title: Contraceptive adherence among women Veterans with mental illness and substance use disorder.
abstract: OBJECTIVE
  Emerging data suggest that mental illness and substance use disorder (SUD) are important risk factors for inconsistent contraceptive use. We investigated whether mental illness without or with SUD is associated with contraceptive adherence and continuation of hormonal methods among women Veterans.
  
  
  METHODS
  We conducted a retrospective analysis of national Veteran's Administration data among women aged 18-45 with a hormonal contraceptive prescription (pill/patch/ring/injectable) during the first week of fiscal year 2013. We tested associations between mental illness diagnoses (depression, posttraumatic stress disorder, anxiety, bipolar disorder, schizophrenia, adjustment disorder) without or with SUD diagnoses (drug/alcohol abuse) and 12-month contraceptive adherence (number and length of gaps ≥7 days between refills and months of contraceptive coverage) using multivariable regression models.
  
  
  RESULTS
  Among 9780 Veterans, 43.6% had mental illness alone, 9.4% comorbid mental illness and SUD, and 47.0% neither diagnosis. In adjusted analyses, compared to women with neither diagnosis, women with mental illness alone had a similar rate of gaps but increased odds of having gaps longer than 30 days [odds ratio (OR): 1.35, 95% confidence interval (CI): 1.10-1.52] and fewer months of contraceptive coverage (β_coefficient: -0.39, 95% CI: -0.56 to -0.23). Women with mental illness and SUD experienced more gaps (incidence rate ratio: 1.12, 95% CI: 1.03-1.21), increased odds of gaps longer than 30 days (OR: 1.46, 95% CI: 1.10-1.79), fewer months of contraceptive coverage (β_coefficient: -0.90, 95% CI: -1.20 to -0.62) and reduced odds of continuous 12-month coverage (adjusted OR: 0.76, 95% CI: 0.63-0.93).
  
  
  CONCLUSIONS
  Mental illness, particularly with comorbid SUD, is associated with reduced contraceptive adherence and continuation among women Veterans. Women with these risk factors could potentially benefit from use of long-acting reversible methods.
  
  
  CONCLUSIONS
  Women Veterans have a high burden of mental illness and SUD, which we found are associated with inconsistent contraceptive use. Efforts to improve adherence to hormonal contraceptives and to increase availability of long-acting reversible methods in this vulnerable population are warranted.
authors: Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way S-152, Seattle, WA 98108; Department of Obstetrics & Gynecology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195. Electronic address: lisa.callegari@va.gov.
authors: Lisa S
authors: LS
authors: Callegari
authors: Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, University Drive (151C), Building 30, Pittsburgh PA 15240.
authors: Xinhua
authors: X
authors: Zhao
authors: Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way S-152, Seattle, WA 98108; Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195.
authors: Karin M
authors: KM
authors: Nelson
authors: Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, University Drive (151C), Building 30, Pittsburgh PA 15240; Department of Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Pittsburgh, PA 15217.
authors: Sonya
authors: S
authors: Borrero
mesh_terms: D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D016001:Confidence Intervals; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003271:Contraceptive Agents, Female / Q000145:classification*; D005260:Female; D006801:Humans; D016014:Linear Models; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014728:Veterans / Q000706:statistics & numerical data*; D058014:Veterans Health; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D003271:Contraceptive Agents, Female
keywords: Alcohol-related disorders; Contraception; Medication adherence; Mental illness; Substance-related disorders; Veterans health