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2019 HSR&D/QUERI National Conference Abstract

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4069 — Reproductive Life Planning in Women with Mental Illness

Lead/Presenter: Amy Drapalski,  VISN 5 Mental Illness Research Education and Clinical Center
All Authors: Drapalski AL (VISN 5 Mental Illness Research Education and Clinical Center), Kreyenbuhl, J (VISN 5 Mental Illness Research, Education, and Clinical Center, University of Maryland School of Medicine), Lucksted, A (VISN 5 Mental Illness Research, Education, and Clinical Center, University of Maryland School of Medicine) Medoff, D (University of Maryland School of Medicine) Despeaux, K (VISN 5 Mental Illness Research, Education, and Clinical Center) Federline, A (VISN 5 Mental Illness Research, Education, and Clinical Center)

Objectives:
Considerations unique to mental illness play a role in decisions regarding family planning for many women Veterans of reproductive age. This presentation describes findings from two pilot studies: 1) a survey assessing the family planning needs of women Veterans with mental illness and 2) pilot-testing of a mental health-informed reproductive life planning (RLP) and goal setting intervention (RLP-MH).

Methods:
Study 1: Forty women Veterans of reproductive age with serious mental illness who were not currently/actively trying to become pregnant completed an assessment that included measures of knowledge and attitudes toward pregnancy. Study 2: Six women Veterans of reproductive age with mental illness who were not currently pregnant completed the facilitated RLP-MH intervention followed by a qualitative interview.

Results:
Study 1: While a number of participants expressed clear intentions to avoid pregnancy (43%), many expressed ambivalence (48%) or little interest in avoiding pregnancy (10%). Participants endorsed both positive and negative aspects of becoming pregnant, the most common concerns included those related to the effect of pregnancy on mental health symptoms (endorsed by 88%), the possible need to discontinue psychiatric medications (76%), and concerns that their child would develop a mental health disorder (83%). Study 2: Using information from Study 1 and feedback from experts, we adapted existing RLP materials to create the RLP-MH intervention. Pilot-testing showed that the intervention was feasible, acceptable, and perceived as useful to women with a range of pregnancy intentions. Participants reported having a better understanding of RLP and its potential benefits and feeling more prepared to meet with their providers, more comfortable initiating RLP discussions with providers, and more confident in completing identified action steps after completing it.

Implications:
Women Veterans with mental health concerns may benefit from discussing RLP goals and developing action steps to address them. Concerns associated with mental illness, its treatment, and its impact on reproductive health should be a part of these discussions.

Impacts:
Women Veterans with mental illness are interested in and may benefit from RLP goal setting. Further evaluation of the feasibility, acceptability, and potential efficacy of the RLP-MH intervention will be examined via a future pilot randomized trial (PPO 18-089).