Summary / Abstract

Title: Teenage mothers and the adult mental health of their sons: evidence from a Stockholm cohort

Synopsis: Data from a Swedish male cohort born in 1953 is used to investigate the effects of teenage motherhood onlater mental health and illness. Measures of coping ability and psychiatric impairment at the age of 19 years and ofhospitalization with a psychiatric diagnosis at ages 20–30 show that the sons of teenage mothers have a poorer health recordthan those born to older women. The differences disappear, however, when controls are introduced for the marital and socio-economicstatus of the boys' mothers, and the data suggest that teenage motherhood is not associated with poor outcomes in the absence ofother predisposing factors. mothers, cohort, age, teenage mothers, coping ability, psychiatrists, born, mental health, sons, psychiatric diagnosis, outcomes, hospitalization, social class, psychiatric impairment, Timms, Stockholm, adolescence, cohort members, teenage motherhood, Draft Board, Project Metropolitan, poor outcomes, parental social class, psychiatric disorder, working class, child rearing, poorer health record, investigators, unmarried mothers, distribution,

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Additional keywords for: Teenage mothers and the adult mental health of their sons: evidence from a Stockholm cohort

journal adolescence 1996 19 545 556 teenage mothers adult mental health sons evidence stockholm cohort duncan timms data swedish male cohort born 1953 investigate effects teenage motherhood mental health illness measures coping ability psychiatric impairment age 19 years hospitalization psychiatric diagnosis ages 20 30 show sons teenage mothers poorer health record born older women differences disappear controls introduced marital socio economic status boys mothers data suggest teenage motherhood associated poor outcomes absence predisposing factors 1996 association professionals services adolescents introduction age child parent parents important factor ecology child rearing variations parental age expected exert long lasting influence outcome developmental process making contribution psychological health adulthood academic research public concern focussed significance age mother child born particular emphasis placed problem posed teenage motherhood large number studies focused difficulties posed teenage pregnancy health development mothers comparison surprisingly studies looked outcomes children teenagers life despite general consensus child bearing age 20 years bad mother child baldwin cain 1980 furstenberg brooks gunn 1986 robbins et al 1985 p 567 increasing number births teenage mothers concern early parenthood illegitimacy associated lower educational occupational attainment poorer mental physical health mother child study children teenage mothers baltimore furstenberg et al 1987 observe adolescence children show increased incidence drug alcohol abuse anxiety depression review studies furstenberg notes relative paucity relevant research suggests effects born teenager long lasting furstenberg 1990 p 159 j ust handful studies actually examine special problems offspring teenage parents negotiating adolescence good reason reprint requests correspondence addressed d timms department applied social science university stirling stirling fk9 4la scotland 0140 1971 96 06054512 25 00 0 1996 association professionals services adolescents 546 d timms suspect children tend problems academic achievement general behaviour offspring mature parents investigators concluded early childbearing pose special risks children teenage parents competent care givers possess material resources offer stable family environment desirable role models experience competing demands time youth teenage mothers main cause concern comparison older women teenage mothers described lacking experience personal resources necessary provide supportive environment child development furstenberg points passage evidence effects inconclusive phoenix 1991 adopts perspective pointing evidence asserting teenage women young function adequately mothers circumstantial assertion frequently based confusion potential causal factors analysis sample british women mothers ages 16 19 years early 1980s concludes youth gives rise problems combination factors poor education economic difficulties lack supportive relationships view correlates young parenthood tend associated problematic child rearing age child mother se label young mother covers multitude different social circumstances expected different consequences order examine implications young parenthood development children adulthood necessary take circumstances account longitudinal data swedish cohort project metropolitan enables task attempted indicators mental health illness early adulthood male members cohort outcome measures project metropolitan database cohort forms base project metropolitan defined registered living stockholm metropolitan area november 1963 born 1953 overview project janson 1995 original numbers cohort 7719 males 7398 females present analysis confined male members cohort analysis data gathered cohort enables effect differences maternal age family characteristics time birth cohort members 1953 related mental