Hostname: page-component-5f56664f6-spj7j Total loading time: 0 Render date: 2025-05-07T08:35:12.473Z Has data issue: false hasContentIssue false
  • English
  • Français

Oral contraceptive use and risk of suicidal behavior among young women

Published online by Cambridge University Press:  21 October 2020

Alexis C. Edwards Open the ORCID record for Alexis C. Edwards [Opens in a new window] ,
Sara Larsson Lönn ,
Casey Crump ,
Eve K. Mościcki ,
Jan Sundquist Open the ORCID record for Jan Sundquist [Opens in a new window] ,
Kenneth S. Kendler Open the ORCID record for Kenneth S. Kendler [Opens in a new window]  and
Kristina Sundquist Open the ORCID record for Kristina Sundquist [Opens in a new window]
Alexis C. Edwards*
Affiliation:
Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
Sara Larsson Lönn
Affiliation:
Center for Primary Health Care Research, Lund University, Malmö, Sweden
Casey Crump
Affiliation:
Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
Jan Sundquist
Affiliation:
Center for Primary Health Care Research, Lund University, Malmö, Sweden Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
Kenneth S. Kendler
Affiliation:
Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
Kristina Sundquist
Affiliation:
Center for Primary Health Care Research, Lund University, Malmö, Sweden Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
*
Author for correspondence: Alexis C. Edwards, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Oral contraceptive use has been previously associated with an increased risk of suicidal behavior in some, but not all, samples. The use of large, representative, longitudinally-assessed samples may clarify the nature of this potential association.

Methods

We used Swedish national registries to identify women born between 1991 and 1995 (N = 216 702) and determine whether they retrieved prescriptions for oral contraceptives. We used Cox proportional hazards models to test the association between contraceptive use and first observed suicidal event (suicide attempt or death) from age 15 until the end of follow-up in 2014 (maximum age 22.4). We adjusted for covariates, including mental illness and parental history of suicide.

Results

In a crude model, use of combination or progestin-only oral contraceptives was positively associated with suicidal behavior, with hazard ratios (HRs) of 1.73–2.78 after 1 month of use, and 1.25–1.82 after 1 year of use. Accounting for sociodemographic, parental, and psychiatric variables attenuated these associations, and risks declined with increasing duration of use: adjusted HRs ranged from 1.56 to 2.13 1 month beyond the initiation of use, and from 1.19 to 1.48 1 year after initiation of use. HRs were higher among women who ceased use during the observation period.

Conclusions

Young women using oral contraceptives may be at increased risk of suicidal behavior, but risk declines with increased duration of use. Analysis of former users suggests that women susceptible to depression/anxiety are more likely to cease hormonal contraceptive use. Additional studies are necessary to determine whether the observed association is attributable to a causal mechanism.

