title: An exploratory analysis of contraceptive method choice and symptoms of depression in adolescent females initiating prescription contraception.
abstract: OBJECTIVE
  We examine the association between depressive symptoms and contraceptive method choice among adolescents initiating prescription contraception.
  
  
  METHODS
  This cross-sectional study analyzes baseline data of 220 urban, minority adolescent females (ages 15-19 years) presenting for prescription contraceptive initiation at a comprehensive, free-of-cost, adolescent health center in New York City. All participants met with a health care provider who provided standard contraception counseling before initiating contraception. Each participant then selected a short- or long-acting contraceptive: a 3-month supply of the pill, patch, ring or a medroxyprogesterone acetate depot injection (short-acting), or placement/referral for an intrauterine device (IUD; long-acting). We assess the independent association between contraceptive method selection and symptoms of depression [assessed by the Center for Epidemiological Studies - Depression (CES-D) scale].
  
  
  RESULTS
  Ten percent (n=21/220) of adolescent females selected an IUD. Bivariate analysis revealed that those with elevated levels of depressive symptoms were more likely to select an IUD as compared to those with minimal symptoms (mean CES-D score 20 vs. 13; t=3.052, p=.003). In multivariate logistic regressions, adolescent females had increased odds of selecting an IUD if they reported moderate to severe depressive symptoms (adjusted odds ratio=4.93; confidence interval, 1.53-15.83; p=.007) after controlling for ethnicity/race, education, number of lifetime partners and gravidity.
  
  
  CONCLUSIONS
  Inner-city, minority adolescents with elevated symptoms of depression who present for prescription contraceptive initiation may be more likely to select an IUD rather than shorter-acting methods. By recognizing adolescent females with depressive symptoms, providers can strategize their approach to effective contraception counseling.
authors.affiliation: Department of Pediatrics, Division of Child and Adolescent Health, Columbia University Medical Center, New York, NY 10032, USA. Electronic address: jf2815@cumc.columbia.edu.
authors.forename: Jenny
authors.initials: J
authors.lastname: Francis
authors.affiliation: Department of Pediatrics, Division of Adolescent Medicine, Mount Sinai Adolescent Health Center, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA.
authors.forename: Liandra
authors.initials: L
authors.lastname: Presser
authors.affiliation: Tribeca Pediatrics, Adolescent Medicine Specialist, New York, NY 10007, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Malbon
authors.affiliation: Department of Pediatrics, Division of Adolescent Medicine. Vanderbilt University Medical Center, Nashville, TN 37232, USA.
authors.forename: Debra
authors.initials: D
authors.lastname: Braun-Courville
authors.affiliation: Department of Pediatrics, Division of Adolescent Medicine, Mount Sinai Adolescent Health Center, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA.
authors.forename: Lourdes Oriana
authors.initials: LO
authors.lastname: Linares
mesh_terms: D000293:Adolescent; D002755:Choice Behavior; D003267:Contraception / Q000379:methods* / Q000523:psychology; D003271:Contraceptive Agents, Female / Q000627:therapeutic use; D003274:Contraceptive Devices, Female / Q000706:statistics & numerical data; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D007434:Intrauterine Devices / Q000706:statistics & numerical data*; D016015:Logistic Models; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use*; D015999:Multivariate Analysis; D016017:Odds Ratio; D057968:Transdermal Patch; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D003278:Contraceptives, Oral, Hormonal; D017258:Medroxyprogesterone Acetate
keywords: Birth control; Contraception; Depressive symptoms; IUD; Mental health; Selection or choice