The effects of preabortion depressive symptoms on postabortion contraceptive effectiveness level chosen among women seeking abortions

Objective: We examined whether preabortion depressive symptoms were associated with contraceptive method effectiveness level chosen among women seeking abortions. Study design: Three-hundred and forty-seven young, low-income women 18 years or older who were seeking abortions at 3 community reproductive health clinics in Northern California were recruited to participate in a study on contraceptive decision making. We classified women into choosing low-, moderate-or high-effectiveness contraceptive methods based on typical-use failure rates. We used the Center for Epidemiologic Studies Depression scale to assess depressive symptoms as a continuous and dichotomous variable. Using the standard cutoff of 20, women who scored at or above this were considered depressed for the dichotomous measure. We used multinomial logistic regression to examine the association between preabortion depressive symptoms and contraceptive effectiveness level chosen to use after an abortion, adjusting for sociodemographics, abortion characteristics, pregnancy history, future pregnancy desires, relationship characteristics and adverse experiences. Results: After adjusting for covariates, we found that a one-unit increase in depressive symptoms was associated with a higher likelihood of choosing low-versus moderate-[adjusted odd ratio (aOR) = 1.05, 95% confidence interval (CI): 1.01-1.10, p<.02] and high-effectiveness methods (aOR = 1.05, 95% Cl: 1.002-1.10, p<.05). Furthermore, women scoring above the cutoff for depression were more likely to choose low-versus moderate-effectiveness methods (aOR=4.56, 95% Cl: 1.27-16.32, p=.02). Conclusions: More preabortion depressive symptoms were independently associated with choosing low-versus moderate-and high-effectiveness contraceptives. Implications: These findings together with other findings show that preabortion depressive symptoms do not uniformly influence effectiveness level of contraceptive method selected to use after an abortion. Reproductive health care providers should consider the impact of women's psychological symptoms on their contraceptive decision making. (C) 2018 Elsevier Inc. All rights reserved.