43% of Adolescent Mothers in Ghana Face Psychological Distress: RESPONSE Study Reveals Mental Health Crisis

Introduction

In Ghana’s primary healthcare facilities, a stark mental health crisis affects adolescent mothers, with 43% experiencing significant psychological distress. This revelation comes from the RESPONSE research project, a four-year study led by the London School of Hygiene & Tropical Medicine (LSHTM) in collaboration with the Ghana Health Service Research and Development Division (GHS RDD). Presented at a national policy dissemination event on November 27 at the Ghana College of Physicians and Surgeons (GCPS), the findings highlight the urgent need for integrated mental health support in maternal care services.

Adolescent mothers, aged 14-19, face nearly 1.6 times higher rates of distress compared to adult women. This psychological distress in adolescent mothers in Ghana underscores systemic challenges, including stigma and overburdened health workers. Understanding these statistics through tools like the WHO’s Self-Reporting Questionnaire (SRQ-20) provides a verifiable benchmark for action, aligning with global goals like the Sustainable Development Goals (SDGs) for maternal health.

Analysis

Methodology and Screening Tools

The RESPONSE project screened over 2,000 women across six primary health facilities in the Prampram-Ningo and Shai-Osudoku districts of Greater Accra. Researchers used the SRQ-20, a validated World Health Organization tool that measures psychological distress through 20 yes/no questions on symptoms like anxiety, depression, and somatic complaints. A score of 6 or higher indicates clinically significant distress.

For health workers, the Depression, Anxiety, and Stress Scale (DASS-21) was administered via a mobile app to 172 participants, categorizing severity levels from normal to extremely severe.

Key Statistics on Maternal Mental Health

Among 172 teenage mothers screened:

• 43% scored 6 or higher on SRQ-20, signaling psychological distress in minor moms.
• This contrasts with 27% among adult women aged 20+, making adolescents 1.6 times more likely to be affected.
• Overall, 28% of all screened women showed distress signs.
• 5% reported suicidal thoughts in the prior month.

Pregnancy-stage analysis revealed 36% distress in pregnant women versus 25% in postnatal clients, indicating issues often begin antenatally. Women with pregnancy loss faced the highest rate at 50%.

Health Workers’ Mental Health Burden

Frontline caregivers mirror patient struggles:

• 51% moderate to extremely severe anxiety.
• 40% moderate to extremely severe stress.
• 37% moderate to extremely severe depression.

Professor Irene Agyepong, Co-Principal Investigator and Ghana Team Lead, noted that caregiver well-being is foundational: health workers emphasized caring for their mental health first to support patients effectively.

Summary

The RESPONSE study exposes a dual teenage moms mental health crisis in Ghana: adolescent mothers endure disproportionate psychological distress, exacerbated by early pregnancy onset, while health workers face high anxiety, stress, and depression rates. Systemic integration of mental health screening—using SRQ-20 and mhGAP referrals—into routine care is recommended. Stakeholders, including GHS and Mental Health Authority, committed to policy revisions at the dissemination event.

Key Points

Practical Advice

To address maternal mental health screening in Ghana, healthcare providers can implement these evidence-based steps:

1. Adopt SRQ-20 Routinely: Integrate the 20-question tool into antenatal and postnatal visits for quick distress identification.
2. mhGAP Training: Refer positive cases to WHO mhGAP-trained nurses for intervention.
3. Support Health Workers: Offer DASS-21 screening and peer support programs via mobile apps.
4. Targeted Outreach: Prioritize adolescent mothers and pregnancy loss survivors with community education to reduce stigma.
5. Policy Advocacy: Push for National Reproductive Health Guidelines updates including dedicated mental health budgets.

These tools, pilot-tested in the RESPONSE project, are scalable and cost-effective for primary care settings.

Points of Caution

While the data is robust, consider these limitations pedagogically:

• Regional Scope: Findings from Greater Accra may not fully represent rural Ghana; national scaling requires broader validation.
• Stigma Barriers: Prof. Mirzoev highlighted pervasive stigma impeding help-seeking for patients and providers.
• Resource Strain: High health worker distress risks burnout; unaddressed caregiver needs undermine patient care.
• Early Intervention Gap: Focus beyond postpartum to antenatal phases, as distress often starts in pregnancy.
• Self-Report Bias: Tools like SRQ-20 rely on honest responses; cultural factors may underreport symptoms.

Comparison

Adolescent vs. Adult Mothers

Adolescent mothers’ 43% distress rate dwarfs the 27% in adults, a 1.6-fold increase. This aligns with global patterns where younger age correlates with higher vulnerability due to social isolation and incomplete development.

Pregnant vs. Postnatal Women

36% antenatal distress exceeds 25% postnatal, challenging the traditional postpartum depression focus and calling for pregnancy-wide screening.

Patients vs. Health Workers

Patients’ 28% overall distress parallels providers’ 37-51% multi-domain struggles, creating a feedback loop. Unlike patients, workers’ issues stem from workload and vicarious trauma.

Global Context

Ghana’s figures exceed WHO estimates for low-resource settings (15-20% maternal depression), emphasizing local urgency while mirroring trends in sub-Saharan Africa.

Legal Implications

No direct legal violations are cited in the study, but policy integration carries implications. Revising National Reproductive Health Guidelines to mandate mental health screening could establish enforceable standards under Ghana’s health laws. Incorporating tools into the National Health Insurance Scheme (NHIS) would require regulatory approval, ensuring reimbursable services. Commitments to a Technical Working Group for sustainable financing align with constitutional rights to health under Article 34, promoting equity without litigation risks if implemented promptly.

Conclusion

The RESPONSE project’s findings illuminate a pressing adolescent mothers mental health crisis in Ghana, with 43% of minor moms in psychological distress and strained health workers amplifying the issue. Professor Agyepong’s call rings true: maternal and caregiver mental health is foundational to universal health coverage and SDGs. Stakeholders’ pledges for guideline revisions, budgeting, and NHIS integration signal momentum. Swift, evidence-based action—starting with SRQ-20 and DASS-21—can transform primary care responsiveness, reducing stigma and saving lives.

This crisis demands a cultural shift, prioritizing mental health as integral to maternal services. By addressing both patients and providers, Ghana can lead in scalable solutions for low-resource settings worldwide.

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