WHAT IS THE LIVED EMOTIONAL EXPERIENCE OF FIRST-TIME ADOLESCENT MOTHERS? By NANCY A. AMOS Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Dissertation Adviser: Elizabeth M. Tracy, PhD Jack, Joseph and Morton Mandel School of Applied Social Sciences CASE WESTERN RESERVE UNIVERSITY August 2016 i CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the thesis/dissertation of NANCY A. AMOS candidate of the degree of Ph.D *. Committee Chair Elizabeth M. Tracy, Ph. D Committee Member Kathleen J. Farkas, Ph.D Committee Member Victor Groza, Ph. D Committee Member Julie Baylor, Ph.D., RN, CNE Date of Defense June 28, 2016 * We also certify that written approval has been obtained for any proprietary material contained therein. ii Table of Contents List of Tables ..................................................................................................................... v List of Figures ................................................................................................................... vi Dedication ........................................................................................................................ vii Abstract ............................................................................................................................. ix CHAPTER 1: INTRODUCTION AND STUDY AIMS ............................................... 1 Introduction ..................................................................................................................... 1 Postpartum Depression – History and Evolution ............................................................ 1 Statement of the Problem ................................................................................................ 3 Impact of Maternal Depression on Adolescents and Their Babies ................................. 7 Research Epistemology and Ontology .......................................................................... 10 Purpose of the Study ..................................................................................................... 12 Relevance to Social Work Practice and Policy ............................................................. 13 CHAPTER 2: LITERATURE REVIEW..................................................................... 15 Introduction ................................................................................................................... 15 Relational-Cultural Theory ........................................................................................... 15 Emotional and Relational Female Adolescent Development ........................................ 17 RCT and the Construction of Adolescence ................................................................... 21 RCT and Relationships by Level of Social Work Practice ........................................... 22 Empirical Literature Review ......................................................................................... 25 Summary of Causal Process .......................................................................................... 40 Concept Definitions ....................................................................................................... 41 Research Questions and Hypotheses ............................................................................. 46 iii CHAPTER 3: RESEARCH METHODS ..................................................................... 48 Introduction ................................................................................................................... 48 Rationale for Choice of Phenomenology as a Method .................................................. 48 Sample Selection ........................................................................................................... 48 Participant Recruitment ................................................................................................. 51 Research Methodology .................................................................................................. 53 Date Collection. ......................................................................................................... 53 Data Analysis. ............................................................................................................ 54 Validity. ..................................................................................................................... 57 Protection of Human Subjects. .................................................................................. 57 CHAPTER 4: RESEARCH FINDINGS ...................................................................... 59 Introduction ................................................................................................................... 59 The Story That the Findings Told ................................................................................. 59 Description of Sample ................................................................................................... 61 Theme 1. Reaction to Pregnancy ................................................................................... 64 Theme 2. Knowledge .................................................................................................... 67 Theme 3. Relationship to the Medical System .............................................................. 69 Theme 4. Relationship to Child Care ............................................................................ 72 Theme 5. Relationship to School .................................................................................. 75 Theme 6. Legal System ................................................................................................. 78 Theme 7. Relationship to Baby ..................................................................................... 78 Theme 8. Relationships to Persons and Spiritual Concepts .......................................... 80 Findings in Relationship to Research Questions and Hypotheses ................................ 87 iv Summary of Findings in Relationship to Relational-Cultural Theory .......................... 88 CHAPTER 5: DISCUSSION AND IMPLICATIONS .................................................... 90 Introduction ................................................................................................................... 90 Study Critique ............................................................................................................... 91 Study Strengths. ......................................................................................................... 91 Study Limitations. ..................................................................................................... 92 Difficulty in Recruiting a Sample for the Study. ....................................................... 94 Implications ................................................................................................................... 95 Practice. ..................................................................................................................... 95 Policy. ........................................................................................................................ 97 Future research .............................................................................................................. 97 Appendix ........................................................................................................................ 102 References ...................................................................................................................... 116 v List of Tables Table 1. Expression of Depressive Symptoms ................................................................. 43 Table 2. Description of the Sample ................................................................................... 63 Table 3. Self-Report of Race ............................................................................................ 63 Table 4. Reaction to the Pregnancy .................................................................................. 66 Table 5. Knowledge of Pregnancy .................................................................................... 68 Table 6. Relationship to the Medical System ................................................................... 70 Table 7. Relationship to Child Care .................................................................................. 74 Table 8. Connections to School ........................................................................................ 76 Table 9. Disconnections to School .................................................................................... 77 Table 10. Relationship to Baby ......................................................................................... 80 Table 11. Relationship with Father of Baby ..................................................................... 81 Table 12. What You Want Adults to Know ...................................................................... 85 vi List of Figures Figure 1. Data Collection in Phenomenology ................................................................... 12 Figure 2. Experiences of Adolescent Mothers ................................................................. 64 Figure 3. Conceptual Model ............................................................................................. 90 vii Dedication The story of this dissertation