Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4071 — Understanding the Contraceptive Counseling Needs of Women Veterans with Serious Mental Illness

Lead/Presenter: Amy Drapalski
All Authors: Drapalski AL (VISN 5 MIRECC) Kreyenbuhl J (VISN 5 MIRECC & University of Maryland) Lucksted A (VISN 5 MIRECC & University of Maryland) Federline A (VISN 5 MIRECC)

Objectives:
Many women Veterans are of reproductive age and, of those, a substantial number experience mental health concerns. Considerations unique to mental illness likely play a role in decisions regarding family planning and contraception. This study aimed to gain a better understanding of the family planning and contraceptive counseling needs of women Veterans with serious mental illness.

Methods:
An exploratory mixed-method approach was used. Forty women Veterans of reproductive age (18-45) with serious mental illness who were not currently or actively trying to become pregnant were recruited from outpatient mental health and women's health programs at 2 VA Medical Centers. All participants completed an assessment of their knowledge, attitudes, and preferences regarding contraception and contraception decision-making. A subset (n = 14) also completed a qualitative interview focused on family planning/contraceptive use decisions and important factors in making those decisions.

Results:
Most participants (88%) were currently using contraception; however, many had less knowledge of and few (35%) were using the more effective forms of contraception (e.g., IUD). While effectiveness was cited most often as a key factor in method choice (93%), a number of other factors were reported to influence these decisions including ones specific to mental health (e.g. potential interactions with psychiatric medications and effects on mood). Although many reported receiving counseling or information on contraception in the past year (60%), qualitative interviews suggest interest in receiving additional information around family planning/contraception, preferably via conversations with providers. Preferences for who initiated conversations varied; however, provider initiation of these conversations was generally viewed positively, including when it occurred as part of mental health care.

Implications:
Potential issues and/or concerns associated with mental illness, its treatment, and its impact on reproductive health should be included as part of family planning/contraceptive counseling discussions. Mental health visits may serve as opportunities to engage women Veterans in these discussions.

Impacts:
Women Veterans with serious mental illness are interested in and may benefit from family planning and contraceptive counseling services. Data is being used to modify a structure approach to developing a reproductive life plan that incorporates considerations specific to women with serious mental illness.