Prevalence of depression and anxiety among polycystic ovarian syndrome patients: a cross-sectional study

INTRODUCTION

Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders among women in reproductive age group, and defined as a complex metabolic, endocrine, and reproductive disorder that results in hyper androgenism, polycystic ovaries, oligomenorrhoea or amenorrhoea and is associated with insulin resistance.¹

According to Indian fertility society prevalence of PCOS ranges from 3.7% to 22.5%. Majority of the women with PCOS presents with overweight which can contribute to clinical hyper androgenism or alteration in sex steroid hormone synthesis.² In addition to gynaecological, endocrine, metabolic features of PCOS many mental complications are also associated with PCOS.³ Women with PCOS have experienced adverse social, physical, emotional, and psychological consequences that negatively impacted their health. Eating disorders and suicidal behaviours are also noticed among the women with PCOS.⁴ As a result, their social and interpersonal relationships are hampered. Moreover, obesity, hirsutism, hair loss, menstrual abnormalities, and facial acne harmed their physical health. Furthermore, impaired infertility makes them humiliated and lowers their self-confidence, and the available literature was showing that they are at risk of having psychological issues such as anxiety, depression, sadness, and loneliness than others. Hence, the present study was conceptualised to estimate the prevalence of depression and Anxiety including their socio demographic factors among women suffering from PCOS, attending the Gynaecology outpatient department of Gandhi Hospital, Hyderabad. And this obtained data can be utilised by the stakeholders to prepare the services which can help in early diagnosis and treatment of depression and anxiety among the PCOS women.

METHODS

The present study on depression and anxiety among women effected with PCOS at Gandhi Medical College, Telangana was conducted by using following material and methodology. A descriptive crossectional study was conducted among the women diagnosed with PCOS as per (Rotterdam criteria) who were in the age group of 18 to 45 years attending the gynaecology outpatient department Gandhi hospital, Secunderabad, for a period of 3 months (April to June 2022).⁵

The study sample was selected from the women affected with PCOS, who were fulfilling the inclusion criteria, through Convenient sampling method, resulting in a sample size of 65. Women with Pregnancy, mental illness prior to PCOS and PCOS women who has not given consent were excluded from the study. The present study was approved by the Institutional ethical committee.

The data was collected by using study tools (i) pre designed, semi structured and pilot tested questionnaire in local language; (ii) international classification of disease-10 was used for the diagnosis of depression and anxiety among PCOS women; (iii) Hamilton depression and anxiety rating scales was used to assess the severity.^6-8 Data entry and processing was done using Microsoft excel and it was statistically analysed using Microsoft excel version 2010, Epi info software 3.01, and Statistical package for social sciences (SPSS Version 26).

The study categorical variables were summarized with frequencies and percentages, while quantitative variables were summarized by means and standard deviation. All results were presented in tabular form and represented graphically.

The difference in two groups was tested for statistical significance using the Chi-square test, p value less than 0.05 was considered to be statistically significant.

RESULTS

Socio-demographic profile

A total of 65 women already diagnosed with PCOS as per Rotterdam criteria attending the gynaecology outpatient department, Gandhi Hospital, Secunderabad were included in the present study.

The mean age of the study population was 24.2±4.7 years. About 66.1% were living in urban areas and 33.9% were from urban slums. Majority 69.2% of the study participants were Hindus followed by Muslims and Christians. About 44% of the study participants studied graduate followed by intermediate and high school and 40% of the study population were from upper middle class.

About 66.1% of the study population were married and 7.6% were having children. Majority 66.2% of them were not doing physical activity and 80% were having junk food consumption.

The prevalence of depression and anxiety among the study population was 66.1% (n=43), 56.9% (n=37) respectively. The prevalence of mild and moderate depression among the study population was 13.9% and 12.3% respectively where as 9.3% and 30.7% presented with severe and very severe depression. Among the study population around 32.4% presented with mild anxiety, 27.1% and 40.5% presented with moderate and severe anxiety respectively.

Among the study population menstrual irregularities 86.6% was the most common symptom followed by alopecia 73.1%, weight gain 61.2%. Among the study participants, symptoms of acanthosis, alopecia, and infertility are associated with higher proportion of depression.

This association was found to be statistically significant (p value=0.01, 0.0008, 0.01). Study participants presented with acanthosis, alopecia, weight gain, infertility, and menstrual irregularities, had higher prevalence of anxiety. This association was found to be statistically significant (p value=0.005, 0.002, 0.02, 0.00001, 0.006).

