THEORY INTO PRACTICE, 46(2), 130137
Laura F. Romo
Erum Nadeem
School Connectedness, Mental
Health, and Well-Being of
Adolescent Mothers
In this article, the authors describe recent re-
search on risk factors associated with adolescent
mothers mental health outcomes. They outline
the consequences associated with three major
risk factors that impact the teen mothers ad-
justment to her new parental role: lack of social
support, caregiver stress, and feelings of low
self-efficacy. The article concludes with specific
recommendations in how school personnel can
address the mental health and related needs of
teen mothers.
Laura Romo is Assistant Professor at Gevirtz Graduate
School of Education, University of California, Santa
Barbara, Santa Barbara, California.
Erum Nadeem, Ph.D., is a Postdoctoral Fellow at
School of Public Health and Health Services Research
Center, 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
130
B eing a parent for the rst time is
stressful for adults and adolescents alike.
For adolescent mothers, this stress may be com-
pounded by the fact that they are often from
impoverished, underprivileged backgrounds and
are faced with a first time pregnancy and moth-
erhood, as well as potential conflicts with and
disconnection from friends and family. The de-
mands of parenting may make it difficult for
adolescent mothers to continue more age ap-
propriate tasks such as emotional and identity
development, friendships with their peers, and
normal adolescent dating relationships (Coley
& Chase-Lansdale, 1998). Subsequently, their
health and future relationships may be affected
adversely. Many adolescent mothers have el-
evated depressive symptomatology and other
forms of psychological distress, especially in the
year following childbirth (Wiemann, Berenson,
Wagner, & Landwehr, 1996). Depression rates
among postpartum teenagers have been reported
as ranging between 16 to 44 percent, significantly
higher than postpartum adult women and non-
pregnant adolescent girls (Miller, 1998). These
Romo and Nadeem School Connectedness, Mental Health, and Well-Being of Adolescent Mothers
are very meaningful figures considering that ma-
ternal depression is a stable predictor of negative
parenting and interaction styles and depression
among offspring (Hammen & Brennan, 2000).
Although many adolescent mothers and their
children fare well, it is important for schools to be
mindful of common challenges that, when com-
pounded, can lead to negative outcomes. This
article reviews recent literature related to risk fac-
tors associated with adolescent mothers mental
health. We organize the literature around three
prevalent risk factors that can affect the teen
mothers adjustment to the new parental role:
lack of social support, caregiver stress, and feel-
ings of low self-efficacy. We then outline ways
in which schools can address these factors to
enhance adolescent well-being. This review de-
scribes studies that are most relevant to mental
health 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 majority
of teenage mothers today in the United States.
Risk Factors Associated with
Adolescent Mothers Mental Health
Lack of Social Support
Several studies conducted with African Amer-
icans and Latinas suggest that a close, supportive
relationship with their mothers is a critical
resource for the mental health of adolescent
mothers. Emotional and material support from
their mothers have been shown to predict pos-
itive parenting attitudes, nurturing caregiving
skills, lower depression, and higher levels of
life 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 found
in a sample of low-income African Ameri-
can families, older teen mothers and their own
mothers may resent a living situation that im-
pinges on their independence, which has negative
consequences on the quality of their parenting
skills (Chase-Lansdale, Brooks-Gunn, & Zam-
sky, 1994). Or, the grandmothers involvement
with childcare may clash with the adolescent
mothers desire to develop a separate identity and
achieve autonomy (Caldwell, Antonucci, & Jack-
son, 1998). These conflicts potentially threaten
mother-daughter relationship quality, which has
serious implications for the adolescents mental
health, including increased levels of depres-
sive symptomology (Kalil, Spencer, Spieker, &
Gilchrist, 1998). As such, it is important that par-
ents and adolescents communicate about these
issues. It is not co-residence per se but rather the
nature and quality of the family relationship that
relates to better outcomes for adolescent mothers
and their children.
Teen mothers without familial support are also
at risk for experiencing multiple pregnancies.
