Description of the included studies
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| «Kraft MZ, Rojczyk P, Weiss T, ym. Symptoms of ment...»1 | Systematic review and meta-analysis | Females over 12 years | Oral contraceptives use compared to naturally cycling women Other contraceptive methods excluded (IUD, injections) |
1) Clinically relevant symptoms of mental disorders measured with a formal psychological
instrument, including self-report OR 2) a diagnosis of a mental disorder OR 3) psychotropic drug use. |
High |
| «Worly BL, Gur TL, Schaffir J. The relationship bet...»2 | Systematic review | Women of all ages | Use of progestin-only contraceptives including pills, injections, intrauterine devices and subdermal implants | Depression, measured with externally validated depression scales. |
Moderate |
RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis, OC= oral contraceptives
Additional comments for included studies
| Reference | Comments |
|---|---|
| «Kraft MZ, Rojczyk P, Weiss T, ym. Symptoms of ment...»1 | Varying outcomes: different psychiatric symptoms and diagnoses included. However,
most studies (17/22) examined depression or depressive symptoms. High heterogeneity I2=99.8%, possibly due to differing outcomes. Risk of bias and level of evidence were only assessed by one author. Most included studies were observational, hindering the assessment of a causal relationship between OC use and psychiatric symptoms or disorders. |
Results
Outcome: Clinically relevant symptoms or diagnoses of mental disorders
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative effect (95% CI) |
|---|---|---|---|---|---|
| Level of evidence: very low The quality of evidence is downgraded due to study limitations (high risk of bias) and inconsistency. |
|||||
| «Kraft MZ, Rojczyk P, Weiss T, ym. Symptoms of ment...»1 | 16 studies included in meta-analysis. I n= 5,432229 C n= 5,210611 |
Varying in the studies: from 1 month to >10 years | 121,945 | 109,944 | Random effect model RR: 1.00 (0.82 to 1.22) |
| «Worly BL, Gur TL, Schaffir J. The relationship bet...»2 | 26 studies that met inclusion criteria, including 5 randomized controlled trials, 11 cohort studies and 10 cross-sectional studies. | Varying | no meta-analysis performed | no meta-analysis performed | No clear association between progestin-only methods and depression. No correlation with depression was found in five low-quality, high-risk-of-bias progestin subdermal implant studies and four out of five varying-quality and medium-risk-of-bias levonorgestrel intrauterine device studies. Two progestin-only contraceptive pill studies with varying levels of quality and bias indicate no increase in depression scores, while one good-quality, medium-bias study shows an association between progestin-only pills or intrauterine device and depression. |
I= intervention; C=comparison; CI=confidence interval