Integrating Mental Health Screening in Reproductive Health Care: Associations between Symptoms of Depression and Anxiety, Contraceptive Method Choice, and STI Diagnosis

A project integrating routine, standardized mental health and behavioral risk factor (BRF) screening of patients at eight reproductive health centers has included research and evaluation efforts to identify links between mental health and reproductive and sexual health. An analysis of data from all new prenatal and family planning patients BRF-screened from January 2005 - June 2006 included results from routine STI screening (Chlamydia and Gonorrhea) (new prenatal and family patients, n=6,627) and contraceptive method choice after counseling (new family planning patients only, n=3,053). Among patients studied the mean age was 27, 65% were Latina, 61% were foreign-born representing 68 countries of birth, and 67% had at least one live birth. While the number of STIs diagnosed through routine screening was low, patients who screened positive for anxiety (8% of patients) were significantly more likely to later receive a positive STI diagnosis (OR=1.6; 95%CI:1.2-2.1). Excluding patients who were seeking pregnancy, reported infertility or sterilization, or who were missing data on method choice, most family planning patients (84%) were provided a method of contraception at the end of the visit. Patients who screened positive for depression (8.4% of patients screened with the PHQ-9) were significantly more likely to choose no method or to rely on abstinence or natural family planning (OR=1.7, 95%CI:1.2-2.4). These significant associations between mental health status and sexual health provide support for the integration of mental health screening and referral into existing services as a way to enhance reproductive health outcomes.