This article was originally published here

BMJ Open. October 1, 2021; 11 (10): e049553. doi: 10.1136 / bmjopen-2021-049553.


OBJECTIVES: From a reproductive justice framework, we sought to investigate how a possible association between the use of hormonal contraceptives (HC) and antidepressants (as an indicator of depression) is distributed across intersectional strata of the population. We sought to visualize how cross-power dynamics can work in combination with the use of HC to increase or decrease the subsequent use of antidepressants. Our main hypothesis was that the previously observed association between HC use and antidepressants would vary between strata, being more pronounced in more oppressed intersectional settings. To this end, we applied an intersectional multilevel analysis of individual heterogeneity and a discriminatory precision approach.

DESIGN: Prospective observational cohort study using record linkage from national Swedish registries.

SETTING: The people of Sweden.

PARTICIPANTS: All 915,954 women aged 12 to 30 residing in Sweden 2010, without recent pregnancy and alive during the one-year individual follow-up.

PRIMARY OUTCOME MEASURE: Use of any antidepressant, i.e. at least one antidepressant (ATC: N06A) has been issued during follow-up.

RESULTS: Previously mentally healthy HC users had an OR of 1.79 for antidepressant use compared to non-users, compared with 1.28 for women with previous history of depression. Mental Health. The highest use of antidepressants was uniformly found in strata with previous mental health problems, with highest use among women aged 24 to 30 with no immigrant background, low income and using HC (51.4%). The greatest difference in antidepressant use between HC users and non-users was observed among adolescent girls and among low-income immigrant women. Of the total individual variance of the latent propensity to use antidepressants, 9.01% (healthy) and 8.16% (with prior mental health issues) were found at the intersectional stratum.

Conclusions: Our study suggests that low-income, immigrant girls and women may be more sensitive to the mood effects of HC, an important heterogeneity to consider moving forward.

PMID: 34598985 | DOI: 10.1136 / bmjopen-2021-049553


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