Chapter 2 58 Figure 2.2. Visualization of mean scores and adjusted estimations and 95% confidence intervals of the IDS score, IDS atypical depression symptom score and WHI-IRS score from the adjusted model in Table 2.2. The estimate is adjusted for age, education level and birth country. OC=oral contraceptives, NC=naturally cycling, IDS-SR=Self-Reported Inventory of Depressive Symptoms, WHI-IRS=Women’s Health Initiative Insomnia Rating Scale, SE=Standard Error. 4. Discussion This study examined associations between current OC use and depressive disorders, severity of depressive symptoms, and insomnia symptoms in a large cohort of adult women, of whom the diagnoses and symptoms of depression were well phenotyped over the course of 9 years. Our first findings showed no indications that self-reported OC status was associated with more severe depressive symptoms (including symptoms of atypical depression), nor with higher prevalence of MDD or dysthymia. Moreover, having a previous or current diagnosis of MDD or dysthymia did not moderate the associations between OC use and insomnia or depressive symptoms. Although our overall results on OC and depression did not confirm our hypotheses, which were that OC use would be associated with more severe depressive symptoms and higher prevalence of depressive disorders, the results from the post-hoc analysis indicated that our original lack of accounting for the within- and between-participant measurements might have obscured underlying associations between OC and depression outcomes, because the between- and within-person estimates showed opposite directions. Furthermore, insomnia symptoms were consistently found to be more severe during OC use, both in the overall analysis as well as in the between- and within person estimates, although the effect size was small. To understand our contradictory results from between- and within-subject estimates, it is important to realize that in our study setup, OC use was not
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