ABSTRACT
Rates of the sexually transmitted infections (STIs) Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) have risen in women by 13% and 40%, respectively, since 2015. Women with Serious Mental Illness (SMI) are at disproportionate risk for STIs. A retrospective chart review was performed at a safety-net healthcare system in the Southeastern United States (US) from 2014 to 2017. CT/GC positivity rates did not differ between the general and SMI populations (6.6% vs. 6.5% for CT and 1.8% vs. 2.2% for GC, respectively). Emergency Medicine accounted for more positive STI test results in SMI patients than the general population (25.2% vs. 19.1% for CT, 47.8% vs. 35.5% for GC, respectively). SMI patients received large portions of STI care in emergency settings, where follow-up is poor. Point of Care (POC) testing could improve care in this setting, and mental healthcare providers must address sexual health with patients who otherwise may not receive this care.
ABSTRACT
OBJECTIVE: We sought to determine the prevalence of postpartum contraceptive use among women with postpartum depressive symptoms (PDS) and examine the association between PDS and contraceptive method. STUDY DESIGN: We evaluated data from 16,357 postpartum women participating in the 2009-2011 Pregnancy Risk Assessment Monitoring System. PDS was defined as an additive score of ≥10 for three questions on depression, hopelessness, and feeling physically slowed. Contraceptive use was categorized as permanent, long-acting reversible contraception (LARC), user-dependent hormonal, and user-dependent non-hormonal. Logistic regression models compared postpartum contraceptive use and method by PDS status. RESULTS: In total, 12.3% of women with a recent live birth reported PDS. Large percentages of women with (69.4%) and without (76.1%) PDS, used user-dependent or no contraceptive method. There were no associations between PDS and use of any postpartum contraception (adjusted Prevalence Ratio (aPR)=1.00, 95% CI 0.98-1.03) or permanent contraception (aPR=1.05, 95% CI 0.88-1.27). LARC use was elevated, but not significantly, among women with PDS compared to those without (aPR=1.16, 95% CI: 1.00-1.34). CONCLUSIONS: Large percentages of women with and without PDS used user-dependent or no contraception. Since depression may be associated with misuse of user-dependent methods, counseling women about how to use methods more effectively, as well as the effectiveness of non-user dependent methods, may be beneficial. IMPLICATIONS: A large percentage of women with PDS are either not using contraception or using less effective user-dependent methods. Since depression may be associated with misuse of user-dependent contraceptive methods, counseling women about how to use methods more effectively, as well as non-user dependent options, such as LARC, may be beneficial.
