The Effect of Depression on Women's Contraceptive Behaviors and Teenage Pregnancy
Steinberg, Julia R.
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Objective: The overall objective of this dissertation was to investigate the effect of depression on women’s contraceptive behaviors and teenage pregnancy. Methods: In the first study, the relationship between pre-abortion depressive symptoms and effectiveness level of contraceptive method chosen (low, moderately, or highly effective) after contraceptive counseling was examined using multinomial logistic regression in a group of women seeking abortion services. In the second study Cox proportional hazards models were used to estimate the hazard of contraceptive method discontinuation and unintended pregnancy among women experiencing any current and past elevated depressive symptoms in reproductive health settings. The third study examined the association between first depressive episode relative to age at first sex, and the hazard of first teenage pregnancy among girls participating in the National Comorbidity Survey–Adolescent Supplement. Results: More pre-abortion depressive symptoms were associated with higher odds of choosing a low contraceptive method than a moderately or a highly effective contraceptive method. Compared to non-depressed women, women exposed to baseline and a history of elevated depressive symptoms and those exposed to a history of elevated depressive symptoms had 39% and 12% increased hazards of contraceptive method discontinuation respectively; though the associations were not statistically significant when examining all contraceptive methods together. These associations were significant among patch and the injectable users. Finally, adolescent girls whose first depressive episode occurred at the same age as their sexual debut had a higher likelihood of experiencing first teenage pregnancy (HR: 2.73, 95% CI 1.07, 6.97) than those experiencing no depression onset. Conclusion: This dissertation provides evidence for the critical role of timing of depression in determining women’s contraceptive behaviors and reproductive decisions. The findings collectively suggest that not only the presence or absence of depression, but also the time the condition manifests itself during the course of women’s live can predict women’s decisions surrounding contraceptive method choice, continuation, and pregnancy. Implications: The integration of mental and reproductive health as well as a more effective patient-physician communication are warranted in an effort to optimize pregnancy outcomes in women at risk for depression.