Influence of depression and stress symptoms on young women's consistency of contraceptive use

Objective Depression and psychological stress contribute to high-risk sexual behavior and medication misuse yet their influence on contraceptive use patterns is unknown. We examined relationships between young women's psychological symptoms and consistency of contraceptive use.

Methods Women ages 18-19 years (n=1,250) participating in a longitudinal cohort study completed weekly journals assessing contraceptive, reproductive, relationship and health characteristics and outcomes. Excluding journals in which women were pregnant or sexually inactive, we examined 7829 pairs of journals (weeks) from 12 months follow-up (n=639). Our outcome was consistency of contraceptive use during the last week (dichotomous). Predictors were baseline depression (CESD-5, range 0-15) and stress (PSS-4, range 0-16) scores and moderate/severe psychological symptoms (standardized score cut-offs). Analyses used random effects multivariate logistic regression models.

Results Mean depression and stress scores were 2±3 and 6±3 points; 26% and 25% of the sample met criteria for moderate/severe depression and stress symptoms, respectively. Consistent contraceptive use was reported for 72% of weeks. Proportions of consistent contraceptive use were lower among women with moderate/severe depression and stress symptoms than those without (64% vs. 74% and 61% vs. 76%, respectively, p-values<0.001). Controlling for covariates, the odds of consistent contraceptive use were reduced by 12% and 15% for each point increase in depression (OR 0.88, CI 0.81-0.96, p=0.004) and stress (OR 0.85, CI 0.78-0.92, p<0.001) scores. Women with moderate/severe stress symptoms were less likely to use contraception consistently than those without stress (OR 0.35, CI 0.20-0.63, p<0.001).

Conclusion Psychological symptoms predict subsequent inconsistent contraceptive use patterns among young women.