Abstract / Summary
Abstract Background Mental health conditions such as depression, anxiety and severe mental illness (SMI), are increasing globally among young women. These conditions can influence sexual behaviour, partner dynamics, and healthcare engagement, increasing the risk of unintended pregnancy, sexually transmitted infections, and adverse pregnancy outcomes. Contraceptive decision making may also be shaped by the cognitive, emotional and social challenges associated with mental health disorders. Despite this, evidence on contraceptive patterns among young women with mental health conditions remains limited, particularly in Australia. This study aimed to investigate patterns of contraceptive use among young Australian women with mental health conditions. Methods Data from 15,244 young women enrolled in the Australian Longitudinal Study on Women’s Health (ALSWH), born 1989–1995 were analysed. Latent transition analysis was employed to explore patterns of contraceptive use among women with diagnosed mental health conditions. A multinomial mixed-effects model examined associations between mental health conditions and contraceptive use. Results Contraceptive use at the last vaginal sexual encounter was similar for women with and without a mental health condition (approximately 86%), however, contraceptive patterns differed. Compared to women without a mental health condition using the oral contraceptive pill, women with a mental health condition had higher odds of using hormonal long-acting reversible contraception (LARC) and condoms (OR = 1.52;95%CI = 1.30–1.79) or other contraception and condoms (OR = 1.44;95%CI = 1.18–1.76). In sensitivity analyses, women with SMI had twice the odds of using LARC and condoms (OR = 1.92;95%CI = 1.30–2.83), and other combined contraceptive methods with condoms (OR = 1.66;95%CI = 1.10–2.49), compared to women without SMI using the oral contraceptive pill. However, women with SMI also had greater odds of not using any contraception than women without SMI using the pill. Conclusions The findings highlight the need for contraceptive counselling that is responsive to the needs of young women with mental health conditions. Integrating tailored contraceptive support into routine mental health care, particularly for women with SMI, who demonstrated higher odds of non-use, may help support informed contraceptive decision-making. Strengthening healthcare provider communication, improving access to clear contraceptive information, and supporting informed, person-centred choices may reduce the risk of unintended pregnancy and sexually transmitted infections and enhance reproductive autonomy for young women with mental health conditions.