depression (Yakupova & Liutsko, 2021). Moreover, the lack of support from a partner during childbirth and limited involvement in infant care are significant risk factors for the development of depression in mothers. Notably, marital dissatisfaction and postpartum depression are significantly correlated during the first year after childbirth. Lee and Hwang (2015) conducted a study and concluded that being satisfied with their marital relationship can reduce the risk of PPD.
Based on the regression analysis, it has been determined that marriage satisfaction, family income, and the number of children are the most significant factors associated with postpartum depression in adolescent mothers. The odds ratio for family income was 0.362, indicating that low-income mothers had a 0.362 times greater chance of experiencing postpartum depression in comparison to higher-income mothers. Similarly, the odds ratio for the number of children was 3.68, suggesting that primipara mothers were at a higher risk of experiencing postpartum depression compared to multiple/multipara mothers. These findings indicate that dissatisfaction with marriage correlates with lower family income and mothers who lack previous experience caring for children. This is consistent with Usmani et al. (2021), which found that low income and unemployment were risk factors for postpartum depression among adolescents. The inability to meet household needs may contribute to mothers perceiving less satisfaction with their marriage, especially as adolescent mothers may still depend on their extended family for support while also facing increasing financial demands related to baby care. Furthermore, the study also found that children of mothers with postpartum depression were more likely to experience developmental delays from an early age than children of mothers who did not experience PPD, as noted by previous research (Alhusen et al., 2013).
Implications of the Study for Nursing and Midwife Practice
Several implications of this study for nursing and midwifery practices: Firstly, the findings emphasize the importance of mental health concerns, particularly postpartum depression, among adolescent mothers. Nurses and midwives should enhance their ability to detect and screen for postpartum depression during routine postnatal care, especially for teenage mothers with low socioeconomic status, those having their first child, and those adjusting to marriage with a partner. Early detection can lead to timely interventions and support for affected mothers, improving their overall well-being. Secondly, nurses and midwives should conduct comprehensive mental health assessments that consider various factors, such as marital satisfaction, family income, and the number of children, along with the presence of depressive symptoms. By considering these factors, healthcare providers can identify vulnerable groups of adolescent mothers at higher risk of experiencing postpartum depression. Tailoring appropriate support and interventions for these individuals can lead to more effective outcomes in managing and preventing postpartum depression. Thirdly, nurses and midwives can provide educational interventions to adolescent mothers and their families regarding postpartum depression and its risk factors. Educating them about the significance of social and family support, healthy marital relationships, and stress management can empower mothers to take proactive steps in managing their mental well-being. Fourthly, the findings can serve as basic data to advocate for policy changes and increased resource allocation for mental health services targeting adolescent mothers. By advocating for improved access to mental health screenings, counseling services, and support groups, healthcare providers can contribute to better mental health outcomes for adolescent mothers.
Limitations of the Study and Recommendations
The study has several limitations. Firstly, the study design was cross-sectional, where independent and dependent variables were measured only once. This limits our ability to establish causality or determine how these variables change over time. A longitudinal study would be more appropriate to understand the relationship between variables better, allowing for the tracking of participants over an extended period. Secondly, the study population was drawn from a specific community setting, representing only two districts in West Java Province. This selection may not comprehensively describe the entire population of adolescent mothers, limiting the generalizability of the findings. Future studies could benefit from a more diverse and representative sample to obtain a broader picture of postpartum depression among adolescent mothers. Additionally, for a more comprehensive examination of postpartum depression, future research could focus on the first three months after birth and explore the impact of PPD on maternal well-being and infant care. Including multiple religious aspects could provide valuable insights into how different religious backgrounds may relate to PPD among adolescent mothers. Furthermore, investigating other psychological factors in conjunction with religiosity could help to identify additional factors that may contribute to the development and management of PPD in this population.
Conclusion
The prevalence of PPD in adolescent mothers in West Java, Indonesia, was relatively high. The study identified that factors such as marital satisfaction, family income, and the number of children were significantly associated with PPD in adolescent mothers. On the other hand, Islamic religiosity and social support did not show any significant association with postpartum depression in this population. Mothers who expressed dissatisfaction with their marriage and had lower family income were found to be at a higher risk of experiencing postpartum depression. Family income and the number of children influenced PPD in these adolescent mothers. Additionally, the study revealed that first-time mothers faced a greater risk of experiencing postpartum depression than mothers with more than one child. These findings highlight the importance of considering these factors when addressing and managing postpartum depression in adolescent mothers. This can aid nurses and midwives in providing targeted support and interventions to improve mental health outcomes for this vulnerable population.