Family Planning Needs and Contraceptive Use in Female Psychiatric Outpatients

doi:10.21763/TJFMPC.02816

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Family Planning Needs and Contraceptive Use in Female Psychiatric Outpatients

Journal Article•DOI•

Family Planning Needs and Contraceptive Use in Female Psychiatric Outpatients

Kadriye Pehlivanoglu, Ozlem Tanriover, Nesrin Tomruk, Nesrin Karamustafalioglu, Evrim Oztekin, Nihat Alpay - Show less +2 more

01 Sep 2007-Turkish journal of family medicine and primary care-Vol. 1, Iss: 3

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.

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Abstract: Background 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.

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Journal Article•DOI•

Selective review of age-related needs of women with schizophrenia.

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Mary V. Seeman¹, Rina Gupta•Institutions (1)

University of Toronto¹

01 Apr 2015-Clinical Schizophrenia & Related Psychoses

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.

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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

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8 citations

Journal Article•DOI•

A population-based study of the frequency and predictors of induced abortion among women with schizophrenia.

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Hilary K. Brown¹, Cindy-Lee Dennis¹, Paul Kurdyak², Simone N. Vigod³•Institutions (3)

University of Toronto¹, Centre for Addiction and Mental Health², Women's College Hospital³

01 Dec 2019-British Journal of Psychiatry

TL;DR: Vulnerability related to reproductive healthcare for women with schizophrenia is demonstrated and evidence-based interventions to support optimal sexual health, particularly in young women, those with psychiatric and addiction comorbidity, and women who have already had a child are warranted.

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Abstract: BACKGROUND Induced abortion is an indicator of access to, and quality of reproductive healthcare, but rates are relatively unknown in women with schizophrenia. AIMS We examined whether women with schizophrenia experience increased induced abortion compared with those without schizophrenia, and identified factors associated with induced abortion risk. METHOD In a population-based, repeated cross-sectional study (2011-2013), we compared women with and without schizophrenia in Ontario, Canada on rates of induced abortions per 1000 women and per 1000 live births. We then followed a longitudinal cohort of women with schizophrenia aged 15-44 years (n = 11 149) from 2011, using modified Poisson regression to identify risk factors for induced abortion. RESULTS Women with schizophrenia had higher abortion rates than those without schizophrenia in all years (15.5-17.5 v. 12.8-13.6 per 1000 women; largest rate ratio, 1.33; 95% CI 1.16-1.54). They also had higher abortion ratios (592-736 v. 321-341 per 1000 live births; largest rate ratio, 2.25; 95% CI 1.96-2.59). Younger age (<25 years; adjusted relative risk (aRR), 1.84; 95% CI 1.39-2.44), multiparity (aRR 2.17, 95% CI 1.66-2.83), comorbid non-psychotic mental illness (aRR 2.15, 95% CI 1.34-3.46) and substance misuse disorders (aRR 1.85, 95% CI 1.47-2.34) were associated with increased abortion risk. CONCLUSIONS These results demonstrate vulnerability related to reproductive healthcare for women with schizophrenia. Evidence-based interventions to support optimal sexual health, particularly in young women, those with psychiatric and addiction comorbidity, and women who have already had a child, are warranted.

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6 citations

Journal Article•DOI•

Female Sexual Dysfunction and Schizophrenia: A Clinical Review:

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Pragya Lodha, Avinash De Sousa

24 Apr 2020

TL;DR: A clinical review that looks at various facets of FSD in relation to schizophrenia and the victimization of female patients with schizophrenia is laid out.

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Abstract: Female sexual dysfunction (FSD) is understudied and unexplored in clinical practice. There is a need for psychiatrists to acknowledge the same and explore this symptom in patients with schi...

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5 citations

Reproductive, preconceptual and antenatal needs of women with schizophenia

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J. Barkla, John J. McGrath

01 Jan 2000

4 citations

Journal Article•DOI•

An Examination of Turkish Nurses' Attitudes, Awareness and Practices Regarding Reproductive Health Needs of Individuals With Schizophrenia.

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Burcu Ceylan, Deniz Kocoglu-Tanyer¹•Institutions (1)

Selçuk University¹

03 Jan 2019-Issues in Mental Health Nursing

TL;DR: Both nurses working in primary care and psychiatric clinics had negative attitudes towards the reproductive health of individuals with schizophrenia, and it appears that nurses, as members of society, do not approve of marriage or parenting by individuals with psychosis.

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Abstract: Aim: This study was conducted to evaluate Turkish nurses' attitudes, awareness and practices regarding reproductive health needs of individuals with schizophrenia. Method: The sample of this descriptive study consisted of 96 psychiatric nurses and 90 nurses and midwives working in family health centers who agreed to participate. The data were presented as numbers and percentages, and chi-square analyses were used to compare the groups. Findings: Although the majority of nurses stated that family planning education should be given to individuals with schizophrenia, to both genders and to both single and married patients, the proportion of those who give family planning education is only 23.5%. Of the nurses, 58.8% recommend tubal ligation as a method of family planning for individuals with schizophrenia, 39.6% of nurses think that involuntary abortion or sterilization for individuals with schizophrenia is necessary even if they do not support it culturally, and 20.3% of nurses provide sexual health counseling to individuals with schizophrenia. It appears that nurses, as members of society, do not approve of marriage or parenting by individuals with schizophrenia. Result: This study found that both nurses working in primary care and psychiatric clinics had negative attitudes towards the reproductive health of individuals with schizophrenia.

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2 citations

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Sexuality Pregnancy and Childrearing AmongWomen With Schizophrenia-Spectmm Disorders

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Molly Finnerty

01 Jan 1996

TL;DR: In this article, the authors compared the sexual, reproduction, and childrearing characteristics of women with schizophrenia-spectrum disorders with those of women without serious mental illness, and found that women with schizophrenic disorders had more lifetime sexual partners, were less likely to have a current partner, and were more likely to engage in prostitution.

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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,

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230 citations

Journal Article•DOI•

Sexuality, pregnancy, and childrearing among women with schizophrenia-spectrum disorders.

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Laura J. Miller¹, M Finnerty•Institutions (1)

University of Illinois at Chicago¹

01 May 1996-Psychiatric Services

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.

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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

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217 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 Article•DOI•

Sexuality, Reproduction, and Family Planning in Women With Schizophrenia

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Laura J. Miller¹•Institutions (1)

University of Illinois at Chicago¹

01 Jan 1997-Schizophrenia Bulletin

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.

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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.

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166 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 Article•DOI•

Family planning needs and STD risk behaviours of female psychiatric out-patients

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John H. Coverdale¹, Sarah H. Turbott, Helen Roberts•Institutions (1)

University of Auckland¹

01 Jul 1997-British Journal of Psychiatry

TL;DR: The results underscore the priority for developing programmes that reduce female psychiatric patients' risk for unwanted pregnancies and STDs.

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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.

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87 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 Article•DOI•

Family planning needs of female chronic psychiatric outpatients.

[...]

John H. Coverdale¹, John A. Aruffo•Institutions (1)

Baylor College of Medicine¹

01 Nov 1989-American Journal of Psychiatry

TL;DR: The authors discuss the special contraceptive needs of chronic psychiatric patients and encourage psychiatrists to inquire about patients' family planning practices.

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Abstract: The authors investigated the pregnancy outcomes, contraceptive behavior, and contraceptive needs of 80 female chronic psychiatric outpatients

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77 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...
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