Disability, Depression, Opioids, and Suicide among Women of Reproductive Age: Four Different Studies of Nationally Representative Samples

Abstract

Disability adversely affects a substantial proportion of the United States (US) population and is a recognized major public health challenge. Despite established associations between disability and adverse health conditions, limited information exists regarding its effects among women of reproductive age. This dissertation consists of four different studies that examine depression, opioids, and suicide among US women of reproductive age with disabilities. Using data from the Pregnancy Risk Assessment Monitoring System, the first study in Chapter One examined disability, stressful life events, and postpartum depressive symptoms among women. Descriptive statistics, bivariate, and binary logistic regression analyses were conducted to estimate the effect of stressful life events on postpartum depressive symptoms among women with and without disabilities. Compared to their peers without disabilities, women with disabilities reported a higher number of stressful life events (87% to 67%) and post depressive symptoms (37% to 9%). Women with disabilities experiencing six or more stressful life events were more likely (odds ratio = 3.78, 95% confidence interval = [1.57-9.10]) to report postpartum depressive symptoms, compared to those with no stressful life events. Data from the National Survey on Drug Use and Health (NSDUH) were used in the second, third, and fourth studies. The analyses included descriptive statistics, bivariate analyses, and logistic regression to measure associations. All of the analyses were weighted to account for the complex survey design of NSDUH. The second study in Chapter Two examined disability and prescription opioids among pregnant women. Pregnant women with any type of disability had higher adjusted odds of using (adjusted odds ratio = 1.71, 95% confidence interval = [1.27-2.29]) and misusing (adjusted odds ratio = 2.00, 95% confidence interval = [1.22-3.28]) opioids within the past year compared to their peers without disabilities. The third study in Chapter Three assessed disability and prescription opioids among non-pregnant women of reproductive age. The findings of this study indicate that similarly to the pregnant population, non-pregnant women with disabilities had higher adjusted odds of opioid use (adjusted odds ratio = 1.59, 95% confidence interval = [1.50-1.67]) and misuse (adjusted odds ratio = 2.01, 95% confidence interval = [1.82-2.21]) than their peers without disabilities. The fourth study in Chapter Four examined disability and suicidal behaviors among non-pregnant women of reproductive age. Women with disabilities had greater adjusted odds of past-year suicidal behaviors (adjusted odds ratio = 1.73, 95% confidence interval = [1.60-1.87]) than women without disabilities. Disability adversely affects women of reproductive age in multiple facets of life. Compared to their peers without disabilities, women with disabilities are at an amplified risk for stressful life events, opioid use and misuse, and postpartum depressive symptoms. Early prenatal screenings for disabilities, life stressors, and opioid use or misuse is critical for timely awareness and appropriate treatment to prevent associated adverse health conditions. Further postnatal screening for postpartum depressive symptoms and opioid use or misuse is vital to optimize favorable health outcomes for mothers and their children. Both pregnant and non-pregnant women with disabilities are at increased risk for prescription opioid use and misuse relative to their peers without disabilities. Furthermore, non-pregnant women of reproductive age with disabilities are at increased risk for suicidal behaviors, particularly suicide attempts, compared to their counterparts without disabilities. Effectively mitigating the effects of opioids prior to reproduction will prevent associated adverse consequences for prospective mothers, children, and families. Furthermore, this study’s findings elucidate the complexity of suicidal behaviors among women with disabilities and the influence of specific health determinants on such behaviors. Enhancing our knowledge of suicidal behaviors and associated health determinants among women with disabilities can preserve the wellbeing of future generations via enhanced prevention, detection, and intervention enterprises.