Approximately 30 to 35 percent of adolescent
mothers experience another pregnancy within one
year of having the first child, and 40 to 50 percent
have another pregnancy within the first two years
(Coard, Nitz, & Felice, 2000). These statistics are
noteworthy as the negative consequences of ado-
lescent childbearing are compounded when an
adolescent has multiple children during her teen
years. While a lack of access to family planning
information and contraceptives may be at fault,
research has identified other contributors to rapid
repeat pregnancies during adolescence, including
the 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 to
the need to help adolescent mothers create and
maintain positive connections with supportive
networks.
The literature reveals mixed findings about
the supportive benefits of a relationship with the
babys father or romantic partner. The outcome
largely depends on the circumstances that led up
to the pregnancy (e.g., whether the teen mother
and babys 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 associated
with greater life satisfaction, decreased stress,
131
Adolescent Mental Health
decreased depression, and less negative feelings
about motherhood (e.g., Milan et al., 2004), all
of which have positive effects on the mother-
infant relationship. However, recent research also
indicates that abuse and violence from intimate
partners 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 either
a source of support or further strain on adoles-
cent mothers and is an area in need of further
research.
Caregiver Stress
Given the increased stress that adolescent
mothers face and their potential immaturity as
parents, it might be surmised that adolescents
would have more difficulty being good parents
than adults (Brooks-Gunn & Furstenberg, 1986).
Initial research in this area is somewhat inconclu-
sive as it has been plagued with methodological
shortcomings, the most important of which is
the noncomparability of adults and adolescents in
terms of ethnicity and socioeconomic indicators.
It has also been argued that the negative parent-
ing associated with teenage childbearing may be
a function of exposure to chronic poverty rather
than the age of the mother (McLoyd, 1998).
However, some well-designed studies compar-
ing adolescent mothers to adult mothers have
found that adolescent mothers tend to provide
less stimulating home environments than adult
mothers (Luster & Dubow, 1990), a risk factor
for delays in childrens cognitive functioning and
preparedness for school (McLoyd, 1998). Other
research indicates that although adolescent moth-
ers are as warm as older mothers, they are often
less 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 benefits
to educating adolescents about the intellectual
and emotional needs of their infants, and how
caregiver stress can interfere with their levels of
responsiveness.
132
Low Self-Efficacy to Succeed
In addition to coping with parenting re-
sponsibilities, it is important to enhance teen
mothers self-efficacy in other domains. Self-
efficacy refers to the beliefs in ones capacity
to perform well (Bandura, 1997), and it is pos-
itively linked to academic achievement (Pajares,
1996). Prior to becoming pregnant, many of the
teen mothers were struggling academically, were
disengaged from school, or had learning disabil-
ities (Stephens, Wolf, & Batten, 1999). Hence,
many adolescent mothers may have doubts about
their capability to obtain a high school diploma,
a key reason to track closely and support their
academic progress.
Interestingly, for some teens, having a child
creates an incentive to overcome barriers to suc-
cess. In an ethnographic study that explored the
resiliency and strengths of adolescent mothers,
one motivating factor for an adolescent mother to
succeed (e.g., finish school, become financially
independent) was the rebellious determination
to prove she was not doomed to failure (Carey,
Ratliffe, & Lyle, 1998, p. 347). Pregnant and
parenting adolescents report that their drives to
succeed are inspired by their desire to be good
examples for their children (Shanok & Miller,
2005; Way & Leadbeater, 1999). Feelings of
responsibility and protectiveness over their chil-
dren also motivate some pregnant and parenting
adolescents 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 and
parenting teens maintain resilience in the face of
educational and economic challenges.
In summary, various risk factors, such as lack
of social support, caregiver stress, and feelings
of low self-efficacy impact the teen mothers
adjustment to the new parental role and may
have long-term negative consequences. Yet, it the
accumulation of risk factors that predicts neg-
ative life outcomes for adolescent mothers, not
the presence of any one risk factor alone. Only
a subset of young mothers will experience ex-
treme hardship, such as dealing with depression,
Romo and Nadeem School Connectedness, Mental Health, and Well-Being of Adolescent Mothers
substance use, poverty, and partner violence, is-
sues that require intervention from mental health
professionals.
