Department of Obstetrics and Gynecology, School of Medicine, Institute for Social Research, Population Studies Center, University of Michigan, L4000 Women's Hospital, 1500 East Medical Center Dr., Ann Arbor, MI 48109, United States.
Institute for Social Research, Population Studies and Survey Research Centers, University of Michigan, 426 Thompson St., Ann Arbor, MI 48106-1248, United States.
Soc Sci Med. 2014 Jan;100:62-71. doi: 10.1016/j.socscimed.2013.10.037. Epub 2013 Nov 7.
Depression and stress have been linked with poor contraceptive behavior, but whether existing mental health symptoms influence women's subsequent risk of unintended pregnancy is unclear. We prospectively examined the effect of depression and stress symptoms on young women's pregnancy risk over one year. We used panel data from a longitudinal study of 992 U.S. women ages 18-20 years who reported a strong desire to avoid pregnancy. Weekly journal surveys measured relationship, contraceptive use and pregnancy outcomes. We examined 27,572 journal surveys from 940 women over the first study year. Our outcome was self-reported pregnancy. At baseline, we assessed moderate/severe depression (CESD-5) and stress (PSS-4) symptoms. We estimated the effect of baseline mental health symptoms on pregnancy risk with discrete-time, mixed-effects, proportional hazard models using logistic regression. At baseline, 24% and 23% of women reported moderate/severe depression and stress symptoms, respectively. Ten percent of young women not intending pregnancy became pregnant during the study. Rates of pregnancy were higher among women with baseline depression (14% versus 9%, p = 0.04) and stress (15% versus 9%, p = 0.03) compared to women without symptoms. In multivariable models, the risk of pregnancy was 1.6 times higher among women with stress symptoms compared to those without stress (aRR 1.6, CI 1.1,2.7). Women with co-occurring stress and depression symptoms had over twice the risk of pregnancy (aRR 2.1, CI 1.1,3.8) compared to those without symptoms. Among women without a prior pregnancy, having co-occurring stress and depression symptoms was the strongest predictor of subsequent pregnancy (aRR 2.3, CI 1.2,4.3), while stress alone was the strongest predictor among women with a prior pregnancy (aRR 3.0, CI 1.1,8.8). Depression symptoms were not independently associated with young women's pregnancy risk. In conclusion, stress, and especially co-occurring stress and depression symptoms, consistently and adversely influenced these young women's risk of unintended pregnancy over one year.
抑郁和压力与不良避孕行为有关，但现有心理健康症状是否会影响女性随后意外怀孕的风险尚不清楚。我们前瞻性地研究了抑郁和压力症状对年轻女性一年后怀孕风险的影响。我们使用了一项对 992 名年龄在 18-20 岁的美国女性进行的纵向研究的面板数据，这些女性报告说强烈希望避免怀孕。每周的日记调查衡量了关系、避孕措施和怀孕结果。我们对 940 名女性在第一年的 27572 份日记调查进行了研究。我们的结果是自我报告的怀孕。在基线时，我们评估了中度/重度抑郁（CESD-5）和压力（PSS-4）症状。我们使用逻辑回归的离散时间、混合效应、比例风险模型来估计基线心理健康症状对怀孕风险的影响。在基线时，分别有 24%和 23%的女性报告有中度/重度抑郁和压力症状。在研究期间，有 10%的年轻女性没有怀孕就怀孕了。与没有症状的女性相比，基线时有抑郁（14%对 9%，p=0.04）和压力（15%对 9%，p=0.03）的女性怀孕率更高。在多变量模型中，与没有压力症状的女性相比，有压力症状的女性怀孕的风险高出 1.6 倍（调整后的相对风险 1.6，95%置信区间 1.1，2.7）。与没有症状的女性相比，同时有压力和抑郁症状的女性怀孕的风险高出两倍多（调整后的相对风险 2.1，95%置信区间 1.1，3.8）。在没有既往怀孕的女性中，同时存在压力和抑郁症状是随后怀孕的最强预测因素（调整后的相对风险 2.3，95%置信区间 1.2，4.3），而在有既往怀孕的女性中，压力是最强的预测因素（调整后的相对风险 3.0，95%置信区间 1.1，8.8）。抑郁症状与年轻女性的怀孕风险无关。总之，压力，特别是同时存在压力和抑郁症状，在一年多的时间里对这些年轻女性的意外怀孕风险产生了持续的不利影响。
