Hostname: page-component-7b9c58cd5d-9klzr Total loading time: 0 Render date: 2025-03-15T09:33:00.567Z Has data issue: false hasContentIssue false
  • English
  • Français

Depression, anxiety and perceived stress in women with and without PCOS: a community-based study

Published online by Cambridge University Press:  22 August 2018

Anna L. Damone ,
Anju E. Joham ,
Deborah Loxton ,
Arul Earnest ,
Helena J. Teede  and
Lisa J. Moran
Anna L. Damone
Affiliation:
Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Locked Bag 29, Clayton, VIC 3168, Australia
Anju E. Joham
Affiliation:
Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Locked Bag 29, Clayton, VIC 3168, Australia Diabetes and Vascular Medicine Unit, Monash Health, Locked Bag 29, Clayton, VIC 3168, Australia
Deborah Loxton
Affiliation:
Research Centre for Generational Health and Ageing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
Arul Earnest
Affiliation:
Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Locked Bag 29, Clayton, VIC 3168, Australia
Helena J. Teede
Affiliation:
Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Locked Bag 29, Clayton, VIC 3168, Australia Diabetes and Vascular Medicine Unit, Monash Health, Locked Bag 29, Clayton, VIC 3168, Australia
Lisa J. Moran*
Affiliation:
Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Locked Bag 29, Clayton, VIC 3168, Australia The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, South Australia, 5000, Australia
*
Author for correspondence: Lisa J. Moran, E-mail: lisa.moran@monash.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Polycystic ovary syndrome (PCOS) is associated with increased psychological distress in clinical populations. We aimed to assess depression, anxiety and perceived stress in women with and without PCOS in a large community-based sample and investigate the role of stress in contributing to and mediating the relationship between PCOS, depression and anxiety.

Methods

A cross-sectional analysis was performed from the Australian Longitudinal Study of Women's Health (ALWSH) comparing women with (n = 478) or without (n = 8134) a self-reported diagnosis of PCOS. Main outcome measures were depression, anxiety and perceived stress measured using validated scales. The χ2 and t tests were used to assess differences between groups. Univariable and multivariable regression were performed to determine factors contributing to each outcome.

Results

Women reporting PCOS, compared with women not reporting PCOS, reported higher prevalence of depression (27.3% v. 18.8%), anxiety symptoms (50% v. 39.2%) and greater score for perceived stress (1.01 ± 0.03 v. 0.88 ± 0.01). After adjusting for body mass index, infertility and socio-demographic factors, women with PCOS were still more likely to be depressed, anxious and to have a higher level of perceived stress. There was a high-level mediation effect of stress between PCOS and both depression and anxiety.

Conclusion

Compared with women not reporting PCOS, women reporting PCOS have increased depression, anxiety and perceived stress. Stress may play a role in the association between PCOS, depression and anxiety. Further studies should consider assessment and management of stress in PCOS as it may be relevant for understanding the aetiology and treatment of psychological distress.

