Approximately 400,000 live births occur to adolescents in the United States annually. Of the 50% of adolescent mothers who experience depressive symptoms, less than 25% comply with referrals for depression evaluation and treatment due to lack of knowledge of depression symptoms (literacy), negative attitude towards mental health treatment, perception that individuals with depression are stigmatized (subjective norms), lack of understanding of health resources that are available to her and under her control (perceived control), and lack of time. Untreated depression creates a public health problem in this vulnerable group impacting the adolescent's relationships, functioning at work and school, health care seeking behaviors, mothering skills, and development as well as the development of her child. An innovative and evidence based approach is needed that overcomes each of these barriers, is feasible, is acceptable to adolescent mothers and leads to greater rates of depression treatment. Social media is a promising vehicle to reach and educate adolescent mothers since most adolescent mothers use social media for communication and to search for health information. Based upon the Theory of Planned Behavior, we will target 10 counties in Kentucky with a social media ad campaign that will result in adolescent mothers (n=140) from those counties enrolling in an internet based intervention related to postpartum depression. The previously tested intervention includes vignettes from other adolescent mothers, questions and answers, resources, and an option to enroll in text message service. Before the intervention, after the intervention, and two weeks later the adolescent mothers will complete established questionnaires to determine if the intervention improved attitude and subjective norms towards depression and depression treatment, perceived control and intention related to seeking depression treatment, and the number of adolescent mothers with symptoms of depression who receive depression treatment. Data will be compared to scores on the same instruments from adolescent mothers (n=140) from the control group (10 other counties in Kentucky) that have not been targeted with the social media ad campaign or participated in the intervention. Data from the adolescent mothers in the control group will be collected in partnership with community agencies. The overall purpose of this trial is to test a cost effective and feasible method for reducing the cognitive an emotional barriers to accessing depression treatment in adolescent mothers.
The specific aims are to (1) measure the extent to which a social media ad campaign is effective as a recruitment strategy;(2) test the effectiveness of an internet based social marketing intervention on both intention to seek treatment and rates of depression treatment, and (3) examine the dose effect of the intervention. The innovative use of social media ads and an internet based social marketing intervention to increase rates of depression treatment in adolescent mothers has the potential to improve public health of two generations, adolescent mothers and their infants, and allows us to address a serious national health problem.

Public Health Relevance

Fifty percent of teen mothers experience symptoms of depression, but few seek or receive depression treatment. Untreated depression creates a public health problem in this vulnerable group impacting the teen's relationships, her functioning at work and school, healthcare seeking behaviors, her mothering skills, and her and her child's development. We will target teen mothers in 10 Kentucky counties with Google and Facebook ads, invite them to participate in an internet intervention that encourages depression treatment, and compare their rate of depression treatment to a control group of teen mothers in 10 other Kentucky counties.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Academic Research Enhancement Awards (AREA) (R15)
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Special Emphasis Panel (ZRG1-HDM-R (90))
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Roary, Mary
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University of Louisville
Schools of Nursing
United States
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