Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, US.
Universidad de Antioquia, Columbia, USA.
BMC Pregnancy Childbirth. 2024 May 30;24(1):396. doi: 10.1186/s12884-024-06587-9.
Contraceptive use is the principal method by which women avoid unintended pregnancy. An unintended pregnancy can induce long-term distress related to the medical, emotional, and social consequences of carrying that pregnancy to term.
This review investigates the effects of modern contraception techniques such as birth control pills, long-acting reversible contraceptives (e.g., intrauterine devices, implants), and condoms on mental health status.
We searched multiple databases from inception until February 2022, with no geographical boundaries. RCTs underwent a quality assessment using the GRADE approach while the quality of observational studies was assessed using the Downs and Black scoring system. Data were analyzed through meta-analysis and relative risk and mean difference were calculated and forest plots were created for each outcome when two or more data points were eligible for analysis.
The total number of included studies was 43. In women without previous mental disorders, both RCTs (3 studies, SMD 0.18, 95% CI [0.02, 0.34], high quality of evidence) and cohort studies (RR 1.04 95% CI [1.03, 1.04]) detected a slight increase in the risk of depression development. In women with previous mental disorders, both RCTs (9 studies, SMD - 0.15, 95% CI [-0.30, -0.00], high quality of evidence) and cohort studies (SMD - 0.26, 95% CI [-0.37, -0.15]) detected slight protective effects of depression development. It was also noticed that HC demonstrated protective effects for anxiety in both groups (SMD - 0.20, 95% CI [-0.40, -0.01]).
Among women with pre-existing mental disorders who use hormonal contraceptives, we reported protective association with decreased depressive symptoms. However, the study also draws attention to some potential negative effects, including an increase in the risk of depression and antidepressant use among contraceptive users, a risk that is higher among women who use the hormonal IUD, implant, or patch/ring methods. Providers should select contraceptive methods taking individual aspects into account to maximize benefits and minimize risks.
避孕是女性避免意外怀孕的主要方法。意外怀孕会带来长期的困扰，包括怀孕带来的医疗、情感和社会后果。
本综述研究了现代避孕方法，如避孕药、长效可逆避孕方法（如宫内节育器、植入物）和避孕套，对心理健康状况的影响。
我们从创建开始到 2022 年 2 月在多个数据库中进行了搜索，没有地域限制。RCT 采用 GRADE 方法进行质量评估，而观察性研究的质量则采用 Downs 和 Black 评分系统进行评估。通过 meta 分析和相对风险和平均差异来分析数据，并在有两个或更多数据点符合分析条件时创建每个结果的森林图。
共纳入 43 项研究。在没有先前精神障碍的女性中，RCT（3 项研究，SMD 0.18，95%CI [0.02, 0.34]，高质量证据）和队列研究（RR 1.04，95%CI [1.03, 1.04]）都发现抑郁发展的风险略有增加。在有先前精神障碍的女性中，RCT（9 项研究，SMD -0.15，95%CI [-0.30, -0.00]，高质量证据）和队列研究（SMD -0.26，95%CI [-0.37, -0.15]）都发现抑郁发展有轻微的保护作用。还注意到，HC 在两组中对焦虑都有保护作用（SMD -0.20，95%CI [-0.40, -0.01]）。
在使用激素避孕药的有先前精神障碍的女性中，我们报告了与抑郁症状减轻相关的保护关联。然而，这项研究也引起了人们对一些潜在负面影响的关注，包括使用激素避孕的女性中抑郁风险和抗抑郁药使用的增加，而使用激素宫内节育器、植入物或贴片/戒指方法的女性的风险更高。提供者应考虑个体方面选择避孕方法，以最大限度地提高益处并最小化风险。
