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Journal ArticleDOI

Family Planning Needs and Contraceptive Use in Female Psychiatric Outpatients

TL;DR: Schizophrenic and bipolar female patients’ awareness and attitudes on family planning and contraceptive use were unsatisfactory and both psychiatrists and family physicians should be aware of the needs of psychiatric outpatients on contraceptive counseling.

AbstractBackground and aim: Despite the importance of reproductive behaviours of patients with mental illness, there are only few studies concerning the family planning needs and contraceptive use of psychiatric patients. The aim of this study is to assess family planning needs and contraceptive use in female psychiatric outpatients. Methods: The study was conducted in the outpatient clinic of Bakirkoy Neuropsychiatry Hospital, Istanbul, Turkey. Schizophrenic, bipolar and unipolar depressive patients in remission (50 patients in each group) were compared with a control group of 50 healthy individuals. A semi-structure d questionnaire was used for sociodemographic characteristics, family planning needs and contraceptive use. Results: Of schizophrenic patients only 26.6% and of bipolar patients only 37.5% had gynecological examination during the last three years compared to 56% in healthy individuals. Of schizophrenic patients only 40% discussed family planning issues with partner and of bipolar patients only 50% compared to 90% in controls. Conclusion: Schizophrenic and bipolar female patients’ awareness and attitudes on family planning and contraceptive use were unsatisfactory. Both psychiatrists and family physicians should be aware of the needs of psychiatric outpatients on contraceptive counseling.

Topics: Outpatient clinic (55%), Family planning (54%)

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Citations
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Journal ArticleDOI
TL;DR: Clinicians are encouraged to explore knowledge of appropriate methods of contraception for women who suffer from schizophrenia to be alert for potential interactions among oral hormonal contraceptives, smoking, and therapeutic drugs.
Abstract: Although women with serious mental illness have high rates of lifetime sexual partners, they infrequently use contraception. Consequently, the prevalence of sexually transmitted infections is high in this population. In addition, while the overall rate of pregnancy in women with schizophrenia of child-bearing age is lower than in the general population, the percentage of pregnancies that are unwanted is higher than that in the general population. The objective of this paper is to help clinicians explore knowledge of appropriate methods of contraception for women who suffer from schizophrenia. The authors reviewed recent literature on the use of contraceptive methods by women with schizophrenia treated with antipsychotic and adjunctive medications. Contraceptive counseling to women and their partners is an important part of comprehensive care for women with serious and persistent mental illness. Women with schizophrenia who smoke, are overweight, or have diabetes, migraine, cardiovascular disease, or a family history of breast cancer should be offered non-hormonal contraception. Women with more than one sexual partner should be advised on barrier methods in addition to any other contraceptive measures they are using. Clinicians should be alert for potential interactions among oral hormonal contraceptives, smoking, and therapeutic drugs. Long-lasting contraceptive methods, such as intrauterine devices, progesterone depot injections, or tubal ligation are reasonable options for women having no wish to further expand their families.

33 citations


Journal ArticleDOI
TL;DR: It was found that female patients with psychiatric disorders had more negative attributes with regard to marriage, sexuality, family planning, maternal characteristics and pregnancy, compared with a corresponding healthy population.
Abstract: Aims and objectives To determine what problems female psychiatric patients have in terms of reproductive health. Background The reproductive health problems faced by female psychiatric patients are matters that have been neglected in the areas of both psychiatry and women's health. This study aims to make a contribution from Turkey to the literature in this neglected field. Design The study is descriptive and was conducted with 292 female patients treated in an acute inpatient psychiatric ward. Methods Data were collected through face-to-face interviews and a questionnaire based on the literature and prepared by the researchers which was designed to determine the kinds of reproductive health issues the patients were experiencing. Results It was found that compared with healthy women, the distinctive features of the participants in terms of sexuality were more negative; in particular, patients diagnosed with bipolar disorder were more likely to have been forced by their partners to have sex, they had suffered from rape or sexually transmitted diseases, the majority of those who had previous sexual experience had tried to use contraceptives but had been unable to continue using them, they were most likely to choose the method of withdrawal for contraception, their rates of pregnancy and abortion were high, they received less antenatal care, and they were more likely to have smoked during pregnancy. Conclusions It was found that female patients with psychiatric disorders had more negative attributes with regard to marriage, sexuality, family planning, maternal characteristics and pregnancy, compared with a corresponding healthy population. Relevance to clinical practice The results of this study may be useful for nurses in the clinical field for calling an attention and raising an awareness of the reproductive health problems of women with psychiatric disorders, taking the necessary preventive measures, and developing damage-reducing strategies.

