The role of depression, anxiety, and negative emotions in post-abortion contraceptive decision-making
Contraception
Awarded 2010
Large Research Grants
Julia Steinberg, PhD
University of California, San Francisco
$119,926

Background: While prior research has shown that psychological health prior to an abortion is a strong predictor of post-abortion mental health and coping, research understanding the role of psychological health in other important post-abortion outcomes, such as contraceptive decision-making is lacking. Objective: The goal of this research is to examine how women’s levels of depression, anxiety, stress, and negative emotions just before an abortion relate to contraceptive decision-making processes in the abortion care setting. Building upon a small study conducted at the Women’s Options Center at San Francisco General Hospital, we conducted a similar study at three additional abortion clinics to investigate how women’s psychological health just before their abortion influenced post-abortion contraceptive decision-making processes. Collecting data at more than one clinic allowed us to examine how mental health and emotions influence post-abortion contraceptive choice among beyond clinic-level factors. Methods: We conducted a survey at two time points in women’s abortion care visit: just before their abortion and contraceptive counseling and after contraceptive counseling. In Part 1 of the survey, we assessed levels of depression, anxiety, and negative affect just before women’s abortion using validated instruments in the psychological literature. Following others’ examples, we also created a composite of these four measures to assess global psychological distress. In Part 1, we also assessed which contraceptive method women were planning to use after their abortion. After contraceptive counseling (Part 2), we again assessed the contraceptive method women were planning to use after their abortion. Contraceptive method at both time points was coded into a three-level effectiveness category: low (condoms, EC, no method), moderately (pill, patch, ring, and shot), and high effective methods (IUD and implant). We conducted multinomial logistic regression to test whether those with more depressive, anxiety, and stress symptoms and more negative affect and global psychological distress was related to effectiveness level planning to use pre-counseling and post-counseling. Results: Among 461 women who completed Part 1, preliminary results from unadjusted multinomial logistic regression models show that women with more depressive symptoms and global psychological distress were more likely pre-counseling and pre-abortion to plan to use low versus moderately and high effective methods. Similarly, among 430 women who completed Parts 1 and 2, preliminary results from multinomial logistic regression models show that women with more depressive and stress symptoms, and global psychological distress were more likely to post-counseling choose low versus moderately effective methods. In addition, those with more depressive symptoms and global psychological distress were also more likely to choose low effective versus highly effective methods. Conclusions: While results are preliminary, they show that women with more psychological distress — including depressive and stress symptoms and global psychological distress — before their abortion intended to use post-abortion low versus moderately and high effective methods both before and after contraceptive counseling, suggesting that women experiencing more psychological distress before their abortion may be at higher risk of subsequent unwanted pregnancy. These results are in contrast to another study showing that at one hospital-based abortion clinic, more global psychological distress was associated with choosing more effective methods. Results may differ because of the contraceptive counseling received or the nature of the clinics differ.

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