Immediate and Longer-Term Connections Between Support and Stress in Pregnant/Parenting and Non-Pregnant/Non-Parenting Adolescents
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- Devereux, P.G., Weigel, D.J., Ballard-Reisch, D. et al. Child Adolesc Soc Work J (2009) 26: 431. doi:10.1007/s10560-009-0175-z
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Despite the substantial amount of literature focusing on social support for pregnant and parenting adolescents, few studies have directly examined the relationships among stress and social support across their transition to parenting. The present study investigates the nature of the relationship between stress and support both before and after the birth of the baby. Two groups of adolescent females (one group facing parenthood and one not) completed measures of support and stress across a 7-month period (N = 231) to coincide with the transition to parenthood. In general, support and stress were negatively related when measured concurrently and positively related over time for parenting adolescents but not the non-parenting group. Understanding how long social support impacts stress will enable practitioners to identify when best to provide interventions for pregnant and parenting adolescents.
KeywordsSocial supportStressAdolescent pregnancyAdolescent parenting
The United States continues to have the highest teenage birth rate in the developed world (Alford and Hauser 2008) and in 2006, there were 441,832 births to teens under 19 (Martin et al. 2009). The problems associated with adolescent pregnancy and parenthood are well known. For instance, adolescent mothers and their offspring often face adverse social, economic, and health consequences, although this is not the case for all adolescent mothers (Holub et al. 2007). Teen mothers, on average, have lower educational attainment, are more likely to make-up single-parent families, and to be dependent on public assistance, often during their children’s important developmental years (National Campaign to Prevent Teen Pregnancy 2002). Their children may suffer poor cognitive development, and social-behavioral adjustment problems (Klein and the Committee on Adolescence 2005; Langfield and Pasley 1997). Also, a disproportionate number of these children are low birth-weight babies, and teen mothers are at greater risk for premature labor and fetal and maternal death (Rickel 1989).
A number of factors have been found to help offset the potential difficulties associated with adolescent pregnancy and parenthood, including ensuring the presence of and access to helpful community services (Letourneau et al. 2004), fostering school completion and educational attainment (Brosh et al. 2007), and creating supportive school environments (Saunders and Saunders 2002). The presence of social support, in particular, has been found to help pregnant and parenting adolescents adjust to the potential stress of pregnancy and parenthood (Langfield and Pasley 1997). Studies have shown that social support can also promote maternal well-being (Logsdon and Koniak-Griffin 2005) and improve mother–infant interactions (Clemmens 2001).
Although social support has been found to influence the health and well-being of pregnant and parenting adolescents, little research has directly examined the connections between stress and support as adolescents make the transition to parenthood (for a qualitative example see, Breedlove 2005). In particular, it is unclear whether support helps adolescents cope with stress of pregnancy or parenthood only when immediately provided or whether support continues to lessen stress levels at later time periods. This is important because much effort has been directed at helping improve the support systems for pregnant and parenting adolescents (Letourneau et al. 2004).
Identifying how long support can be expected to impact pregnant and parenting adolescents’ experience of stress will enable social workers and other practitioners to identify when existing support has “worn off” and when interventions to increase social support are needed. This paper examines the connections between stress and support across the transition to parenthood. It is hoped that by examining support longitudinally, scholars and practitioners can identify whether support best helps the adolescent cope with stressful life events only when immediately provided or whether support continues to have a positive impact in the future. The study also includes a comparison group of non-pregnant/non-parenting adolescents, allowing for the identification of relationships between social support and stress for two groups of adolescents who are experiencing very different life events. In this study, our focus is on received social support which is defined as the actual provision of financial, emotional or informational support from a network member (Berkman and Glass 2000). Stress is defined as the perception that results when circumstances exceeds one’s perceived ability to cope or from an imbalance between demands and resources (Lazarus and Folkman 1984).
Social Support, Adolescent Pregnancy and Parenthood
During pregnancy and the initial phases of parenthood, people must make major adjustments to new responsibilities and roles, which can affect new parents’ perceptions of both themselves and their infants (Twenge et al. 2003). Pregnancy and the birth of a child can create many changes for young mothers, on top of the normal changes and transitions of adolescence (Gee and Rhodes 2003; Langfield and Pasley 1997). The transition to parenthood for adolescents often produces stress from role ambiguity, balancing competing developmental tasks, and having to negotiate multiple transitions simultaneously (Birkeland et al. 2005). Pregnant adolescents, compared with non-pregnant adolescents, are less involved in interpersonal relationships and therefore, often receive less support from peers and family (Passino et al. 1993).