Keywords

Cohort studyoral contraceptionregistry datasuicidal behavior
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 9 , July 2022 , pp. 1710 - 1717
Check for updates
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Abbasi, S., Chuang, C. H., Dagher, R., Zhu, J., & Kjerulff, K. (2013). Unintended pregnancy and postpartum depression among first-time mothers. Journal of Women's Health (Larchmt), 22(5), 412–416. doi: 10.1089/jwh.2012.3926.CrossRefGoogle ScholarPubMed
Baca-Garcia, E., Perez-Rodriguez, M. M., Mann, J. J., & Oquendo, M. A. (2008). Suicidal behavior in young women. Psychiatric Clinics of North America, 31(2), 317–331. doi: 10.1016/j.psc.2008.01.002.CrossRefGoogle ScholarPubMed
Beral, V., Hermon, C., Kay, C., Hannaford, P., Darby, S., & Reeves, G. (1999). Mortality associated with oral contraceptive use: 25 year follow up of cohort of 46 000 women from Royal College of General Practitioners' oral contraception study. The BMJ, 318(7176), 96–100. doi: 10.1136/bmj.318.7176.96.CrossRefGoogle ScholarPubMed
Brent, D. A., & Mann, J. J. (2005). Family genetic studies, suicide, and suicidal behavior. American Journal of Medical Genetics Part C Seminars in Medical Genetics, 133C(1), 13–24. doi: 10.1002/ajmg.c.30042.CrossRefGoogle ScholarPubMed
Caminis, A., Henrich, C., Ruchkin, V., Schwab-Stone, M., & Martin, A. (2007). Psychosocial predictors of sexual initiation and high-risk sexual behaviors in early adolescence. Child and Adolescent Psychiatry and Mental Health, 1(1), 14. doi: 10.1186/1753-2000-1-14.CrossRefGoogle ScholarPubMed
Charlton, B. M., Rich-Edwards, J. W., Colditz, G. A., Missmer, S. A., Rosner, B. A., Hankinson, S. E., … Michels, K. B. (2014). Oral contraceptive use and mortality after 36 years of follow-up in the Nurses' Health Study: Prospective cohort study. The BMJ, 349, g6356. doi: 10.1136/bmj.g6356.CrossRefGoogle ScholarPubMed
Colditz, G. A. (1994). Oral contraceptive use and mortality during 12 years of follow-up: The Nurses' Health Study. Annals of Internal Medicine, 120(10), 821–826. doi: 10.7326/0003-4819-120-10-199405150-00002.CrossRefGoogle ScholarPubMed
Curtin, S., Warner, M., & Hedegaard, H. (2015). Increase in suicide in the United States, 1999–2014. Hyattsville, MD: National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db241.htm.Google Scholar
Daniels, K., & Abma, J. C. (2018). Current contraceptive status among women aged 15-49: United States, 2015–2017. NCHS Data Brief, no. 327. Atlanta, GA: Centers for Disease Control and Prevention.Google Scholar
Duke, J. M., Sibbritt, D. W., & Young, A. F. (2007). Is there an association between the use of oral contraception and depressive symptoms in young Australian women? Contraception, 75(1), 27–31. doi: 10.1016/j.contraception.2006.08.002.CrossRefGoogle ScholarPubMed
Eaton, D. K., Foti, K., Brener, N. D., Crosby, A. E., Flores, G., & Kann, L. (2011). Associations between risk behaviors and suicidal ideation and suicide attempts: Do racial/ethnic variations in associations account for increased risk of suicidal behaviors among Hispanic/Latina 9th- to 12th-grade female students? Archives of Suicide Research, 15(2), 113–126. doi: 10.1080/13811118.2011.565268.CrossRefGoogle ScholarPubMed
Furman, W., Low, S., & Ho, M. J. (2009). Romantic experience and psychosocial adjustment in middle adolescence. Journal of Clinical Child and Adolescent Psychology, 38(1), 75–90. doi: 10.1080/15374410802575347.CrossRefGoogle ScholarPubMed
Graber, J. A. (2013). Pubertal timing and the development of psychopathology in adolescence and beyond. Hormones and Behavior, 64(2), 262–269. doi: 10.1016/j.yhbeh.2013.04.003.CrossRefGoogle ScholarPubMed
Gregory, S. T., Hall, K., Quast, T., Gatto, A., Bleck, J., Storch, E. A., & DeBate, R. (2018). Hormonal contraception, depression, and academic performance among females attending college in the United States. Psychiatry Research, 270, 111–116. doi: 10.1016/j.psychres.2018.09.029.CrossRefGoogle ScholarPubMed
Hannaford, P. C., Iversen, L., Macfarlane, T. V., Elliott, A. M., Angus, V., & Lee, A. J. (2010). Mortality among contraceptive pill users: Cohort evidence from Royal College of General Practitioners' Oral Contraception Study. The BMJ, 340, c927. doi: 10.1136/bmj.c927.CrossRefGoogle ScholarPubMed
