Association of Hormonal Contraceptive Use With Reduced Levels of Depressive Symptoms: A National Study of Sexually Active Women in the United States

• Published in: American journal of epidemiology 2013-11, Vol.178 (9), p.1378-1388
• Main Authors: KEYES, Katherine M, CHESLACK-POSTAVA, Keely, WESTHOFF, Carolyn, HEIM, Christine M, HALOOSSIM, Michelle, WALSH, Kate, KOENEN, Karestan
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Adult and adolescent clinical studies; Biological and medical sciences; Birth control; Body Mass Index; Contraceptive Agents, Female - adverse effects; Depression; Depression - chemically induced; Epidemiology; Estrogens - adverse effects; Exercise; Female; General aspects; Gynecology. Andrology. Obstetrics; Health Behavior; Health Status; Humans; Longitudinal Studies; Medical sciences; Mental depression; Mood disorders; Original Contributions; Progestins - adverse effects; Propensity Score; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Public health. Hygiene; Public health. Hygiene-occupational medicine; Sexual Behavior; Smoking - epidemiology; Socioeconomic Factors; Suicide; Suicide, Attempted - statistics & numerical data; Suicides & suicide attempts; United States; Women
• ISSN: 0002-9262; 1476-6256
• DOI: 10.1093/aje/kwt188

An estimated 80% of sexually active young women in the United States use hormonal contraceptives during their reproductive years. Associations between hormonal contraceptive use and mood disturbances remain understudied, despite the hypothesis that estrogen and progesterone play a role in mood problems. In this study, we used data from 6,654 sexually active nonpregnant women across 4 waves of the National Longitudinal Study of Adolescent Health (1994-2008), focusing on women aged 25-34 years. Women were asked about hormonal contraceptive use in the context of a current sexual partnership; thus, contraceptive users were compared with other sexually active women who were using either nonhormonal contraception or no contraception. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale. At ages 25-34 years, hormonal contraceptive users had lower mean levels of concurrent depressive symptoms (β = -1.04, 95% confidence interval: -1.73, -0.35) and were less likely to report a past-year suicide attempt (odds ratio = 0.37, 95% confidence interval: 0.14, 0.95) than women using low-efficacy contraception or no contraception, in models adjusted for propensity scores for hormonal contraceptive use. Longitudinal analyses indicated that associations between hormonal contraception and depressive symptoms were stable. Hormonal contraception may reduce levels of depressive symptoms among young women. Systematic investigation of exogenous hormones as a potential preventive factor in psychiatric epidemiology is warranted.