Is depression associated with contraceptive motivations, intentions, and use among a sample of low-income Latinas?
BACKGROUND
Latinas in the United States experience high rates of unintended pregnancy and low rates of contraception use, yet reasons are not completely understood. Depression is common among pregnant and nonpregnant Latinas; its influence on contraceptive motivations, intentions, and use is understudied.


OBJECTIVE
We sought to 1) describe Latinas' contraceptive motivations, intentions, and use; 2) use structural equation modeling to test associations between depression and contraceptive self-efficacy/motivations/intentions/use; and 3) determine whether associations differ by pregnancy status.


METHODS
This cross-sectional study included Latinas ages 15 to 45 recruited from an urban Federally Qualified Health Center in Baltimore, Maryland. Structured surveys were used to collect data regarding depressive symptoms measured using the PHQ-9. All other constructs were measured with previously validated questions. Constructs included contraceptive self-efficacy, positive and negative contraceptive motivations (perceived advantages and disadvantages of using contraception), contraceptive intentions to begin or continue contraception use, and contraceptive methods currently used.


RESULTS
Among pregnant Latinas, depression was associated with negative motivations (β = 0.16; p < .05), negative motivations were associated with intentions (β = -0.22; p < .01), and contraceptive self-efficacy was associated with intentions (β = 0.43; p < .001). Among nonpregnant Latinas, contraceptive self-efficacy was associated with intentions (β = 0.78; p < .001) and intentions were associated with use (β = 0.40; p < .05).


CONCLUSIONS
Among pregnant Latinas, negative motivations intervene in the association between depression and contraceptive intentions. For nonpregnant Latinas, intentions intervene in the association between self-efficacy and contraceptive use. This study underscores the importance of depression screening during pregnancy and encourages practitioners to target contraceptive motivations to improve contraceptive use.
Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland. Electronic address: dcarvaja@montefiore.org.
Diana N
DN
Carvajal
Biostatistics, Epidemiology and Data Management (BEAD) Core, Center for Child & Community Health Research, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Sharon R
SR
Ghazarian
Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Sarah
S
Shea Crowne
Maternal and Child Health and Multicultural Programs, Baltimore Medical System, Inc., Baltimore, Maryland.
Pamela
P
Bohrer Brown
Department of Epidemiology and Biostatistics, University of Maryland College Park School of Public Health, College Park, Maryland.
Olivia
O
Carter Pokras
Department of Pediatrics, Health Policy and Management, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Anne K
AK
Duggan
Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Beth
B
Barnet
D000328:Adult; D015142:Baltimore; D003267:Contraception / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000208:ethnology* / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000208:ethnology* / Q000209:etiology / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006630:Hispanic or Latino / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D033182:Intention; D016015:Logistic Models; D009042:Motivation; D016017:Odds Ratio; D011203:Poverty; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D020377:Self Efficacy; D014505:Urban Population