■作者比较了首次使用低,medium-,和大剂量左炔诺孕酮宫内缓释系统(LNG-IUS)。
■这项国家队列研究基于丹麦首次使用LNG-IUS的注册数据,15-44岁,2000年至2022年。Cox回归和G公式估计器用于报告1年平均绝对风险,风险差异,和抑郁的风险比,定义为开始抗抑郁药或接受抑郁症诊断,为日历年标准化,年龄,教育水平,父母有精神障碍史,子宫内膜异位症,月经过多,多囊卵巢综合征,痛经,平滑肌瘤,和产后开始。
■总共,149,200名妇女开始使用LNG-IUS,其中22,029人开始低剂量(平均年龄,22.9年[SD=4.5]),47,712个中等剂量的(平均年龄,25.2年[SD=6.2]),和79,459个高剂量的(平均年龄,30.2年[标准差=5.6])。相关的1年调整后的抑郁事件绝对风险为1.21%(95%CI=1.06-1.36),1.46%(95%CI=1.33-1.59),和1.84%(95%CI=1.72-1.96),分别。对于高剂量LNG-IUS的用户,与低剂量和中剂量LNG-IUS的使用者相比,风险比为1.52(95%CI=1.30-1.74)和1.26(95%CI=1.10-1.41),分别。对于中等剂量LNG-IUS的用户,与低剂量LNG-IUS使用者相比,风险比为1.21(95%CI=1.03-1.39).
■首次使用LNG-IUS与低,medium-,和高剂量LNG-IUS。尽管该研究的观察设计不允许因果推断,剂量-反应关系有助于大量证据表明左炔诺孕酮暴露与抑郁风险之间存在关系.
UNASSIGNED: The authors compared the associated risk of incident depression between first-time users of low-, medium-, and high-dose levonorgestrel-releasing intrauterine systems (LNG-IUSs).
UNASSIGNED: This national cohort study was based on Danish register data on first-time users of LNG-IUSs, 15-44 years of age, between 2000 and 2022. Cox regression and a G-formula estimator were used to report 1-year average absolute risks, risk differences, and risk ratios of incident depression, defined as initiation of an antidepressant or receipt of a depression diagnosis, standardized for calendar year, age, education level, parental history of mental disorders, endometriosis, menorrhagia, polycystic ovary syndrome, dysmenorrhea, leiomyoma, and postpartum initiation.
UNASSIGNED: In total, 149,200 women started using an LNG-IUS, among whom 22,029 started a low-dose one (mean age, 22.9 years [SD=4.5]), 47,712 a medium-dose one (mean age, 25.2 years [SD=6.2]), and 79,459 a high-dose one (mean age, 30.2 years [SD=5.6]). The associated subsequent 1-year adjusted absolute risks of incident depression were 1.21% (95% CI=1.06-1.36), 1.46% (95% CI=1.33-1.59), and 1.84% (95% CI=1.72-1.96), respectively. For the users of high-dose LNG-IUSs, the risk ratios were 1.52 (95% CI=1.30-1.74) and 1.26 (95% CI=1.10-1.41) compared with users of the low- and medium-dose LNG-IUSs, respectively. For users of medium-dose LNG-IUSs, the risk ratio was 1.21 (95% CI=1.03-1.39) compared with users of low-dose LNG-IUSs.
UNASSIGNED: First-time use of an LNG-IUS was positively associated with incident depression in an LNG-dose-dependent manner across low-, medium-, and high-dose LNG-IUSs. Although the observational design of the study does not permit causal inference, the dose-response relationship contributes to the body of evidence suggesting a relationship between levonorgestrel exposure and risk of depression.