Sixty-eight percent of pregnancies among women ages 18-24 are unintended, and approximately one quarter of U.S. women in this age group have had a depressive episode in the past year. Much research at the intersection of psychology and reproductive health has focused on depression as an outcome of reproductive health experiences such as childbirth, unintended pregnancy, infertility, or contraceptive use. In contrast, this K01 Mentored Research Scientist Development Award focuses on conceptualizing depression as a precursor to unintended pregnancy among young women because using contraception requires knowledge, motivation, and a sense of agency that depressed individuals may lack. To better understand theories of fertility and to integrate demographic perspectives into my work, I propose the following career development activities: 1) obtain formal training in population and demographic research and methods, 2) develop a sound conceptualization of the role of depression in unintended pregnancy, 3) extend my statistical skill set to include longitudinal and mediational analyses, and 4) learn about and gain experience with qualitative methods. The research activities complement these training goals and are: 1) to investigate the extent to which depression influences contraceptive behaviors such as choice of contraceptive method, contraceptive use patterns, method discontinuation, and inconsistent use, 2) to use quantitative and qualitative methods to examine potential mechanisms by which depression influences contraceptive behaviors, and 3) to develop and pilot a prospective cohort study to investigate the extent to which and mechanisms by which intra-individual changes in depression influence changes in contraceptive behaviors relative to other significant explanatory factors. These endeavors will benefit from an advisory board comprised of world-renown scholars including primary mentor Nancy Adler, PhD, co-mentor Jennifer Johnson-Hanks, PhD, scientific advisor James Trussell, PhD, and scientific advisor Tina Raine-Bennett, MD. In addition, faculty consultants Chuck McCulloch, PhD, Owen Wolkowitz, MD, and Judith Barker, PhD will provide expertise in statistical analysis techniques, clinical aspects of depression, and qualitative methods, respectively. The UMCP SPH Department of Family Science will provide the infrastructure to support these activities. The training and research activities proposed in this K01 will facilitate my transition to an independent investigator who takes an interdisciplinary and multi-method approach to understanding psychological aspects of reproductive health and will broaden our understanding of what leads to unintended pregnancy.

Public Health Relevance

Sixty-eight percent of pregnancies are unintended among U.S. women ages 18-24 and each year 24% of women in this age group experience depression, the leading cause of disability among young women. Many common reversible contraceptive methods used to prevent pregnancy in the U.S. require accurate knowledge, motivation, and agency, which depression may undermine. This research will provide new insights into the role of depression in young women's contraceptive behaviors. Findings will detail ways in which reproductive health policies, programs, and services can better address the reproductive needs of young women.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Scientist Development Award - Research & Training (K01)
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Study Section
Biobehavioral and Behavioral Sciences Subcommittee (CHHD)
Program Officer
King, Rosalind B
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University of Maryland College Park
Schools of Public Health
College Park
United States
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Steinberg, Julia R; Adler, Nancy E; Thompson, Kirsten M et al. (2018) Current and past depressive symptoms and contraceptive effectiveness level method selected among women seeking reproductive health services. Soc Sci Med 214:20-25
Vafai, Yassaman; Steinberg, Julia R (2018) The effects of preabortion depressive symptoms on postabortion contraceptive effectiveness level chosen among women seeking abortions. Contraception 97:335-340
Gelman, Amanda; Rosenfeld, Elian A; Nikolajski, Cara et al. (2017) Abortion Stigma Among Low-Income Women Obtaining Abortions in Western Pennsylvania: A Qualitative Assessment. Perspect Sex Reprod Health 49:29-36
Vafai, Yassaman; Steinberg, Julia R; Shenassa, Edmond D (2016) Maternal postpartum depressive symptoms and infant externalizing and internalizing behaviors. Infant Behav Dev 42:119-27
Steinberg, Julia R; Tschann, Jeanne M; Furgerson, Dorothy et al. (2016) Psychosocial factors and pre-abortion psychological health: The significance of stigma. Soc Sci Med 150:67-75
Nikolajski, Cara; Miller, Elizabeth; McCauley, Heather L et al. (2015) Race and reproductive coercion: a qualitative assessment. Womens Health Issues 25:216-23
Foster, D G; Steinberg, J R; Roberts, S C M et al. (2015) A comparison of depression and anxiety symptom trajectories between women who had an abortion and women denied one. Psychol Med 45:2073-82
Hall, Kelli Stidham; Steinberg, Julia R; Cwiak, Carrie A et al. (2015) Contraception and mental health: a commentary on the evidence and principles for practice. Am J Obstet Gynecol 212:740-6
Borrero, Sonya; Nikolajski, Cara; Steinberg, Julia R et al. (2015) ""It just happens"": a qualitative study exploring low-income women's perspectives on pregnancy intention and planning. Contraception 91:150-6
Steinberg, Julia R; Rubin, Lisa R (2014) Psychological Aspects of Contraception, Unintended Pregnancy, and Abortion. Policy Insights Behav Brain Sci 1:239-247

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