Current and past depressive symptoms and contraceptive effectiveness level method selected among women seeking reproductive health services
Current and past depressive symptoms and contraceptive effectiveness level method selected among women seeking reproductive health services
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DOI：
10.1016/j.socscimed.2018.08.009
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发表时间：
2018-10-01
影响因子：
5.4
通讯作者：
Harper, Cynthia C.
中科院分区：
文献类型：
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作者：
Steinberg, Julia R.;Adler, Nancy E.;Harper, Cynthia C.
理由：更彻底地了解在生殖健康访问中选择的避孕方法的有效性水平与抑郁症状升高之间的关系可以帮助妇女预防意外怀孕。目的：本研究探讨了当前和过去的抑郁症状与门诊选择的避孕方法的有效性水平之间的关系如何随生殖健康就诊类型的变化而变化。方法：对1215名年龄在18-25岁、在美国40个社区诊所寻求一般生殖健康或堕胎服务的女性进行当前和过去的抑郁症状和避孕方法的评估。使用基于典型使用期间怀孕率的有效性标准分类，所选择的妇女避孕方法被编码为低（例如，无方法，退出，避孕套），中等（药丸，贴片，环或注射）或高效方法（宫内节育器，绝育，植入）。抑郁状态分为四类：1)从未有过抑郁症状升高，2)目前只有抑郁症状升高，3)过去只有抑郁症状升高，4)过去和现在都有抑郁症状升高。访问类型，一般生殖健康与堕胎护理，是调节因素。采用多项logistic回归分析，估计抑郁症状与就诊类型对所选避孕方法效果水平的交互作用。结果：在一般生殖健康就诊中；有当前和过去的抑郁症状。增加了女性选择低有效方法与中等有效方法的可能性（RRR = 5.63, 95% CI = 2.31至13.71,p < .0005）。相比之下，在流产患者中，只有当前抑郁症状升高与选择高或中等疗效方法相关（RRR = 1.74, 95% CI = 1.06至2.86,p = 0.029）。结论：结果表明，考虑妇女目前和过去的抑郁症状升高和生殖健康就诊的类型可能有助于提供者帮助妇女预防意外怀孕。
Rationale: More thoroughly understanding the association between elevated depressive symptoms and effectiveness level of contraceptive method selected at a reproductive health visit could help women prevent unintended pregnancy.Objective: This study examined how the association between both current and past depressive symptoms and effectiveness level of contraceptive method selected at a clinic visit varies by type of reproductive health visit.Methods: Current and past depressive symptoms and contraceptive method selected were assessed among 1215 women aged 18-25 years seeking general reproductive health or abortion services at 40 community clinics throughout the United States. Using standard categories of effectiveness based on pregnancy rates during typical use, women's contraceptive method selected was coded as a low (e.g., no method, withdrawal, condoms), moderately (pill, patch, ring, or shot), or highly effective method (IUD, sterilization, implant). Depression status was divided into four categories: 1) no elevated depressive symptoms ever, 2) current elevated depressive symptoms only, 3) past elevated depressive symptoms only, and 4) past and current elevated depressive symptoms. Visit type, general reproductive health versus abortion care, was a moderator. The interaction effect between depressive symptoms and visit type on contraceptive method effectiveness level chosen was estimated with multinomial logistic regression analyses.Results: In general reproductive health visits;having both elevated current and past-depressive symptoms. increased women's likelihood of choosing low versus moderately effective methods (RRR = 5.63, 95% CI = 2.31 to 13.71, p < .0005). In contrast, among abortion patients, only current elevated depressive symptoms were associated with choosing high versus moderate effectiveness methods (RRR = 1.74, 95% CI = 1.06 to 2.86, p = .029).Conclusion: Results suggest that considering both women's current and past elevated depressive symptoms and the type of reproductive health visit may assist providers in helping women prevent unintended pregnancy.