Depression and hormonal contraception

Association of hormonal contraceptive use with reduced levels of depressive symptoms: a national study of sexually active women in the United States

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.

The association between anxiety and C-reactive protein (CRP) levels: results from the Northern Finland 1966 birth cohort study

BACKGROUND

Anxiety frequently accompanies low-grade inflammation-associated conditions like depression, insulin resistance, coronary heart disease and metabolic syndrome. The association between anxiety and low-grade inflammation is, unlike between depression and low-grade inflammation, a very sparsely studied area in general populations. The aim of the present study was to investigate whether anxiety symptoms as well as comorbid anxiety and depressive symptoms are associated with low-grade inflammation at population level.

METHODS

The general population-based Northern Finland 1966 Birth Cohort was followed until age 31 (n=2688 males and 2837 females), when the highly sensitive CRP concentrations were measured. Anxiety and depressive symptoms were defined by Hopkins Symptom Checklist-25 (HSCL-25).

RESULTS

After adjusting for confounders, logistic regression analyses showed that anxiety symptoms alone increased the probability for elevated hs-CRP levels (>3.0mg/L) in males over two-fold (2.19 CI 95% 1.08-4.46), while comorbid anxiety and depressive symptoms caused a 1.7-fold (1.76 CI 95% 1.13-2.74) increase in the probability for elevated hs-CRP levels (1.0-3.0mg/L).

CONCLUSIONS

Our results support the hypothesis that anxiety as well as comorbid anxiety and depression can be associated with an increased risk for low-grade inflammation in males at population level.

Birth control within reach: a national survey on women's attitudes toward and interest in pharmacy access to hormonal contraception

OBJECTIVE

This survey was conducted to better understand women's experiences with hormonal contraception and their interest in and attitudes toward gaining direct access to oral contraception (OC), patch, ring or emergency contraception (EC) in pharmacies.

METHOD

A nationally representative telephone survey of 811 women aged 18-44 years who were at risk for unintended pregnancy was conducted in the United States.

RESULTS

It was found that 68% of women in the United States said they would use pharmacy access to OC, patch, ring and/or EC. Likely users include women not using contraception who would begin using hormonal contraceptives (41%) if they were available directly in pharmacies, and OC, patch or ring users who were interested in obtaining their method this way (66%). Over half of the women (55%) said they would be more likely to use EC if they were available directly in pharmacies. Interest in pharmacy access is higher among uninsured and low-income women. Support for pharmacy access hinges on pharmacist screening, with 63% of women agreeing that OC, patch and ring should be available without prescription if pharmacists screen women for medically safe use.

CONCLUSION

Most women in the United States believe that hormonal contraception should be available without prescription and would personally use pharmacy access. Seventeen to 22 million women constitute the potential market for pharmacy access to hormonal contraceptives in the United States. Women's enthusiasm for pharmacy access suggests that the pharmacy is an important site for the provision of sexual health education, screening and supplies.

The association between C-reactive protein levels and depression: Results from the northern Finland 1966 birth cohort study

BACKGROUND

To investigate whether depressive episodes (previous, current single, and recurrent) are associated in both genders with highly sensitive C-reactive protein (hs-CRP) levels, earlier recommended for risk assessment of cardiovascular disease. The impact of the severity of current single and recurrent depressive episodes on this putative association was also investigated.

METHODS

The genetically homogeneous Northern Finland 1966 Birth Cohort was followed until age 31, when, in a cross-sectional setting (n = 5269), the highly sensitive enzyme immunoassay (hs-EIA) method was used to measure CRP concentration. Depressive episodes were defined through mailed questionnaires, including Hopkins Symptom Checklist-25 (HSCL-25) and information on self-reported, doctor-diagnosed depression.

RESULTS

After adjusting for confounders, logistic regression analyses showed that in male subjects, elevated hs-CRP levels (> or =1.0 mg/L) increased the probability for severe current and recurrent depressive episodes 1.7-fold and 3.1-fold, respectively. Correspondingly, an hs-CRP level of >3.0 mg/L increased the probability for recurrent depression up to 4.1-fold. In female subjects, no statistically significant associations were found.

CONCLUSIONS

Our results support the hypothesis that an activation of systemic inflammatory processes may contribute to the pathophysiology of severe depression in men. Further investigations are needed regarding the impact of our findings on diagnostic/treatment strategies concerning severe and, especially recurrent, depression in men.

Primary care services for an emergency department population: a novel location for contraception

OBJECTIVE

To assess contraceptive provision site preferences in female urban Baltimore emergency department patients.

METHODS

This cross-sectional questionnaire study was completed by 790 women, a population sufficient to detect a 10% intersite difference. The results were analyzed with chi-square, univariate and multivariate logistic regression analyses.

RESULTS

Obtaining contraception other than from a physician's office was acceptable to 57.2% of the subjects, particularly those uninsured (p=.006) and without primary care providers (p<.001). Contraceptive provision in the emergency department (ED) was acceptable to 44.0%, particularly those who are frequent ED users (p=.003) and those at risk for unintended pregnancy (p=.024; pooled, p<.001). Care in nontraditional settings may preclude pelvic examination; 34.0% of the subjects felt safe obtaining contraception without this examination, significantly for those desiring contraceptive provision in the ED.

CONCLUSION

Contraceptive services are acceptable in nontraditional settings, including the ED, particularly to women of limited resources. This service is acceptable without pelvic examination for a sizable proportion of the women using the ED.

Association between skin test diagnosed atopy and professionally diagnosed depression: a Northern Finland 1966 Birth Cohort study

BACKGROUND

Several studies have suggested an association between IgE-mediated atopic allergies and depression, although thus far no epidemiologic evidence involving a large, unselected, general-population sample and valid methods in diagnosing atopy support this putative association.

METHODS

We used the Northern Finland 1966 Birth Cohort, which was followed prospectively to age 31. Of the total cohort, 5428 individuals underwent skin tests for three of the most common allergens (i.e., cat, birch, and timothy grass) and for dust mites (Dermatophagoides pteronyssinus). Data on doctor-diagnosed lifetime depression were obtained from questionnaires.

RESULTS

After adjusting for social class, mothers' parity, place of residence, and psychiatric morbidity, the logistic regression analysis showed that the risk of developing depression when compared with nonatopic subjects increased up to 1.8-fold in atopic women (adjusted odds ratio 1.8, 95% confidence interval [CI] 1.2-2.6) and, when compared with skin-test-negative female subjects without allergic symptoms, reached 2.7-fold increases (95% CI 1.6-4.6) in those suffering from clinically manifest atopic disorders. Corresponding associations were not found among male subjects.

CONCLUSIONS

Our results indicate that women suffering from atopic diseases may possess an elevated risk for developing depression during early adulthood. Possible background theories (i.e., genetic abnormalities in serotonin metabolism, hypothalamic-pituitary-adrenal axis dysfunction, and histamine theory) are discussed.