Adolescent Mental Health, Contraceptive Knowledge, and Teen Pregnancy Risk: A Systematic Review

TL;DR

This review finds that adolescent mental health issues are linked to reduced contraception knowledge and access, which may indirectly increase teen pregnancy risk.

Contribution

The study provides a systematic synthesis of how mental health affects contraceptive behavior and pregnancy risk in adolescents.

Findings

Depressive and anxiety symptoms are associated with reduced contraception access and use.

Adolescents with mental health issues are less likely to know where to obtain contraception.

Same-day contraception initiation in emergency departments is significantly higher with targeted interventions.

Abstract

Background: Adolescent depressive and anxiety symptoms may erode motivation and problem-solving needed for timely contraception, while online information quality is uneven. We synthesized evidence linking mental health, contraceptive knowledge/access, and teen pregnancy risk. Methods: Following PRISMA-2020, we searched PubMed, Embase, and Scopus to 7 July 2025 for primary studies including adolescents that measured validated mental health symptoms or psychiatric settings and reported contraceptive knowledge/access/behavior and/or teen pregnancy outcomes. Two reviewers screened/extracted data; risk of bias was appraised with the Newcastle–Ottawa Scale and ROBINS-I. Given heterogeneity, we conducted narrative synthesis. Results: Six U.S.-based studies met the criteria, spanning community colleges, a national cohort, school surveillance, psychiatric inpatient care, and pediatric emergency departments (samples: n = 143 to weighted N = 29,755). Depressive symptoms were associated with contraception access (adjusted odds ratio [aOR] 1.58, 95% CI 1.27–1.96) and anxiety/stress with similar risk (aOR 1.46, 1.17–1.82). A first depressive episode in the same year as sexual debut increased teenage pregnancy hazard (adjusted hazard ratio 2.70, 1.15–6.34). School surveillance showed mental health indicators correlated with contraception non-use at last sex (odds ratios 1.78–2.71). Among psychiatric inpatients, not knowing where to obtain contraception and access difficulties strongly predicted interest in information (aOR 2.96–3.33) and initiation (aOR 2.85–4.72). In a pediatric emergency department trial, same-day initiation occurred in 26.8% versus 3.1% under usual care. Conclusions: Evidence directly linking adolescent mental health symptoms to teen pregnancy is limited (one study), whereas multiple studies show associations with contraception knowledge/access and delayed or non-use, suggesting plausible indirect pathways to pregnancy risk. These findings support hypothesis-generating, integrated approaches and highlight the need for studies with teen pregnancy endpoints.

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