24 citations


Cites background or result from "Family Planning Needs and Contracep..."

  • ...In another study, Pehlivanoglu et al. (2007) referred to the usage of the family planning methods....

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  • ...…characteristics compared with the healthy population (a higher number of unwanted pregnancies and birth, abortions, miscarriages; Howard et al. 2002, Dickerson et al. 2004, MacCabe et al. 2009, Bundy et al. 2011), other studies report no such difference (Saugstad 1989, Pehlivanoglu et al. 2007)....

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  • ...In many studies, it has been reported that few people with serious mental illness use contraceptive methods and that the rate of people who have unprotected sex in this group is between 33–73% (Miller 1997, Pehlivanoglu et al. 2007)....

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  • ...Similar to what was found in the present study, Pehlivanoglu et al. (2007) have not reported any differences in the number of births, stillbirths and miscarriages between patients with mental illness and healthy populations....

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Journal ArticleDOI
TL;DR: Three sets of guidelines for three groups of patients, representing the continuum of chronically and variably impaired autonomy, are proposed, which should contribute significantly to the quality of obstetric and gynecologic care for female patients with chronic mental illness.
Abstract: OBJECTIVE: This article proposes ethically justified clinical guidelines for family planning interventions to prevent pregnancy in female patients. STUDY DESIGN: We reviewed literature on family planning and consequences of pregnancy in patients with chronic mental illness and related that literature to ethical principles. RESULTS: Patients with chronic mental illness are ethically unique because they have chronically and variably impaired autonomy. Existing guidelines and proposals for family planning interventions for mentally retarded patients are shown not to apply to such patients. CONCLUSION: Three sets of guidelines for three groups of patients, representing the continuum of chronically and variably impaired autonomy, are proposed: (1) a set of guidelines for patients who can achieve thresholds of autonomy, (2) a set of guidelines for patients irreversibly near thresholds of autonomy, and (3) a set of guidelines for patients irreversibly below thresholds of autonomy. These guidelines should contribute significantly to the quality of obstetric and gynecologic care for female patients with chronic mental illness.

15 citations


Journal ArticleDOI
TL;DR: A need for greater communication and assistance in the areas of intimacy and sexuality for persons with psychotic disorders is highlighted, and a need for better access to resources such as dating skills and couples therapy programs as well as more consumer-oriented research is needed.
Abstract: For individuals with a psychotic disorder, dating can present several challenges and lead many to be excluded from intimate relationships. These difficulties may stem from a number of factors, including impairments in social and sexual functioning. Although scientific interest in this topic is mounting, the last quantitative review of the literature dates back to 2003. Objectives The aim of this systematic review was to collect, evaluate, and synthesize quantitative data from studies published in the last 15 years on romantic relationships and sexuality in the context of a psychotic disorder. Methods Articles were retrieved from PsycINFO, PubMed, Web of Science, and ProQuest databases and were retained if they met the following inclusion criteria: (a) original research or meta-analysis, (b) complete or partial sample with a psychotic disorder diagnosis, (c) provision of quantitative data specific to the population of interest, and (d) studies focusing on romantic relationship and/or sexuality variables as correlates, predictors, mediators, or outcomes. Study quality was evaluated using PRISMA criteria. Results 43 studies were identified, 24 of which were categorized as obstacle-related (e.g., focusing on negative aspects of intimacy, such as risky behaviors) and 19 of which were deemed neutral or recovery-oriented (e.g., focusing on positive aspects of intimacy, such as marital functioning). Conclusions and implications for practice Results highlight a need for greater communication and assistance in the areas of intimacy and sexuality for persons with psychotic disorders. Better access to resources such as dating skills and couples therapy programs as well as more consumer-oriented research is needed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

