This dissertation is a mixed methods analysis investigating postpartum depression as it is experienced by self-reported depressed Mexican American adolescent and adult mothers. The qualitative portion of this study explores pregnancy and motherhood to better understand meanings attached to depression. Six adolescent and six adult mothers, were recruited from the Dallas/Fort-Worth area. Each was interviewed twice, using semi-structured interview guides. The quantitative phase utilizes a national sample of self-reported depressed Hispanic mothers to identify breastfeeding behavior and mothers' perceptions of the physical health of their babies. Specifically, a secondary analysis of the National Survey of Children's Health, 2003 was used to supplement the qualitative data. This study provides a theoretical framework of fragmented identity to explain socio-cultural factors contributing to postpartum depression among Mexican American adolescent and adult mothers. Common themes leading to a fragmented identify were indentified. Contributors to postpartum depression include: unplanned pregnancy, internal struggle between cultures, body image and family conflict. Stigma associated with teen motherhood also contributed to depression among adolescent mothers while the medicalization of childbirth was a contributing factor of depression among the adult mothers. Additionally, the duration of breastfeeding and mothers' perceptions of their babies' physical health were impacted by depression, but breastfeeding initiation was not.

Six serial focus groups were used to explore the perceptions of postpartum depression among nine adolescent mothers. The discussions were tape recorded, transcribed and analyzed using symbolic interaction theory, specifically Goffman's concept of stigma. Participants identified major stigma themes in relation to postpartum depression, teenage pregnancy and motherhood, all of which were portrayed negatively in the media. Several key causes of adolescent postpartum depression were also found including self esteem relating to poor body image and social support. The findings indicate a much needed change in the way adolescent mothers are identified and treated for postpartum depression. Additionally, the importance of social support in preventing and treating adolescent postpartum depression is highlighted and programs addressing such concerns must be implemented.

Adolescent mothers are a vulnerable population for a multitude of reasons. For one, adolescent mothers concurrently undergo two significant developmental phases and transitions: adolescence and parenting. Adolescence is the psychosocial period of adjustment marked by dramatic neural, hormonal, cognitive, psychological, physical, and biological changes. While adolescence is a time of cognitive advancement, it is also a time of stress, identity development, peer pressure, mood disruptions, and emotion regulation difficulties. While parenthood presents with positive changes, it simultaneously introduces challenges, such as increases in caretaking responsibilities, time commitment, and distress. Additionally, as statistics have shown, many adolescent mothers face a host of risk factors (e.g., poverty, low socioeconomic status (SES), and low educational attainment), making these “adolescent mothers at risk (AMARs)” a highly vulnerable population. Adolescence is also a time when substance use initiation and experimentation occur. While some level of substance use is normative among adolescents, substance use is especially detrimental for adolescent mothers and their children. According to the literature, substance-using mothers differ from their non-substance-using counterparts in terms of how the former parent their children. For example, substance-using mothers tend to display decreased levels of warmth (Barnow, Schuckit, Lucht, John, & Freyberger, 2002; Gruber and Taylor, 2006; Mayes & Truman, 2002; Suchman et al., 2007) as well as extreme styles of parenting (e.g., minimal supervision and intolerant attitudes) (Suchman & Luthar, 2000). This dissertation used archived data to examine AMARs and explore their levels of distress tolerance, substance use, and parenting attitudes and beliefs. Specifically, this dissertation sought to address the following questions: Is there an association between distress tolerance, substance use, and parenting attitudes and beliefs? Does substance use mediate the association between distress tolerance and parenting attitudes and beliefs? Seventy-two mothers living in nine Transitional Living Programs (TLPs) across a Northeast state were interviewed. Participants were aged 16-22 years with a mean age of 19. Participants were predominantly Latino and African American, and nearly half of the participants reported having a history of living in foster care or group home with an average of five years spent in these institutions. Data were collected from the baseline interview of a pilot randomized control trial examining an intervention for increasing positive parenting among homeless AMARs. Distress tolerance was operationalized via the Distress Tolerance Scale (Simons & Gaher, 2005), and parenting attitudes and beliefs were operationalized through the Adult Adolescent Parenting Inventory-2 (Bavolek & Keene, 2010). Lifetime and recent frequency of substance use was also examined. Race/ethnicity was controlled for in all analyses because the past literature has documented racial/ethnic minority adolescent mothers experiencing more adversities and vulnerabilities compared to their White counterparts (Huang et al., 2014, 2019). Consistent with the literature, we found an association between distress tolerance and substance use, substance use and parenting attitudes and beliefs, as well as distress tolerance and parenting attitudes and beliefs. Specifically, there was an association between low distress tolerance and high levels of substance use; high levels of substance use and poor parenting attitudes and beliefs; and low distress tolerance and poor parenting attitudes and beliefs. In terms of the mediation analysis, only substance use within the past six months mediated the relationship between distress tolerance and parenting attitudes and beliefs. In other words, low distress tolerance led to higher levels of substance use within the past six months, which in turn led to poorer parenting attitudes and beliefs. One implication of the results is that recent substance use, rather than lifetime history, has a more salient effect on parenting attitudes and beliefs. Overall, the majority of the AMARs in the current study’s sample demonstrated resilience and had scores reflective of positive parenting attitudes and beliefs despite their notably low levels of distress tolerance. While the results of the study are promising, they should be interpreted with caution considering several limitations, including a small effect size from the mediation analysis and potential underreporting among AMARs. Future research should continue to explore various iterations of the research question (e.g., different combinations of distress tolerance, substance use, and parenting attitudes and beliefs as the independent, mediating, and outcome variables) and psychometric properties of the measures utilized.

