Prescription Contraception Use Among Psychiatric Inpatients

Mental health symptoms are known to affect contraceptive behavior. Psychiatrically hospitalized patients-those with severe symptoms-are a unique population that may have distinct patterns of contraception use; however, relevant data are currently lacking. This data paucity is notable, given the complex considerations of this population-including potential exposure to medications that are teratogens or interact with contraception. This study aimed to assess patterns of prescription contraception (PC) use and help guide contraceptive counseling in inpatient psychiatric settings.

The study was a retrospective chart review that included all biologically female patients ages 18-45 years who were admitted to inpatient behavioral health care from 2017 to 2023 (N=1,258). Patients were separated into PC users and nonusers. Data regarding diagnoses, medications, demographic characteristics, and general medical health were abstracted. The authors measured odds ratios (ORs) of PC use for variables of interest.

PC, used by 42% of included patients, was significantly positively associated with younger age (OR=1.60, p<0.01), single marital status (OR=1.56, p<0.01), lithium (OR=1.53, p=0.02) and antidepressant (OR=1.48, p=0.03) use, and borderline personality disorder diagnosis (OR=1.42, p<0.01). The most prescribed form of PC was an oral contraceptive pill, followed by an intrauterine device.

This study identified distinct PC use patterns among psychiatrically hospitalized patients. These findings emphasize the importance of psychiatrists providing contraceptive counseling and prescribing contraception, both during hospitalization and at discharge-particularly for patients receiving teratogenic medications such as valproic acid.