health illness early adulthood 18 30 years two main sources information available mental health male members cohort records extracted military draft board stockholm district 1971 1973 cohort members aged 18 20 years inpatient register hospitals stockholm county slutenvardsregistret covering period 1971 83 information available 6928 men approximately 96 population risk details draft board material reports published project metropolitan research report series timms 1990 1991 1995 information comes questionnaires tests completed draftees interviews psychologists physicians number direct observations examinations 547 teenage mothers sons forms assessment relevant mental health illness recorded assessments coping ability psychological ability function face stress results medical examinations psychiatric diagnosis assessment psychiatric impairment draft board nine point scale ranging 0 reduction health conditions 9 substantial reduction giving rise exemption military non military defence obligations assessment degree impairment accompanied diagnosis standard icd 8 terms analyses reported categorised severely disabled excused military service terms 11 cohort assessed suffering psychiatric impairment measurements coping ability involves global assessment team psychiatrists psychologists involved draft board examination measure highly correlated concurrent psychiatric diagnosis provides good prediction psychiatric events relative risk receiving diagnosis severe psychiatric impairment draft board examination cohort members two lowest stanines coping ability scale 200 times two highest incidence hospitalization pyschiatric diagnosis 11 years draft board examination 1973 83 ranges 134 1000 cohort members received coping ability rating falling lowest stanine 7 1000 categorised highest stanine ratio 19 1 information age mother birth child marital socio economic status parent taken delivery records population registers data mother age straightforward relating marital status social class problematic 1960 census cohort 7 years old full classification different types marital status attempted birth data possible simple dichotomy contrasting children cohabiting married couples analysis data 1960s mid childhood cohort timms 1995 shows considerable differences health outcomes living married widowed separated divorced parents children married widowed significantly better health outcomes parents separate divorce detail examined birth cohort majority registered non married cohabiting couples fact born married women 1953 classification parental social class information derived delivery records see project metropolitan 1980 pp 9 14 data refer occupation child father stated mother time delivery mother occupation classification mother single cohabiting 1953 single 1957 n 216 small number cases information father stepfather occupation missing stepfather occupation basis classification mother single 1953 married man biological father 1958 cohort member adopted 1958 information adoptive father occupation possible data parental occupation lacking case 277 boys majority cases n 213 born mothers family situation unknown partner socio economic classification based developed central 548 d timms statistical bureau official reports swedish living conditions e g vogel et al 1988 basic distinction middle working class groups occupation reference male head household information missing husband wife husband working class occupation wife occupation upper middle class higher noted born young mother necessarily mean raised members project metropolitan cohort brought biological mothers analyses follow mother age taken woman legally socially recognised mother regardless biological parenthood age mother coping ability psychiatric impairment median date birth mothers cohort members march 1925 giving median age birth cohort member 28 years time birth cohort member 4 social mothers project metropolitan boys aged 20 years 22 aged 20 24 years 31 aged 25 29 years 26 aged 30 34 years 12 aged 35 39 years 4 aged 40 years older case 67 members cohort identifiable person mother role table 1 compares sons teenage mothers older mothers terms draft board ratings coping ability psychiatric impairment incidence hospitalization psychiatric diagnosis ages 20 30 years data support belief children born brought mothers teens start life disadvantage compared older mothers disadvantage remains apparent age 30 years odds ratios sons teenage mothers compared rest cohort 1 36 rated low coping ability draft board 1 59 receiving diagnosis psychiatric impairment draft board examination 1 60 admitted hospital psychiatric diagnosis 11 years draft board distinction teenage mothers women crude contrasting 4 table 1 measures coping ability psychiatric disorder ages 20 30 years sons teenage mothers compared rest cohort age mother years high low h l db diag hospadm total cohort 20 7 2 17 2 0 42 165 60 303 10 2 13 2 0 77 111 38 6558 total 10 2 13 3 0 77 114 41 6928 high top two stanines national distribution coping scores low bottom two stanines national distribution coping scores h l ratio high low coping scores db diag serious psychiatric impairment draft board examination 1971 73 rate 1000 hospadm 11 year incidence hospitalization psychiatric diagnosis 