The Role of Schools in Addressing
Mental Health Risks
In this section, we outline ways that schools
can enhance the well-being of adolescent moth-
ers. We advocate that the best approach to
improving adolescent mothers mental health in-
volves working simultaneously on multiple issues
(e.g., mental health care, caregiver skills, social
and academic support). Although we generalize
research findings in this section to all ado-
lescents, one should keep in mind that some
recommendations 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 be
attuned to the beliefs, values, and practices of the
local community in all of the services and sup-
ports that they provide. For example, Latina adult
and adolescent mothers report turning to family
members during stressful times more than other
ethnic groups do, are more open to advice from
others regarding childrearing issues, and allow
extended family more involvement in childcare
(Becerra & de Anda, 1984; Fuller, Holloway, &
Liang, 1996). Hence, schools may find that in-
creased family involvement in childcare enhances
well-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 may
be stressful and even have negative consequences
on infant parenting styles for both the teen moth-
ers and the grandmothers (Chase-Lansdale et al.,
1994).
Enhancing Adolescents Self-Efficacy
to Succeed
The preponderance of evidence paints a very
grim picture of adolescent educational outcomes,
but the news is not all bad. Many adolescent
mothers are able to complete high school, and
by their mid to late twenties, they are often able
to earn wages that equal their peers who did
not 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 are
adapting to the needs of adolescent mothers by
providing greater access to and support for edu-
cation. Nevertheless, 25 percent of teen mothers
never become economically self-sufficient and
30 percent do not finish high school (Whit-
man, Borkowski, Keogh, & Weed, 2001), leaving
many adolescents unprepared and noncompeti-
tive for future employment. Given that financial
strain is directly linked to depressive symptoms
in teen mothers (Kalil & Danziger, 2000), posi-
tive mental health outcomes are dependent upon
achieving educational success.
To enhance academic motivation and achieve-
ment, Batten and Stowell (1999) recommend that
school personnel incorporate flexibility into the
school day and instructional practices. For ex-
ample, teens may feel defeated when they are
repeatedly late to school or have to miss classes
and assignments due to childcare issues or med-
ical appointments. To avoid dropping out of
school, parenting teens would benefit from class
schedules that allow for early dismissal or late ar-
rival. It may also be beneficial to combine school
attendance with home tutoring and make-up as-
signments that allow teens with parenting and
health issues to miss school. Summer programs
and partial crediting systems can help teens make
up instructional time. Finally, it is especially criti-
cal that teen parents have positive perceptions of
the school environment. Messages that convey
low educational expectations from teachers (e.g.,
being advised not to take smart classes) nega-
tively impact adolescent mothers confidence to
succeed academically (Kalil, 2002).
In addition to academic self-efficacy, schools
can play a role in promoting mothering com-
petence. Adolescent mothers who are more
knowledgeable about child development and who
hold more realistic parenting expectations seem
to be better adjusted and more successful par-
ents. They provide their children with a higher
quality home environment, and their children
133
Adolescent Mental Health
perform better on cognitive assessments and
show fewer behavior problems years later (Be-
nasich & Brooks-Gunn, 1996). Understanding
how caregiver behaviors impact cognitive and
language development may motivate teen moth-
ers to interact and play with their infants in
cognitively stimulating ways (e.g., monitor the
childs gaze behavior, follow in on the childs in-
terests instead of redirecting attention to other
objects). Although it is beyond the scope of
the current review to address outcomes for
teen fathers, caregiver support programs should
also engage adolescent fathers, with sensitiv-
ity to the relationship dynamics between the
parents.
Increasing Social Support
Today, shared caregiving between mothers and
adolescent daughters is common, given recent
policies which require that adolescent mothers
must live with a guardian to receive finan-
cial assistance (U.S. House of Representatives,
1996). As mentioned, for the most part such an
arrangement where there is increased family in-
volvement in childcare enhances well-being for
teen mothers. In cases when co-residence is detri-
mental due to highly strained mother-daughter
relationships, referrals to professional counseling
services may be needed for resolving conflicts.
