Association between adolescent oral contraceptive use and future major depressive  disorder: a prospective cohort study

Christine Anderl; Anouk E de Wit; Erik J Giltay; Albertine J Oldehinkel; Frances S Chen

doi:10.1111/jcpp.13476

Contraception Oral Contraceptives

Association between adolescent oral contraceptive use and future major depressive disorder: a prospective cohort study

Anderl C, de Wit AE, Giltay EJ, Oldehinkel AJ, Chen FS

Published March 2022 Journal of Child Psychology and Psychiatry, and Allied Disciplines, 63(3), 333-341

DOI 10.1111/jcpp.13476 PMID 34254301 PMC PMC9291927

RRM Academy Synopsis

Adolescent Oral Contraceptive Use Linked to Later Depression Risk

Teenage use of birth control pills was tied to higher depression risk years later, a Dutch study of 725 women found. Every one of 818 analytic models estimated a higher risk, with a median odds ratio of 1.41, a finding the authors call small but robust.

Study at a glance, prospective cohort of 725 women: Teen pill use was tied to higher depression risk later. Source: Anderl C et al., 2022, PMID 34254301.

Key Findings

Among 725 women followed from adolescence to their mid-twenties, 73.7% had used oral contraceptives at some point as teenagers.
Across 818 analytic models, every single odds ratio exceeded 1.0, with a median odds ratio of 1.41 (range 1.08 to 2.18, p < .001).
In the 583 women with no prior history of major depressive disorder, the association was stronger: median odds ratio 1.72 (range 1.21 to 2.18, p < .001).
Which sample was analyzed explained 79.5% of the variation in effect sizes across models; the outcome measure used explained 15.4%, and choice of covariates only 2.8%.
16.6% of models reached statistical significance in the full sample, rising to 34.4% in the subgroup with no prior depression history.

Interpretation

This cohort study followed the same women from their teen years to age 25, tracking pill use before any depression diagnosis. The design let researchers show that pill use came first. The finding held up across all 818 models tested, and a check against 1,000 random simulations backed up the pattern. The authors note that results from this Dutch group may not apply to other countries, such as the United States, where teens get the pill in different ways. In their view, the teen years are a sensitive time for development, and pill use then may raise a woman's risk of depression later in life.

RRM Context

Restorative reproductive medicine looks for and treats the body's own cause behind a symptom. This study adds to a small but growing body of research on mood side effects from giving teens the pill. Few doctors raise this risk when the pill is given to teens for acne, irregular cycles, or pain. Fertility awareness methods track a woman's own cycle without adding synthetic hormones.

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

Abstract

Background

Because of the widespread use of oral contraceptives (OCs) and the devastating effects of depression both on an individual and a societal level, it is crucial to understand the nature of the previously reported relationship between OC use and depression risk. Insight into the impact of analytical choices on the association is important when interpreting available evidence. Hence, we examined the association between adolescent OC use and subsequent depression risk in early adulthood analyzing all theoretically justifiable models.

Methods

Data from the prospective cohort study TRacking Adolescents' Individual Lives Survey, among women aged 13-25 years were used. Adolescent OC use (ages 16-19 years) was used as a predictor and major depressive disorder (MDD) in early adulthood (ages 20-25 years), as assessed by the Diagnostic and Statistical Manual of Mental Disorders-IV oriented Lifetime Depression Assessment Self-Report and the Composite International Diagnostic Interview, was used as an outcome. A total of 818 analytical models were analyzed using Specification Curve Analysis in 534 adolescent OC users and 191 nonusers.

Results

Overall, there was an association of adolescent OC use and an episode of MDD in early adulthood [median odds ratio (OR)(median) = 1.41; OR(min) = 1.08; OR(max) = 2.18, p < .001], which was driven by the group of young women with no history of MDD (OR(median) = 1.72; OR(min) = 1.21; OR(max) = 2.18, p < .001).

Conclusions

In summary, adolescent OC use was associated with a small but robust increased risk for experiencing an episode of MDD, especially among women with no history of MDD in adolescence. Understanding the potential side effects of OCs will help women and their doctors to make informed choices when deciding among possible methods of birth control.

Topics

Contraception Oral Contraceptives Metabolic Effects

Contraception › Oral Contraceptives › Metabolic Effects

Christine Anderl, Anouk E de Wit, Erik J Giltay, Albertine J Oldehinkel, Frances S Chen

Chris Anderl, C Anderl, A Wit, E Giltay, A Oldehinkel, F Chen

PMID 34254301 34254301 DOI 10.1111/jcpp.13476 10.1111/jcpp.13476 Anderl et al. 2022, Anderl 2022

Keywords

Contraceptives, Oral