Herd, P., Higgins, J., Sicinski, K., & Merkurieva, I. (2016). The implications of unintended pregnancies for mental health in later life. American Journal of Public Health, 106(3), 421–429. doi: 10.2105/AJPH.2015.302973.CrossRefGoogle ScholarPubMed
Hughes, L. D., & Majekodunmi, O. (2018). Hormonal contraception and suicide: A new dimension of risk. British Journal of General Practice, 68(676), 512–513. doi: 10.3399/bjgp18X699473.CrossRefGoogle ScholarPubMed
Keyes, K. M., Cheslack-Postava, K., Westhoff, C., Heim, C. M., Haloossim, M., Walsh, K., & Koenen, K. (2013). Association of hormonal contraceptive use with reduced levels of depressive symptoms: A national study of sexually active women in the United States. American Journal of Epidemiology, 178(9), 1378–1388. doi: 10.1093/aje/kwt188.CrossRefGoogle ScholarPubMed
Kulkarni, J. (2007). Depression as a side effect of the contraceptive pill. Expert Opinion on Drug Safety, 6(4), 371–374. doi: 10.1517/14740338.6.4.371.CrossRefGoogle ScholarPubMed
Lewis, M. A. (1999). The transnational study on oral contraceptives and the health of young women. Methods, results, new analyses and the healthy user effect. Human Reproduction Update, 5(6), 707–720. doi: 10.1093/humupd/5.6.707.CrossRefGoogle Scholar
Lundin, C., Danielsson, K. G., Bixo, M., Moby, L., Bengtsdotter, H., Jawad, I., … Sundstrom Poromaa, I. (2017). Combined oral contraceptive use is associated with both improvement and worsening of mood in the different phases of the treatment cycle-A double-blind, placebo-controlled randomized trial. Psychoneuroendocrinology, 76, 135–143. doi: 10.1016/j.psyneuen.2016.11.033.CrossRefGoogle ScholarPubMed
Malmborg, A., Persson, E., Brynhildsen, J., & Hammar, M. (2016). Hormonal contraception and sexual desire: A questionnaire-based study of young Swedish women. European Journal of Contraception and Reproductive Health Care, 21(2), 158–167. doi: 10.3109/13625187.2015.1079609.CrossRefGoogle ScholarPubMed
Mangla, K., Hoffman, M. C., Trumpff, C., O'Grady, S., & Monk, C. (2019). Maternal self-harm deaths: An unrecognized and preventable outcome. American Journal of Obstetrics and Gynecology, 221(4), 295–303. doi: 10.1016/j.ajog.2019.02.056.CrossRefGoogle ScholarPubMed
Marrocco, J., & McEwen, B. S. (2016). Sex in the brain: Hormones and sex differences. Dialogues in Clinical Neuroscience, 18(4), 373–383.CrossRefGoogle ScholarPubMed
McEwen, B. S., & Milner, T. A. (2017). Understanding the broad influence of sex hormones and sex differences in the brain. Journal of Neuroscience Research, 95(1–2), 24–39. doi: 10.1002/jnr.23809.CrossRefGoogle ScholarPubMed
Mota, N. P., Chartier, M., Ekuma, O., Nie, Y., Hensel, J. M., MacWilliam, L., … Bolton, J. M. (2019). Mental disorders and suicide attempts in the pregnancy and postpartum periods compared with non-pregnancy: A population-based study. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 64(7), 482–491. doi: 10.1177/0706743719838784.CrossRefGoogle ScholarPubMed
Oinonen, K. A., & Mazmanian, D. (2002). To what extent do oral contraceptives influence mood and affect? Journal of Affective Disorders, 70(3), 229–240. doi: 10.1016/s0165-0327(01)00356-1.CrossRefGoogle ScholarPubMed
Orri, M., Gunnell, D., Richard-Devantoy, S., Bolanis, D., Boruff, J., Turecki, G., & Geoffroy, M.-C. (2019). In-utero and perinatal influences on suicide risk: A systematic review and meta-analysis. The Lancet Psychiatry, 6(6), 477–492. doi: 10.1016/s2215-0366(19)30077-x.CrossRefGoogle ScholarPubMed
Pagano, H. P., Zapata, L. B., Berry-Bibee, E. N., Nanda, K., & Curtis, K. M. (2016). Safety of hormonal contraception and intrauterine devices among women with depressive and bipolar disorders: A systematic review. Contraception, 94(6), 641–649. doi: 10.1016/j.contraception.2016.06.012.CrossRefGoogle ScholarPubMed
Pedersen, N. L., & Fiske, A. (2010). Genetic influences on suicide and nonfatal suicidal behavior: Twin study findings. European Psychiatry, 25(5), 264–267. doi: 10.1016/j.eurpsy.2009.12.008.CrossRefGoogle ScholarPubMed
Piscopo, K., Lipari, R. N., Cooney, J., & Glasheen, C. (2016). Suicidal thoughts and behavior among adults: results from the 2015 national survey on drug use and health. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-DR-FFR3-2015/NSDUH-DR-FFR3-2015.htm.Google Scholar
Robakis, T., Williams, K. E., Nutkiewicz, L., & Rasgon, N. L. (2019). Hormonal contraceptives and mood: Review of the literature and implications for future research. Current Psychiatry Reports, 21(7), 57. doi: 10.1007/s11920-019-1034-z.CrossRefGoogle ScholarPubMed
