SUPPLEMENTAL DIGITAL CONTENT 4. Cumulative incidence of mental health conditions among women who did not have any of the 20 chronic conditions at baseline, overall and in strata by age at hysterectomy and by indication
Hysterectomy Referent women Unadjusted modelsa Adjusted modelsb
Condition N at
risk
Person- years
N of events
N at risk
Person- years
N of events
Hazard ratio
(95% CI) P Hazard ratio
(95% CI) P
Overall
Depression 1,204 22,127 378 1,433 25,641 339 1.30 (1.12-1.49) <0.001 1.31 (1.14-1.51) <0.001 Anxiety 1,204 23,492 302 1,433 26,726 279 1.23 (1.05-1.44) 0.01 1.24 (1.06-1.45) 0.008 Substance
abuse disorders 1,204 26,779 49 1,433 29,412 43 1.26 (0.84-1.89) 0.25 1.28 (0.85-1.92) 0.24 Dementia 1,204 26,981 68 1,433 29,625 63 1.07 (0.77-1.49) 0.69 1.08 (0.78-1.52) 0.64 Schizophrenia
and psychosis 1,204 27,139 20 1,433 29,753 28 0.72 (0.41-1.28) 0.27 0.79 (0.44-1.41) 0.43 Age 18-35 years
Depression 326 5,582 114 424 7,108 101 1.43 (1.10-1.87) 0.008 1.46 (1.12-1.92) 0.006
Anxiety 326 5,990 97 424 7,551 76 1.63 (1.21-2.19) 0.001 1.65 (1.22-2.23) 0.001
Substance
abuse disorders 326 6,968 23 424 8,264 17 1.61 (0.88-2.96) 0.12 1.55 (0.83-2.87) 0.17
Dementia 326 7,175 9 424 8,430 7 1.49 (0.59-3.74) 0.40 0.99 (0.39-2.53) 0.99
Schizophrenia
and psychosis 326 7,209 2 424 8,451 3 0.78 (0.13-4.58) 0.78 0.63 (0.10-3.99) 0.63 Age 36-50 years
Depression 760 14,351 229 891 16,373 207 1.27 (1.05-1.52) 0.01 1.28 (1.06-1.54) 0.009 Anxiety 760 15,225 180 891 16,928 185 1.08 (0.88-1.32) 0.46 1.08 (0.89-1.33) 0.43 Substance
abuse disorders 760 17,326 23 891 18,772 20 1.26 (0.69-2.28) 0.45 1.23 (0.68-2.25) 0.50 Dementia 760 17,441 24 891 18,944 20 1.26 (0.70-2.27) 0.45 1.28 (0.71-2.33) 0.41 Schizophrenia
and psychosis 760 17,489 9 891 18,970 13 0.74 (0.32-1.71) 0.48 0.86 (0.36-2.03) 0.73
SUPPLEMENTAL DIGITAL CONTENT 4. Continued
Hysterectomy Referent women Unadjusted modelsa Adjusted modelsb
Condition N at
risk
Person- years
N of events
N at risk
Person- years
N of events
Hazard ratio
(95% CI) P Hazard ratio
(95% CI) P
Age >50 years
Depression 118 2,194 35 118 2,160 31 1.14 (0.71-1.83) 0.58 1.17 (0.73-1.88) 0.51
Anxiety 118 2,278 25 118 2,247 18 1.34 (0.74-2.42) 0.34 1.40 (0.76-2.55) 0.28
Substance
abuse disorders 118 2,485 3 118 2,377 6 0.47 (0.12-1.88) 0.29 0.52 (0.13-2.08) 0.36
Dementia 118 2,365 35 118 2,251 36 0.89 (0.56-1.41) 0.63 0.99 (0.62-1.57) 0.96
Schizophrenia
and psychosis 118 2,441 9 118 2,333 12 0.69 (0.29-1.63) 0.39 0.72 (0.30-1.70) 0.45 Leiomyomasc
Depression 452 8,285 124 525 9,038 123 1.11 (0.87-1.43) 0.39 1.11 (0.87-1.42) 0.41
Anxiety 452 8,507 106 525 9,390 101 1.16 (0.88-1.52) 0.29 1.16 (0.88-1.52) 0.29
Substance
abuse disorders 452 9,743 18 525 10,427 14 1.40 (0.70-2.81) 0.34 1.42 (0.71-2.86) 0.32
Dementia 452 9,824 25 525 10,507 20 1.03 (0.57-1.84) 0.93 1.08 (0.60-1.93) 0.80
Schizophrenia
and psychosis 452 9,829 9 525 10,555 9 0.99 (0.39-2.48) 0.98 1.07 (0.42-2.70) 0.89 Menstrual disordersc
Depression 324 6,042 114 385 7,089 97 1.38 (1.05-1.80) 0.02 1.41 (1.07-1.85) 0.01
Anxiety 324 6,497 94 385 7,453 77 1.41 (1.05-1.89) 0.02 1.44 (1.06-1.95) 0.02
Substance
abuse disorders 324 7,475 16 385 8,224 10 1.84 (0.84-4.04) 0.13 2.10 (0.94-4.68) 0.07
Dementia 324 7,633 11 385 8,306 14 0.85 (0.38-1.89) 0.69 0.78 (0.35-1.78) 0.56
Schizophrenia
and psychosis 324 7,644 5 385 8,332 5 1.06 (0.31-3.68) 0.93 1.25 (0.34-4.62) 0.74
SUPPLEMENTAL DIGITAL CONTENT 4. Continued
Hysterectomy Referent women Unadjusted modelsa Adjusted modelsb
Condition N at
risk
Person- years
N of events
N at risk
Person- years
N of events
Hazard ratio
(95% CI) P Hazard ratio
(95% CI) P
Uterine prolapsec
Depression 235 4,462 68 300 5,474 72 1.14 (0.82-1.58) 0.43 1.17 (0.84-1.62) 0.36
Anxiety 235 4,761 54 300 5,634 61 1.01 (0.71-1.44) 0.96 1.01 (0.71-1.44) 0.96
Substance
abuse disorders 235 5,318 7 300 6,222 9 0.89 (0.34-2.32) 0.81 0.90 (0.34-2.36) 0.83
Dementia 235 5,260 25 300 6,222 21 1.31 (0.74-2.34) 0.36 1.36 (0.76-2.43) 0.31
Schizophrenia
and psychosis 235 5,374 5 300 6,235 11 0.45 (0.16-1.25) 0.13 0.49 (0.17-1.40) 0.18
a Hazard ratios calculated using Cox proportional hazards models with age as the time scale.
b Hazard ratios calculated using Cox proportional hazards models with age as the time scale and adjusted using inverse probability weights derived from a logistic regression model including all 20 chronic conditions present at baseline (index date), years of education (≤12, 13-16, >16, unknown), race (white vs nonwhite), and age and calendar year at baseline (continuous). These adjustments were performed separately in each stratum to maximize the balance at baseline. Overall interactions by age (18-35, 36-50, >50 years) were assessed for each mental health condition: depression P=0.10, anxiety P=0.48, substance abuse disorders P=0.12, dementia P=0.64, and schizophrenia and psychosis P=0.83. Similarly, overall
interactions by indication (leiomyomas, menstrual disorders, uterine prolapse) were assessed for each mental health condition: depression P=0.14, anxiety P=0.43, substance abuse disorders P=0.72, dementia P=0.80, and schizophrenia and psychosis P=0.54.
c A total of 308 women with other non-cancer indications for hysterectomy were not included in the analyses stratified by indication.
