Taking Hormonal Contraception Postpartum May Raise Risk of Depression

Starting most hormonal contraceptives in the first year postpartum may raise the risk of depression even among first-time mothers with no recent history of the disorder, according to a study published by JAMA Network Open.

“This study observed that the hormonal contraceptive initiation postpartum was associated with an increased risk of depression across all age groups,” wrote Soren Vinther Larsen, Ph.D., of Copenhagen University Hospital–Rigshospitalet, and colleagues. The risk was increased for all hormonal contraceptives except for progestogen-only “mini-pills,” for which risk was inconclusive.

Using Danish registry data, the researchers examined health records for 610,038 first-time mothers who gave birth between 1997 and 2022, of whom 41% started a hormonal contraceptive within 12 months of delivery. The researchers excluded women who had depression within 24 months before giving birth, multiple births, or stillbirth. Depression was defined as filling a prescription for an antidepressant or receiving a hospital discharge with a diagnosis of depression within 12 months of delivery.

Overall, there were 21 cases of depression per 1,000 person-years among women who started hormonal contraceptives, compared with 14 per 1,000 person-years among those who did not. This amounted to a 49% higher risk of depression among hormonal contraceptive users compared with nonusers, after adjusting for factors like age, history of mental illness, or birth complications. The absolute prevalence of postpartum depression was 1.54% among all women, which the researchers calculated would have been 1.36% had no one taken contraceptives.

The researchers observed this elevated risk of depression for several types of hormonal contraceptives: combined-hormone pills and combined nonoral (patch and vaginal ring) or progestogen-only nonoral (implants, depot injections, and levonorgestrel-releasing IUDs). Progestogen-only mini-pills were an exception, for which an increased risk was evident only after eight months postpartum.

The risk varied by type of hormonal contraceptive: Compared with nonuse, levonorgestrel-releasing IUDs raised risk of depression by 27% during the study period, progestogen-only nonoral contraceptives by 40%, combined-hormone pills by 72%, and combined-hormone patches and vaginal rings by 97%.

“These findings raise the issue of whether the incidence of depression postpartum may be inflated by routine hormonal contraceptive initiation, which is important information to convey at postpartum contraceptive counseling,” Larsen and colleagues wrote.

For related information, see the Psychiatric News article “Depression After Hormonal Contraception Initiation Linked to PPD.”

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Eating Disorders Affect More Racially Diverse Population Than Previously Thought

Eating disorders are often thought to primarily affect White people, but a study in the International Journal of Eating Disorders suggests that eating disorders affect college students at largely similar rates across racial and ethnic groups. Furthermore, where differences emerged along racial and ethnic lines, some minoritized groups had a greater probable prevalence and severity of eating disorders than Whites.

Carli P. Howe, a graduate student at the University of Washington in St. Louis, and colleagues analyzed data from 3,929 students from 26 U.S. colleges and universities whose results on a mental health screen suggested the presence of an eating disorder. Participants self-identified as Asian, Black, Hispanic, multiracial, or White. They were also asked about their gender identity and were categorized as men, women, cisgender, or non-cisgender.

The researchers found that:

• Non-cisgender Asian participants had the highest prevalence of probable anorexia nervosa (8.64%), followed by cisgender Asian women (3.61%), non-cisgender multiracial participants (3.28%), and cisgender multiracial women (2.5%).
• Non-cisgender Hispanic participants had the highest prevalence of probable clinical or subclinical bulimia nervosa/binge eating disorder (20.49%), followed by cisgender Hispanic women (18.2%), cisgender multiracial women (17.25%), and cisgender White women (15.54%).
• Non-cisgender Black participants were most likely to be at high risk for eating disorder onset (6.67%), followed by cisgender Hispanic women (5.87%), cisgender White women (4.83%), and cisgender Black women (4.52%).
• Among participants with probable eating disorders, there were no significant differences between racial or ethnic groups across any gender with respect to the frequency of eating disorder behaviors such as binge eating, vomiting, or laxative/diuretic use in the past three months.

“These findings are key for refuting widely held stereotypes that [eating disorders] primarily affect White individuals and also underscore a critical need for solutions aimed to equitably address [eating disorders] in college populations,” the researchers wrote.

They added that universal screening and intervention for eating disorders on college campuses have the potential to significantly reduce the population prevalence of eating disorders in college students: “Such universally delivered programs may include targeted interventions for racially/ethnically minoritized students. These directions represent a critical path to closing the large [eating disorder] treatment gap in this high-risk population.”

For further information, see the Psychiatric Services article “Eating Disorder Treatment Access in the United States: Perceived Inequities Among Treatment Seekers.”

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