Oral Contraceptive Use and its Association with Depression among Women in Taif, Saudi Arabia

 

Shatha Hallal Alziyadi1, Sara Mohammed AlNemari2, Miad Matuq AlOsaimi2, Mashael Eidhah AlSufyani2*, Taif Majid AlReefi2, Samah Faez AlShanbari2, Samar Mohammed Salim Koursan2

1Department of Obstetrics and Gynecology, Faculty of Medicine, Taif University, Saudi Arabia.

2Faculty of Medicine, Taif University, Saudi Arabia.

 

*Email: [email protected]


ABSTRACT

The oral contraceptive pill (OCP) is a type of birth control pill that is taken orally. OCP is the world's most frequently used contraceptive method today. To estimate the prevalence of depression among hormonal contraceptive users in Taif city. The study was a cross-sectional questionnaire survey, based on a structured questionnaire that was developed by authors conducted in Taif city in the kingdom of Saudi Arabia The required sample was calculated, which is approximately 384. The prevalence of using oral contraceptive pills (OCPs) was found to be 57.5% The Beck Depression Inventory (BDI) score was calculated by adding the scores of all the items in the questionnaire. The mean scores for the BDI were found to be 14.1 ± 10.1. A BDI score of 17 or more was considered to have clinical depression, and it was found that the prevalence of depression was 37.8%. The Levels of Depression were calculated based on the total score as Normal (1-10), Mild mood disturbance (11-16), Borderline clinical depression (17-20), Moderate depression (21-30), Severe depression (31-40), Extreme depression (>40). The analysis showed that 2.4% and 4.4% demonstrated extreme and severe depression, respectively. The findings showed that females' oral contraceptive pills were the most commonly used contractive methods. About 37.8% of the females who used OCPs had demonstrated depression symptoms.

Key words: Hormone contraception, Estrogen, Progesterone, Depressed mood, Depression


INTRODUCTION

Hormonal contraceptives (HCs) are one of the most influential discoveries of the twentieth century, with over 100 million users worldwide. HCs are an effective contraception and family planning strategy, as well as a way to manage cycle-related physiological symptoms (e.g., ovulation pain, acne, hirsutism). The data implies that HC use is good for many women, but a small percentage of women experience significant mood-related adverse effects [1, 2]. The most commonly reported adverse effects are mood disturbances and depression [3, 4]. Depression is defined as a type of mood illness characterized by a persistent sense of sadness and lack of interest. The study showed that women are about twice as likely as males to suffer from depression [5]. In addition to that women who started using a contraceptive patch experienced roughly twice the risk of subsequently starting an antidepressant or being diagnosed with depression [6]. Another study conducted in Denmark showed an association between oral contraceptive pills (OCPs) use and subsequent use of antidepressants and a diagnosis of depression [7]. In 2019, research has been conducted on the Effects of Hormonal Contraceptives on Mood and the result has shown that Hormonal contraceptives (HCs) appear to have the most detrimental effects on mood in women who have a history of depressive symptoms and/or a negative experience with HC use. Although inconsistent to some extent, current evidence suggests that HC users have a negativity bias in emotion identification and reaction. However, some evidence suggests that certain HC users have a reduced reward response and a potential dysregulation of the stress response [1]. A study was performed on 354 young family planning patients and found that discrimination against oral contraceptive pills is associated with depression and mood disorders [8]. Finally, psychological research found that in the 60s and 70s when oral contraceptive pills were used in large amounts it will increase depressive symptoms [9-11]. Due to the limitation of published research in Saudia Arabia about oral contraceptives and their relationship with depression, we conducted this study to measure the association between oral contraceptive pills and depression.

