101. The Relationship between Depression and Non-Barrier Contraceptive Use in Adolescent Females

There is limited research examining depression and contraceptive use among adolescent females. To address this gap, this study assessed the relationship between depression and non-barrier contraceptive practices, contraceptive self-efficacy, and sexual behaviors among sexually active adolescent females. It was hypothesized that a positive depression screen would be associated with lower use and inconsistent use of non-barrier contraception in the last three months, and with lower contraceptive self-efficacy. Sexually active adolescent females from 32 school-based health centers (SBHCs) in seven states were recruited as part of a study to assess an intervention designed to promote patient-centered contraceptive care. We assessed the cross-sectional associations of a positive screening for depressive symptoms (sum score >3 on the Patient Health Questionnaire-2 or PHQ-2) with non-barrier contraception practices, sexual health behaviors (number of partners, frequency of sex), and self-efficacy for using contraception (three item scale, range 0-30, α=0.76). Chi-square statistics and t-test were used to assess the bivariate relationships. A total of 142 sexually active adolescent females completed the baseline survey. The mean age was 16.7 and nearly half (49.3%) were Hispanic/Latina. Most (85.9%) indicated it was very important to avoid becoming pregnant, although 50.0% were not using any form of non-barrier contraception at the time of their SBHC visit and another 11.3% participants were not using non-barrier contraception method as prescribed. On the PHQ-2, 23.2% screened positive for depressive symptoms. Compared to their negative counterparts, participants who screened positive for depressive symptoms reported less non-barrier contraceptive use in the past three months (39.4% vs. 53.8%, p=0.149), a lower mean contraceptive self-efficacy score (22.6 vs. 24.8, p=0.65), and a lower mean frequency of vaginal sex in the last three months (7.7 vs. 11.9, p=0.060); however, the associations did not reach statistical significance. Results from this preliminary data indicate that many adolescents, who are coming in for care at SBHCs, are both at risk of unintended pregnancy and have mental health needs. Further, data suggests a relationship between depressive symptoms and lower rates of contraception use and lower self-efficacy. While the associations only approached significance, this is likely due to the small sample size and the limitations of a two-question mental health assessment. The mental health crisis in a post-pandemic world has significant implications across multiple domains of adolescent health; however, these relationships have not been adequately explored. This study suggests that the risk of unintended pregnancy in adolescence may be related to depression. This and future research can inform interventions to address both depression and contraceptive use among adolescents which can ultimately lead to reducing rates of unintended pregnancy.