Simmons, R. G., Sanders, J. N., Geist, C., Gawron, L., Myers, K., & Turok, D. K. (2019). Predictors of contraceptive switching and discontinuation within the first 6 months of use among Highly Effective Reversible Contraceptive Initiative Salt Lake study participants. American Journal of Obstetrics and Gynecology, 220(4), 376, e371–376 e312. doi: 10.1016/j.ajog.2018.12.022.CrossRefGoogle Scholar
Skovlund, C. W. (2018). Clarifying methods and results in studies of the association between hormonal contraception and mental health issues: Response to Berlin et al. American Journal of Psychiatry, 175(7), 684–684. doi: 10.1176/appi.ajp.2018.18010057r.CrossRefGoogle ScholarPubMed
Skovlund, C. W., Morch, L. S., Kessing, L. V., Lange, T., & Lidegaard, O. (2018). Association of hormonal contraception with suicide attempts and suicides. American Journal of Psychiatry, 175(4), 336–342. doi: 10.1176/appi.ajp.2017.17060616.CrossRefGoogle ScholarPubMed
Skovlund, C. W., Morch, L. S., Kessing, L. V., & Lidegaard, O. (2016). Association of hormonal contraception with depression. JAMA Psychiatry, 73(11), 1154–1162. doi: 10.1001/jamapsychiatry.2016.2387.CrossRefGoogle ScholarPubMed
Substance Abuse and Mental Health Services Administration (2018). Key substance use and mental health indicators in the United States: Results from the 2017 national survey on drug use and health. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHFFR2017/NSDUHFFR2017.htm.Google Scholar
Svendal, G., Berk, M., Pasco, J. A., Jacka, F. N., Lund, A., & Williams, L. J. (2012). The use of hormonal contraceptive agents and mood disorders in women. Journal of Affective Disorders, 140(1), 92–96. doi: 10.1016/j.jad.2012.03.030.CrossRefGoogle ScholarPubMed
Toffol, E., Heikinheimo, O., Koponen, P., Luoto, R., & Partonen, T. (2011). Hormonal contraception and mental health: Results of a population-based study. Human Reproduction, 26(11), 3085–3093. doi: 10.1093/humrep/der269.CrossRefGoogle ScholarPubMed
Toffol, E., Heikinheimo, O., Koponen, P., Luoto, R., & Partonen, T. (2012). Further evidence for lack of negative associations between hormonal contraception and mental health. Contraception, 86(5), 470–480. doi: 10.1016/j.contraception.2012.02.014.CrossRefGoogle ScholarPubMed
United Nations (2015). Trends in contraceptive Use worldwide 2015 (ST/ESA/SER.A/349). New York: United Nations Department of Economic and Social Affairs Population Division.Google Scholar
Vessey, M. P., Villard-Mackintosh, L., McPherson, K., & Yeates, D. (1989). Mortality among oral contraceptive users: 20 year follow up of women in a cohort study. The BMJ, 299(6714), 1487–1491. doi: 10.1136/bmj.299.6714.1487.CrossRefGoogle ScholarPubMed
White, K., Potter, J. E., Hopkins, K., Fernandez, L., Amastae, J., & Grossman, D. (2012). Contraindications to progestin-only oral contraceptive pills among reproductive-aged women. Contraception, 86(3), 199–203. doi: 10.1016/j.contraception.2012.01.008.CrossRefGoogle ScholarPubMed
World Health Organization. Reproductive Health and Research (2010). Medical eligibility criteria for contraceptive use (4th ed.). Geneva: Department of Reproductive Health and Research, World Health Organization.Google Scholar
Worly, B. L., Gur, T. L., & Schaffir, J. (2018). The relationship between progestin hormonal contraception and depression: A systematic review. Contraception, 97(6), 478–489. doi: 10.1016/j.contraception.2018.01.010.CrossRefGoogle ScholarPubMed
Zethraeus, N., Dreber, A., Ranehill, E., Blomberg, L., Labrie, F., von Schoultz, B., … Hirschberg, A. L. (2017). A first-choice combined oral contraceptive influences general well-being in healthy women: A double-blind, randomized, placebo-controlled trial. Fertility and Sterility, 107(5), 1238–1245. doi: 10.1016/j.fertnstert.2017.02.120.CrossRefGoogle ScholarPubMed
Zettermark, S., Perez Vicente, R., & Merlo, J. (2018). Hormonal contraception increases the risk of psychotropic drug use in adolescent girls but not in adults: A pharmacoepidemiological study on 800 000 Swedish women. PLoS One, 13(3), e0194773. doi: 10.1371/journal.pone.0194773.CrossRefGoogle ScholarPubMed
Supplementary material: File

Edwards et al. supplementary material

Edwards et al. supplementary material

Download Edwards et al. supplementary material(File)
File 3 MB