Elsevier

Contraception

Volume 88, Issue 5, November 2013, Pages 641-649
Contraception

Original research article
Young women’s consistency of contraceptive use — does depression or stress matter?

https://doi.org/10.1016/j.contraception.2013.06.003Get rights and content

Abstract

Background

We prospectively examined the influence of young women’s depression and stress symptoms on their weekly consistency of contraceptive method use.

Study Design

Women ages 18-20 years (n= 689) participating in a longitudinal cohort study completed weekly journals assessing reproductive, relationship and health characteristics. We used data through 12 months of follow-up (n= 8877 journals) to examine relationships between baseline depression (CES-D) and stress (PSS-10) symptoms and consistency of contraceptive methods use with sexual activity each week. We analyzed data with random effects multivarible logistic regression.

Results

Consistent contraceptive use (72% of weeks) was 10–15 percentage points lower among women with moderate/severe baseline depression and stress symptoms than those without symptoms (p<.001). Controlling for covariates, women with depression and stress symptoms had 47% and 69% reduced odds of contraceptive consistency each week than those without symptoms, respectively (OR 0.53, CI 0.31–0.91 and OR 0.31, CI 0.18–0.52). Stress predicted inconsistent use of oral contraceptives (OR 0.27, CI 0.12–0.58), condoms (OR 0.40, CI 0.23–0.69) and withdrawal (OR 0.12, CI 0.03–0.50).

Conclusion

Women with depression and stress symptoms appear to be at increased risk for user-related contraceptive failures, especially for the most commonly used methods.

Implications

Our study has shown that young women with elevated depression and stress symptoms appear to be at risk for inconsistent contraceptive use patterns, especially for the most common methods that require greater user effort and diligence. Based upon these findings, clinicians should consider women’s psychological and emotional status when helping patients with contraceptive decision-making and management. User-dependent contraceptive method efficacy is important to address in education and counseling sessions, and women with stress or depression may be ideal candidates for long-acting reversible methods, which offer highly effective options with less user-related burden. Ongoing research will provide a greater understanding of how young women’s dynamic mental health symptoms impact family planning behaviors and outcomes over time.

Introduction

Contraceptive users account for over half of the annual 3.1 million unintended pregnancies in the United States, with 90% attributed to non-, inconsistent or incorrect use of contraceptive methods [1], [2], [3], [4]. Factors contributing to contraceptive misuse leading to unintended pregnancy are complex and include a wide range of demographic, social, reproductive, relationship and attitudinal characteristics [1], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15]. Young age, low educational attainment, low income, minority race/ethnicity, transient sexual partnerships, greater numbers of sexual partners, ambivalent attitudes towards pregnancy, dynamic life or professional circumstances (e.g. moving to a new home, starting/stopping a job, having a personal crisis), access issues, and method tolerability are a few examples of known predictors of poor contraceptive behavior [9], [10], [11], [12], [13], [14].

What has been studied to a lesser extent is the influence of mental health symptoms on women’s contraceptive use patterns. Depression, anxiety and related psychological stress are common among young women [16], [17] and are known to impact health behaviors including prescription medication adherence [18], [19]. These mental health symptoms have also been linked with potentially risky sexual practices correlated with negative reproductive sequelae including early and unprotected coitarche, higher number of sexual partners, acquistion of sexually transmitted infections, sex while under the influence of alcohol and drugs and intimate partner violence [20], [21], [22], [23], [24].

In contraceptive research, studies that have examined mental health symptoms have largely focused mood symptoms occurring with hormonal contraception [25], [26], [27] or have used cross-sectional or retrospective designs, limited psychological measures, or finite outcomes like oral contraceptive (OC) discontinuation [28], [29], [30], [31], [32]. It is unclear how women’s mental health symptoms may affect their use of contraceptive methods over time and within the context of their daily lives.

We prospectively investigated the influence of depression and stress on young women’s weekly consistency of contraceptive use, overall and by contraceptive method.

Section snippets

Sample and design

We used data from 992 young women participating in a longitudinal cohort study. Young women residing in a racial/ethnically and socioeconomically diverse county in Michigan were identified from state driver’s license and personal identification card registers. Names and contact information were randomly selected from these public records and eligible women (age 18–20 years at time of recruitment and a resident of the county) were contacted by mail or phone and asked to participate. Sampling

Weekly contraceptive use

Characteristics of our sample are described in Table 1. Among the 689 women who were sexually active and not pregnant (n= 8877 weeks), contraceptive nonuse was reported in 10% of study weeks, while 48% of weeks were covered by non-coital methods and 42% by coital methods alone. For contraceptive methods used each week (n= 7999), women reported long-acting methods (injectable 6%, IUD < 1% and implant < 1%), OCs (44%), other hormonal methods including the ring (1%) and patch (1%), condoms (27%),

Discussion

Using a unique longitudinal population-based design with weekly measurement of both sexual activity and contraceptive behavior, our study provides a more nuanced understanding of contraceptive behavior and factors associated with contraceptive misuse among young women [1], [2], [8], [9], [10]. We found that while sexually active young women reported using a contraceptive method in 90% of study weeks, a method was not used with every act of intercourse just over one-quarter of the time.

Conclusion and implications

Our study has shown that young women with elevated depression and stress symptoms appear to be at risk for inconsistent contraceptive use patterns, especially for the most common methods that require greater user effort and diligence. Based upon these findings which suggest that mental health status appears to be an important factor in women’s contraceptive behavior, clinicians should assess and even address women’s psychological and emotional status when helping patients with contraceptive

Acknowledgments/funding source

This work was supported by a NICHD Building Interdisciplinary Careers in Women’s Health K-12 Career Development grant (Hall, #K12HD001438), by a NICHD grant #R01-HDHD050329 (P.I. Barber, University of Michigan), and by a NICHD center grant for Infrastructure for Population Research at Princeton University (Trussell and Hall while she was a postdoctoral research fellow at Princeton University, #R24HD047879).

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    Disclosure statement: None of the authors have a conflict of interest.

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