DISCUSSION

Present study has shown the mean age of study population was 24.2±4.7 years, which was almost same in Hussain et al in Kashmir valley 24.7±2.3 years and Upadhyaya et al, Uttarakhand i. e.; 25.2±3.6 years.^9,10

In the present study about 66.1% of the study participants were married and 7.6% were having children. Whereas Chaudhari et al study (Mumbai) revealed that 50% and 48.57% of the study participants were married and having children respectively.¹¹ Majority of the study participants were graduates (44.6%); similar results were also observed in Saima et al study in Pakistan where majority of the study participants were graduates (44.5%).¹² The present study revealed that more than half of study participants were belonged to the middle class (52.3%) followed by lower class (29.2%). Similar results were observed in Prathap et al study in Kerala (middle class 49.5 %, lower class 19.4%).¹³

Among the PCOS affected women the prevalence of depression and anxiety was found to be 66.1 % and 56.9% respectively. And almost similar findings were given by Vishnubhotla in Telangana that was 62.9% whereas Habib et al reported low prevalence of anxiety and depression with 25% and 20% respectively this difference may be due to different study tools used in their study.^14,15 In the present study menstrual abnormalities were the most common symptoms 86.6% and acanthosis, alopecia, infertility, weight gain was associated with depression and anxiety. Similar findings were observed by Chaudhari et al where menstrual abnormality was the most common symptom and infertility, alopecia were associated with anxiety and acne was associated with depression.¹¹

Limitations

Due to the cross-sectional nature of the study, causal relationships cannot be established, and some of the data may be subject to recollection bias.

CONCLUSION

Mean age of the study population was 24.2±4.7 years and 2/3^rd of them were from urban area whereas nearly half of them were graduated and hailing from middle class. And 2/3 were married. The present study shown that 2/3^rd of them were having depression and more than half of the study population were presented with anxiety. Menstrual abnormalities were found to be most common symptom followed by alopecia, weight gain, acne.

Recommendations

Symptoms of acanthosis, alopecia, and infertility are associated with higher prevalence of depression and study participants presented with acanthosis, alopecia, weight gain, infertility, and menstrual irregularities, had higher prevalence of anxiety. As most of the symptoms of PCOS are associated with depression and anxiety. Hence, the present study recommends for regular screening of PCOS patients for psychiatric morbidities. Health education should be done regarding the diet modification, regular physical activity, early diagnosis, and treatment in PCOS patients

ACKNOWLEDGEMENTS

We are thankful to faculty, staff, and patients for their support.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. Centers for Disease control and Prevention, 2022. Available at: https://www.cdc.gov/diabetes/basics/pco. Accessed on 10 April 2023.
2. 2. Malik S, Jain K, Talwar P, Prasad S, Dhorepatil B, Devi G. Management of polycystic ovary syndrome in India. Fertil Sci Res. 2014;1:23-43.
3. 3. Yildiz BO, Knochenhauer ES, Azziz R. Impact of obesity on the risk for polycystic ovary syndrome. J Clin Endocrinol Metab. 2008;93(1):162-8.
4. 4. Månsson M, Holte J, Landin-Wilhelmsen K, Dahlgren E, Johansson A, Landén M. Women with polycystic ovary syndrome are often depressed or anxious--a case control study. Psychoneuroendocrinology. 2008;33(8):1132-8.
5. 5. Smet ME, McLennan A. Rotterdam criteria, the end. Australas J Ultrasound Med. 2018;21(2):59-60.
6. 6. Faiad Y, Khoury B, Daouk S, Maj M, Keeley J, Gureje O, et al. Frequency of use of the International Classification of Diseases ICD-10 diagnostic categories for mental and behavioural disorders across world regions. Epidemiol Psychiatr Sci. 2018;27(6):568-76.
7. 7. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23(1):56-62.
8. 8. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23(1):56-62.
9. 9. Hussain A, Chandel RK, Ganie MA, Dar MA, Rather YH, Wani ZA, et al. Prevalence of psychiatric disorders in patients with a diagnosis of polycystic ovary syndrome in kashmir. Indian J Psychol Med. 2015;37(1):66-70.
10. 10. Upadhyaya SK, Sharma A, Agrawal A. Prevalence of anxiety and depression in polycystic ovariansyndrome. Int J Med Sci Public Health 2016;5:681-3.
11. 11. Chaudhari AP, Mazumdar K, Mehta PD. Anxiety, Depression, and Quality of Life in Women with Polycystic Ovarian Syndrome. Indian J Psychol Med. 2018;40(3):239-46.
12. 12. Batool S, Ahmed A. Depression and Anxiety in Women with Polycystic Ovary Syndrome and Its Biochemical Associates. J South Asian Fed Obstetr Gynaecol. 2016;8(1):44-7.
13. 13. Prathap A, Subhalakshmi TP, Varghese PJ. A Cross-sectional Study on the Proportion of Anxiety and Depression and Determinants of Quality of Life in Polycystic Ovarian Disease. Indian J Psychol Med. 2018;40(3):257-62.
14. 14. Vishnubhotla DS, Tenali SN, Fernandez M, Madireddi S. Evaluation of Prevalence of PCOS and Associated Depression, Nutrition, and Family History: A Questionnaire-based Assessment. Indian J Endocrinol Metab. 2022;26(4):341-7.
15. 15. Habib S, Anwar A, Hoda F, Verma R, Akhtar M, Najmi AK. Prevalence of depression, anxiety and quality of life among North Indian polycystic ovary syndrome women: evidence from a prospective observational study. Int J Basic Clin Pharmacol. 2021;10:1360-7.