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

Abstract

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.

Keywords: adolescent; depression; gender; hormonal contraception; oral contraceptives; suicide.

Figure 1.

Selection of the study sample from participants in the wave 4 interview (ages 25–34 years) of the National Longitudinal Study of Adolescent Health (Add Health), 2007–2008.

Figure 2.

Distribution of propensity scores among users (A) and nonusers (B) of hormonal birth control aged 25–34 years in a nationally representative sample of sexually active nonpregnant US women, National Longitudinal Study of Adolescent Health, 2007–2008.

Figure 3.

Adjusted odds ratios (ORs) for the association between hormonal contraceptive (HC) use and past-week high depression score (Dep) among nonpregnant women aged 18–34 years with a current sex partner in 2 study waves, National Longitudinal Study of Adolescent Health, 2001–2008. For OR = 0.76, P = 0.06; for OR = 3.72, OR = 0.83, and OR = 2.08, P < 0.05. Wave 3 logistic regression analyses adjusted for race/ethnicity, wave 3 education, age, parity, past-year monogamy, lifetime number of vaginal sex partners, importance of religion, regular engagement in an individual sport (e.g., running or jogging), body mass index, visiting a dentist in the last 2 years, smoking, wave 1 or 2 highest depression score, and wave 1 or 2 use of hormonal birth control. Wave 4 logistic regression analyses adjusted for race/ethnicity and wave 4 age, education, smoking, parity, past-year monogamy, lifetime number of vaginal sex partners, importance of religion, regular engagement in an individual sport (e.g., running or jogging), body mass index, visiting a dentist in the last 2 years, undergoing a routine checkup by a physician in the last 2 years, wave 1, 2, or 3 high depression, and wave 1, 2, or 3 use of hormonal birth control. A high depression score was defined as a score greater than or equal to 11 on the 10-item Center for Epidemiologic Studies Depression Scale.

Figure 4.

Adjusted odds ratios (ORs) for the association between hormonal contraceptive (HC) use and past-year suicide attempts (SA) among nonpregnant women aged 18–34 years with a current sex partner in 2 study waves, National Longitudinal Study of Adolescent Health, 2001–2008. For OR = 9.30, OR = 0.31, and OR = 2.00, P < 0.05. Wave 3 logistic regression analyses adjusted for race/ethnicity, wave 3 education, age, parity, past-year monogamy, lifetime number of vaginal sex partners, importance of religion, regular engagement in an individual sport (e.g., running or jogging), body mass index, visiting a dentist in the last 2 years, smoking, wave 1 or 2 suicide attempts, and wave 1 or 2 use of hormonal birth control. Wave 4 logistic regression analyses adjusted for race/ethnicity and wave 4 age, education, smoking, parity, past-year monogamy, lifetime number of vaginal sex partners, importance of religion, regular engagement in an individual sport (e.g., running or jogging), body mass index, visiting a dentist in the last 2 years, undergoing a routine checkup by a physician in the last 2 years, wave 1, 2, or 3 suicide attempts, and wave 1, 2, or 3 use of hormonal birth control. A high depression score was defined as a score greater than or equal to 11 on the 10-item Center for Epidemiologic Studies Depression Scale.