Abstract
BackgroundPregnant and postnatal adolescent women are a high-risk group for common mental disorders (CMDs); however, they have low levels of engagement and retention with mental health services. Negative consequences of CMDs have been documented for both mother and child.AimThe study aimed to explore the barriers and facilitators to service access for adolescents in low-resource settings.SettingWe interviewed 12 adolescents, aged 15–19 years, from low-resource settings in Cape Town, South Africa. Participants had previously engaged with a mental health service, integrated into maternity care.MethodsTwelve semi-structured, individual interviews were used for this qualitative study. Interviews were recorded, transcribed and coded. A framework analysis was employed for data analysis.ResultsAdolescents perceived considerable stigma around both teenage pregnancy and mental illness, which inhibited use of mental health services. Other barriers included fearing a lack of confidentiality as well as logistical and environmental obstacles. Service uptake was facilitated by support from other adults and flexible appointment times. Face-to-face individual counselling was their preferred format for a mental health intervention.ConclusionSeveral key components for adolescent-friendly mental health services emerged from our findings: integrate routine mental health screening into existing obstetric services to de-stigmatise mental health problems and optimise screening coverage; coordinate obstetric and counselling appointment times to rationalise the use of limited resources; and sensitise care providers to the needs of adolescents to reduce stigma around adolescent sexual activity and mental illness. A non-judgemental, caring and confidential relationship between counsellors and clients is crucial for successful interactions.
Highlights
Of the approximate 16 million adolescent girls who give birth annually, 95% of these births occur in low-and middle-income countries (LMICs).[1]
The findings indicate that adolescents perceive considerable stigma around both teenage pregnancy and mental illness, inhibiting their use of mental health services
This article adds an understanding of the experience of adolescents in low-resource settings who engaged with a mental health service during and after pregnancy, the barriers and facilitators to mental health service access as well as the type of services preferred by this group
Summary
Of the approximate 16 million adolescent girls who give birth annually, 95% of these births occur in low-and middle-income countries (LMICs).[1] Globally, adolescents display low levels of help-seeking behaviour and poor retention in health services.[2]. The adolescent growth and consolidation phase, which occurs between the ages of 15 and 19 years, is a time of brain restructuring, linked to exploration, experimentation and the initiation of behaviours that are lifelong determinants of health.[3] In addition to negotiating adolescent development, teenage mothers are faced with the challenges of adapting to new roles and responsibilities of parenting. Pregnant and parenting adolescents have been shown to be at an increased risk for adverse physical and mental health outcomes compared with their adult counterparts.[4]. Pregnant and postnatal adolescent women are a high-risk group for common mental disorders (CMDs); they have low levels of engagement and retention with mental health services. Negative consequences of CMDs have been documented for both mother and child
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