Toffol Elena, Partonen Timo, Heikinheimo Oskari, But Anna, Latvala Antti, Haukka Jari
Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, PO BOX 20, Helsinki, 00014, Finland.
Department of Healthcare and Social Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.
Eur J Epidemiol. 2025 Jul 2. doi: 10.1007/s10654-025-01267-0.
Earlier findings on the relationship between use of hormonal contraception (HC) and depressive symptoms and disorders are contradictory. Thus, we assessed the associations of use of different types of systemic hormonal contraceptives in the six preceding months with the risk of depression in women aged 15-49 years. Data were obtained from national registers in Finland. All cases of depression in the years 2018-2019 were identified in a population-based cohort of women. We used a nested case-control design with 1:4 ratio (n = 117,360 cases) and applied multivariable conditional logistic regression models. During the follow-up a total of 23,480 new cases with the diagnosis of depression were observed (incidence rate: 21.7, 95% confidence interval = 21.5-22.0 per 1000 person-years). Use of HC in the six preceding months, specifically that of combined hormonal contraceptives (containing gestodene and ethinylestradiol, drospirenone and ethinylestradiol, and nomegestrol and estradiol), was significantly associated with a lower risk of depression compared to non-use when controlling for marital status, socioeconomic status, education, recent delivery, recent psychiatric hospitalization, chronic diseases, use of psychiatric medications (excluding antidepressants) and former use of HC (odds ratio: 0.90, 95% confidence interval = 0.85-0.95; 0.86, 95% confidence interval = 0.81-0.91, respectively). Current use of progestogen-only preparations (norethisterone, levonorgestrel, desogestrel) was not associated with depression. This pattern was evident in all age groups, including adolescent girls. HC use appeared not associated with an increased risk of depression in fertile-aged women and across all age groups, including adolescent girls.
早期关于激素避孕（HC）使用与抑郁症状及障碍之间关系的研究结果相互矛盾。因此，我们评估了在过去六个月内使用不同类型的全身性激素避孕药与15至49岁女性患抑郁症风险之间的关联。数据来自芬兰的国家登记册。在以人群为基础的女性队列中识别出了2018 - 2019年所有的抑郁症病例。我们采用了1:4比例的巢式病例对照设计（n = 117,360例），并应用多变量条件逻辑回归模型。在随访期间，共观察到23,480例新诊断为抑郁症的病例（发病率：每1000人年21.7例，95%置信区间 = 21.5 - 22.0）。在控制婚姻状况、社会经济地位、教育程度、近期分娩、近期精神科住院治疗、慢性病、精神科药物使用（不包括抗抑郁药）以及既往激素避孕使用情况后，与未使用相比，过去六个月内使用激素避孕，特别是复方激素避孕药（含孕二烯酮和炔雌醇、屈螺酮和炔雌醇以及诺孕酯和雌二醇）与较低的抑郁症风险显著相关（优势比：0.90，95%置信区间 = 0.85 - 0.95；0.86，95%置信区间 = 0.81 - 0.91）。目前仅使用孕激素制剂（炔诺酮、左炔诺孕酮、去氧孕烯）与抑郁症无关。这种模式在所有年龄组中都很明显，包括青春期女孩。在育龄妇女以及包括青春期女孩在内的所有年龄组中，使用激素避孕似乎与抑郁症风险增加无关。
