Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
JAMA Psychiatry. 2023 Jul 1;80(7):682-689. doi: 10.1001/jamapsychiatry.2023.0807.
Hormonal sensitivity may contribute to the risk of depression in some women, as observed during the premenstrual, postpartum, and perimenopausal phases, and when initiating hormonal contraception (HC). However, little evidence exists to support that such depressive episodes are linked across the reproductive life span.
To determine whether prior depression associated with HC initiation is coupled with a higher risk of postpartum depression (PPD) than prior depression not associated with HC initiation.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used Danish health registry data collected from January 1, 1995, through December 31, 2017, and analyzed from March 1, 2021, through January 1, 2023. All women living in Denmark born after 1978 with their first delivery between January 1, 1996, and June 30, 2017, were eligible for inclusion; 269 354 met these criteria. Women were then excluded if they had never used HC or if they had a depressive episode before 1996 or within 12 months prior to delivery.
Prior depression associated with vs not associated with HC initiation, ie, if developed within 6 months after start of an HC exposure or not. Depression was defined as a hospital diagnosis of depression or filling a prescription for antidepressant medication.
Crude and adjusted odds ratios (ORs) were calculated for the incidence of PPD defined as the development of depression within 6 months after first delivery.
Of 188 648 first-time mothers, 5722 (3.0%) (mean [SD] age, 26.7 [3.9] years) had a history of depression associated with initiation of HC use, and 18 431 (9.8%) (mean [SD] age, 27.1 [3.8] years) had a history of depression not associated with the initiation of HC. Women with HC-associated depression had a higher risk of PPD than women with prior non-HC-associated depression (crude OR, 1.42 [95% CI, 1.24-1.64]; adjusted OR, 1.35 [95% CI, 1.17-1.56]).
These findings suggest that a history of HC-associated depression may be associated with a higher risk of PPD, supporting that HC-associated depression may indicate PPD susceptibility. This finding offers a novel strategy in clinical PPD risk stratification and points to the existence of a hormone-sensitive subgroup of women.
在经前期、产后和围绝经期以及开始使用激素避孕（HC）时，以及在开始使用 HC 时，荷尔蒙敏感性可能会导致一些女性出现抑郁风险。然而，几乎没有证据表明这种抑郁发作在整个生殖期都有关联。
确定与 HC 起始相关的先前抑郁是否与与 HC 起始无关的先前抑郁相比，与产后抑郁症（PPD）的风险更高。
设计、设置和参与者：这项队列研究使用了丹麦健康登记数据，这些数据是从 1995 年 1 月 1 日到 2017 年 12 月 31 日收集的，并从 2021 年 3 月 1 日到 2023 年 1 月 1 日进行了分析。所有 1978 年后出生、1996 年 1 月 1 日至 2017 年 6 月 30 日之间首次分娩的丹麦居民都有资格入组；共有 269354 人符合这些标准。如果女性从未使用过 HC，或者在 1996 年之前或分娩前 12 个月内出现过抑郁发作，则将其排除在外。
与 HC 起始相关的 vs 不相关的先前抑郁，即如果在 HC 暴露开始后 6 个月内发展或不发展。抑郁的定义是医院诊断为抑郁或开抗抑郁药物的处方。
计算了 PPD 发生率的粗比值比（OR）和调整比值比（OR），PPD 的定义为首次分娩后 6 个月内出现抑郁。
在 188648 名初产妇中，5722 名（3.0%）（平均[SD]年龄 26.7[3.9]岁）有与 HC 使用起始相关的抑郁史，18431 名（9.8%）（平均[SD]年龄 27.1[3.8]岁）有与 HC 起始无关的抑郁史。与 HC 相关的抑郁史的女性发生 PPD 的风险高于与非 HC 相关的抑郁史的女性（粗 OR，1.42[95%CI，1.24-1.64]；调整 OR，1.35[95%CI，1.17-1.56]）。
这些发现表明，与 HC 相关的抑郁史可能与 PPD 风险增加有关，这支持了与 HC 相关的抑郁史可能表明 PPD 易感性。这一发现为临床 PPD 风险分层提供了一种新策略，并指出存在一个荷尔蒙敏感的女性亚组。
