General discussion and future directions 243 participants related to prior eating disorders and their age. This presumption about fertility posed risk for UPs through the misunderstanding that using contraceptives was still needed to prevent UPs (Chapter 7). Although these cases support the first hypothesis, we conclude a lack of examples wherein common psychiatric symptoms such as depressed mood, apathy, hypersexuality, loss of overview, confusion, memory loss and delusions relate to problems with contraceptive adherence or reproductive control in addition to data from larger (quantitative) samples in which this link is investigated. This relates to several important limitations of Chapter 6 and Chapter 7. First, interviewees were employed women who could verbalize their stories well. We potentially lacked inclusion of women with low literacy, difficulty with expressing their needs or taking charge of their mental health situation. Women with florid psychotic episodes were excluded for ethical considerations. However, inclusion of this relatively stable group of women with psychiatric vulnerability, narrows the spectrum of women for which our findings are representative. In Chapter 6, we lack insights of women from other cultural and ethnic background than Dutch, as the focus groups were held in Dutch language and a prerequisite was sufficient knowledge thereof. Figure 9.1 - Hypothesis 1: there is a causal relationship between psychiatric vulnerability and UPs Hypothesis 2: there is overlap between social and psychiatric risk factors An overlap between social and psychiatric risk factors could also predict UPs in women with psychiatric vulnerability. UPs are linked to low socioeconomic status, young age, unmarried status, low income, low educational level, lack of insurance and of social support40-44. In studies on UPs amongst women with psychiatric
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