7 citations


Journal ArticleDOI
TL;DR: There is clinical utility in cataloguing the needs of younger and older women with schizophrenia and conceptualizing interventions according to gender and age rather than viewing needed services along purely diagnostic lines.
Abstract: Objective: Recognizing that needs differ between men and women with schizophrenia and that they vary over time, this review attempts to categorize the needs that are relevant to younger and to older women Method: This is a selective literature review focusing on topic areas the two authors determined to be most germane to women with schizophrenia Articles were selected on the basis of currency, comprehensiveness, and study design Particular attention was paid to the voices of the women themselves Results: There is considerable overlap between the needs of younger and older women with schizophrenia, but as a general rule, younger women require preventive strategies to stop the escalation of illness while older women require recovery interventions to regain lost hopes and abilities Conclusions: There is clinical utility in cataloguing the needs of younger and older women with schizophrenia and conceptualizing interventions according to gender and age rather than viewing needed services along purely dia

6 citations


References
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01 Jan 1996
Abstract: Objective: This study compared sexuality, reproduction, and childrearing characteristics of women with schizophrenia-spectrum disorders with those of women without serious mental illness. Methods: A semistructured interview was given to 46 women meeting Research Diagnostic Criteria for schizophrenia or schizoaffective disorder and to 50 control subjects without major mental illness who were matched for age, race, education, employment status, and religion. Results: Compared with the control subjects, the women with schizophrenic disorders had more lifetime sexual partners, were less likely to have a current partner, and were more likely to have been raped and to have engaged in prostitution. Despite being at high risk for HIV infection,

230 citations


Journal ArticleDOI
TL;DR: Health care delivery systems could better meet the needs of women with severe mental illness by providing social skills training, family planning, and more consistent screening for pregnancy, HIV, and battering.
Abstract: OBJECTIVE: This study compared sexuality, reproduction, and childrearing characteristics of women with schizophrenia-spectrum disorders with those of women without serious mental illness. METHODS: A semistructured interview was given to 46 women meeting Research Diagnostic Criteria for schizophrenia or schizoaffective disorder and to 50 control subjects without major mental illness who were matched for age, race, education, employment status, and religion. RESULTS: Compared with the control subjects, the women with schizophrenic disorders had more lifetime sexual partners, were less likely to have a current partner, and were more likely to have been raped and to have engaged in prostitution. Despite being at high risk for HIV infection, as a group they were less likely to have been tested for HIV. They reported wanting sex less often than did control subjects and rated their physical and emotional satisfaction with sex lower. They had fewer planned pregnancies, more unwanted pregnancies, and more abortions and were more often victims of violence during pregnancy. They were more likely to have lost custody of children and to report that they were unable to meet their children's basic needs and less likely to have another caregiver helping them raise their children. Both groups reported high rates of substance abuse during pregnancy. CONCLUSIONS: Health care delivery systems could better meet the needs of women with severe mental illness by providing social skills training, family planning, and more consistent screening for pregnancy, HIV, and battering. In addition, barriers to care for pregnant women with severe mental illness and substance abuse should be reduced, and parenting training should be incorporated into psychosocial rehabilitation programs for mentally ill parents. Language: en

207 citations


"Family Planning Needs and Contracep..." refers background in this paper

  • ...The rate of unwanted/unplanned pregnancy and abortion was high; and they did not discuss the issue with psychiatrist.(2-8) They did not follow periodic gynecological examinations and they did not have adequate partner support....

    [...]

  • ...unplanned and unwanted pregnancies was higher.(2,8,11,12) Our result of low access to attend family planning clinics emphasized the importance of increasing the number and service quality of family planning centers....