Adolescence is a period of rapid development marked by significant neurological and behavioral change. Normative neurological shifts that take place during this stage of life occur in the areas of the brain most associated with response inhibition and emotion regulation which is understood in the context of the observed increases in impulsivity and emotional lability among many adolescents. These facets of development may present unique challenges for those adolescents who enter parenthood ruing this period of life as increasing evidence suggests that emotional and cognitive control are highly related to parenting behavior. Those parents who are better able to modulate their emotional responses are best able to cultivate sensitive and nurturing home environments for their children. Compounding the risk for themselves and their children, adolescent mothers also face a constellation of risk factors including poverty, low educational attainment, elevated levels of stress and high rates of early life trauma exposures. Those adolescent mothers who experience homelessness face additional risk, in part because social support and family involvement have been shown to benefit young parents and their children. A substantive body of literature suggests that these interrelated risk factors may stress the capacity to effectively parent, leading adolescent mothers to be less affectionate, less positive, more hostile and intrusive and less emotionally available when interacting with their children. Consequently, supporting adolescent mothers is of great public health concern as they, and their children, are at risk for a range of non-optimal outcomes. The aim of this dissertation was to contribute to the current body of literature linking maternal emotion regulation with positive parenting practices among a highly vulnerable sample of homeless adolescent mothers and their children. Specifically, this dissertation used archival data to extend the current understanding of these associations by exploring the ways in which early life exposure to psychological aggression influenced the regulatory capacities and parenting behaviors of a sample of homeless adolescent mothers. To date, few studies have utilized a computerized measure of response control and behavioral inhibition under emotionally salient conditions in conjunction with ecologically valid multiple observer coded video observations of parent-child interactions within this high-risk population. Participants (N=72) were adolescent mothers and their children living in nine Transitional Living Programs (TLPs) across a Northeastern state, aged 16-22 years old and predominantly Latinx and Black American. On average, participants had one child (M=1.3 years-old). Nearly half of the participants reported a history of foster care or group home involvement. Thirty-two percent of the sample self-reported clinically significant levels of depression and, on average, participants reported slightly elevated levels of anxiety. Consistent with the literature, the sample evidenced significant trauma exposures with participants reporting having experienced an average of three discrete traumatic events. For example, 37.3% reported having experienced physical violence in their home, 72% reported having experienced violence in their community, 45.3% reported having witnessed violence in their community, and 36.3% reported having experienced some form of sexual abuse. Data were collected from the baseline interview of a randomized control trial examining the effectiveness of an intervention designed to increase positive parenting among a sample of adolescent mothers living in TLPs. For this study, interpersonal trauma exposure was operationalized via the Psychological Aggression Scale of the Parent Child Conflict Tactics Scale (Straus, 1999). Maternal sensitivity and hostility were operationalized using the Sensitivity and Non-Hostility scales of the Emotional Availability Scales, 4th edition (EA Scales; Biringen, 2008). Maternal emotion recognition and regulation were operationalized via the Emotion Go/NoGo (EGNG) paradigm. Maternal depression and anxiety were also examined. Consistent with the literature, this study found evidence for the complex associations between maternal exposure to psychological aggression, maternal emotion regulation and parenting behaviors. Specifically, there was a significant positive association between the accurate discrimination of sad from neutral facial expressions and maternal sensitivity. The accurate discrimination of fearful from neutral facial expressions, however, was associated with less sensitive parenting. Additionally, those mothers who were more impulsive when confronted with sad facial expressions during the EGNG sad emotion “go” task were less sensitive when interacting with their children. This study also found evidence for a significant interaction between maternal exposure to psychological aggression and impulsivity in the EGNG fearful emotion “go” task in the explanation of maternal sensitivity. Specifically, for those adolescent mothers who had experienced psychological aggression, impulsivity when confronted with fearful facial cues on a computerized task was associated with increased maternal sensitivity during dyadic interactions. For those mothers who had not experienced psychological aggression, however, increased impulsivity when confronted with fearful faces on the computerized task was associated with reduced maternal sensitivity. Maternal exposure to psychological aggression was consistently associated with increased hostility with those mothers who had been exposed to psychological aggression evidencing more hostility when interacting with their children. Finally, in optimal conditions on a computerized task (i.e., when confronted with happy faces during the EGNG paradigm) those mothers who were rated as more sensitive during dyadic interactions all responded within approximately the same amount of time to the computerized stimuli. No relationship between maternal sensitivity and mean response time was found in the negatively valenced EGNG conditions. There was not sufficient evidence to suggest that emotion regulation and behavioral impulsivity mediated the relationship between exposure to psychological aggression and parenting behavior. Consistent with the literature, these findings suggest a role for both maternal trauma exposure and regulatory capacities in the explanation of parenting behavior. These findings highlight the need for greater research on these complex and multidetermined relationships, particularly within the highly vulnerable adolescent parent population. Additionally, this study’s findings suggest possible avenues for interventions within this population, highlighting the need to consider the ways in which adolescent mothers’ regulatory capacities may influence their ability to intuit and respond to their children. Directions for future research and clinical implications are discussed.