Original article
Role of Young Women's Depression and Stress Symptoms in Their Weekly Use and Nonuse of Contraceptive Methods

https://doi.org/10.1016/j.jadohealth.2013.02.009Get rights and content

Abstract

Purpose

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

Methods

We examined data from 689 women ages 18–20 years participating in a longitudinal cohort study. Women completed 8,877 weekly journals over the first year, which assessed reproductive, relationship, and health information. We focused on baseline depression (Center for Epidemiologic Studies-Depression Scale) and stress (Perceived Stress Scale) symptoms and weekly contraceptive method use. Analyses used multivariate random effects and multinomial logistic regression.

Results

Approximately one quarter of women exhibited moderate/severe depression (27%) and stress (25%) symptoms at baseline. Contraception was not used in 10% of weekly journals, whereas coital and noncoital methods were used in 42% and 48% of weeks, respectively. In adjusted models, women with moderate/severe stress symptoms had more than twice the odds of contraception nonuse than women without stress (odds ratio [OR] 2.23, confidence interval [CI] 1.02–4.89, p = .04). Additionally, women with moderate/severe depression (RR .52, CI .40–.68, p < .001) and stress (relative risk [RR] .75, CI .58–.96, p = .02) symptoms had lower relative risks of using long-acting methods than oral contraceptives (OCs; reference category). Women with stress symptoms also had higher relative risks of using condoms (RR 1.17, CI 1.00–1.34, p = .02) and withdrawal (RR 1.29, CI 1.10–1.51, p = .001) than OCs. The relative risk of dual versus single method use was also lower for women with stress symptoms.

Conclusion

Women's psychological symptoms predicted their weekly contraceptive nonuse and use of less effective methods. Further research can determine the influence of dynamic psychological symptoms on contraceptive choices and failures over time.

Section snippets

Sample and design

Our data come from a representative population-based cohort study of 992 young women aged 18–20 years residing in a racial/ethnically and socioeconomically diverse Michigan county. Names and contact information were randomly selected from state driver's license and personal identification card registries. Eligible women (age 18–20 and a county resident) were contacted by mail or phone and asked to participate. Sampling occurred between March 2008 and March 2009. This study was approved by the

Sample baseline sociodemographic and reproductive characteristics

(Table 1) Women were ages 18 (43%), 19 (49%), and 20 (8%) years old at enrollment. The majority identified as white (58%) or black (32%) race/ethnicity. More than half of women were enrolled in a 4-year (25%) or 2-year (29%) college or vocational/technical school. Many women were employed (51%), although 28% were receiving public assistance. Weekly religious services attendance was reported by 21% of women. More than half (57%) were in a special romantic relationship; 21% were living with a

Discussion

Ours is the first study of which we are aware to prospectively measure weekly method choice and sexual activity among a population-based cohort. Building on other researchers' work of contraceptive method use [1], we found that OCs and condoms were consistently young women's preferred contraceptives each week. However, 10% of these women's weeks were not covered by a contraceptive method. Our findings provide new insights into contraceptive nonuse and specific method use patterns among women at

Acknowledgments

This work was supported by the National Institute of Child Health and Human Development for grant #R01-HDHD050329 (principal investigator J. B., University of Michigan), by an NICHD Building Interdisciplinary Careers in Women's Health K-12 Career Development grant (project principal investigator K.S.H., #K12HD001438), and by NICHD center grant for Infrastructure for Population Research at Princeton University (J.T. and K.S.H. while the latter was a postdoctoral research fellow at Princeton

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    Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.