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Does the use of hormonal contraceptives increase the risk of depression - systematic review and secondary analysis of NHANES data

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posted on 2023-08-30, 20:23 authored by Julia Gawronska
Background: The debate whether hormonal contraceptives increase the risk of experiencing de-pression is still open. The existing research has failed to draw a firm conclusion in this area. The importance of clarifying the risk of hormonal contraceptives on depression is crucial to protect women from unintended pregnancies and abortions as a consequence. Methods: This thesis has been divided into three parts: a systematic review and meta-analysis, NHANES data analysis and an online survey. The systematic review and meta-analysis assessed the existing literature on the effect of hormonal contraceptives on depression, and systematically summarised the available data. A secondary analysis of NHANES data examined the association between oral contraceptive pill (OCP) and depression. Whilst the online survey investigated the association between the two main types of OCP, namely combined oral contraceptive pill (COC) and progestogen only pill (POP), and depression. Results: The systematic review narrative synthesis suggests that compared to non-users of hormonal contraceptives, women taking COCs do not have an increased risk of experiencing depression. Whilst, women using the contraceptive patch, vaginal ring, POP, levonorgestrel-intrauterine system (LNG-IUS) have an increased risk of suffering from depression. The risk of depression amongst women using contraceptive injection and contraceptive implant remains unclear. The meta-analyses suggest several different associations. A lack of association between depression in women using combined hormonal contraception (CHC) compared with women not using hormonal contraceptives. A lack of association between depression in women taking COCs compared with women not using hormonal contraceptives. A lack of an association between depression in women using progestin containing long-acting reversible contraceptive (LARC) compared with women not using hormonal contraceptives. A positive association between depression in women taking progestogen-only contraceptives (POCs) compared with women not using hormonal contraceptives; this association was present in high quality studies and absent in low quality studies. The secondary analysis of the NHANES data suggests that women using OCPs had a lower prevalence of depressive symptoms compared to non-users of OCPs. This association was stronger in younger women and attenuated with age. Finally, the online survey suggests that neither COC nor POP use is associated with clinically relevant depression. Conclusion: The results obtained suggest that there is no clear relationship between the whole class of hormonal contraceptives and depression. However, use of the contraceptive patch, vaginal ring, POPs, and LNG-IUS are associated with increased risk of experiencing depression. Further-more, the study design seems to influence research findings with a tendency for cross-sectional studies to show a trend towards lower or no risk, and higher quality prospective studies to show a trend towards higher risk of depression. Therefore, more research will be required to elucidate the causes of this effect.

History

Institution

Anglia Ruskin University

File version

  • Accepted version

Language

  • eng

Thesis name

  • PhD

Thesis type

  • Doctoral

Legacy posted date

2022-12-19

Legacy creation date

2022-12-19

Legacy Faculty/School/Department

Theses from Anglia Ruskin University/Faculty of Health, Education, Medicine & Social Care

Note

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