title: The role of stress, depression, and violence on unintended pregnancy among young urban women.
abstract: BACKGROUND
  Unintended pregnancy (UP) is common, particularly among women exposed to violence, and it is linked to adverse maternal and child outcomes. This study investigated the potential role of current depressive symptoms, social support, and psychosocial stress in moderating the association between violence exposure and UP.
  
  
  METHODS
  Pregnant women, being treated at an urban Emergency Room, completed a self-reported baseline interview where pregnancy intention as well as depression symptoms, perceived stress, past and current violence, and demographic factors were evaluated.
  
  
  RESULTS
  Pregnant women were identified among women aged 14-40 years presenting to an urban emergency department. Women reporting sadness or planning to terminate the pregnancy were classified as having an UP. A higher number of women reported an UP if they had at least one episode of childhood sexual assault (CSA) (odds ration [OR]=1.39, 95% confidence interval [CI]: 1.03-1.87), but this association disappeared after adjusting for socioeconomic factors. Relative to women reporting an intended pregnancy, women reporting sadness or wanting to abort the pregnancy reported lower social support (mean number of friends 2.5 vs. 3.0, p=0.005), had a higher prevalence of current depressive symptoms (67% vs. 49%, OR=2.14, 95% CI: 1.72-2.66), and had higher mean levels of current perceived stress (6.9 vs. 5.6, p<0.001). At least one episode of CSA and current depressive symptoms was positively associated with the report of sadness or wanting to abort the pregnancy relative to women with no depressive symptoms and no history of CSA. In addition, high level of stress positively moderated the role of CSA and reporting sadness or wanting to abort the pregnancy.
  
  
  CONCLUSIONS
  Ongoing screening for depressive symptoms and stress among female survivors of CSA may be important in reducing the high rates of unintended pregnancy in urban communities.
authors.affiliation: Department of Public Health, College of Health Professions and Social Work, Temple University, Philadelphia, Pennsylvania 19112, USA. dnelson@temple.edu
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Nelson
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Lepore
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D019548:Crime Victims / Q000523:psychology / Q000706:statistics & numerical data; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D017579:Domestic Violence / Q000523:psychology* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D015143:Philadelphia / Q000453:epidemiology; D011247:Pregnancy; D049168:Pregnancy, Unplanned / Q000523:psychology*; D037841:Pregnant People / Q000523:psychology*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012742:Sex Offenses / Q000523:psychology / Q000706:statistics & numerical data; D012944:Social Support; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult