Unintended pregnancy risk among young women with psychological stress and depression symptoms

Objective: Our previous research demostrated the negative influence of young women's depression and stress symptoms on their contraceptive behavior. We further examined relationships between psychological symptoms and women's risk of unintended pregnancy. Methods: We used data from a longitudinal cohort study of 992 women ages 18-19 years, 97% of whom reported no intention of and a strong desire to avoid pregnancy. Weekly journals measured reproductive, relationship and health characteristics, contraceptive use, and pregnancy outcomes. We examined 27,610 journals from 978 women at risk of pregnancy during the first follow-up year. Our outcome was self-reported pregnancy. Predictors were baseline depression (CESD-5) and stress (PSS-4) (moderate/severe symptoms using score cut-offs). Random effects multivariate logistic regression was used to control for sociodemographic and reproductive covariates. Results: At baseline, 24% and 23% of women reported moderate/severe depression and stress symptoms, respectively. Ten percent of at-risk women became pregnant during the first study year (n=98); 93 women reported one pregnancy while 5 reported two pregnancies. Rates of pregnancy were higher among women with baseline depression (14% vs. 9%, p=0.04) and stress (14% vs. 9%, p=0.03) symptoms compared to women without symptoms. In multivariate models, women with baseline stress had an 8 times higher odds of pregnancy than those without stress (OR 8.1, CI 2.3-28.4, p=0.001). Depression did not predict pregnancy (OR 1.5, CI 0.5-4.7, p=0.65). Conclusion: Women with baseline moderate/severe stress symptoms experienced an elevated risk of unintended pregnancy over 1 year. Additional research will examine women's time-varying psychological symptoms throughout their unintended pregnancy experiences.