Reproductive health experiences of women and non-binary people with early psychosis: a qualitative study

BACKGROUND AND HYPOTHESIS: Psychosis typically emerges in young adulthood and can impact reproductive health, including risk for suboptimal fertility and unplanned pregnancies. This study aimed to explore the reproductive health experiences of young women and non-binary people with psychosis. STUDY DESIGN: In this qualitative study, young women and non-binary service users with experience of early psychosis in Toronto, Canada participated in semi-structured interviews about their reproductive health experiences (sexual health experiences analyzed separately). Clinicians providing healthcare for this population also participated in interviews/focus groups. Thematic analysis was used to describe core themes among service users, then understand how clinician perspectives related to these. STUDY RESULTS: Interviews with service users (n = 19, aged 18-31; cisgender women n = 15, transgender women n = 2, non-binary individuals n = 2) yielded two core themes: (1) Complex reproductive health needs exist irrespective of psychosis, and (2) Psychosis does specifically impact reproductive health priorities and plans. These were discussed across three clinical content areas: contraception, menstruation, and future pregnancy/family planning. A final theme emerged from clinicians (n = 36): (3) Clinicians grapple with clinical complexity, and sometimes have different priorities than their patients (e.g., menstruation was a priority for service users only). CONCLUSIONS: This study offers insights into the reproductive health experiences of women and non-binary individuals with early psychosis, including complexity that exists irrespective of psychosis, and additional psychosis-related complexity. The study also explored clinicians' perspectives, and identified areas of discordance between service user and clinician perspectives (e.g., related to menstruation). Findings can help shape interventions to improve this population's reproductive health.