Patient characteristics associated with symptoms of anxiety, depression, and reduced body appreciation in women with polycystic ovary syndrome

Abstract

Study question: Which polycystic ovary syndrome (PCOS)-related and general patient characteristics are associated with higher levels of anxiety and depressive symptoms, as well as with reduced body appreciation in women with PCOS?

Summary answer: Anxiety was more common among participants with alopecia, obesity, younger age, and a history of anxiety or depression; depression was more common in participants with alopecia, unemployment, and a history of depression; and body appreciation scores were lower in participants with hirsutism, acne, alopecia, obesity, younger age, and a history of anxiety or depression.

What is already known: Women diagnosed with PCOS face over 30% likelihood of clinically relevant anxiety symptoms, over a 15% likelihood of clinically relevant depressive symptoms, and also experience reduced body appreciation. Evidence suggests that in women with PCOS, various factors may contribute to increased levels of anxiety and depression and reduced body appreciation. However, findings across studies are inconsistent, and the nature of these associations, as well as the potential influence of patient characteristics that have been less studied, are still not well understood.

Study design, size, duration: A cross-sectional online survey study was carried out from May 2021 to July 2023. Recruitment occurred through fertility clinics in the Netherlands, employing posters, leaflets with QR codes, and online platforms run by patient organizations.

Participants/materials, setting, methods: The participants were women with self-reported PCOS. They completed the Hospital Anxiety and Depression Scale (HADS) and the Body Appreciation Scale-2 (BAS-2). We assessed the association with mental health outcomes (symptoms of anxiety and depression, as well as body appreciation) with PCOS-related patient characteristics (hirsutism, acne, alopecia, obesity, and oligomenorrhea) and general characteristics (age, employment status, medical history, and medication use). Multivariable logistic and linear regression analyses were used, and adjusted odds ratios (aORs) or adjusted mean differences (aMDs) with 95% CI were calculated.

Main results and the role of chance: We included 982 women, with 37.0% showing clinically relevant symptoms of anxiety (score ≥11) and 17.4% showing clinically relevant depressive symptoms (score ≥11). Risk factors associated with anxiety symptoms were alopecia (aOR: 1.79, 95% CI 1.35-2.38), obesity (aOR: 1.40, 95% CI 1.03-1.90), younger age (aOR per year older: 0.93, 95% CI: 0.91-0.96), and medical history of anxiety or depression (aOR: 2.63, 95% CI 1.82-3.79 and aOR: 1.60, 95% CI 1.13-2.28). Risk factors associated with symptoms of depression were alopecia (aOR: 1.74, 95% CI 1.21-2.50), unemployment (aOR: 2.59, 95% CI 1.56-4.31), and a medical history of depression (aOR: 1.89, 95% CI 1.25-2.85). Risk factors associated with reduced body appreciation were hirsutism (aMD: -2.29, 95% CI -3.41 to -1.16), acne (aMD: -1.14, 95% CI -2.11 to -0.17), alopecia (aMD: -1.93, 95% CI -2.89 to -0.97), obesity (aMD: -6.31, 95% CI -7.36 to -5.27), oligomenorrhea (aMD: -1.81, 95% CI -2.78 to -0.83), and younger age (aMD per year older: 0.13, 95% CI 0.04-0.23). A medical history of anxiety or depression disorder was also associated with reduced body appreciation (aMD: -1.80, 95% CI -3.10 to -0.50; aMD: -2.81, 95% CI -4.05 to -1.57, respectively).

Limitations, reasons for caution: Results are based on self-reported PCOS diagnoses and may have been affected by sampling bias.

Wider implications of the findings: It is crucial for healthcare providers to understand which characteristics in women with PCOS may influence the development of anxiety, depression, or reduced body appreciation. Such awareness helps them to be more alert and better recognize the different types of mental health concerns, enabling referrals and more targeted mental health support.

Study funding/competing interest(s): This study was not funded by a specific grant. No conflicts of interest were reported in relation to the current research.

Trial registration number: Not applicable.

Keywords: PCOS; anxiety; body image; depression; predictors.