Adolescents with psychiatric symptoms have unique sexual health needs. These adolescents can have younger age at first sex, less frequent and/or inconsistent contraception use, and higher risk sexual behaviors than their peers without psychiatric symptoms. We examined contraception knowledge, use, and preferences among adolescents assigned female at birth (AFAB) hospitalized for psychiatric care, in addition to patient factors associated with contraceptive use.

Between November 2021 and March 2023, we recruited 451 adolescents AFAB ages 14-17 from 4 inpatient psychiatric units at a large children's hospital. As part of a larger study examining integration of contraception care in inpatient psychiatric settings, participants answered a survey about reproductive health, mental health, contraception knowledge, use, and preferences. The survey was administered via an electronic tablet using REDCap. Participants received a gift card incentive. Descriptive statistics included mean and standard deviation (SD) for continuous variables and frequencies and percentages for categorical variables. We used logistic regression to examine characteristics associated with contraception use. This study was approved by the institutional review board.

Mean age was 16.1 (95% CI: 14.1-18.1); 65.4% identified as white and 9.3% identified as Hispanic. Most respondents reported knowledge about the contraceptive pill (98.9%), implant (76.1%), intrauterine device (IUD; 75.2%), and injectable (51.4%). Among the 44.6% of respondents that reported ever having intercourse, condoms (49.3%), withdrawal (29.4%) and contraceptive pills (23.4%) were the most common methods of contraception. Some (37.3%) reported using multiple methods and few (13.4%) reported using no method to prevent pregnancy. When asked to select their preferred method, participants chose contraceptive pills (38.6%) most, followed by the implant (16.0%) and IUD (11.3%). Age was significantly associated with contraceptive use (OR: 1.6; 95% confidence interval 1.3, 1.9; p< 0.001) with older adolescents reporting higher odds of contraceptive use. Patient race, experience with sexual education, and insurance status were not significantly associated with contraceptive use.

Many adolescents hospitalized with psychiatric disorders are sexually active. Despite knowledge of contraceptives and preferences for more effective methods, their use of condoms and withdrawal may indicate their contraceptive needs are not being met. As adolescents face increasing rates of psychiatric symptoms, effort is recommended to ensure they have accessible sexual health services.