Depression, anxiety, and stress and fulfillment of contraceptive preferences among young people in Texas and California

Background Young people face both increased mental health concerns and growing barriers to accessing reproductive healthcare. Objective This study examined the association of depressive, anxiety and stress symptoms with preferred contraceptive method use, a measure of healthcare access and reproductive autonomy. Methods We used baseline data (April 2018-May 2023) from a cluster randomized trial at 29 community colleges in Texas and California. Participants were 2,065 sexually active, first-year community college students ages 18–25. We used multivariable mixed effects multinomial logistic regression for clustered data to examine the association of depressive (CESD-10) or anxiety and stress symptoms (DASS-21) and fulfillment of participants’ contraceptive preferences (unfulfilled, fulfilled or unknown), controlling for factors related to mental health and care access. Results Overall, 51% of participants had an unfulfilled contraceptive preference, and 4% did not know what they preferred. Multivariable results showed elevated depressive symptoms (relative risk ratio [RRR]: 1.31, 95% confidence interval [CI]: 1.01, 1.71) or anxiety and stress symptoms (RRR: 1.31, 95% CI 1.03, 1.66) were associated with having an unfulfilled contraceptive preference versus a fulfilled preference. Additionally, elevated depressive symptoms were associated with having an unknown preference versus fulfilled preference (RRR: 2.98, 95% CI: 1.78, 4.99). Participants with mental distress were also significantly more likely to report cost or insurance barriers as reasons for having an unfulfilled preference (p < 0.05). Conclusions Young people experiencing mental distress were less likely to realize their contraceptive preference. Future interventions should focus on providing mental health support and improving contraceptive access for young people, including addressing insurance barriers. A primary care model integrating both mental and reproductive healthcare will help to address important health needs of young people. Trial registration ClinicalTrials.gov Identifier: NCT03519685