Keywords

AnxietydepressionPCOSstress
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 9 , July 2019 , pp. 1510 - 1520
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Açmaz, G, Albayrak, E, Acmaz, B, Başer, M, Soyak, M, Zararsız, G and İpekMüderris, İ (2013) Level of anxiety, depression, self-esteem, social anxiety, and quality of life among the women with polycystic ovary syndrome. The Scientific World Journal 2013, 1–7.Google Scholar
Altinok, M, Glintborg, D, Depont Christensen, R, Hallas, J and Andersen, M (2014) Prescription of antidepressants is increased in Danish patients with polycystic ovary syndrome and is associated with hyperandrogenism. A population-based cohort study. Clinical Endocrinology 80, 884–889.Google Scholar
Álvarez-Blasco, F, Luque-Ramírez, M and Escobar-Morreale, HF (2010) Obesity impairs general health-related quality of life (HR-QoL) in premenopausal women to a greater extent than polycystic ovary syndrome (PCOS). Clinical Endocrinology 73, 595–601.Google Scholar
Andresen, EM, Malmgren, JA, Carter, WB and Patrick, DL (1994) Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). American Journal of Preventive Medicine 10, 77–84.Google Scholar
Aziz, R, Carmina, E, Dewailly, D, Diamanti-Kandarakis, E, Escobar-Morreale, H and Futterweit, W (2006) Position statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an androgen excess society guideline. The Journal of Clinical Endocrinology & Metabolism 91, 4237–4245.Google Scholar
Azziz, R, Woods, KS, Reyna, R, Key, TJ, Knochenhauer, ES and Yildiz, BO (2004) The prevalence and features of the polycystic ovary syndrome in an unselected population. The Journal of Clinical Endocrinology & Metabolism 89, 2745–2749.Google Scholar
Barry, JA, Kuczmierczyk, AR and Hardiman, PJ (2011) Anxiety and depression in polycystic ovary syndrome: a systematic review and meta-analysis. Human Reproduction 26, 2442–2451.Google Scholar
Bell, S and Lee, C (2002) Development of the perceived stress questionnaire for young women. Psychology, Health & Medicine 7, 189–201.Google Scholar
Bell, S and Lee, C (2003) Perceived stress revisited: the Women's Health Australia project young cohort. Psychology, Health & Medicine 8, 343–353.Google Scholar
Benson, S, Janssen, O, Hahn, S, Tan, S, Dietz, T, Mann, K, Pleger, K, Schedlowski, M, Arck, P and Elsenbruch, S (2008) Obesity, depression, and chronic low-grade inflammation in women with polycystic ovary syndrome. Brain, Behavior, and Immunity 22, 177–184.Google Scholar
Benson, S, Arck, P, Tan, S, Hahn, S, Mann, K, Rifaie, N, Janssen, O, Schedlowski, M and Elsenbruch, S (2009 a) Disturbed stress responses in women with polycystic ovary syndrome. Psychoneuroendocrinology 34, 727–735.Google Scholar
Benson, S, Hahn, S, Tan, S, Mann, K, Janssen, O, Schedlowski, M and Elsenbruch, S (2009 b) Prevalence and implications of anxiety in polycystic ovary syndrome: results of an internet-based survey in Germany. Human Reproduction 24, 1446–1451.Google Scholar
Benson, S, Hahn, S, Tan, S, Janssen, OE, Schedlowski, M and Elsenbruch, S (2010) Maladaptive coping with illness in women with polycystic ovary syndrome. Journal of Obstetric, Gynecologic, & Neonatal Nursing 39, 37–45.Google Scholar
Brown, WJ, Bryson, L, Byles, JE, Dobson, AJ, Lee, C, Mishra, G and Schofield, M (1999) Women's Health Australia: recruitment for a national longitudinal cohort study. Women & Health 28, 23–40.Google Scholar
Cousineau, TM and Domar, AD (2007) Psychological impact of infertility. Best Practice & Research Clinical Obstetrics & Gynaecology 21, 293–308.Google Scholar
Davis, SR and Tran, J (2001) Testosterone influences libido and well being in women. Trends in Endocrinology & Metabolism 12, 33–37.Google Scholar
De Ridder, D, Geenen, R, Kuijer, R and van Middendorp, H (2008) Psychological adjustment to chronic disease. The Lancet 372, 246–255.Google Scholar
Deeks, AA, Gibson-Helm, ME and Teede, HJ (2010) Anxiety and depression in polycystic ovary syndrome: a comprehensive investigation. Fertility and Sterility 93, 2421–2423.Google Scholar
