(970) The association between postpartum depressive symptoms and contraception

Postpartum depression affects one in five birthing people and is associated with changes in healthcare service utilization. Our objective was to evaluate whether postpartum depressive symptoms are associated with changes in decisions to use any method of contraception, given that both short interpregnancy interval and un- or under-treated depression pose significant perinatal health risks.

Study Design:

This retrospective cohort study included birthing people who delivered between 2017-2022 and were referred to a collaborative care program. Through this program, birthing people with mental health conditions had access to specialized mental health care. Postpartum depressive symptoms were assessed via PHQ-9 scores at the postpartum visit and stratified by severity according to clinical cutoffs. Contraceptive method choice was determined by documentation in the electronic health record and dichotomized as “none” if the participant declined all forms of contraception both at delivery and at the postpartum visit. Bivariable and multivariable analyses were performed.

Results:

Of the 1871 participants that met inclusion criteria, 159 (8.5%) had postpartum PHQ-9 scores > 14, representing moderately severe or worse depressive symptoms. Participant characteristics, stratified by PHQ-9 severity, are shown in Table 1. The choice to use any contraceptive method decreased with increasing depressive symptoms in bivariable and multivariable analyses, particularly in patients with severe depressive symptoms (PHQ-9 ≥ 20; Table 2).

Conclusion:

For patients with postpartum depressive symptoms, severe depressive symptoms are associated with a declination of any form of postpartum contraception. This finding becomes increasingly relevant as reproductive justice continues to be threatened across the US.