The Association between Mental Health Disorders and History of Unintended Pregnancy among Women Veterans

Judge-Golden, Colleen; Borrero, Sonya; Zhao, Xinhua; Mor, Maria K.; Callegari, Lisa S.

doi:10.1007/s11606-018-4647-8

Cited by 18 publications

(13 citation statements)

References 36 publications

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“…Women with psychiatric comorbidity also had increased likelihood of incident pregnancy despite lower likelihood of initiating contraception. Previous studies have shown that women with a history of mental health disorders are more likely to report unintended pregnancies than those without mental illness [ 36–38 ]. Furthermore, psychiatric comorbidities during pregnancy are associated with increased risk of pregnancy-related morbidity, as are unintended pregnancies [ 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Low Rates of Contraception Use in Women With Human Immunodeficiency Virus

Bhatta

Bian

Norwood

et al. 2022

Open Forum Infectious Diseases

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Background Women with HIV (WWH) have low rates of hormonal or long-acting contraceptive use. Few studies have described contraception use among WWH over time. Methods We examined contraception (including all forms of hormonal contraception, intrauterine devices, and bilateral tubal ligations) use among cis-gender women aged 18-45 years in care at Vanderbilt's HIV clinic (Nashville, TN) from 1998-2018. Weighted annual prevalence estimates of contraception use were described. Cox proportional hazards models examined factors associated with incident contraception use and pregnancy. Results Of the 737 women included, median age at clinic entry was 31 years, average follow-up was 4.1 years. At clinic entry, 47 (6%) women were on contraception and 164 (22%) were pregnant. The median annual percent of time on any contraception use among non-pregnant women was 31.7% and remained stable throughout the study period. Younger age was associated with increased risk of pregnancy and contraceptive use. Psychiatric comorbidity decreased likelihood of contraception (adjusted HR [aHR] 0.52 [95%CI: 0.29-0.93]) and increased likelihood of pregnancy (aHR 1.77 [95%CI: 0.97-3.25]). While not associated with contraceptive use, more recent year of clinic entry was associated with higher pregnancy risk. Race, substance use, CD4 cell count, HIV RNA, smoking, and antiretroviral therapy were not associated with contraception use nor pregnancy. Conclusions Most WWH did not use contraception at baseline nor during follow-up. Likelihood of pregnancy increased with recent clinic entry while contraception use remained stable over time. Continued efforts to ensure access to effective contraception options are needed in HIV clinics.

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Section: Discussionmentioning

confidence: 99%

Low Rates of Contraception Use in Women With Human Immunodeficiency Virus

Bhatta

Bian

Norwood

et al. 2022

Open Forum Infectious Diseases

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“…In a more recent study using survey data from ECUUN, women Veterans with self-reported mental illness diagnoses (including major depression, bipolar disorder, posttraumatic stress disorder, schizophrenia, and anxiety/panic disorder) were found to have similar rates of contraceptive use and method efficacy at last sex compared with Veterans without a diagnosis of mental illness. 41 These two studies together do not suggest that mental health diagnoses are a barrier to contraceptive access in the VA, which may reflect the strong integration of mental health services in primary care within the VA system. Questions remain regarding contraception for women with SUD, in part due to the limitations associated with identifying SUD with administrative data (the ECUUN study did not assess SUD).…”

Section: Vulnerable Populationsmentioning

confidence: 92%

Contraceptive Care in the Veterans Health Administration

et al. 2019

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In recent years, the number of women Veterans obtaining care in the Veterans Affairs (VA) Healthcare System has grown, expanding the need for provision of contraceptive care. Women Veterans are a diverse group of women with complex sociodemographic and medical backgrounds, and meeting their needs presents a unique challenge for VA. Efforts including the establishment of comprehensive women's health clinics and training practitioners in women's health have greatly improved healthcare services for women Veterans over the last few decades. Recent data from a large cross-sectional survey study suggest that contraceptive use in VA is similar to the general population and that rates of unintended pregnancy, while still significant, are not higher than that in the general population. Subgroup analyses of this survey data, however, suggest that ongoing efforts are needed to improve outcomes in vulnerable subpopulations of women Veterans, particularly ethnic/racial minorities and Veterans with complex medical backgrounds. Policy changes such as the elimination of copayments for contraceptive prescriptions and the dispensing of more months of contraceptive supply are evidence-based starting points for improvements, in addition to leveraging VA's integrated system and research infrastructure to improve patient-centered counseling and contraceptive access.

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“…3). 56 Mental health conditions have been linked to a variety of poor maternal and neonatal outcomes. Depression and PTSD are associated with increased risks of preterm birth, low birth weight, and postpartum depression [57][58][59] and poor infant outcomes such as respiratory failure and low birthweight.…”

Section: Mental Health and Psychosocial Factorsmentioning

confidence: 99%

Preconception Care in the Veterans Health Administration

et al. 2018

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Preconception care (PCC), defined as a set of interventions to help women optimize their health and well-being prior to pregnancy, can improve pregnancy outcomes and is recommended by national organizations including the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists. Women Veterans who use the Department of Veterans Affairs (VA) health care system may face elevated risks of adverse pregnancy and birth outcomes due to a high prevalence of chronic medical and mental health conditions as well as psychosocial stressors including sexual trauma history and intimate partner violence. Many women Veterans of childbearing age experience poverty and homelessness, which are key social determinants of poor reproductive health outcomes. Furthermore, racial/ethnic disparities in maternal and neonatal outcomes are well documented, and nearly half of women Veterans of reproductive age are minority race/ethnicity. High-quality, equitable, patient-centered PCC services to address modifiable risks in this population are therefore a priority for VA. In this article, we provide a brief background of PCC, discuss the health risks of Veterans associated with adverse pregnancy outcomes, and highlight VA initiatives related to PCC. Lastly, we discuss implications and future directions for PCC research and policy within VA and across other health systems.

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The Association between Mental Health Disorders and History of Unintended Pregnancy among Women Veterans

Abstract: Women Veterans with mental health disorders are more likely to have experienced any and greater numbers of unintended pregnancies than Veterans without mental health disorders.

Cited by 18 publications

References 36 publications

Low Rates of Contraception Use in Women With Human Immunodeficiency Virus

Low Rates of Contraception Use in Women With Human Immunodeficiency Virus

Contraceptive Care in the Veterans Health Administration

Preconception Care in the Veterans Health Administration

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