Assessing the role of adolescent hormonal contraceptive use on risk for  depression: a 3-year longitudinal study protocol

Bita Zareian; Christine Anderl; Joelle LeMoult; Liisa A M Galea; Jerilynn C Prior; Jason D Rights; Colin J Ross; Sabrina Ge; Annie C Hayward; Frances S Chen

doi:10.1186/s12905-022-01623-2

Research Methods Study Design

Assessing the role of adolescent hormonal contraceptive use on risk for depression: a 3-year longitudinal study protocol

Zareian B, Anderl C, LeMoult J, Galea LAM, Prior JC, Rights JD, Ross CJ, Ge S, Hayward AC, Chen FS

Published February 23, 2022 BMC Women's Health, 22(1), 48

DOI 10.1186/s12905-022-01623-2 PMID 35197045 PMC PMC8864455

RRM Academy Synopsis

Protocol tracks whether teen birth control use predicts depression

A 2022 study protocol will follow 320 teen girls for three years to test whether starting combined hormonal birth control as a teen raises the risk of depression. A team at the University of British Columbia will check in with the girls three times, testing stress hormones, mood, and how well they read faces.

Key Findings

The power calculation drew on an earlier study: 16.1% of teen contraceptive users and 5.7% of teens with no such history had major depression within the past year, odds ratio 3.17.
To reach enough statistical power, the team plans to enroll 320 girls between 13 and 15 years old who were assigned female at birth and have started their periods.
Each participant will take part in three rounds of testing spread across three years: an opening session, then follow-ups near the 18-month and 36-month marks.
At every round, the team gathers mood ratings, a stress-hormone sample, a diurnal cortisol record, and a facial-emotion test, along with an update on contraceptive use.
Enrollment opened in September 2019, and the plan has clearance from the university's ethics review board overseeing behavioral research.

Interpretation

This is a study protocol: it lays out a planned three-year longitudinal design and has not yet reported outcome data. The design follows the same teens over time, which lets researchers test whether starting birth control comes before mood symptoms appear. The team plans to enroll 320 teens aged 13 to 15, with that target set from an effect size reported in an earlier study. The completed study will support further research into early hormone exposure and adolescent mood.

RRM Context

Charting a woman's cycle, a core tool of fertility awareness, ties hormone tests to a known day. This protocol uses that same early-cycle window for its saliva sampling. One study author, Jerilynn C. Prior, has written widely on using cycle charts to track ovulation and hormone shifts.

Our editorial summary of this paper, not the article's abstract.

Abstract

Background

The incidence of depression in human females rises steadily throughout adolescence, a critical period of pubertal maturation marked by increasing levels of gonadal hormones including estrogens and progesterone. These gonadal hormones play a central role in social and emotional development and may also contribute to the increased occurrence of depression in females that begins in early adolescence. In this study, we examine whether and how introducing synthetic estrogen and progestin derivatives through the use of combined hormonal contraceptives (CHC), affects adolescent females' risk for developing depression. We further assess potential links between CHC use and alterations in stress responses and social-emotional functioning.

Methods

Using a longitudinal cohort design, we will follow a sample of adolescent females over the span of three years. Participants will be assessed at three time points: once when they are between 13 and 15 years of age, and at approximately 18 and 36 months after their initial assessment. Each time point will consist of two online sessions during which participants will complete a clinical interview that screens for key symptoms of mental health disorders, along with a series of questionnaires assessing their level of depressive symptoms and history of contraceptive use. They will also complete a standardized social-evaluative stress test and an emotion recognition task, as well as provide saliva samples to allow for assessment of their circulating free cortisol levels.

Discussion

In this study we will assess the effect of CHC use during adolescence on development of Major Depressive Disorder (MDD). We will control for variables previously found to or proposed to partially account for the observed relationship between CHC use and MDD, including socioeconomic status, age of sexual debut, and CHC-related variables including age of first use, reasons for use, and its duration. In particular, we will discover whether CHC use increases depressive symptoms and/or MDD, whether elevated depressive symptoms and/or MDD predict a higher likelihood of starting CHC, or both. Furthermore, this study will allow us to clarify whether alterations in stress reactivity and social-emotional functioning serve as pathways through which CHC use may result in increased risk of depressive symptoms and/or MDD.

Topics

Research Methods › Study Design › Cohort Studies · Contraception › Adverse Effects › Mood and Libido · Therapeutics › Hormonal Agents › Progesterone and Progestins

Bita Zareian, Christine Anderl, Joelle LeMoult, Liisa A M Galea, Jerilynn C Prior, Jason D Rights, Colin J Ross, Sabrina Ge, Annie C Hayward, Frances S Chen

B Zareian, Chris Anderl, C Anderl, J LeMoult, L Galea, J Prior, J Rights, C Ross, S Ge, A Hayward, F Chen

PMID 35197045 35197045 DOI 10.1186/s12905-022-01623-2 10.1186/s12905-022-01623-2 Zareian et al. 2022, Zareian 2022

Keywords

Contraceptive Agents