Callegari Lisa S, Zhao Xinhua, Nelson Karin M, Borrero Sonya
Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way S-152, Seattle, WA 98108; Department of Obstetrics & Gynecology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195.
Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, University Drive (151C), Building 30, Pittsburgh PA 15240.
Contraception. 2015 May;91(5):386-92. doi: 10.1016/j.contraception.2015.01.013. Epub 2015 Jan 28.
Emerging data suggest that mental illness and substance use disorder (SUD) are important risk factors for inconsistent contraceptive use. We investigated whether mental illness without or with SUD is associated with contraceptive adherence and continuation of hormonal methods among women Veterans.
We conducted a retrospective analysis of national Veteran's Administration data among women aged 18-45 with a hormonal contraceptive prescription (pill/patch/ring/injectable) during the first week of fiscal year 2013. We tested associations between mental illness diagnoses (depression, posttraumatic stress disorder, anxiety, bipolar disorder, schizophrenia, adjustment disorder) without or with SUD diagnoses (drug/alcohol abuse) and 12-month contraceptive adherence (number and length of gaps ≥7 days between refills and months of contraceptive coverage) using multivariable regression models.
Among 9780 Veterans, 43.6% had mental illness alone, 9.4% comorbid mental illness and SUD, and 47.0% neither diagnosis. In adjusted analyses, compared to women with neither diagnosis, women with mental illness alone had a similar rate of gaps but increased odds of having gaps longer than 30 days [odds ratio (OR): 1.35, 95% confidence interval (CI): 1.10-1.52] and fewer months of contraceptive coverage (β_coefficient: -0.39, 95% CI: -0.56 to -0.23). Women with mental illness and SUD experienced more gaps (incidence rate ratio: 1.12, 95% CI: 1.03-1.21), increased odds of gaps longer than 30 days (OR: 1.46, 95% CI: 1.10-1.79), fewer months of contraceptive coverage (β_coefficient: -0.90, 95% CI: -1.20 to -0.62) and reduced odds of continuous 12-month coverage (adjusted OR: 0.76, 95% CI: 0.63-0.93).
Mental illness, particularly with comorbid SUD, is associated with reduced contraceptive adherence and continuation among women Veterans. Women with these risk factors could potentially benefit from use of long-acting reversible methods.
Women Veterans have a high burden of mental illness and SUD, which we found are associated with inconsistent contraceptive use. Efforts to improve adherence to hormonal contraceptives and to increase availability of long-acting reversible methods in this vulnerable population are warranted.
新出现的数据表明，精神疾病和物质使用障碍（SUD）是避孕措施使用不一致的重要风险因素。我们调查了无SUD或伴有SUD的精神疾病是否与女性退伍军人的避孕依从性及激素避孕方法的持续使用有关。
我们对2013财年第一周有激素避孕处方（药丸/贴片/阴道环/注射剂）的18 - 45岁女性退伍军人的国家退伍军人管理局数据进行了回顾性分析。我们使用多变量回归模型测试了无SUD诊断（药物/酒精滥用）或伴有SUD诊断的精神疾病诊断（抑郁症、创伤后应激障碍、焦虑症、双相情感障碍、精神分裂症、适应障碍）与12个月避孕依从性（续方之间间隔≥7天的次数和时长以及避孕覆盖月数）之间的关联。
在9780名退伍军人中，43.6%仅有精神疾病，9.4%患有精神疾病合并SUD，47.0%两者均未诊断出。在调整分析中，与两者均未诊断出的女性相比，仅有精神疾病的女性间隔发生率相似，但间隔超过30天的几率增加[比值比（OR）：1.35，95%置信区间（CI）：1.10 - 1.52]，且避孕覆盖月数减少（β系数： - 0.39，95% CI： - 0.56至 - 0.23）。患有精神疾病合并SUD的女性经历更多间隔（发病率比：1.12，95% CI：1.03 - 1.21），间隔超过30天的几率增加（OR：1.46，95% CI：1.10 - 1.79），避孕覆盖月数减少（β系数： - 0.90，95% CI： - 1.20至 - 0.62），且连续12个月覆盖的几率降低（调整后OR：0.76，95% CI：0.63 - 0.93）。
精神疾病，尤其是合并SUD时，与女性退伍军人避孕依从性降低和持续使用减少有关。有这些风险因素的女性可能会从长效可逆避孕方法的使用中获益。
女性退伍军人精神疾病和SUD负担较重，我们发现这与避孕措施使用不一致有关。有必要努力提高对激素避孕的依从性，并增加这一弱势群体中长效可逆避孕方法的可及性。
