title: Associations of mental illness and substance use disorders with prescription contraception use among women veterans.
abstract: OBJECTIVE
  To investigate whether mental illness and substance use disorder (SUD) are associated with having a prescription contraceptive method among women veterans.
  
  
  METHODS
  We conducted a retrospective analysis of National Veterans Administration (VA) administrative and clinical data for women veterans aged 18-45 years who made at least one primary care visit in 2008. We assessed associations between mental illness (depression, posttraumatic stress disorder, anxiety, bipolar disorder, schizophrenia and adjustment disorder) and SUD (drug/alcohol use disorder) with having a prescription contraceptive method from VA (pill, patch, ring, injection, implant and intrauterine device) using multivariable logistic regression with random effects for VA facility, adjusting for confounders.
  
  
  RESULTS
  Among 94,115 reproductive aged women, 36.5% had mental illness only, 0.6% had SUD only, 5.3% had both mental illness and SUD and 57.7% had neither diagnosis. In these groups, 22.1%, 14.6%, 18.2% and 17.7% (p<0.001), respectively, had documentation in 2008 of prescription contraception. After adjusting for potential confounders, women with mental illness only were as likely as women with neither diagnosis to have a prescription method and were more likely to use a highly effective prescription method (implant or intrauterine device) if using contraception [adjusted odds ratio (aOR) 1.17, 95% confidence interval (CI) = 1.08-1.27]. Women with SUD (with or without mental illness) were significantly less likely to have a prescription method than women with neither diagnosis (aOR 0.73, 95% CI = 0.57-0.95 and aOR 0.79, 95% CI = 0.73-0.86, respectively).
  
  
  CONCLUSIONS
  Women veterans with SUD are less likely to have prescription contraception compared to other women, which may increase their risk of unintended pregnancy.
authors.affiliation: Health Services Research and Development (HSR&D), Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA; Department of Obstetrics & Gynecology, University of Washington, Seattle, WA. Electronic address: lcallega@uw.edu.
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Callegari
authors.affiliation: Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, Pittsburgh, PA, Seattle, WA.
authors.forename: Xinhua
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Health Services Research and Development (HSR&D), Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA.
authors.forename: Karin M
authors.initials: KM
authors.lastname: Nelson
authors.affiliation: Mental Illness Research, Education and Clinic Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle WA.
authors.forename: Keren
authors.initials: K
authors.lastname: Lehavot
authors.affiliation: Health Services Research and Development (HSR&D), Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA; Group Health Research Institute, Seattle, WA.
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Bradley
authors.affiliation: Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, Pittsburgh, PA, Seattle, WA; Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Sonya
authors.initials: S
authors.lastname: Borrero
mesh_terms: D000293:Adolescent; D003267:Contraception / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Alcohol-related disorders; Contraceptive behavior; Highly effective reversible contraception; Mental disorder; Substance-related disorders; Veterans health