Hall Kelli Stidham, Richards Jennifer L, Harris Kathleen Mullan
Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
J Adolesc Health. 2017 Jun;60(6):688-697. doi: 10.1016/j.jadohealth.2016.12.003. Epub 2017 Jan 18.
We investigated the influence of depression on subsequent risk of unintended pregnancy and social disparities within this relationship, during adolescence and young adulthood.
Drawing upon 15-year, nationally representative data from 8,810 young U.S. women in the National Longitudinal Study of Adolescent to Adult Health, we estimated associations between depression and time to first pregnancies reported as unintended, overall and stratified by race/ethnicity, socioeconomic status, and age with Cox proportional hazard models.
Moderate/severe depression symptoms were associated with an increased risk of unintended first pregnancy (hazard ratio [HR], 1.21; confidence interval [CI], 1.02-1.44). In stratified models, depression increased the pregnancy risk for all minority groups (HRs, 1.36-3.25) but not white women. Depression increased the pregnancy risk for women with $0-$19,999 (HR, 1.48; CI, 1.11-1.98) and $20,000-$49,999 (HR, 1.33; CI, 1.05-1.68) income levels but not those at higher levels. Depression increased the pregnancy risk for adolescents <20 years (HR, 1.35; CI, 1.07-1.71) but decreased the risk for women >24 years (HR, .47; CI, .25-.86).
Findings may inform more equitable, holistic public health strategies that target depression as a modifiable risk factor for adverse reproductive outcomes during adolescence and young adulthood.
我们研究了抑郁对青少年和青年期意外怀孕后续风险的影响，以及这种关系中的社会差异。
利用美国国家青少年健康纵向研究中8810名美国年轻女性的15年全国代表性数据，我们使用Cox比例风险模型估计了抑郁与首次意外怀孕时间之间的关联，总体上以及按种族/族裔、社会经济地位和年龄分层进行了估计。
中度/重度抑郁症状与首次意外怀孕风险增加相关（风险比[HR]，1.21；置信区间[CI]，1.02 - 1.44）。在分层模型中，抑郁增加了所有少数群体的怀孕风险（HR，1.36 - 3.25），但白人女性没有。抑郁增加了收入水平为0 - 19999美元（HR，1.48；CI，1.11 - 1.98）和20000 - 49999美元（HR，1.33；CI，1.05 - 1.68）女性的怀孕风险，但对收入较高水平的女性没有影响。抑郁增加了20岁以下青少年的怀孕风险（HR，1.35；CI，1.07 - 1.71），但降低了24岁以上女性的风险（HR，0.47；CI，0.25 - 0.86）。
研究结果可为更公平、全面的公共卫生策略提供参考，这些策略将抑郁作为青少年和青年期不良生殖结局的可改变风险因素加以关注。
