org355: Birth control and depression

Only one question this week: What is your reaction to the RCT that Brett Worly proposes?

This issue also reminds me of a hypothesis that arose a few years ago, that certain forms of hormonal birth control were associated with increased susceptability to HIV. Again, the means to come up with a way to get a definitive answer - balancing both epidemiologic and ethical considerations - is extremely challenging. But yet extremely important to resolve, given the wide use of hormonal birth control.

I welcome your comments! -s

Re: Birth control and depression

by | Catherine Bunting - Wednesday, 9 March 2022, 8:57 PM

This is very tricky. I can see that it would be of huge value to women everywhere to have strong evidence about the effect of hormonal birth control on mental health. But running this RCT would mean randomising some women to non-hormonal birth control, which might be less effective in preventing pregnancy and have unpleasant side effects.

Also, you would only be able to run this trial among women who were willing to be randomised to either hormonal or non-hormonal birth control, and these women are unlikely to be representative of the wider female population - so there would be questions about the generalisability of results. I think the trial would need to be pretty big so that you could do sub-group analyses - different types of birth control might affect different women in different ways. And there could be major problems with loss to follow-up and non-compliance.

Despite all the difficulties, I feel like a trial like this will happen at some point. Maybe there needs to be a lot of consultation with patient groups to work through the ethical issues?

Thanks for the link Sujit. I'm interested in the hormonal aspects of mental health in women and think it's an area of research that deserves more attention!

Re: Birth control and depression

by | Sujit Rathod - Saturday, 12 March 2022, 5:00 AM

Welcome Catherine, and thanks for this response!

Yes, indeed, patient consultation will be vital to ensure that one designs the study in such a way that there will be high follow up and adherence. Along those lines, one should design a study to ensure internal validity. External validity/generalisability is not an absolute requirement for (most) good epidemiologic research, but something to aim for without compromising the internal validity.
See: https://hrr.w.uib.no/files/2018/09/Rothman-2013-Why-representativene.pdf

Perhaps there's a way for you to engage with this research question in your MSc project?