Do hormonal contraceptives impact avoidant behaviour among women with severe somatic and psychiatric conditions? – A comparative study

Introduction

Hormonal contraceptives (HOC) have long been studied for their potential effects on mental health, particularly depression and anxiety. Costly avoidance is one of the core features of affective disorders, in which the person avoids potentially rewarding experiences to mitigate emotional distress. In a previous study submitted for publication, HOC users exhibited less avoidant behaviour and reported lower social anxiety in comparison to non-users; however, participants with severe psychiatric conditions were excluded from that final sample. In the present study, conducted as a subanalysis of the original dataset, we explore if HOC use is associated with avoidant behaviour and affective symptoms among women with severe somatic and/or psychiatric conditions.

Methods

A total of 68 women with severe somatic or psychiatric conditions participated in an online data collection study in 2024. Participants completed self-report measures of medication use, the Inventory of Depression and Anxiety Symptoms – II (IDAS-II) and an online approach-avoidance conflict task. Of these, 29 participants were HOC users and 39 were non-users. Inclusion required specialist care or use of medications typically prescribed in specialist care in Sweden and were verified by a licensed medical doctor. IDAS-II subscales analysed were “General Depression”, “Dysphoria”, “Social Anxiety”, “Lost appetite”, “Ill-temper”, “Insomnia” and “Suicidality”. Costly avoidance was assessed as a proportion of avoidant behaviour. Task-based measures included reward sensitivity, expected aversiveness and valence ratings among groups. The statistical analysis included t-tests and a multivariate regression with avoidance proportion as the predictor, IDAS-II scores as outcomes and HOC use as a moderator. In a follow-up step, we ran univariate regressions.

Results

HOC users and non-users did not differ in costly avoidance proportion, but HOC users reported lower symptoms of general depression, dysphoria, social anxiety, appetite loss, and suicidality (all p < .05), with no differences in ill temper or insomnia. No group differences were observed on the AACT in-task measures (all p ≥ .09). The multivariate regression using Pillai’s trace revealed a significant multivariate effect of hormone medication use, V = 0.24, F(7, 58) = 2.64, p = .019. The main effect of the costly avoidance proportion was not significant, V = 0.10, F(7, 58) = 0.92, p = .50. The interaction between avoidant behaviour and hormone medication status approached significance, V = 0.21, F(7, 58) = 2.17, p = .050. Univariate regression follow-ups of the interaction model demonstrated that there was a significant interaction between costly avoidance and hormone medication use for suicidality, F(1, 64) = 5.06, p = .028. No other interaction effects were significant.

Conclusions

In this psychiatric patient group, HOC use was associated with lower self-reported affective symptom levels and moderated the relationship between costly avoidance and suicidality, with HOC users reporting lower suicidality symptoms than non-users. These findings should be interpreted with caution given the observational design and the potential for self-selection bias.

References

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