 

MATERIALS AND METHODS

 

This is a cross-sectional analytic descriptive study, which is under approval. The study population included all females who are taking contraceptive methods in Taif, KSA. The sample size was estimated using the Qualtrics calculator with a confidence level of 95%, a sample size of 384, and a margin error of 5%. Inclusion criteria are as follows: females who have already used oral contraceptive pills Aged 15 and more, in Taif KSA and who agree to Participate. Exclusion criteria are as follows: females less than 14 years old, men, non-oral contraceptive users, living other than Taif city KSA, and who refuse to participate. The survey will be conducted between Oct 2021-Oct 2022. The instrument used was an electronic questionnaire in Arabic from Alfaifi, M. et al. (2021) [3], and we used a google questionnaire which included questions about using and duration of OCPs, depression symptoms, and their correlation. The survey instrument was a self-administered questionnaire. The questionnaire was divided into three main sections: the first section was for demographic data; the second section consists of questions about OCPs, and the third section consisted of questions about depression symptoms. After that by using the Microsoft Office Excel software program data was entered and statistically analyzed using the Social Science Software Statistical Package (SPSS), version 26.

 

RESULTS AND DISCUSSION

 

Table 1. Baselines characteristics of the participant

 

n

%

Age

18-25 years

74

29.7

26-35 years

84

33.7

36-45 years

70

28.1

46-55 years

19

7.6

>55 years

2

0.8

Marital status

Married

201

80.7

Separated or divorced or widowed

48

19.3

Smoking

No

230

92.4

Yes

19

7.6

Number of children

No children

82

32.9

1-2

73

29.3

3 and more

94

37.8

Family type

Small family

207

83.1

Large family

42

16.9

Educational level

No primary education

2

0.8

Primary

3

1.2

Middle

8

3.2

Secondary or higher

236

94.8

Workforce Participation

Employed

115

46.2

Unemployed

134

53.8

Family Income (Salary)

Very weak

6

2.4

Weak

14

5.6

Average

207

83.1

High

22

8.8

Duration of Oral contraceptive use

3-6 months

90

36.1

>6-12 months

35

14.1

>1 year

124

49.8

 

Table 1 shows the baseline characteristics of the participants showed that 84 (33.7%) belonged to the age group of 26-35 years, 201 (80.7%) were married, 230 (92.4%) were smokers, 94 (37.8%) had children three or more, 207 (83.1%) belonged to small family type, 236 (94.8%) had secondary or higher education, 134 (53.8%) were unemployed, 207 (83.1%) had average family income, and 124 (49.8%) were using OCPs for more than one year.

 

Table 2. Depression and related factors

 

N

%

Received any treatment for depression in the past

No

234

94.0

Yes

15

6.0

Social support

Lots of social support

119

47.8

Little social support

130

52.2

Recording cases of living problems in the past two months

No

172

69.1

Yes

77

30.9

Relationship with the husband

Not comfortable at all

38

15.3

Somewhat convenient

129

51.8

Comfortable-very comfortable

82

32.9

Having health problems in the past two months

No

99

39.8

Yes

150

60.2

Type of health problems (n=150)

Muscle and bone pain

17

11.3

Limb problems

4

2.7

Backache

16

10.7

Gastrointestinal symptoms

5

3.3

Headache

21

14.0

Multiple health problems

87

58.0

Husband experiences chronic disease(s )

Nothing

192

77.1

One disease

46

18.5

2 or more

11

4.4

Self-assessment of health

Good / very good

191

76.7

Exposition

52

20.9

Too bad

6

2.4

It was reported by 15 (6%) participants that they received some treatment for depression in the past, and 52.2% mentioned that they received little social support. It was observed that 69.1% had cases of living problems in the past two months, and 15.3% had an uncomfortable relationship with their husband. About 150 participants reported that they were suffering from some health problems, whereas 58% had multiple health problems. It was reported by 18.5% and 4.4% of the participants that their husbands suffered from one or two or more chronic diseases, respectively. About 76.7% of the participants self-assessed their health as good or very good (Table 2).

 

Chart, pie chart

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Figure 1. Prevalence of oral contraceptives using

We received a total response from 433 participants who were using some form of contraceptive methods and out of this, the prevalence of using oral contraceptive pills (OCPs) was found to be 57.5% (n=249) (Figure 1).