Department of Psychiatry, University of California, 3333 California St., Ste. 465, Box 0848, San Francisco, CA 94143-0848, USA.
Contraception. 2013 Dec;88(6):717-24. doi: 10.1016/j.contraception.2013.08.009. Epub 2013 Sep 9.
We investigated whether more psychological distress before an abortion is associated with the effectiveness of contraception selected (low, moderate, or high effectiveness) at an abortion clinic visit.
Using data from 253 women attending an urban abortion clinic that primarily serves low-income women, we tested the association between pre-abortion psychological distress and the effectiveness level of post-abortion contraceptive choice. Based on typical use failure rates, we classified effectiveness of contraceptive choice into three levels-low, moderate, and high effectiveness. We measured psychological distress with four validated measures of depressive, anxious, and stress symptoms, and negative affect, as well as with a global measure comprising these four measures. We used multivariable ordinal logistic regression to measure the association of each psychological distress measure with post-abortion contraceptive method effectiveness level, adjusting for sociodemographic factors, pregnancy history, trimester of abortion, and importance of avoiding pregnancy in the next year.
We found that compared to women experiencing less stress symptoms, negative affect and global psychological distress, women experiencing more stress symptoms [AOR=1.028, 95% CI: 1.001-1.050], negative affect [AOR=1.05, 95% CI: 1.01-1.09] and global psychological distress [AOR=1.46, 95% CI: 1.09-1.95] were more likely to choose more effective versus less effective methods, p<.05, in adjusted models. Using dichotomous psychological measures we found similar results.
Women experiencing more psychological distress before an abortion selected more effective contraceptive methods after their abortion. Future research should examine whether this distress is associated with subsequent contraceptive use or continuation.
The current study suggests that contraceptive providers should not assume that women experiencing more psychological distress prefer to use less effective contraceptive methods.
我们调查了在堕胎前是否有更多的心理困扰与在堕胎诊所就诊时选择的避孕方法（低、中、高效）的有效性有关。
利用 253 名在一家主要为低收入妇女服务的城市堕胎诊所就诊的妇女的数据，我们检验了堕胎前心理困扰与堕胎后选择避孕方法的有效性水平之间的关系。根据典型使用失败率，我们将避孕方法的有效性分为低、中、高三个水平。我们使用四项经过验证的抑郁、焦虑和压力症状以及负性情绪的测量工具，以及包括这四项测量工具的综合测量工具来衡量心理困扰。我们使用多变量有序逻辑回归来衡量每个心理困扰测量与堕胎后避孕方法有效性水平的关系，调整了社会人口因素、妊娠史、堕胎的孕周期以及下一年避免怀孕的重要性。
我们发现，与应激症状、负性情绪和总体心理困扰较轻的女性相比，应激症状更严重的女性[比值比（AOR）=1.028，95%置信区间（CI）：1.001-1.050]、负性情绪（AOR=1.05，95%CI：1.01-1.09）和总体心理困扰（AOR=1.46，95%CI：1.09-1.95）更有可能选择更有效的避孕方法，而不是更无效的避孕方法，p<.05，在调整后的模型中。使用二分类心理测量，我们得到了类似的结果。
在堕胎前经历更多心理困扰的女性在堕胎后选择了更有效的避孕方法。未来的研究应该检验这种困扰是否与随后的避孕使用或持续有关。
本研究表明，避孕提供者不应假设经历更多心理困扰的女性更倾向于使用低效的避孕方法。
