You're a teenage girl, around 14 years old and you find out that you are pregnant. You are sent to a special public school for pregnant young girls your age. Everyone is telling you that you are making a mistake. You are treated as if you are a leper. But, you really want this baby. The whole experience has turned your life around-you've gotten off drugs, gotten off the street, you want to be a good mother. It's depressing to know that no one is supportive of your decision.

These are the kinds of girls that Assistant Professor of Psychology and Education Lisa Miller has been working with at P.S. 911 in Manhattan, a school specifically designated for pregnant girls in 8th, 9th and 10th grades. With funding from the National Institute of Mental Health (NIMH), Miller and her associates worked with girls at the school who are on the pathway toward depression and provided interpersonal psychotherapy with them.

"The national rate of depression for pregnant girls is about 20 to 30 percent," Miller said. "The rate for these girls before we came was 60 percent. Now 90 percent of the girls we did prevention with are not depressed."

The first group Miller and her associates worked with was a self-chosen group that felt they were experiencing struggling times due to their pregnancy. They participated in a 12-week after-school program of interpersonal psychotherapy which had been shown to help adolescents in general and pregnant adult women but had not been used with pregnant adolescents. "It was an ideal treatment for them because of the high amounts of stress they were experiencing," Miller said. "Many have been thrown out of their homes and terribly mistreated by their family and even their boyfriend, the baby's father."

She added, "They are depressed because they are discriminated against for being young and pregnant. They are really some of the most resilient, loving young women that I have ever met and they are treated terribly by society."

This year, after finding so many depressed girls in the school, they wanted to conduct a widespread intervention that would treat girls who were currently severely depressed and also protect and prevent depression in girls who were headed in that direction. After the intervention, comparisons were made showing that after the 12-week program, only 10 percent showed signs of depression. "That is a remarkably low number considering that previous research shows that pregnant adolescents normally show a 50 percent increase in the rate of depression from the second to the third trimester," Miller noted.

Once Miller and her associates began working with the girls, it was clear that their reasons for becoming mothers was not for any material gain. "They were not going to be better off financially, they expected less emotional support and less popularity and community support. Yet they were committed to becoming mothers," Miller said. "It became clear their motivation was spiritual."

To show the girls support for their perspective, the psychologists helped them own up to and respect the role of motherhood as a social and spiritual journey. "We showed them ancient drawings of mothers throughout time and asked them, ‘What would you imagine is the oldest representation of human beings?' It is not a man shooting an arrow or leading a war. No, it was a woman giving birth to a child. That is what the backbone of humanity is, and you are carrying a life."

The girls talk about their children giving them a higher purpose. "We do everything that we can to be right there with them and support them in that. To deny it and be silent would be to annihilate their entire orientation in living. So to be present with the girls, we have to embrace a holistic model that is a spiritual model," Miller said.

In addition to testing the participants for depression at the end of the 12-week program, all the girls in the group were tested post partum and, according to Miller, the gains of treatment were maintained. "Depression in pregnancy is a predictor of post-partum depression. Girls did not show an increase in depression," she said. "Their sense of calling as mothers was something strong and enduring and translatable into practical improvements in their lives."

As a next step, Miller would like to be able work with the girls for 15 months to two years to see how they are doing and develop follow-up intervention that extends into early motherhood.

Arielle Shanok and Merav Gur, two TC doctoral students who contributed to this program, received NIMH research prizes. The young investigator awards (plus an $1,800 stipend) were based upon exceptional presentations of their research findings at the NIMH conference, "Beyond the Clinical Walls," on improving access to treatment for high risk adolescents.

Published Monday, Mar. 7, 2005