RESUMO
Background: Oral contraceptives (OCs) are an essential medicine used by millions of people every day. Given the widespread usage of these medicines, even a small increase in psychiatric risk could be of clinical significance. Although mood-related side effects are a common reason for OC hesitancy and discontinuation, studies investigating psychiatric responses to OC treatment have had inconsistent results. Summary: While OCs are beneficial for most users, there is evidence that a subgroup of users is susceptible to mood side effects. Randomized controlled trials have generally failed to find differences in mood symptoms between OC and placebo users, but observational studies comparing OC users to non-users have reported increases in symptoms of depression, anxiety, and eating disorders. Additionally, observational evidence suggests that OC users may be more likely to use prescription psychotropic medications and to attempt or die by suicide. However, responses to OC treatment are highly heterogeneous, and some users report mood improvement. A variety of factors may increase the likelihood of negative psychiatric side effects, including younger age, previous experience of side effects from OCs, and preexisting psychiatric disorders. Progestin-only pills may confer a higher psychiatric risk than combination pills. Key Messages: Further research investigating factors that contribute to susceptibility to the mood-related side effects of OCs is clearly warranted. Genomic approaches may provide insight as to why some users experience side effects while others do not. Research elucidating who is most at risk and why will be essential to addressing prevalent concerns about the psychiatric risk of OCs.
RESUMO
Background: Previous epidemiological research has linked posttraumatic stress disorder (PTSD) with specific physical health problems, but the comprehensive landscape of medical conditions associated with PTSD remains uncharacterized. Electronic health records provide an opportunity to overcome clinical knowledge gaps and uncover associations with biological relevance that potentially vary by sex. Methods: PTSD was defined among biobank participants (N = 145,959) in 3 major healthcare systems using 2 ICD code-based definitions: broad (≥1 PTSD or acute stress codes vs. 0; n cases = 16,706) and narrow (≥2 PTSD codes vs. 0; n cases = 3325). Using a phenome-wide association study design, we tested associations between each PTSD definition and all prevalent disease umbrella categories, i.e., phecodes. We also conducted sex-stratified phenome-wide association study analyses including a sex × diagnosis interaction term in each logistic regression. Results: A substantial number of phecodes were significantly associated with PTSDNarrow (61%) and PTSDBroad (83%). While the strongest associations were shared between the 2 definitions, PTSDBroad captured 334 additional phecodes not significantly associated with PTSDNarrow and exhibited a wider range of significantly associated phecodes across various categories, including respiratory, genitourinary, and circulatory conditions. Sex differences were observed in that PTSDBroad was more strongly associated with osteoporosis, respiratory failure, hemorrhage, and pulmonary heart disease among male patients and with urinary tract infection, acute pharyngitis, respiratory infections, and overweight among female patients. Conclusions: This study provides valuable insights into a diverse range of comorbidities associated with PTSD, including both known and novel associations, while highlighting the influence of sex differences and the impact of defining PTSD using electronic health records.
Posttraumatic stress disorder (PTSD) is a debilitating psychiatric disorder that some people develop following a traumatic event. In addition to mental symptoms, PTSD can impact human health in ways other ways; for example, there are many known conditions that co-occur with PTSD, such as cardiovascular conditions. In this study, we set out to understand the breadth and degree to which PTSD co-occurs with medical outcomes in a sample of over 146,000 patients across 3 large medical systems. We found that both narrowly and broadly defined PTSD diagnosis co-occurred with hundreds of medical conditions, and the strongest associations were with other psychiatric disorders, respiratory conditions (asthma, GERD), sleep-related conditions, and pain. These results provide insights into future genetic studies of PTSD in large-scale biobanks and deepen our understanding of the complex needs of patients with PTSD.