title: Contraception and mental health: a commentary on the evidence and principles for practice.
abstract: Among the most prevalent and disabling chronic diseases affecting reproductive-aged women worldwide, depression and anxiety can contribute to adverse reproductive health outcomes, including an increased risk of unintended pregnancy and its health and social consequences. For women with these common mental health conditions who want to avoid an unintended pregnancy, effective contraception can be an important strategy to maintain and even improve health and well-being. Reproductive health clinicians play a critical role in providing and managing contraception to help women with mental health considerations achieve their desired fertility. In this commentary, we review the literature on relationships between mental health and contraception and describe considerations for the clinical management of contraception among women with depression and anxiety. We discuss issues related to contraceptive method effectiveness and adherence concerns, mental health-specific contraceptive method safety and drug interaction considerations, and clinical counseling and management strategies. Given important gaps in current scientific knowledge of mental health and contraception, we highlight areas for future research.
authors.affiliation: Department of Obstetrics and Gynecology and Institute for Social Research, Population Studies Center, University of Michigan, Ann Arbor, MI. Electronic address: hkelli@umich.edu.
authors.forename: Kelli Stidham
authors.initials: KS
authors.lastname: Hall
authors.affiliation: Department of Psychiatry, University of California, San Francisco, San Francisco, CA.
authors.forename: Julia R
authors.initials: JR
authors.lastname: Steinberg
authors.affiliation: Department of Obstetrics and Gynecology, Emory University, Atlanta, GA.
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Cwiak
authors.affiliation: Department of Obstetrics and Gynecology, Brown University, Providence, RI.
authors.forename: Rebecca H
authors.initials: RH
authors.lastname: Allen
authors.affiliation: Department of Psychiatry, University of Michigan, Ann Arbor, MI.
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Marcus
mesh_terms: D001007:Anxiety / Q000453:epidemiology; D003267:Contraception; D003271:Contraceptive Agents, Female; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D008603:Mental Health
chemical_list: D003271:Contraceptive Agents, Female
keywords: anxiety; contraception; contraceptive management; depression; mental health; unintended pregnancy