RUNNING HEAD: Contraception and Depression 1

What is the Association Between Contraception Use and Depression Among Young Females in

the U.S.?

Jasmine Henry

University of North Florida

RUNNING HEAD: Contraception and Depression 2

Introduction

Depression is a major public health issue that can affect a community. This mood

disorder can be a source of an unwanted burden for individuals and their families, especially

women who are pregnant or recently birthed (O'Connor, Rossom, Henninger, Groom & Burda,

2016). About 12 million women in the U.S. have been diagnosed with clinical depression- and

that is only those who have been able to be screened for it. Many cases are not reviewed due to

lack of funds, denial of having a mental disorder or even a fear of hospitals. Depression is

normally accompanied by anxiety- both can add to adverse reproductive health and can cause

unintended pregnancy (Bailey, 2013).

It has been established that women with depressive or bipolar disorders are at an

increased risk for unintended pregnancy (Ashley, Harper, Arms-Chavez & LoBello, 2016). This

is why knowledge of contraception use is so important to those who may be predisposed to either

affliction. Contraception in the United States is widely available to women of reproductive age;

approximately 98% of all sexually active women between the ages of 15–44 have been exposed

to at least one contraceptive method, and about 38.1 million women reported to using

contraception in 2002 (Siu et al.,2016). Its use is so necessary because access to contraceptives

has been known to increase an individual’s children’s college completion, work participation,

wage, and family income decades later (Doyle, Stern, Hagan, Hao & Gricar, 2008). Hall et al.

(2015) reported that reproductive health doctors play a key role in providing and managing

contraceptive use in order to help women with mental health predispositions achieve their

desired fertility without too many harsh side effects.

RUNNING HEAD: Contraception and Depression 3

Multiple researchers have been studying the possible association between contraception

use and the emergence of depression using many types of study designs. Despite the attention

shown to the topic, it was soon noticed that there were gaps in the research and as such no true

conclusion could be decisively drawn. We can highlight areas for future research due to the

current gaps in research conducted by credible sources (Patel, Lee, Hirth, Berenson & Smith,

2016). It is the purpose of this literature review to uncover the association between the use of

contraception and the onset of depression in young women of the United States. If contraceptives

are used, then it is predicted that the side effect of clinical depression may ensue in young

females.
RUNNING HEAD: Contraception and Depression 4

The connection between contraception use and the onset of depression has been a

topic of interest in these last few decades due to the new discoveries in clinical depression. The

prevalence of this sometimes debilitating disorder is raising medical practitioner’s concern and

have called into question what items used or consumed by humans can be environmental factors.

Contraceptive researcher teams in the 60s and 70s hypothesized that high doses of synthetic

estrogens and progestins in oral contraceptives could potentially interact with neurotransmitters

that affect mood (Hall, Steinberg, Cwiak, Allen & Marcus, 2015).

The majority of the available literature on this supposed connection have concluded that

there is no clear association between oral contraceptive use and the onset of depression.

Although there are no published clinical trials using hormone bioassays or brain images to clarify

these relationships, Hall et al. (2015) reveals that new evidence suggests that the steroid activity

of low dosing modern contraceptives have no physiological bearing on a women’s mood or

mood-related neuroendocrine functioning. This assertion has been echoed in both Böttcher’s et

al. (2012) and Pagano’s et al. (2016) studies- no measurable indication that depression can be

derived by using oral contraceptives. Additionally, all three of these sources have concluded that

lower rates of depression have been observed in the populations using the pills. Pagano and Hall

came to their conclusion using articles that met certain inclusion criteria and synthesized these

findings. The Böttcher et al. (2012) source, conversely, used a secondary study approach by

using PubMed and MEDLINE databases in order to find data centered on examining the relation

between depressive disorders and hormonal contraception of the years 1976–2010. Some

additional conclusions were drawn from each of these studies. Böttcher et al. (2012) revealed

that at least two confounding variables can influence the analysis of available data and was the
RUNNING HEAD: Contraception and Depression 5

main reason for unclear conclusions. Those variables included the inconsistent definition of the

term “depression” and the overwhelming number of combined contraceptives which can vary

in their compositions. Although Pagano’s et al. (2016) found no studies that specifically

