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Title: Early onset psychopathology and the risk for teenage pregnancy among clinically referred girls.
Author: Kovacs M, Krol RS, Voti L.
Journal: J Am Acad Child Adolesc Psychiatry; 1994 Jan; 33(1):106-13. PubMed ID: 8138508.
Abstract:
OBJECTIVE: To investigate whether early onset DSM-III depressive and conduct disorders and historical/familial variables increased the risk of teenage pregnancy among clinically referred girls, whose referral was unrelated to their reproductive status. METHOD: The sample of 83 girls, 8 to 13 years old at study entry, were participating in a longitudinal investigation of childhood-onset psychiatric disorders. They were repeatedly evaluated during an interval of up to 12 years. RESULTS: Twenty-nine girls had at least one pregnancy, and 25 had their first pregnancies as teenagers (< or = 18 years old). Several variables that predicted earlier age at first pregnancy in longitudinal univariate analyses became nonsignificant in the multivariate model. In the final model, childhood or adolescent onset conduct disorders (but not depressive disorders), and race were significantly associated with teenage pregnancy. Among the girls with conduct disorders, 54.8% became pregnant teenagers versus 12% of the rest, and 56% of the black adolescents versus 12% of the rest, had teenage pregnancies. CONCLUSIONS: After adjusting for race, early onset conduct disorder represents a risk factor for teenage pregnancy among psychiatrically referred girls. The mechanisms may entail behavioral dysregulation, delay in social-cognitive development, and misinformation about reproductive issues. Such girls may benefit from therapeutic and educational interventions to delay childbearing. An existing longitudinal data set was used to investigate the hypothesis that a depressive disorder in childhood increases the risk of an adolescent pregnancy. Depression is characterized by low self-esteem, lowered concern about one's personal welfare, passivity, and impaired motivation--all of which may prevent teenage girls from taking steps to protect themselves from pregnancy. The 83 subjects had been referred to a child psychiatric clinic (86%) or a general medical facility (12%) in Pittsburgh, Pennsylvania, between the ages of 8-13 years (average age at intake, 11.5 years). They underwent 4 clinical assessments in the first year of study participation and 2 assessments in each subsequent year. 65 girls experienced 1 or more DSM-III-R defined depressive episodes during the study period; the rest, who served as psychopathologic controls, had conduct disorders. 25 of the 83 subjects (30%, compared to the national average of 24%) had documented pregnancies by the age of 18 years. 28% of the pregnant teens had a history of early onset depression compared with 66% of their nonpregnant counterparts. On the other hand, 76% of the pregnant teens had been diagnosed with a conduct disorder by the age of 18 compared with 24% of the nonpregnant girls. Preliminary analysis further indicated that teenage pregnancy was associated with having been born out of wedlock or to a mother aged 18 years or younger; living in an intact family at time of study enrollment and socioeconomic status were not significant correlates. In the multivariate analysis, however, only two factors retained significance: a conduct disorder diagnosis in childhood (mean time to first pregnancy was 17.3 years compared to 18.7 years among remaining subjects) and race (Blacks tended to become pregnant by 17.4 years compared to an average of 18.7 years for Whites). No significant interaction was detected between a conduct disorder and race. These findings suggest that educational interventions aimed at decreasing impulsivity and undesirable consequences should be targeted at girls with conduct disorders.

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