1973 83 rate 1000 549 teenage mothers sons 5 year age band period 20 30 years light significance distinction gained expanding non teenage classification table 2 gives relevant information showing son health maternal age grouped 5 year categories pattern relatively simple boys brought mothers late twenties early thirties tend achieve higher ratings coping ability draft board examination 18 20 years born younger mothers teens early twenties mothers aged 35 years reverse pattern characterises distribution low coping ability members cohort mothers aged late twenties early thirties likely receive low coping ability rating draft board examination mothers younger older analysis prevalence psychiatric impairment diagnosed draft board largely confirms picture members cohort mothers late twenties lowest prevalence serious impairment 98 1000 teenage mothers highest 165 1000 incidence hospital admission 11 years appearance cohort members draft board shows pattern lowest cumulative incidence psychiatric hospitalization 36 1000 found mothers aged 30 34 years time birth highest occurring mothers teens 60 1000 attempted suicide rate follows general pattern psychiatric diagnoses unexpectedly large number cases found sons oldest youngest mothers conversely cases suicide groups sons teenage mothers general worse mothers age group aged 25 34 years distinction mothers aged early twenties surprisingly aged 35 years dramatic coping ability age mother marital status main reasons advanced relatively disadvantaged position children table 2 measures coping ability psychiatric disorder ages 20 30 years age mother birth cohort age mother years high low h l db diag hospadm total cohort 20 7 2 17 2 0 42 165 60 303 20 24 8 9 13 6 0 65 116 56 1515 25 29 11 9 1 25 0 95 98 38 2116 30 34 10 7 12 9 0 83 111 36 1772 35 39 8 3 13 5 0 61 138 39 849 40 6 9 16 3 0 42 108 43 306 total 10 2 13 3 0 77 114 41 6928 see footnotes table 1 explanation terms 550 d timms born teenage women greater likelihood birth take place outside marriage stable relationship project metropolitan cohort 40 births teenage mothers women unmarried compared 5 women early thirties approximately 10 follows differences coping ability mental health variations parental marital circumstances mother age se table 3 enables hypothesis investigated relating distribution coping stanines combination mother age marital status time birth members cohort born married women difference proportion receiving ratings high low coping ability draft board examination teenage mothers mothers aged 20 age cohort members born unmarried mothers likely high ratings coping ability likely receive low scores born married women ratio high low coping ability scores members cohort married mothers two half times single mothers born lone mothers sons teenagers poorly ratio high low coping ability scores seventh total cohort psychiatric disorder age marital status mother patterning coping ability surprising distribution psychiatric impairment draft board hospital admissions 10 years shows systematic variation age marital status cohort mothers table 4 shows relevant data case coping ability data psychiatric disorder show little relationship table 3 coping ability mother age marital status 1953 age married high low h l total cohort high low h l total cohort 20 10 2 12 4 0 82 177 2 5 21 2 0 12 118 rest 10 7 12 8 0 84 5914 6 7 17 0 0 40 535 total 10 7 12 8 0 84 6146 6 0 17 6 0 34 664 table 4 psychiatric disorder mother age marital status 1953 age married dbdiag hospadm total cohort dbdiag hospadm total cohort 20 141 34 177 212 102 118 rest 109 37 5914 157 60 535 total 110 37 6146 166 68 664 see footnotes table 1 explanation abbreviations 551 teenage mothers sons mother age sons married women born married teenagers prevalence psychiatric impairment draft board 30 higher characteristic cohort difference significant relatively low incidence psychiatric hospitalization years draft board members cohort non married mothers consistently higher rates draft board diagnosis psychiatric hospitalization non married teenage mothers doubly disadvantaged twice cohort prevalence rate draft board diagnosis three times incidence hospitalization ages 20 30 general data distribution psychiatric disorder support conclusion reached analysis coping ability disadvantage associated born brought teenage mother reflects higher proportion non married mothers category children married women little evidence support notion children age 20 leads permanent disadvantage unmarried mothers evidence disadvantage compounded coping ability psychiatric disorder relation mother age marital status differences coping ability exaggerate impact differences mother age marital status incidence hospitalization psychiatric diagnosis 10 years draft board members cohort low rating coping ability teenage mothers incidence hospitalization 204 1000 five times characteristic cohort members cohort high rating coping ability draft board evidence relationship mother age incidence psychiatric disorder rates uniformly low cases hospitalization 22 members cohort teenage mothers achieve high rating coping ability compared 10 cases 49 low rating members cohort low scores coping ability draft board born married teenage women cumulative incidence