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Table 3 Translation of second order constructs and construction of line of argument synthesis (themes)

From: No straight lines – young women’s perceptions of their mental health and wellbeing during and after pregnancy: a systematic review and meta-ethnography

Line of argumentSynthesis 3rd order interpretations (or themes)List of 15 translated 2nd order constructs (sub-themes)Definition (translation) of the 2nd order constructPapers that include the 2nd order constructs
Individual bodiesEmbodied trauma: Deep imprints‘Living with violence’ [43]Interpersonal violence in YW’s lives impacts physically and mentally. Violence is tolerated due to low self-esteem and as a familiar pattern in lives.[40, 43, 49, 51, 53, 57]
‘Crying out for help’ [42]: Traumatic after effects of childhoodAbusive, conflictual, violent relationships from childhood contribute to later depression as trauma which has been suppressed resurfaces. Suicidal attempts and self-destructive behaviour linked to childhood abuse; women propelled into intimate relationships early. Abandonment and loss also involved in complex traumatic histories.[40, 42, 43, 46, 48, 54, 58]
Stress and overwhelm: Weight on shoulders‘Carrying all the stress’ [54]: emotionally and physically drainingStress in pregnancy; stress of being pulled between adolescent and mothering roles and having to adapt to responsibility is emotionally and physically draining; stress of children acting out; stress of living circumstances.[41, 47, 51, 52, 54, 55, 58]
Stress: ‘increasing the risk’ [53]Stress of pregnancy and motherhood raises risk of violence, depression and suicidal attempts and leads to fatigue and overwhelm.[43, 44, 47, 51, 53]
Not just hormones: Depression darknessDepression impact on the ‘transition into motherhood’ [56]Post-natal depression is present, difficult and, for some mothers, causes difficulty parenting[40, 51, 56, 57]
Difficulty of identifying and ‘explaining the unexplainable’ [41] of depressionDepression figured as blinding and feels like explaining something unexplainable. YW interpret it as stress or relate it to life events, relationships and circumstances.[41, 45, 48, 52, 55, 58]
Relational influencesHeld together: support, conflict and isolation‘Circle of support’ [54]: sustaining and protectingFamily or wider circles of support can provide validation and increase esteem and lessen stress of pregnancy. Adult relationships can be enabling, provide sense of new pathways and help YW seek help for m/health issues.[41, 45, 48, 52,53,54, 58]
‘Interpersonal disputes and conflict’ [58]Conflict in relationships with partners, family members or other people, and emotional violence or controlling relationships are also trigger for stress and depression as well as for homelessness.[40, 44, 49, 51, 58]
‘Left behind’ [41]: social isolationDespite some sources of support, YW feel social isolation from a sense of abandonment by partners (in particular); friends or family due to being a young mother; or because YW have chosen to stay away from bad influences or violent relationships. Result of isolation or sense of abandonment or exclusion may be a sense of depression, loneliness and suicidal thoughts.[40,41,42, 45, 48, 52, 55, 56, 58]
Socio-economic insecurityUnstable foundations: Ground beneath feetImpact of ‘housing instability’ [58] on mental health and wellbeingHousing instability and/or homelessness and/or tumultuous living conditions impact development and transition to motherhood. Living circumstances lead to or seen as factor in depression.[42,43,44,45, 47, 49,50,51, 54, 56, 58]
Impact of ‘socioeconomic stress’ [44] on mental health and wellbeingEconomic stressors mean YW do not have what need to live healthy lives; poverty primary factor in depression and increased stress, leads to feelings of despair.[44, 50, 54, 58]
Social surveillanceSurveilled and judged: Head downImpact of ‘stigma and perceptions of being judged’ [52] on help seeking for mental healthMental health is seen as a stigmatised or judged issue, which, along with the stigma and judgement associated with being a teenage mum, prevents help seeking, and is hidden from HCPS, as YW try to present themselves as good mothers.[52, 56, 58]
Impact of ‘stigma and perceptions of being judged’ [52] on emotional life worldJudgement from the public or community about being a young, single mother adds to stress, and contributes to depression and to social exclusion. Impact of stigma and perceptions of being judged has a negative impact on emotional wellbeing.[41, 44, 45, 49, 52, 56]
Narrative reparationEmpowerment and resilience: Breaking cycles and managing impressions‘Light in the darkness’ [54]: reparation and empowerment of motherhoodRepairing childhood wounds, positive changes in mental health and wellbeing in becoming a mother including increased motivation, feelings of love for children, opportunity to return to education, positive maternal behaviours, breaking cycles. Pregnancy provides a point to move on from harmful behaviours.[40,41,42,43,44, 46, 51, 53, 54, 56, 57]
‘Impression management’ [56]Young women present stories, in a positive light in order to avoid the ‘stigma’ attached to teenage motherhood and mental illness.[40, 44, 54, 56]