Interventions that provide training for mothers
and daughters to communicate openly and ef-
fectively may improve family functioning and
adolescent parenting.
Some researchers also highlight the impor-
tance of increasing social support from school
personnel (e.g., Kalil, 2002). Adolescent moth-
ers must perceive that teachers, counselors, and
school psychologists are available, interested,
and supportive of their problems (Kalil, 2002).
These perceptions are especially critical in the
absence of a positive family social support net-
work. Additionally, because many teen mothers
feel isolated and stigmatized when raising their
children (Rothenberg & Weissman, 2002), a teen
mother peer support group facilitated by a school
psychologist can provide aid and support, and
create a venue that teens can rely on to discuss
134
parenting challenges and solutions. Adolescent
mothers with higher levels of peer support, and
hence less social isolation, appear to be less
prone to living in the fear or threat of partner
violence (Sussex, 2005).
Reducing Caregiver Stress
Comprehensive programs in which teen moth-
ers receive a range of services are most successful
in reducing stressors associated with teenage
parenting. The California School Age Families
Education (Cal-SAFE) program, administered by
the California Department of Education, is one
example. It is designed to provide support ser-
vices for pregnant or parenting teens to improve
academic achievement and skills, and to provide
quality child care for their children. Programs
operate in local high schools, where teens can
complete their academic requirements towards
earning a high school diploma. Congruent sup-
port services include on-site childcare centers
(at the high school) where teens also get hands
on, supervised experience in caring for chil-
dren. Pregnant and parenting teens are also
provided with vocational counseling and help
linking to other community health services. In
essence, these programs provide a wholly inte-
grated support system to help adolescent mothers
successfully juggle the dual roles of high school
student and mother.
On an individual level, schools can integrate
the needs of adolescent mothers in their existing
structures or provide outside referrals. Currently,
there are about 1500 comprehensive school based
health centers in 43 states and the District of
Columbia (Center for Health and Health Care in
Schools, 2003). In line with the recommendations
of the Presidents New Freedom Commission on
Mental Health to expand school mental health
programs (Hogan, 2003), 83 percent of schools
report providing case management for students
with emotional problems, and nearly half of
all schools work with a community-based or-
ganization to provide mental health or social
services to students (Brenner, Martindale, &
Weist, 2000).
Romo and Nadeem School Connectedness, Mental Health, and Well-Being of Adolescent Mothers
Raising Awareness Among Staff of Mental
Health Needs
As is evident, many adolescent mothers re-
main at high risk for psychological distress,
especially depression. In a recent longitudinal
study conducted with 623 adolescent mothers
from diverse ethnic backgrounds, the researchers
found that over 50 percent of adolescent moth-
ers experienced moderate to severe depressive
symptomatology during the 12 months post-
partum period (Schmidt, Weimann, Rickert, &
Smith, 2006), with its highest prevalence at three-
months postpartum. For some mothers, especially
Mexican-American adolescents, these depressive
symptoms persisted up to four years later, high-
lighting the importance of training school staff to
be mindful of this risk. Schools should educate
their staff about the symptoms of clinical depres-
sion to improve the likelihood of early screening,
early identification, and referral to appropriate
mental health services. In tandem with these ef-
forts, staff should be equally attuned to signs of
intimate partner violence and equipped to pro-
vide necessary resources and referrals to combat
situations of abuse.
Conclusion
In conclusion, adolescent mothers remain at
high risk for psychological distress. The good
news is that school administrators, counselors,
and teachers are poised to make a difference.
The ability of schools to be responsive to the
needs of adolescent mothers has profound long-
term implications. Teen mothers who attend or
graduate from high school are more likely to en-
roll in parent education classes, have increased
knowledge 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 higher
self-esteem (Weed, Keogh, & Borkowski, 2000)
compared to adolescents who do not attend or
graduate 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 parenting
adolescents.
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