Researchers have found that support is beneficial to pregnant and parenting adolescents. Barrera (1981), for example, found that for pregnant adolescents, the number of support persons and satisfaction with support were negatively correlated with depression and anxiety. Likewise, in their study, Turner et al. (1990) found that the level of perceived social support during pregnancy was related to reduced depression following the birth of the child. When measured during pregnancy, social support has been found to increase mastery and life satisfaction in adolescents (Stevenson et al. 1999) and to be positively associated with self-esteem and adjustment to parenting during the weeks and months following childbirth (Samuels et al. 1994). Postpartum social support is negatively associated with depressive symptoms in adolescence (Secco et al. 2007).
Typically researchers have examined the impact of social support and stress on some outcome like psychological well-being and have paid less attention to the specific relationships between social support and stress. We argue that by paying closer attention to the temporal relationships between received support and stress, a better understanding of the relationships between the two in the context of adolescent pregnancy and parenthood is possible.
Barrera (1986) suggests that both positive and negative relationships should exist between stress and support. When examined at the same time period, more enacted support from others should lessen the experience of stress and so a negative relationship between the two variables should also exist at any given time. Likewise, House (1981) argued that because support ameliorates the experience of stress, it is expected that this beneficial effect of support will be demonstrated in the short-term. Thus, when pregnant and parenting adolescents elicit support it should reduce the existing level of stress.
Given the non-normative nature of teen pregnancy and parenting, it is also likely that the relationships between social support and stress will be different for pregnant and parenting adolescents and their non-pregnant, non-parenting peers. Previous researchers have argued that more information is needed about the support differences among adolescents who are non-parenting, pregnant, or parenting (Crase et al. 2007; Stevenson et al. 1999). Therefore, a comparison sample of non-pregnant/non-parenting adolescents was included to better identify the unique effect of support in the pregnant/parenting adolescent.
Overview of Study
The primary goal of this study was to examine social support in female adolescents as they transition from pregnancy status to parenthood. The study extends the extant research on social support and pregnant/parenting adolescents in two important ways. First, the longitudinal linkages between social support and stress were investigated. The relationship between social support and stress was examined at three time periods—8 months prepartum, 2 months postpartum, and 6 months postpartum. This analytic strategy allowed us to determine how support and stress are related contemporaneously and over time. Second, this study examined how the pattern of relationships between support and stress might differ between pregnant/parenting and non-pregnant/non-parenting adolescents.
Participants and Procedures
Participants were recruited from local high schools and service agencies in two urban cities in a Western US state. To recruit pregnant adolescents, fliers with a description of the study, consent forms, the initial survey (Wave 1), and a self-addressed, stamped envelope were left for participants to return to the researchers. Interested teenagers could also call the researchers to have a questionnaire mailed to them. The Wave 1 questionnaire was given to participants when they were approximately 8-months pregnant (i.e., just prior to childbirth). Pregnant/parenting participants were mailed a second questionnaire (Wave 2) when their infant was 2-months old and the final questionnaire (Wave 3) was mailed to the adolescent when their baby was 6-months old.
The comparison group of non-pregnant/non-parenting participants completed the first questionnaire during high school English or Human Development classes. Using the same interval between data points as the pregnant adolescents, participants were surveyed in their classrooms 3 months following the first wave. Students who did not attend class that day were provided the opportunity to continue with the study by mailing the survey back to the research team. Four months after the second assessment, the final survey was mailed to all potential participants. All participants (pregnant/parenting and non-pregnant/non-parenting) were paid $25 for completing all three questionnaires.
Data collection for both groups began at the same time, but the sampling for the pregnant group took place over 2 years to obtain an adequate final sample size for all three waves: 106 pregnant adolescents completed the first Wave, 72 returned completed surveys at the second Wave (68% of Wave 1) and 58 returned surveys were obtained at the third and final questionnaire period, Wave 3 (81% of Wave 2; 55% of Wave 1). A total of 216 non-pregnant female adolescents completed Wave 1, 170 completed surveys at the second Wave (79% of Wave 1) and 135 returned completed surveys at the third and final Wave; (63% of Wave 1). There were no significant differences between those who completed the study and those participants who dropped out at Wave 2 or Wave 3 on any of the demographic or study variables for either group.