observed hormonal contraceptive use among women diagnosed with postpartum depression,

results among non-postpartum women are relevant. They found that contraceptive use during the

postpartum period will decrease the high risk of rapid repeat pregnancy and its associated

adverse effects in women with evident mental disorders like depression or bipolar disorder. Hall

et al. (2015) found that there has been an increased number of studies that have documented high

rates of contraceptive nonuse, abuse, and discontinuation by women with depressive, anxiety,

and other stress and distress symptoms compared with women without these symptoms. These

additional conclusions indicate that further research could be beneficial as it could bring

important information that should be considered by healthcare providers. Individualized, patient-

based decisions centered on the individual’s history and predispositions must be a main concern.

Conversely, there were article that concluded that there was enough evidence to suggest a

relationship between contraception use and the onset of depression. Depressive symptoms are

associated with contraceptive choice for teens and young women that have never conceived

(Roberts & Hansen, 2017), (Francis, Presser, Malbon, Braun-Courville & Linares, 2015). Francis

et al. (2015) used a crossectional study that analyzed data from 220 inner city females aged 15-

19 years old that were initiating contraceptive use. This study found that girls who used an IUD

or similar long acting contraceptive were having elevated levels of depressive symptoms

compared to their initiation. Roberts & Hansen (2017), however, chose to use a secondary study

approach that analyzed data from insurance records of the incidence of antidepressant

prescription being given. Both studies were able to conclude, using these limited subjects that the
RUNNING HEAD: Contraception and Depression 6

onset of depression in females initiating preventative medicine depends on the kind of

contraception used.

Conclusion

The literature selected for this narrative review show that there is conflicting evidence for

the association between contraception use and the onset of depression in young women. Some of

the articles found that there was no biologically measurable difference between women who used

the medicine and those that didn’t. Other articles concluded that it really depended on the type of

contraception used that could yield depressive symptoms. Due to the more accurate analysis and

extensive research behind the articles that conclude that there is no association, the hypothesis

previously stated has been rejected.

RUNNING HEAD: Contraception and Depression 7

References

Ashley, J. M., Harper, B. D., Arms-Chavez, C. J., & LoBello, S. G. (2016). Estimated prevalence

of antenatal depression in the US population. Archives Of Women's Mental Health, 19(2),

395-400.

Bailey, M. J. (2013). Fifty Years of Family Planning: New Evidence on the Long-Run Effects

of Increasing Access to Contraception. Brookings Papers On Economic Activity, 341-

395.

Böttcher, B., Radenbach, K., Wildt, L., & Hinney, B. (2012). Hormonal contraception and

depression: a survey of the present state of knowledge. Archives Of Gynecology &

Obstetrics, 286(1), 231-236

Doyle, J., Stern, L., Hagan, M., Hao, J., & Gricar, J. (2008). Advances in Contraception: IUDs

from a Managed Care Perspective. Journal Of Women's Health (15409996), 17(6), 987-

992.

Francis, J., Presser, L., Malbon, K., Braun-Courville, D., & Linares, L. O. (2015). An

exploratory analysis of contraceptive method choice and symptoms of depression in

adolescent females initiating prescription contraception. Contraception, 91(4), 336-343.

Hall, K. S., Steinberg, J. R., Cwiak, C. A., Allen, R. H., & Marcus, S. M. (2015). Clinical

opinion: Contraception and mental health: a commentary on the evidence and principles

for practice. American Journal Of Obstetrics And Gynecology, 212740-746.

Pagano, H. P., Zapata, L. B., Berry-Bibee, E. N., Nanda, K., & Curtis, K. M. (2016). Review:

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Patel, P. R., Lee, J., Hirth, J., Berenson, A. B., & Smith, P. B. (2016). Changes in the Use of
RUNNING HEAD: Contraception and Depression 8

Contraception at First Intercourse: A Comparison of the National Survey of Family

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Roberts, T. A., & Hansen, S. (2017). Original research article: Association of Hormonal

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Care Screening for and Treatment of Depression in Pregnant and Postpartum Women:

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Force. Jama, 315(4), 388-406. (O'Connor, Rossom, Henninger, Groom & Burda, 2016).

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