Chapter 2 60 The finding that severity of depressive symptoms were equally present in OC measurements in women with or without previous or current diagnosis of MDD or dysthymia, is not line with previous studies on mood disorders and depressive symptoms during OC use, which showed that women with previous or current mood disorders were more likely to report adverse mood during OC use (Bengtsdotter et al., 2018; Hall et al., 2012; Joffe et al., 2003). However, one should keep in mind that we found different within- and between-person estimates for the association between OC use and severity of depressive symptoms, and it is yet unclear to what extent a role history of depression might have influenced these effects. Interestingly, we found an association between OC use and concurrent severity of insomnia symptoms, both in the overall estimates as well as in the within- and between-person estimates. Although severity of insomnia symptoms are generally higher in previously or currently depressed participants (Prather et al., 2015), psychiatric history did not significantly moderate the association between OC and insomnia scores, indicating that the OC-insomnia association is not dependent on history of a diagnosis of MDD or dysthymia. Our post hoc analyses indicate that OC use might be specifically associated with waking up multiple times during the night and earlier awakening. This suggests that differences in insomnia symptom severity during OC use (compared to non-use) could be more related to the area of maintaining sleep than initiating sleep. Our findings are in line with the study by Bezerra et al. (2020), who found that OC users report worse sleep quality than non-users. Also other studies found possible effects of OC on sleep, showing that OC users have less slow wave sleep (Burdick et al., 2002), have higher melatonin secretion and higher nocturnal body temperatures (Baker & Driver, 2007). However, the association between OC and sleep disruptions could also be caused or mediated by lifestyle factors, such as working hours, caffeine or alcohol consumption, or presence of small children (Wilsmore et al., 2013). Although the effect size of the association between OC use and insomnia was small, further studies in the domain of fundamental sleep research could offer more insight to what extent biological changes influence the association between OC use and sleep disruptions and how this may impact on health and functioning. Our study has some particular strengths. First, our study consisted of a large sample of participants, many of whom have a history or a current depressive
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