psychiatric hospitalization 11 years 136 1000 four times characteristic children married women low scores coping ability draft board born unmarried teenage mothers 11 year incidence psychiatric hospitalization 389 1000 7 cases 18 four times rate son unmarried mothers ten times rate cohort receiving rating low coping ability draft board examination likely members cohort born unmarried mothers teens married older parents turn associated greater incidence hospitalization psychiatric diagnosis 10 years disadvantage born non married teenager confined reduction coping ability age 19 members cohort born non married teenage mothers likely receive low rating coping ability draft board controlling higher risk developing psychiatric disorder 10 years members cohort born non married teenager appears 552 d timms associated higher exposure stress factors correlated reduction coping ability mother age social class project metropolitan mothers exception general finding higher socio economic background women bear children clear relationship age cohort mothers social class older mother higher likely social class household cohort member born 303 cohort members teenage mothers classified born upper middle class two thirds classified birth working class conversely older mothers 45 classified working class 14 classified upper middle class distribution coping ability psychiatric disorder cohort members combination age mothers social class household born shown table 5 data inconsistent poorest outcomes health measures found working class teenage mothers noticeable difference patterning coping ability two measures psychiatric disorder variations coping ability associated differing social class families members cohort born class little evidence sons teenage mothers different coping ability older mothers distribution psychiatric illness shows flatter gradient parental class case coping ability differences relating mother age remain apparent obvious explanation data inconsistency mutual influence teenage motherhood marital status parental social class study individual effects mother age marital status social class suggests play determining social capital child enters table 5 measures coping ability psychiatric disorder parental social class mother age 1953 class age high low h l dbdiag hadm total cohort middle class 20 12 8 11 5 1 11 167 51 78 rest 12 9 10 9 1 19 95 32 3382 working class 20 5 4 16 6 0 32 171 59 205 rest 7 4 15 7 0 47 129 42 3003 total 10 2 13 3 0 77 114 41 6928 see footnote table 1 explanation abbreviations middle class upper middle class lower middle class small scale entrepreneurs working class skilled working class unskilled working class 553 teenage mothers sons adulthood order disentangle effects evaluate relative significance procedures logistic regression treating health outcomes turn dependent variable independent variables treated twocategory factor teenage older married middle class working class table 6 illustrates main effects models shows fitted odds ratios parental categories three background factors provides satisfactory fit distribution health outcomes main effect two birth variables marital status social class child parents provide satisfactory fit distribution health outcomes log likelihood ratio statistics g 2 suggesting fits 50 70 area fit better two draft board measures hospital data presumably reflecting length time assessment family background two sets health indicators parental marital status social class entered equation influence mother age insignificant pronounced effect teenage motherhood connection prevalence draft board diagnoses decrease scaled deviance two factor model barely achieves 10 level significance greatest effect models provided mother marital status relatively little difference fitted odds ratios parental social class draft board outcomes fitted values two marital status categories first 0 50 0 55 high coping 1 51 1 37 receipt psychiatric diagnosis case psychiatric hospitalization ages 20 30 years fitted odds ratio sons non married mothers 1 79 born married women parental social class significance odds ratio hospitalization table 6a logistic regression models measures psychiatric health illness based mother marital status class age birth cohort member model high coping ability draft board diagnosis hospital admission g 2 df g 2 df g 2 df marclass 2 9423 5 6 8028 5 3 3180 5 age 2 9321 4 4 0720 4 3 0668 4 extra age 0 0102 1 2 7308 1 0 2512 1 mar marital status table 6b likelihood mental health illness parental marital status social class age three main effects model parental factor high coping ability draft board diagnosis hospital admission married 0 50 1 51 1 79 working class 0 54 1 37 1 22 teenage mother 0 98 1 33 0 87 odds ratios high coping draft board diagnosis psychiatric hospitalization comparing categories parental marital status social class age figures italics significant 554 d timms born working class families compared middle class backgrounds 1 22 little evidence interaction data comparison fitted observed values health outcomes basic main effects model parental marital status social class points slight excess sons health problems born mothers falling teenage non married working class category conclusion male members project metropolitan