    [...]

  • ...Information from health professionals was significantly less in BPD and schizophrenic patients compared to controls and depressive patients Discussion It was reported that sexually active female patients in reproductive ages do not use contraception.(1-13) In a study, David showed that patients with non-psychotic depression may have a sexual life and family planning just like healthy individuals....

    [...]

  • ...In several studies, this rate of sexual intercourses without contraception is reported to vary between 33% and 73%, and lack of contraception methods in patients with serious mental disorders is emphasized.(2,6-8,12,13) Our...

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Journal ArticleDOI
TL;DR: Data is reviewed about how schizophrenia affects sexuality, pregnancy, the puerperium, parenting, and family planning to reduce unwanted pregnancies and incorporate family planning measures into mental health care delivery systems.
Abstract: This article reviews data about how schizophrenia affects sexuality, pregnancy, the puerperium, parenting, and family planning. Women with schizophrenia have high rates of coerced sex, sexual risk behavior, and unwanted pregnancies. High rates of obstetric complications and custody loss increase morbidity for women and their offspring. Since untreated psychosis increases these problems, the risks of withholding pharmacotherapy must be weighed against the risks of prescribing medications during pregnancy. The puerperium is a time when women are especially vulnerable to exacerbations of schizophrenia. Mothers with schizophrenia may have a reduced ability to read children's cues, and they often have weak social support networks. Their children may be more difficult to raise than other children. Parenting rehabilitation can address some of these problems. Often, women with schizophrenia who are sexually active and do not wish to become pregnant do not use contraception. Incorporating family planning measures into mental health care delivery systems may reduce unwanted pregnancies.

162 citations


"Family Planning Needs and Contracep..." refers background in this paper

  • ...Information from health professionals was significantly less in BPD and schizophrenic patients compared to controls and depressive patients Discussion It was reported that sexually active female patients in reproductive ages do not use contraception.(1-13) In a study, David showed that patients with non-psychotic depression may have a sexual life and family planning just like healthy individuals....

    [...]

  • ...The rate of unwanted/unplanned pregnancy and abortion was high; and they did not discuss the issue with psychiatrist.(2-8) They did not follow periodic gynecological examinations and they did not have adequate partner support....

    [...]

  • ...The necessity for family planning in female patients with chronic mental disorders is important.(1-3) Our study compared the family planning and contraceptive use reported by women who have mental illness with those by matched comparison groups from the general population....

    [...]

  • ...unplanned and unwanted pregnancies was higher.(2,8,11,12) Our result of low access to attend family planning clinics emphasized the importance of increasing the number and service quality of family planning centers....

    [...]

  • ...In several studies, this rate of sexual intercourses without contraception is reported to vary between 33% and 73%, and lack of contraception methods in patients with serious mental disorders is emphasized.(2,6-8,12,13) Our...

    [...]


