Article type
Abstract
Unintended pregnancies can lead to long-term suffering due to the psychological, physiological, and social consequences of bringing such pregnancies to term. The primary method for avoiding unwanted pregnancies is contraception, and understanding its relationship with mental health is crucial due to its impact on neurochemical balance and mood. This study investigates the effects of modern contraceptive methods, including condoms, long-acting reversible contraceptives (e.g., implants, intrauterine devices), and birth control tablets, on mental health.
Methods: A comprehensive search was conducted across databases such as CINAHL, OVID Medline, EMBASE, Psycho INFO, Maternity & Infant Care, LILACS, clinical trial.gov, web of Science, SCOPUS, and CENTRAL Database until February 2022. The review included forty-three papers from twenty cohort studies and twenty randomized controlled trials (RCTs). The Downs and Black rating system and the Grades of Recommendation, Assessment, Development, and Evaluation method were employed for quality evaluations.
Results: Meta-analysis revealed that hormonal contraceptives (HC) demonstrated a small increase in depression risk among women without previous mental illnesses (RCTs: SMD 0.18, 95% CI [0.02, 0.34]; Cohort studies: RR 1.04, 95% CI [1.03, 1.04]). Conversely, HC exhibited protective benefits against depression in women with pre-existing mental problems (RCTs: SMD -0.15, 95% CI [-0.30, -0.00]; Cohort studies: SMD -0.26, 95% CI [-0.37, -0.15]). In both groups, HC showed protective benefits against anxiety (SMD -0.20, 95% CI [-0.40, -0.01]). Subgroup analyses indicated an increased risk of depression with hormonal IUDs, implants, or patch/ring procedures.
Conclusions: Hormonal contraceptives were found to be protective against depressive symptoms in women with pre-existing mental problems. However, the study highlights drawbacks, including a higher likelihood of depression and antidepressant usage among contraceptive users, especially those employing hormonal IUDs, implants, or patch/ring methods. Tailoring contraceptive recommendations based on individual patient characteristics, such as age, family history, and physical and mental health, is recommended to maximize benefits and minimize risks.
Methods: A comprehensive search was conducted across databases such as CINAHL, OVID Medline, EMBASE, Psycho INFO, Maternity & Infant Care, LILACS, clinical trial.gov, web of Science, SCOPUS, and CENTRAL Database until February 2022. The review included forty-three papers from twenty cohort studies and twenty randomized controlled trials (RCTs). The Downs and Black rating system and the Grades of Recommendation, Assessment, Development, and Evaluation method were employed for quality evaluations.
Results: Meta-analysis revealed that hormonal contraceptives (HC) demonstrated a small increase in depression risk among women without previous mental illnesses (RCTs: SMD 0.18, 95% CI [0.02, 0.34]; Cohort studies: RR 1.04, 95% CI [1.03, 1.04]). Conversely, HC exhibited protective benefits against depression in women with pre-existing mental problems (RCTs: SMD -0.15, 95% CI [-0.30, -0.00]; Cohort studies: SMD -0.26, 95% CI [-0.37, -0.15]). In both groups, HC showed protective benefits against anxiety (SMD -0.20, 95% CI [-0.40, -0.01]). Subgroup analyses indicated an increased risk of depression with hormonal IUDs, implants, or patch/ring procedures.
Conclusions: Hormonal contraceptives were found to be protective against depressive symptoms in women with pre-existing mental problems. However, the study highlights drawbacks, including a higher likelihood of depression and antidepressant usage among contraceptive users, especially those employing hormonal IUDs, implants, or patch/ring methods. Tailoring contraceptive recommendations based on individual patient characteristics, such as age, family history, and physical and mental health, is recommended to maximize benefits and minimize risks.