cohort born teenage mothers fare born older women association teenage motherhood lowered coping ability heightened disorder association teenage pregnancy unmarried status low social class mother age furstenberg 1990 p 160 points teenagers mothers different variety ways delay parenthood ways notably low social class concomitant low educational attainment associated favourable conditions child rearing low socio economic status motherhood accompanied unmarried status teenage mothers conditions unfavourable data project metropolitan provide strong evidence connecting child rearing unmarried low status teenagers lowered coping capacity heightened risk psychiatric disorder children 20 30 years parental marital status lesser extent social class controlled age mother possesses negligible general significance far mental health illness cohort concerned longitudinal prospective studies based cohort considered powerful design analysis developmental processes remains case dangerous generalise single cohort historical spatial background cohort unique taken account attempting generalise characteristics comparison cohorts removed space time important project metropolitan cohort born stockholm middle 20th century exception rule generalization requires attention paid context comparison mid late twentieth century sweden singled test case examining effects general trends western society popenoe 1988 pessimistic analysis outcome children presents sweden heralding decline nuclear family positive vein hoem 1992 points country leader areas sex education promotion contraception removal stigma associated illegitimacy development taxation social security arrangements reduce costs children limit material deprivation lead egalitarian distribution wealth characteristic western industrial societies light characteristics finding social background birth continues exert influence mental health two three decades powerful testament role social factors psychological development despite policies designed ameliorate negative consequences early disadvantage 555 teenage mothers sons members project metropolitan cohort born brought teenage women tend suffer poorer mental health early adulthood older mothers difference outcomes result association teenage motherhood parental factors sweden continued 1950s 60s 70s negative connotations child rearing notably lack marriage partner low social class continued importance factors surprising view documented divorce marriage childbirth sweden third quarter century relatively small difference living standards social classes period early 1960s early 1980s increasing proportion children sweden born outwith marriage outwith stable consanguineous relationships 1953 development lay future clear childbirth marriage remained moral statistical norm 1956 edition handbook sex instructions swedish schools quoted popenoe 1988 p 134 expresses current orthodoxy attention drawn fact free liaisons sake satisfying instinctual desires result children born parents home offer extremely important pupils realise fully home family groundrock society cemented partly love man woman parents children partly law latter support bonds marriage easier dissolve entail great perils children marriage advice educators little impact behaviour school children intended clearly reflected general mores time fact members project metropolitan cohort unmarried mothers heightened risk poor health outcomes consistent socio cultural context born recent cohorts affected parents bonded marriage parental union stable period 1950 early 1980s continued economic prosperity sweden efforts successive governments reduce class inequalities appeared close success economic differences classes considerably western industrial societies doubted differences class related variables education reduced extent early claims made largely outside observers social class longer associated health inequalities sweden e g leighton et al 1971 disproved number studies shown social class gradients variety health measures characteristic sweden western populations e g vagero lundberg 1989 finding mental health project metropolitan cohort affected marital status social class mothers age results studies based recent samples london baltimore furstenberg brooks gunn 1986 phoenix 1991 groups social characteristics associated teenage motherhood associated poor outcomes age mothers teenage mothers likely suffer complicating factors absence factors children teenage mothers worse born older women easy assumption teenagers 556 d timms make poor mothers needs major qualification depends characteristics circumstances references baldwin w h cain v 1980 children teenage parents family planning perspectives 12 2 3 41 furstenberg f f 1990 coming age changing family system threshold developing adolescent feldman elliott g r eds cambridge mass harvard university press furstenberg f f brooks gunn j 1986 children adolescent mothers physical academic psychological outcomes developmental review 6 224 251 furstenberg f f brooks gunn j morgan p 1987 adolescent mothers life new york cambridge university press hoem b 1992 early phases family transition contemporary sweden early parenthood coming age 1990s rosenheim m k testa m f 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