Journal ArticleDOI
TL;DR: The results underscore the priority for developing programmes that reduce female psychiatric patients' risk for unwanted pregnancies and STDs.
Abstract: BACKGROUND There are few studies concerning the family planning needs of female chronic psychiatric patients. We aimed to determine the contraceptive needs and sexually transmitted disease (STD) risk-behaviours of female psychiatric out-patients. METHOD Sixty-six female out-patients with major psychiatric disorders, including schizophrenia, bipolar disorder and mood disorders, completed a semi-structured interview (response rate = 63%) and were individually matched for age and ethnicity with 66 women who had never been treated for psychiatric illness. They answered questions on child-rearing and on their methods of contraception in relation to their attitudes towards pregnancy, as well as on their risk for STDs. RESULTS Compared with controls, the female patients reported having had significantly more induced abortions and were significantly more likely to have given up their own children for others to raise. Heterosexually active psychiatric patients were significantly more likely than controls to have had more than one male sexual partner, to have been pressured into unwanted sexual intercourse, and to report having had sexual intercourse with a suspected bisexual over the preceding year. CONCLUSIONS These results underscore the priority for developing programmes that reduce female psychiatric patients' risk for unwanted pregnancies and STDs. 66 patients 18-50 years of age with chronic psychiatric disorders were interviewed using semistructured interviews at a community mental health center in Auckland, New Zealand, resulting in a response rate of 62.9%. Each patient was matched with a control for ethnicity and age. The psychiatric patients also completed the Mini-Mental State Examination. The interview covered demographic, obstetric, and gynecologic information and information on women's risk for unwanted pregnancies and STDs. The mean age of cases was 36.03 years and that of the controls was 36.20 years. The mean age of leaving school was around 16 years. The mean duration of psychiatric illness was 12.5 years. 24.2% of patients vs. 50.0% of controls were currently married or living with a male partner (p 0.005); 24.2% of patients vs. 54.5% of controls had a job (p 0.001); and 92.3% of patients vs. 36.4% of controls were receiving social welfare (p 0.001). 43 (65.1%) of the patients reported having been pregnant at least once, the total number of completed pregnancies being 80. 9 of the pregnancies ended in miscarriages, 17 in induced abortions, 2 in stillbirths, and 52 in live births. 58 (87.9%) controls had been pregnant at least once. 17 patients (39.5%) and 8 controls (13.8%) had had one or more induced abortions (p 0.01). There was no significant difference between the two groups with regard to miscarriages or stillbirths. 19 children of the patients were under 16 years of age and 8 of them were not living with their mothers. A significantly greater percentage of children of patients (42%), compared with the children of controls (3.8%), were not being reared by their biological mothers (p 0.001). 35 patients (55.4%) had had heterosexual intercourse within the past year. Only one patient had not used birth control. Heterosexually active patients (n = 35) were significantly more likely than heterosexually active controls (n = 52) to have had more than one male sexual partner, to report having been pressured into unwanted intercourse, and to have had intercourse with a bisexual person.

82 citations


"Family Planning Needs and Contracep..." refers background in this paper

  • ...The rate of unwanted/unplanned pregnancy and abortion was high; and they did not discuss the issue with psychiatrist.(2-8) They did not follow periodic gynecological examinations and they did not have adequate partner support....

    [...]

  • ...Information from health professionals was significantly less in BPD and schizophrenic patients compared to controls and depressive patients Discussion It was reported that sexually active female patients in reproductive ages do not use contraception.(1-13) In a study, David showed that patients with non-psychotic depression may have a sexual life and family planning just like healthy individuals....

    [...]

  • ...The necessity for family planning in female patients with chronic mental disorders is important.(1-3) Our study compared the family planning and contraceptive use reported by women who have mental illness with those by matched comparison groups from the general population....

    [...]


Journal ArticleDOI
TL;DR: The authors discuss the special contraceptive needs of chronic psychiatric patients and encourage psychiatrists to inquire about patients' family planning practices.
Abstract: The authors investigated the pregnancy outcomes, contraceptive behavior, and contraceptive needs of 80 female chronic psychiatric outpatients

76 citations


"Family Planning Needs and Contracep..." refers background in this paper

  • ...The rate of unwanted/unplanned pregnancy and abortion was high; and they did not discuss the issue with psychiatrist.(2-8) They did not follow periodic gynecological examinations and they did not have adequate partner support....

    [...]

  • ...Information from health professionals was significantly less in BPD and schizophrenic patients compared to controls and depressive patients Discussion It was reported that sexually active female patients in reproductive ages do not use contraception.(1-13) In a study, David showed that patients with non-psychotic depression may have a sexual life and family planning just like healthy individuals....

    [...]

  • ...Coverdale reported that psychiatric patients in his study had not have pelvic examination during the last 3 years.(7) In our society, women tend to neglect their gynecological examinations....

    [...]

  • ...In several studies, this rate of sexual intercourses without contraception is reported to vary between 33% and 73%, and lack of contraception methods in patients with serious mental disorders is emphasized.(2,6-8,12,13) Our...

    [...]