Associations between sex hormones, sleep problems and depression 229 Table 8.1. (continued) First author, year of publication Included participants (age range or mean) Study design and duration Hormone measurement and/or intervention Study quality Depression (symptom) assessment Sleep assessment subjective (S) and objective (O) Results: sex hormones and sleep Results: sex hormones and depressive symptoms Results: association sleepdepressive symptoms Shechter et al., 2012 7 women with PMDD and sleep complaints and 5 controls (mean age 31 years old) Prospective case-control study (one full menstrual cycle, measurements every 3rd night) No intervention Measured urinary progesterone Good Prospectively monitored PMDD symptoms S: None O: Sleep PSG REM sleep ↓ in early luteal phase vs. early follicular phase (both groups)*. P levels in PMDD vs. control is N.S. PMDD group ↑SWS * * and ↓ melatonin * than controls. Toffol et al., 2019 182 women attending gynecology clinic either starting (n = 68), continuing (n = 62) or switching (n = 52) their current hormonal contraceptive (HC) (aged 18 or older) Prospective observational cohort study Intervention: hormonal contraceptives (including both short-term contraceptives (e.g. oral) and long-acting (e.g. IUD, implant) No hormone measurements Fair BDI-13 S: Insomnia symptoms, early awakening O: None Insomnia symptoms more likely in HC starters, significant after controlling for kind of contraceptive (long vs. shortacting)* Early awakening significantly more persistent in continuers Starting group had n=6 (9%) who reported self-harm at follow up, significantly higher than other groups. All self-harming participants reported some psychological symptoms at baseline, 2 had psychiatric diagnosis. N.R. ~ indicates predictor-outcome association, = indicates correlation, * indicates p<0.05, ** indicates p<0.01, *** indicates p<0.0001, NR=not reported, NS=not significant. PSG=polysomnography, SWS=Slow Wave Sleep, ArI=Arousal Index, ISI=Insomnia Severity Index, ESS=Epworth Sleepiness Scale, PSQI=Pittsburgh Sleep Quality Index, MDD=Major Depressive Disorder, PMDD=Premenstrual Dysphoria Disorder, PMS=Premenstrual Syndrome, CES-D=Center for Epidemiological Studies Depression Scale, BDI=Beck Depression Inventory, BDI-13=13-item Beck Depression Inventory, MADR-S=Montgomery–Åsberg Depression Rating Scale, STAI-S=StateTrait Anxiety Inventory, DLQ=Daily Life Questionnaire, POMS=profile of mood scale, P=progesterone, E=estradiol, T=testosterone, PdG=pregnanediol (main urinary metabolite for progesterone), E1=estrone, E2=estradiol, OC=oral contraceptives, ISI=insomnia severity index, PdG=pregnanediol, ASD=androsterone, SHDG=Sex hormone-binding globulin.
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