Deeks, A, Gibson-Helm, M, Paul, E and Teede, H (2011) Is having polycystic ovary syndrome a predictor of poor psychological function including anxiety and depression? Human Reproduction 26, 1399–1407.Google Scholar
Dokras, A, Clifton, S, Futterweit, W and Wild, R (2011) Increased risk for abnormal depression scores in women with polycystic ovary syndrome: a systematic review and meta-analysis. Obstetrics & Gynecology 117, 145–152.Google Scholar
Dokras, A, Clifton, S, Futterweit, W and Wild, R (2012) Increased prevalence of anxiety symptoms in women with polycystic ovary syndrome: systematic review and meta-analysis. Fertility and Sterility 97, 225–230. e2.Google Scholar
Ezeh, U, Yildiz, BO and Azziz, R (2013) Referral bias in defining the phenotype and prevalence of obesity in polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism 98, E1088–E1096.Google Scholar
Farkas, J, Rigó, A and Demetrovics, Z (2014) Psychological aspects of the polycystic ovary syndrome. Gynecological Endocrinology 30, 95–99.Google Scholar
Farrell, K and Antoni, MH (2010) Insulin resistance, obesity, inflammation, and depression in polycystic ovary syndrome: biobehavioral mechanisms and interventions. Fertility and Sterility 94, 1565–1574.Google Scholar
Goldberg, D, Bridges, K, Duncan–Jones, P and Grayson, D (1987) Dimensions of neuroses seen in primary-care settings. Psychological Medicine 17, 461–470.Google Scholar
Goldberg, D, Bridges, K, Duncan-Jones, P and Grayson, D (1988) Detecting anxiety and depression in general medical settings. British Medical Journal 297, 897–899.Google Scholar
Guidi, J, Gambineri, A, Zanotti, L, Fanelli, F, Fava, GA and Pasquali, R (2015) Psychological aspects of hyperandrogenic states in late adolescent and young women. Clinical Endocrinology 83, 872–878.Google Scholar
Haapanen, N, Miilunpalo, S, Pasanen, M, Oja, P and Vuori, I (1997) Agreement between questionnaire data and medical records of chronic diseases in middle-aged and elderly Finnish men and women. American Journal of Epidemiology 145, 762–769.Google Scholar
Hammen, C, Kim, EY, Eberhart, NK and Brennan, PA (2009) Chronic and acute stress and the prediction of major depression in women. Depression and Anxiety 26, 718–723.Google Scholar
Himelein, MJ and Thatcher, SS (2006) Depression and body image among women with polycystic ovary syndrome. Journal of Health Psychology 11, 613–625.Google Scholar
Hung, J-H, Hu, L-Y, Tsai, S-J, Yang, AC, Huang, M-W, Chen, P-M, Wang, S-L, Lu, T and Shen, C-C (2014) Risk of psychiatric disorders following polycystic ovary syndrome: a nationwide population-based cohort study. PLoS ONE 9, e97041.Google Scholar
Kerchner, A, Lester, W, Stuart, SP and Dokras, A (2009) Risk of depression and other mental health disorders in women with polycystic ovary syndrome: a longitudinal study. Fertility and Sterility 91, 207–212.Google Scholar
Khan, KS, Daya, S, Collins, JA and Walter, SD (1996) Empirical evidence of bias in infertility research: overestimation of treatment effect in crossover trials using pregnancy as the outcome measure. Fertility and Sterility 65, 939–945.Google Scholar
Kozica, SL, Gibson-Helm, ME, Teede, HJ and Moran, LJ (2013) Assessing self-efficacy and self-help methods in women with and without polycystic ovary syndrome. Behavioral Medicine 39, 90–96.Google Scholar
Lahey, BB (2009) Public health significance of neuroticism. American Psychologist 64, 241.Google Scholar
Lee, C, Dobson, AJ, Brown, WJ, Bryson, L, Byles, J, Warner-Smith, P and Young, AF (2005) Cohort profile: the Australian longitudinal study on women's health. International Journal of Epidemiology 34, 987–991.Google Scholar
Lim, S, Norman, R, Davies, M and Moran, L (2013) The effect of obesity on polycystic ovary syndrome: a systematic review and meta-analysis. Obesity Reviews 14, 95–109.Google Scholar
March, WA, Moore, VM, Willson, KJ, Phillips, DI, Norman, RJ and Davies, MJ (2009) The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction 25, 544–551.Google Scholar
