COVID-19 impacts and videoconference healthcare preferences in relation to depression and sexual risk behaviors among young adults assigned female at birth: a cross-sectional study

Background: Due to decreased access to sexual and reproductive health (SRH) services and an increase in depressive symptoms, the coronavirus disease 2019 (COVID-19) pandemic has exacerbated the risk of unsafe sexual behaviors among already vulnerable young adults assigned female at birth (AFAB). Despite its potential for improving SRH outcomes, little is known about how young adults view virtual SRH counseling. We designed a survey to examine these perspectives and further characterize pandemic-associated changes in mood and healthcare access in young adults AFAB. Methods: Patients of a Midwest family planning organization who were AFAB and aged 21-24 years were recruited via convenience sampling between May and September 2021. Participants answered survey questions about how they perceived that the pandemic had affected their mood and healthcare access. The Patient Health Questionnaire (PHQ)-8 assessed depressive symptoms. Additional questions probed SRH risk behaviors and experience with and opinions on virtual healthcare and research. Non-responses to questions were not included in analyses. Associations among these variables were analyzed using non-parametric bivariate tests (chi-square and Mann-Whitney U). Results: One hundred twenty people participated in the survey. Participants had a median age of 22 years and self-identified predominantly as female and White. Three-quarters of respondents reported their mood worsened as a result of the pandemic and more than 3 in 10 had depression. Those reporting pandemic worsened mood had more severe depressive symptoms than those who did not (U=722.500, P=0.005). Most reported sexual intercourse in the past 3 months, nearly all of whom reported at least one SRH risk. Pandemic mood impacts were not associated with SRH risk. One in four participants reported pandemic associated difficulty accessing healthcare, which was not associated with depression or SRH risk. Most reported comfort with videoconference healthcare, including technology, speaking with a provider, and having enough privacy. Conclusions: The COVID-19 pandemic has increased depression and SRH risk among young adults AFAB and, at the same, impeded their access to healthcare. The study findings suggest that no matter the degree of depression or presence of SRH risk, videoconferencing may be an acceptable option for advancing research and addressing unmet SRH needs in this population.