Psychological Burden and Reproductive Correlates of Oral Contraceptive Pill Use Among Women in Yemen: A Cross-sectional Study

Abstract

Background: Oral contraceptive pills (OCPs) are widely used for family planning. However, evidence regarding their association with psychological symptoms remains inconsistent, particularly in low-resource settings. Objectives: This study aimed to evaluate the association between OCP use and psychological symptoms, including depression, anxiety, and mood swings, and to identify associated sociodemographic and reproductive factors. Methods: This cross-sectional study included 400 women aged 18 - 49 years who attended a tertiary hospital in Yemen. Current OCP use was defined as use within the preceding 3 months. Data were collected through structured interviews covering sociodemographic characteristics, reproductive history, and self-reported psychological symptoms. Multivariable logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for depression, anxiety, and mood swings after adjustment for age, body mass index, smoking, Qat chewing, duration of OCP use, education, income, parity, and employment status. Results: Of the 400 participants, 216 (54.0%) were OCP users. The prevalence of depression (18.1% vs. 10.3%, P = 0.039), mood swings (51.9% vs. 40.2%, P = 0.026), and premenstrual syndrome (65.7% vs. 50.0%, P = 0.002) was higher among OCP users than among non-users. In multivariable analyses, OCP use was associated with increased odds of depression (aOR = 2.11; 95% CI, 1.09 - 4.11; P = 0.027) but was not associated with anxiety or mood swings. Longer duration of OCP use was associated with anxiety and mood swings (aOR = 1.01 per month). Education was inversely associated with depression (aOR = 0.37; P = 0.009), whereas employment was positively associated with depression (aOR = 2.55; P = 0.014). Among OCP users, progestin-only formulations were associated with a higher prevalence of psychological symptoms than combined formulations. Conclusions: Oral contraceptive pill use was associated with a higher likelihood of self-reported depression, but not with anxiety or mood swings. Hormonal formulation and duration of use, together with socioeconomic and contextual factors, may influence psychological outcomes. However, causality cannot be inferred, and prospective studies are needed to clarify these associations and to inform individualized contraceptive counseling.