Evidence map›Paper›PMID 34598985›Full record

Observational studyBMJ open2021

Population heterogeneity in associations between hormonal contraception and antidepressant use in Sweden: a prospective cohort study applying intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA).

Sofia Zettermark, Kani Khalaf, Raquel Perez-Vicente, George Leckie, Diana Mulinari, Juan Merlo

Abstract readObservational Study
In one paragraph

Observational study in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

13 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Sofia ZettermarkUnit for Social Epidemiology, Department of Clinical Sciences, Lund University, Lund, Sweden sofia.zettermark@med.lu.se.ORCID 0000-0003-3181-8609
Kani KhalafUnit for Social Epidemiology, Department of Clinical Sciences, Lund University, Lund, Sweden.
Raquel Perez-VicenteUnit for Social Epidemiology, Department of Clinical Sciences, Lund University, Lund, Sweden.
George LeckieUnit for Social Epidemiology, Department of Clinical Sciences, Lund University, Lund, Sweden.
Diana MulinariDepartment of Gender Studies, Faculty of Social Sciences, Lund University, Lund, Sweden.
Juan MerloUnit for Social Epidemiology, Department of Clinical Sciences, Lund University, Lund, Sweden.ORCID 0000-0001-8379-9708

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesFrom a reproductive justice framework, we aimed to investigate how a possible association between hormonal contraceptive (HC) and antidepressants use (as a proxy for depression) is distributed across intersectional strata in the population. We aimed to visualise how intersecting power dynamics may operate in combination with HC use to increase or decrease subsequent use of antidepressants. Our main hypothesis was that the previously observed association between HC and antidepressants use would vary between strata, being more pronounced in more oppressed intersectional contexts. For this purpose, we applied an intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy approach.

designObservational prospective cohort study using record linkage of national Swedish registers.

settingThe population of Sweden.

participantsAll 915 954 women aged 12-30 residing in Sweden 2010, without a recent pregnancy and alive during the individual 1-year follow-up. PRIMARY OUTCOME MEASURE: Use of any antidepressant, meaning being dispensed at least one antidepressant (ATC: N06A) during follow-up.

resultsPreviously mentally healthy HC users had an OR of 1.79 for use of antidepressants compared with non-users, whereas this number was 1.28 for women with previous mental health issues. The highest antidepressant use were uniformly found in strata with previous mental health issues, with highest usage in women aged 24-30 with no immigrant background, low income and HC use (51.4%). The largest difference in antidepressant use between HC users and non-users was found in teenagers, and in adult women of immigrant background with low income. Of the total individual variance in the latent propensity of using antidepressant 9.01% (healthy) and 8.16% (with previous mental health issues) was found at the intersectional stratum level.

conclusionsOur study suggests teenagers and women with immigrant background and low income could be more sensitive to mood effects of HC, a heterogeneity important to consider moving forward.

Indexed as

Antidepressive AgentsHormonal ContraceptionAdolescentAdultFemaleHumansMultilevel AnalysisPregnancyProspective StudiesSwedenAntidepressive Agentsdepression & mood disordersepidemiologymental healthsex steroids & HRTsocial medicine

Identifiers

PMID34598985
PMCPMC8488727

What Socratic holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.