Moran, L, Gibson-Helm, M, Teede, H and Deeks, A (2010) Polycystic ovary syndrome: a biopsychosocial understanding in young women to improve knowledge and treatment options. Journal of Psychosomatic Obstetrics & Gynecology 31, 24–31.Google Scholar
Moreno-Peral, P, de Dios Luna, J, Marston, L, King, M, Nazareth, I, Motrico, E, GildeGómez-Barragán, MJ, Torres-González, F, Montón-Franco, C and Sánchez-Celaya, M (2014) Predicting the onset of anxiety syndromes at 12 months in primary care attendees. The predictA-Spain study. PLoS ONE 9, e106370.Google Scholar
National Institute of Mental Health DAC (1995) Depression: What Every Woman Should Know Pub No. 95-3871.Google Scholar
Oinonen, KA and Mazmanian, D (2002) To what extent do oral contraceptives influence mood and affect? Journal of Affective Disorders 70, 229–240.Google Scholar
World Health Organization (1999) Obesity: preventing and managing the global epidemic: report of a WHO consultation. WHO Technical Report 894.Google Scholar
Powers, J and Loxton, D (2010) The impact of attrition in an 11-year prospective longitudinal study of younger women. Annals of Epidemiology 20, 318–321.Google Scholar
Raja-Khan, N, Agito, K, Shah, J, Stetter, CM, Gustafson, TS, Socolow, H, Kunselman, AR, Reibel, DK and Legro, RS (2015) Mindfulness-based stress reduction for overweight/obese women with and without polycystic ovary syndrome: design and methods of a pilot randomized controlled trial. Contemporary Clinical Trials 41, 287–297.Google Scholar
Rofey, DL, Szigethy, EM, Noll, RB, Dahl, RE, Lobst, E and Arslanian, SA (2008) Cognitive–behavioral therapy for physical and emotional disturbances in adolescents with polycystic ovary syndrome: a pilot study. Journal of Pediatric Psychology 34, 156–163.Google Scholar
Rowlands, I, Teede, H, Lucke, J, Dobson, A and Mishra, G (2016) Young women's psychological distress after a diagnosis of polycystic ovary syndrome or endometriosis. Human Reproduction 31, 2072–2081.Google Scholar
Simon, GE, Von Korff, M, Saunders, K, Miglioretti, DL, Crane, PK, Van Belle, G and Kessler, RC (2006) Association between obesity and psychiatric disorders in the US adult population. Archives of General Psychiatry 63, 824–830.Google Scholar
Spencer, EA, Appleby, PN, Davey, GK and Key, TJ (2002) Validity of self-reported height and weight in 4808 EPIC–Oxford participants. Public Health Nutrition 5, 561–565.Google Scholar
Stefanaki, C, Bacopoulou, F, Livadas, S, Kandaraki, A, Karachalios, A, Chrousos, GP and Diamanti-Kandarakis, E (2015) Impact of a mindfulness stress management program on stress, anxiety, depression and quality of life in women with polycystic ovary syndrome: a randomized controlled trial. Stress 18, 57–66.Google Scholar
Tan, S, Hahn, S, Benson, S, Janssen, O, Dietz, T, Kimmig, R, Hesse-Hussain, J, Mann, K, Schedlowski, M and Arck, P (2008) Psychological implications of infertility in women with polycystic ovary syndrome. Human Reproduction 23, 2064–2071.Google Scholar
Teede, HJ, Joham, AE, Paul, E, Moran, LJ, Loxton, D, Jolley, D and Lombard, C (2013) Longitudinal weight gain in women identified with polycystic ovary syndrome: results of an observational study in young women. Obesity 21, 1526–1532.Google Scholar
Trent, ME, Rich, M, Austin, SB and Gordon, CM (2003) Fertility concerns and sexual behavior in adolescent girls with polycystic ovary syndrome: implications for quality of life. Journal of Pediatric and Adolescent Gynecology 16, 33–37.Google Scholar
Veltman-Verhulst, SM, Boivin, J, Eijkemans, MJ and Fauser, BJ (2012) Emotional distress is a common risk in women with polycystic ovary syndrome: a systematic review and meta-analysis of 28 studies. Human Reproduction Update 18, 638–651.Google Scholar
Von Korff, M, Ustun, TB, Ormel, J, Kaplan, I and Simon, GE (1996) Self-report disability in an international primary care study of psychological illness. Journal of Clinical Epidemiology 49, 297–303.Google Scholar
Supplementary material: File

Damone et al. supplementary material

Damone et al. supplementary material 1

Download Damone et al. supplementary material(File)
File 66.6 KB