The recruitment procedures resulted in unequal sample sizes between the pregnant and non-pregnant groups at the first wave (n = 106 vs. n = 216, respectively). Therefore, to make the sample sizes more comparable, 58% of the 216 non-pregnant participants (n = 125) from Wave 1 were randomly selected from the total non-pregnant group to better resemble the sample size of the pregnant group. The two samples were first matched on gender, age, and race/ethnicity and then a random sample was drawn from the non-pregnant group. The sample used for these analyses reported in this study at Wave 1 consisted of 106 pregnant and 125 non-pregnant female adolescents. The random sample of non-pregnant adolescents was compared against the full sample of non-pregnant adolescents on the outcome variables of support and stress. There were no significant differences between the random sample used in the analysis and the full sample of non-pregnant adolescents (all t-test’s had p > .20).
Demographic characteristics of study sample
Pregnant sample (n = 106)
Non-pregnant sample (n = 125)
Highest education level completed
Lives in single parent household
Questionnaires at each wave included demographic measures of household composition (single or two-parent household), race/ethnicity, age, and education level. In addition, measures of support and stress were included at each time period.
Received Social Support
To measure social support, participants were presented six categories of potential support providers (mother, father, other family members, boyfriend/partner/spouse, friends, and persons in community agencies) and were asked to rate the support they received from each provider. Participants rated each category along two dimensions, “How much support do you get?” from the network member (1 none to 5 alot) and “How valuable is that support?” (1 notvaluable to 5 extremelyvaluable). Value of support was measured because not all support is positive (Nath et al. 1991). The correlations between amount of support and value of support were relatively high and statistically significant for all network members (ranging from r = .68 for friends to .83 for father; all r’s had p < .001). Therefore, an overall support network variable was created by summing the amount and value responses across network members, resulting in a measure of social support that included both the received amount and value of support (range from 2 to 10).
Cohen’s perceived stress scale (Cohen et al. 1983) was used to assess perceived amounts of stress. Sample items included: “I have found that I could not cope with all the things that I had to do” and “I have felt nervous and stressed.” Participants indicated from 1 (never) to 5 (always) how often they felt fourteen statements of stress during the last month. Higher scores indicated greater perceived stress (range from 14 to 70). In this study, the scale had an alpha reliability of .82 in the pregnant and .85 in the nonpregnant samples.
Following strategies outlined by Pedhuzar (1982) and Pedhazur and Schmelkin (1991), a progressive series of multiple regression analyses were conducted to identify the paths through which support and stress were related across the 7-month time span for the two samples. In the first step, Wave 1 stress was regressed on Wave 1 support. In the second step, Wave 2 support was regressed on Wave 1 stress and Wave 1 support. At each successive step, the dependent variable was regressed on all of the previous variables in the model. This process continued until step 5 when Wave 3 stress was regressed on Wave 3 support, Wave 2 stress, Wave 2 support, Wave 1 stress, and Wave 1 support. This procedure allowed for the identification of both the contemporary relationships between stress and support at each wave, plus their temporal relationships across time.
Ratings of mean (SD) amount and value of support from individual providers by group
Table 2 also presents the ratings of individual support providers for the non-pregnant and non-parenting adolescent sample. Across all study time periods, the three highest rated support providers were boyfriend/partner, friends, and mothers. The lowest rated provider was community agencies. Because these are single-item indicators, ratings of support amount and value for these individual providers were summed into a total support score and used in subsequent analyses.
Means and standard deviations (in parentheses) of support and stress at study waves by study group
Pearson correlation coefficients of model variables at Waves 1, 2, and 3 by study group
1. Stress 1
2. Support 1
3. Stress 2
4. Support 2
5. Stress 3
6. Support 3
1. Stress 1
2. Support 1
3. Stress 2
4. Support 2
5. Stress 3
6. Support 3
In addition, multicollinearity did not appear to be a problem in the data, given that all correlations were <.70 (Myers 1990). Further, collinearity diagnostics in the subsequent path analyses revealed little dependency between the variables in the analysis. The highest variance inflation factor was 3.09 for Wave 2 support and Wave 3 support on Wave 3 stress for pregnant and parenting adolescents. The path model was tested separately for the pregnant and non-pregnant samples to allow for comparisons in patterns of associations between support and stress for the two groups.
Path Analyses for Pregnant and Parenting Adolescents
As for the longitudinal results, several interesting findings can be noted in Fig. 2. For both stress and support, measures at the preceding wave were positively related to their subsequent measures at Wave 1 and Wave 2 (a 3-month interval) and Wave 2 and Wave 3 (a 4-month interval). These results reflect the zero-order correlations and indicate that those pregnant adolescents reporting greater support at Wave 1 also reported greater support at Wave 2. Similarly from Wave 2 to Wave 3: Higher scores on support at Wave 2 were related to higher support scores at Wave 3. The same pattern was found for stress whereby those pregnant and parenting adolescents higher in stress at Wave 1 tended to remain high at Wave 2 and those higher at Wave 2 remained high at Wave 3. In addition, support at Wave 1 was positively associated with support at Wave 3 (a 7-month interval). The same 7-month pattern between Wave 1 and Wave 3 was not found for stress.
