Population heterogeneity in associations between hormonal contraception and antidepressant use in Sweden: a prospective cohort study applying intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)

Zettermark, Sofia; Khalaf, Kani; Pérez-Vicente, Raquel; Leckie, George; Mulinari, Diana; Merlo, Juan

doi:10.1136/bmjopen-2021-049553

Cited by 16 publications

(11 citation statements)

References 65 publications

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“… 34 35 Another recent Swedish register-based study confirmed higher subsequent use of antidepressants in HC users, especially in contexts composed by immigrant, low-income women with previous mental issues. 36 The same authors had previously found an OR of 1.34 for subsequent psychotropic drug use in young women (12–30 years) using HC compared with non-users, with the strongest association in adolescents (but no association after adolescence). 37 Again, because all these, including ours, are epidemiological studies based on observational data, assumptions on causality and directionality of the associations cannot be made.…”

Section: Discussionmentioning

confidence: 86%

“…However, because the studies did not take into account the sequence of drugs used, no assumption on the directionality of the associations could be made 34 35. Another recent Swedish register-based study confirmed higher subsequent use of antidepressants in HC users, especially in contexts composed by immigrant, low-income women with previous mental issues 36. The same authors had previously found an OR of 1.34 for subsequent psychotropic drug use in young women (12–30 years) using HC compared with non-users, with the strongest association in adolescents (but no association after adolescence) 37.…”

Section: Discussionmentioning

confidence: 99%

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Associations between use of psychotropic medications and use of hormonal contraception among girls and women aged 15–49 years in Finland: a nationwide, register-based, matched case–control study

et al. 2022

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ObjectivesThe relationship between the use of contraception and of psychiatric medications is understudied. We examined whether the current and past use of psychotropic medications is associated with the use and type of hormonal contraception (HC).DesignNationwide register-based matched case–control study.SettingsAll fertile-aged (15–49 years) girls and women living in Finland in 2017; data from several national registers.Participants294 356 girls and women with a redeemed prescription of HC in 2017, and their same-sized control group of non-users (n=294 356) identified through the Prescription Centre.Main outcome measuresAssociations between the use of psychotropic medications and the use of HC, and the type of HC tested in logistic regression models.ResultsAltogether 19.5% of the HC users, and 18% of the HC non-users received at least one prescription for a psychotropic medication in 2017. Among HC users, the proportions of occasional and regular users of psychotropic medications in 2013–2016 were 4.5% and 14.8%, while among HC non-users the respective figures were 4.3% and 14.6%, respectively. In multivariable logistic regression models both the use of psychotropic medications in 2017, and their occasional or regular use between 2013–2016 were associated with higher odds of HC use, although with small to very small effect sizes (ORs between 1.37 and 1.06 and 95% CIs 1.22 to 1.53, and 1.03 to 1.09, respectively). After adjustment for covariates, when fixed combinations of progestogens and oestrogens for systemic use was the reference category, women using almost any class of psychotropic medications had higher odds of using other types of HC.ConclusionsFertile-aged girls and women with current and past use of psychotropic medications have higher odds of using HC, with a specific pattern in the type of contraceptives used. Further research is warranted to examine whether our observations indicate a reduction of unwanted pregnancies in women with psychiatric disorders.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Associations between use of psychotropic medications and use of hormonal contraception among girls and women aged 15–49 years in Finland: a nationwide, register-based, matched case–control study

et al. 2022

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“…The AUC-ROC values extend from 0.5 to 1, where 0.5 represents absence DA, and 1 represents perfect DA. The higher the AUC-ROC values above 0.5, the higher the influence of the intersectional strata to differentiate U5y with and without a health outcome (in this case, cough, fever and ARI) [46].…”

Section: Methodsmentioning

confidence: 99%

The effects of social determinants on children’s health outcomes in Bangladesh slums through an intersectionality lens: An application of multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)

Barua

Kibuchi²,

Aktar³

et al. 2023

PLOS Glob Public Health

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Empirical evidence suggests that the health outcomes of children living in slums are poorer than those living in non-slums and other urban areas. Improving health especially among children under five years old (U5y) living in slums, requires a better understanding of the social determinants of health (SDoH) that drive their health outcomes. Therefore, we aim to investigate how SDoH collectively affects health outcomes of U5y living in Bangladesh slums through an intersectionality lens. We used data from the most recent national Urban Health Survey (UHS) 2013 covering urban populations in Dhaka, Chittagong, Khulna, Rajshahi, Barisal, Sylhet, and Rangpur divisions. We applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to estimate the Discriminatory Accuracy (DA) of the intersectional effects estimates using Variance Partition Coefficient (VPC) and the Area Under the Receiver Operating Characteristic Curve (AUC-ROC). We also assessed the Proportional Change in Variance (PCV) to calculate intersectional effects. We considered three health outcomes: cough, fever, and acute respiratory infections (ARI) in U5y.We found a low DA for cough (VPC = 0.77%, AUC-ROC = 61.90%), fever (VPC = 0.87%, AUC-ROC = 61.89%) and ARI (VPC = 1.32%, AUC-ROC = 66.36%) of intersectional strata suggesting that SDoH considered do not collectively differentiate U5y with a health outcome from those with and without a health outcome. The PCV for cough (85.90%), fever (78.42%) and ARI (69.77%) indicates the existence of moderate intersectional effects. We also found that SDoH factors such as slum location, mother’s employment, age of household head, and household’s garbage disposal system are associated with U5y health outcomes. The variables used in this analysis have low ability to distinguish between those with and without health outcomes. However, the existence of moderate intersectional effect estimates indicates that U5y in some social groups have worse health outcomes compared to others. Therefore, policymakers need to consider different social groups when designing intervention policies aimed to improve U5y health outcomes in Bangladesh slums.

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“…The new I-MAIHDA approach has already been applied to examine a variety of health inequalities, including body mass index ( Evans et al, 2018 ; Hernández-Yumar et al, 2018 ), COPD risk ( Axelsson Fisk et al, 2018 ), depression ( Evans & Erickson, 2019 ), prescription opioid (mis)use ( Persmark, Wemrell, Evans, et al, 2019 ; Persmark, Wemrell, Zettermark, et al, 2019 ), biomarkers of healthy aging ( Holman, Salway, & Bell, 2020 ), use of hormonal contraception and risk of depression ( Zettermark et al, 2021 ), and HPV vaccination ( Zubizarreta et al, 2022 ). To date, MAIHDA (and especially I-MAIHDA) have primarily been developed and used to study health inequalities.…”

Section: Introductionmentioning

confidence: 99%

A tutorial for conducting intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)

Evans,

Leckie,

Subramanian

et al. 2024

SSM - Population Health

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Population heterogeneity in associations between hormonal contraception and antidepressant use in Sweden: a prospective cohort study applying intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)

Cited by 16 publications

References 65 publications

Associations between use of psychotropic medications and use of hormonal contraception among girls and women aged 15–49 years in Finland: a nationwide, register-based, matched case–control study

Associations between use of psychotropic medications and use of hormonal contraception among girls and women aged 15–49 years in Finland: a nationwide, register-based, matched case–control study

The effects of social determinants on children’s health outcomes in Bangladesh slums through an intersectionality lens: An application of multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)

A tutorial for conducting intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)

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