Depression and contraceptive behavioral patterns: Analyzing two longitudinal studies

Most research investigating the interplay between contraception and mental health has examined the association between contraceptive use and subsequent depression. Emerging research has begun to focus on whether depression, the leading cause of disability worldwide, is associated with subsequent contraceptive behaviors. An understanding is important because depression is common among women—with 12% of young women experiencing depression each year in the U.S and 26% of women experiencing it at some point in their lives; there are conceptual frameworks suggesting depression undermines motivation, energy, agency, effort, and action which are necessary to engage in consistent and continuous use of contraception. Little research has examined contraceptive behavioral patterns that consider discontinuation, inconsistent use, and switching of methods. The small literature examining depression and contraceptive behaviors is further limited in that studies have largely examined one specific behavior of one type of method (e.g., discontinuation of the pill).The primary objective of this research is to examine the association between depression and contraceptive behavioral patterns of a range of contraceptive methods. To achieve this objective, I will analyze data from two longitudinal data sets that allow us to examine the association between depression and contraceptive behavioral patterns of a variety of methods. The first is a secondary data of medical and pharmacy records of all women initiating new contraception in Kaiser Permanente Northern California (KPNC) between 2014 and 2016, and the second is pilot primary data collection of a cohort study—called the Mental health And Reproductive health and Choice (MARCH) study)—which is specifically examining the role of depression in contraceptive behaviors. We will use medical and pharmacy records from a cohort of 52,325 women initiating prescribed contraception between 2014-2016 at KPNC, a large integrated health services provider. We have a data set that has depression diagnoses and antidepressant use in the year before initiating contraception; and information on the method women initiated and when they initiated it and stopped it if they stopped it in the year after initiating, and all methods they started and stopped and when within a year of initiating this method. To carry out Aim 1, we will use the KPNC data set to examine the association between depression and contraceptive behavioral patterns controlling for race/ethnicity, age, income, past year abortion and childbirth history. To carry out Aim 2, we will use the MARCH study pilot data, which complements the KPNC data, to investigate the association between depression and contraceptive behavioral patterns. This pilot prospective cohort study has recruited 61 women from a Planned Parenthood clinic in DC to fill out monthly surveys on depressive and other mental health symptoms, contraceptive behaviors, and possible confounders, mediators, or moderators of the association between depressive symptoms and contraceptive behaviors. We expect the papers that result from these analyses to be crucial preliminary analyses of an R01 that investigates the role of depression in contraceptive behaviors.