Regarding the connections between stress and support across time, as predicted, stress at Wave 2 was positively related to support at Wave 3, meaning that higher stress measured at 2 months postpartum was linked with higher support at 6 months postpartum. This finding suggests that stress may elicit support from others in the future. On the other hand, contrary to expectations, a direct positive relationship was found between support at Wave 2 and Wave 3 stress; higher support at 2 months postpartum was linked with higher stress 6 months postpartum. This finding suggests that those young mothers high in stress will continue to solicit support throughout the early months of parenting. It also is interesting to note that the longitudinal relationships between support and stress existed when measuring these variables postpartum. These relationships did not exist during the transition to parenting. That is, there were no longitudinal relationships between stress and support from Wave 1 to Wave 2 which corresponds to the period immediately before and after the birth of the baby.
Path Analyses for Non-Pregnant and Non-Parenting Adolescents
Despite the substantial amount of literature focusing on social support for pregnant and parenting adolescents, few studies have directly examined the relationships among stress and social support across the transition to parenting. This is important because this transition is often viewed as a stressful event for adolescent mothers and much effort has gone into developing community services and programs aimed at helping to ease this transition. The present results extend the literature by illustrating the nature of the relationship between stress and support both before and after the birth of the baby.
Several findings of note emerged from the study. The results indicate that for pregnant adolescents, social support before the baby’s birth was positively associated with support when the baby was 2 months old and again when the baby was 6 months old. In other words, it appears that the level of support seen by young mothers that exists in the months prior to the birth of their babies is similar to the support they will receive when their babies are in early infancy. Moreover, those pregnant adolescents who have limited support systems before the birth of their babies will tend to have limited support systems after their babies are born. This means that for social workers and other practitioners working with pregnant adolescents, deficits in support that might impact the adolescent’s resources and parenting abilities can be identified before the birth of the baby. Such girls could be at risk for later problems and should be priorities for intervention. Also, because assessments of current levels of support are linked to perceptions of these variables measured at later periods, researchers and practitioners can use information collected in the present to identify future needs of the adolescent.
Another finding of note concerns the interrelationships between social support and stress. Both when pregnant and when her baby was 6-months-old, social support was negatively related to stress when measured concurrently. That is, social support appears to reduce stress right away. This negative relationship found between social support and stress when measured concurrently supports House’s (1981) discussion of the beneficial short-term impact of support on stress. This finding corresponds with other research that has revealed the positive effects of support for pregnant and parenting adolescents (e.g., Barrera 1981; Luster et al. 2000; Samuels et al. 1994; Stevenson et al. 1999). Therefore, efforts to build support systems for pregnant and parenting adolescents appear to be good ways to offset the potential stress associated with parenthood.
The collection of longitudinal data in the present study also allowed for the examination of the linkages between support and stress across time. In particular, stress measured 2 months following delivery of the baby was positively associated with social support 6 months after delivery. In other words, a young mother who is experiencing a significant amount of stress should then enlist her support systems to help her deal with that stress and this implies a temporal process. Therefore, a positive relationship should exist between stress reported at an earlier time and support measured later, as demonstrated in this study. This finding should encourage those social workers and other practitioners who are involved in designing and delivering community programs to build the support systems of pregnant and parenting adolescents and to teach them how to effectively enlist their support system because the teens will turn to their support system when stressed.
Although we found a negative relationship between social support and stress when measured concurrently, social support does not appear to have a lasting impact in reducing stress. That is, a relationship between higher support and lower stress in the future was not found. However, social support measured when the baby was 2 months old was positively associated with stress measured 4 months later which is consistent with the idea that receiving support from others occurs during stressful periods (Barrera 1986). The temporal component of this study helps clarify when the positive and negative relationships between support and stress proposed by Barrera (1986) should be expected. When study time periods are not clearly specified, these relationships can be obscured which may lead to conflicting results (Norris and Kaniasty 1996; Secco et al. 2007).
