The influence of health care utilization on the association between hormonal contraception initiation and subsequent depression diagnosis and antidepressant use

Ditch, Sarah; Roberts, Timothy A.; Hansen, Shana

doi:10.1016/j.contraception.2019.12.011

Cited by 7 publications

(3 citation statements)

References 22 publications

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“… 52 53 A recent study found that adjustement for healthcare access eliminated the association between HC initiation and subsequent antidepressant use in a US population. 54 Although the healthcare system is different in Sweden and visits to midwifes for contraceptive purposes free, we conducted a sensitivity analysis including only women who had accessed healthcare within the last 3 years to adress this. Using only care-accessors as the reference group did not change our results in any substansive way, see online supplemental material 8 .…”

Section: Discussionmentioning

confidence: 99%

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)

et al. 2021

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ObjectivesFrom a reproductive justice framework, we aimed to investigate how a possible association between hormonal contraceptive (HC) and antidepressants use (as a proxy for depression) is distributed across intersectional strata in the population. We aimed to visualise how intersecting power dynamics may operate in combination with HC use to increase or decrease subsequent use of antidepressants. Our main hypothesis was that the previously observed association between HC and antidepressants use would vary between strata, being more pronounced in more oppressed intersectional contexts. For this purpose, we applied an intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy approach.DesignObservational prospective cohort study using record linkage of national Swedish registers.SettingThe population of Sweden.ParticipantsAll 915 954 women aged 12–30 residing in Sweden 2010, without a recent pregnancy and alive during the individual 1-year follow-up.Primary outcome measureUse of any antidepressant, meaning being dispensed at least one antidepressant (ATC: N06A) during follow-up.ResultsPreviously mentally healthy HC users had an OR of 1.79 for use of antidepressants compared with non-users, whereas this number was 1.28 for women with previous mental health issues. The highest antidepressant use were uniformly found in strata with previous mental health issues, with highest usage in women aged 24–30 with no immigrant background, low income and HC use (51.4%). The largest difference in antidepressant use between HC users and non-users was found in teenagers, and in adult women of immigrant background with low income. Of the total individual variance in the latent propensity of using antidepressant 9.01% (healthy) and 8.16% (with previous mental health issues) was found at the intersectional stratum level.ConclusionsOur study suggests teenagers and women with immigrant background and low income could be more sensitive to mood effects of HC, a heterogeneity important to consider moving forward.

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Section: Discussionmentioning

confidence: 99%

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)

et al. 2021

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“…In a separate study of Swedish national registers, progestin-only users had higher odds of antidepressant use than non-users in all age groups studied (aged 16 to 31), while this was only true for the youngest combination HC users (aged 16 to 19) [23]. While it is true that all users of a medication are more likely to be prescribed psychoactive drugs due to presumably increased healthcare access, one retrospective cohort study addressed this confounder by drawing a sample from the US Military Healthcare System and employing two control groups, one with all HC non-users enrolled in the system and one with only enrollees that accessed medical services during the study period [24]. Compared to the enrolled control group, women using HC containing norgestimate, levonorgestrel, etonogestrel, norethindrone, or norelgestromin had a higher risk of depression diagnosis, but compared to the control group that accessed care, risk was elevated only for levonorgestrel or norelgestromin, while risk was reduced for norethindrone.…”

Section: Depression and Anxiety In Oc Usersmentioning

confidence: 99%

Oral Contraceptives and the Risk of Psychiatric Side Effects: A Review

Ciarcia,

Huckins

2024

Complex Psychiatry

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Importance: Oral contraceptives (OCs) are an essential medicine used by millions of people every day. Given the widespread usage of these medicines, even a small increase in psychiatric risk could be of clinical significance. Although mood-related side effects are a common reason for OC hesitancy and discontinuation, studies investigating psychiatric responses to OC treatment have had inconsistent results. Observations: While OCs are beneficial for most users, there is evidence that a subgroup of users are susceptible to mood side effects. Randomized controlled trials have generally failed to find differences in mood symptoms between OC and placebo users, but observational studies comparing OC users to non-users have reported increases in symptoms of depression, anxiety, and eating disorders. Additionally, observational evidence suggests that OC users may be more likely to use prescription psychotropic medications and to attempt or die by suicide. However, responses to OC treatment are highly heterogeneous, and some users report mood improvement. A variety of factors may increase the likelihood of negative psychiatric side effects, including younger age, previous experience of side effects from OCs, and pre-existing psychiatric disorders. Progestin-only pills may confer a higher psychiatric risk than combination pills. Conclusions and Relevance: Further research investigating factors that contribute to susceptibility to the mood-related side effects of OCs is clearly warranted. Genomic approaches may provide insight as to why some users experience side effects while others do not. Research elucidating who is most at risk and why will be essential to addressing prevalent concerns about the psychiatric risk of OCs.

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“…Although maternal and reproductive health research in Jordan has been adequately addressed (e.g., [1][2][3][4][5]), the connection between the risk of developing PPD and contraceptive use (hormonal vs. non-hormonal) has not, to our knowledge, been addressed. There are many important factors to consider with this topic, both locally and internally, such as the utilization of healthcare services [14], time to initiate antidepressants in postpartum women [15], gestational weight gain [16], and the history of psychiatric disorders [17]. Therefore, the risk of developing PPD could be due to how intrapartum and postpartum biopsychosocial needs are managed, as well as other personal and health-related factors that could contribute to an increased risk of developing PPD.…”

Section: Depressive Symptoms In Postpartum Womenmentioning

confidence: 99%

Predictors of Depressive Symptoms in Postpartum Women: The Role of Contraceptive Use, Type and Health-Related Factors

Hamdan-Mansour¹,

Alkhaldi²,

Awamleh³

et al. 2022

JMJ

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Background: The postpartum period is critical for women due to significant bio-psychosocial changes and the consequences of delivery. Aims: The purpose of this study was to investigate the role of the use of contraceptives and other health-related factors in the risk of developing postpartum depression among women in Jordan. Materials and methods: A cross-sectional, descriptive-correlational design was used to recruit 803 women using a convenience sample technique from the central district of Jordan. Data were collected on depressive symptoms, contraceptive use and type, and pregnancy health-related factors. Results: Using binary logistic regression analysis, non-hormonal contraceptives and musculoskeletal pain were significant predictors (p<.05) of the risk of developing depressive symptoms in the sampled women (OR=4.1, 3.8; respectively). For the women in our sample, 24.9% (n=200) developed depressive symptoms. Most of those who felt depressed reported suffering from insomnia (50.0%] and baby blues (13.0%), while loss of appetite was reported by 33.0%. The analysis also showed that 51.0% (n=409) had used at least one method of contraception. Among those using contraceptive methods, 31.0% had only used hormonal contraceptives compared to 69.0% using non-hormonal forms. Conclusion: Non-hormonal contraceptive use and musculoskeletal pain were found to be significantly associated with the risk of developing postpartum depressive symptoms. Family and reproductive health professionals need to emphasize the bio-psychological aspects of health for pregnant and postpartum women.

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The influence of health care utilization on the association between hormonal contraception initiation and subsequent depression diagnosis and antidepressant use

Cited by 7 publications

References 22 publications

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)

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)

Oral Contraceptives and the Risk of Psychiatric Side Effects: A Review

Predictors of Depressive Symptoms in Postpartum Women: The Role of Contraceptive Use, Type and Health-Related Factors

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