It was somewhat surprising to find that stress measured prenatally was not associated with support after the birth of the baby. One possible explanation is that the type of stress experienced by pregnant adolescents may not be any different from the typical stresses of adolescence. But, by the time the baby is 2 months old, the reality and demands of caring for the baby have mounted. At this point the symbiosis between stress and social support becomes more critical and this is when we found the interrelationships between these two variables.
Another strength of the present study was the collection of data from two samples, one facing parenthood and a comparison group of non-pregnant adolescents, allowing us to identify relationships between social support and stress for these two groups who are experiencing very different life events. We did not find any significant relationships between stress and social support in the non-pregnant sample, with one exception—the expected negative relationship between the two variables was found at the first wave. It may be that the type of stress faced by this comparison sample was not meaningful enough to allow for other relationships between the two variables to be reliably demonstrated. Whereas the nature of the stress the adolescent mother is experiencing may make her more dependent on support from others to help her cope with her situation and care for her baby. Therefore, a stronger relationship between stress and support might be expected for young women confronting pregnancy and parenthood, which these results demonstrate.
It also is worth noting that, although we observed differences between the two groups in the path models, no mean differences were found between the study groups on overall support received and stress. This finding is consistent with previous research that did not find differences between the two groups (Crase et al. 2007). It appears that both pregnant/parenting and non-pregnant/non-parenting adolescents experience stress, but the nature of that stress may differ. Thus, it is important for researchers to continue to include comparison groups who are facing different stressors and to measure specific stressful life events.
Limitations and Implications
Limitations with the study should be noted. Due to attrition, we lost about 24% of the participants from Wave 1 to Wave 2 and 20% from Wave 2 to Wave 3. This may be why certain effects found at Wave 1 (e.g., the negative relationship between support and stress) were not found at Wave 2 for either group or at Wave 3 for the non-parenting group. However, this effect was found for the parenting group at Wave 3, which had the smallest sample size of all the groups. If the sample was too small to detect effects, nonsignificant effects would be most likely for this group at this wave. In addition, our attrition analyses revealed no significant differences between those who remained in the study and those who did not complete later waves. Regardless, the results of this study should be replicated with a larger sample size.
Another potential limitation is our measure of social support. Researchers have demonstrated that social support is a multifaceted construct and different aspects of support have differential effects (see Thoits 1995). In this study, we restricted our measure of support to two components of received support (amount and value) to examine how this measure operates over time in two samples of adolescents. Future research could attempt to replicate these results with measures of specific types of support (e.g., financial, emotional) from specific providers (e.g., parents, peers). In addition, future researchers could examine how long the relationships between support and stress exist by further manipulating the time periods measured.
Despite these limitations, the findings hold several implications for social workers and other practitioners. First, the results imply that efforts to build a network of support, both formal and informal, should have lasting benefits for pregnant and parenting adolescents. A number of such community interventions have been found to be effective in building support and resources for young mothers, including mentoring programs (e.g., Bogat et al. 2008), school-based programs (e.g., Saunders and Saunders 2002), collaborative services (Rothenberg and Weissman 2002), prenatal and well-baby health care (Koniak-Griffin et al. 2000), affordable child care (Camerana et al. 1998), and parent education programs (Quint 1991). The results of the present study indicate that such efforts should help adolescents cope with the potential stress of pregnancy and parenthood.
An examination of the specific support providers reveals that pregnant and parenting adolescents tended to most value the support they receive from their mothers and boyfriends/partners/spouses which is consistent with other research (Crase et al. 2007; Stevenson et al. 1999). This finding implies that efforts to involve parents and partners into the lives of pregnant and parenting adolescents should be beneficial. For instance, young fathers remain involved with the adolescent mother and their baby when there is a positive relationship between the mother and father (Gee et al. 2007). Hence, interventions with young parents should focus on improving the relationship quality of adolescent mothers and their partners.
Community agencies also were seen as somewhat supportive and programs incorporating information sessions on how to access community services would likely be helpful. Even so, one-time interventions will likely have limited impact. For example, a one-time presentation on how to navigate the maze of community services may not be enough to help young mothers gain the confidence to actually attempt it. To build a sustainable system of support, intervention efforts likely need to be ongoing and to take multiple, integrated approaches.
Parenting represents a significant life change for an adolescent. Despite this major transition, social support’s part in alleviating stress for the adolescent mother remains an important resource for her in coping with her new role. The present study extends the literature by demonstrating that support is important throughout the transition to parenthood. Furthermore, social workers and other practitioners can play a critical role in ensuring a network of formal and informal support is available to help adolescents make the transition to parenthood.
This research was supported by a Nevada agricultural experiment station grant.