Abstract
Objectives
To evaluate the depression and anxiety symptoms, or both in adolescents and young women with polycystic ovary syndrome (PCOS) to those without PCOS.
Contents
A comprehensive electronic search was conducted to identify observational studies on PCOS patients (January 1991–December 2020). The population study included adolescents and young women (14–29 years of age) in two groups of cases (with PCOS) and controls (without PCOS) who were diagnosed with PCOS using the Rotterdam or National Institutes of Health criteria (NIH). Symptoms of depression, anxiety, or both, reported separately, were of interest. Mean (SD) of depression or anxiety symptoms, or both, as measured by a quantitatively validated scale for both the case and control groups. All eligible studies were quality assessed using the Newcastle–Ottawa Scale (NOS) tool. The initial database search resulted in the discovery of 1,582 papers, of which 806 were selected after screening the titles and abstracts and removing duplicates. A total of 49 papers were found to be suitable for full-text reading. This meta-analysis included ten studies comprising 941 adolescent/young women (391 with PCOS and 550 without PCOS). The standard mean difference (SMD) and its corresponding confidence interval (CI) at 95 % were used to compare depression or anxiety symptoms, or both, between two groups.
Summary and outlook
The results, which included 192 cases, demonstrated that adolescents/young women with PCOS had significantly more depressive symptoms than those without PCOS (n=360) (SMD 0.72; 95 % CI, 0.09–1.34; Z=2.25, p=0.025; Heterogeneity: I2=89.7 %; p=0.000). Also, the results which included 299 cases demonstrated that adolescents/young women with PCOS had significantly more anxiety symptoms than those without PCOS (n=421) (SMD 0.59; 95 % CI, 0.13–1.05; Z=2.51, p=0.012; Heterogeneity: I2=86.1 %; p=0.000). This meta-analysis demonstrates that adolescent/young women with PCOS have significantly more depression or anxiety symptoms than those without PCOS.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Ethical and legal declarations: I confirm we safeguards to meet ethical and legal standards to writhe the manuscript entitle “Depression and anxiety in adolescents and young women with polycystic ovary syndrome: A systematic review and meta-analysis”.
References
1. Azziz, R, Woods, KS, Reyna, R, Key, TJ, Knochenhauer, ES, Yildiz, BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004;89:2745–9. https://doi.org/10.1210/jc.2003-032046.Search in Google Scholar PubMed
2. Azziz, R, Carmina, E, Dewailly, D, Diamanti-Kandarakis, E, Escobar-Morreale, HF, Futterweit, W, et al.. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril 2009;91:456–88. https://doi.org/10.1016/j.fertnstert.2008.06.035.Search in Google Scholar PubMed
3. Basirat, Z, Faramarzi, M, Esmaelzadeh, S, Abedi Firoozjai, SH, Mahouti, T, Geraili, Z. Stress, depression, sexual function, and alexithymia in infertile females with and without polycystic ovary syndrome: a case-control study. Int J Fertil Steril 2019;13:203–8. https://doi.org/10.22074/ijfs.2019.5703.Search in Google Scholar PubMed PubMed Central
4. Damone, AL, Joham, AE, Loxton, D, Earnest, A, Teede, HJ, Moran, LJ. Depression, anxiety and perceived stress in women with and without PCOS: a community-based study. Psychol Med 2019;49:1510–20. https://doi.org/10.1017/s0033291718002076.Search in Google Scholar PubMed
5. Amiri, FN, Tehrani, FR, Simbar, M, Montazeri, A, Thamtan, RAM. The experience of women affected by polycystic ovary syndrome: a qualitative study from Iran. Int J Endocrinol Metab 2014;12:e13612. https://doi.org/10.5812/ijem.13612.Search in Google Scholar PubMed PubMed Central
6. Amiri, FN, Tehrani, FR, Simbar, M, Thamtan, RAM, Shiva, N. Female gender scheme is disturbed by polycystic ovary syndrome: a qualitative study from Iran. Iran Red Crescent Med J 2014;16:e12423. .10.5812/ircmj.12423Search in Google Scholar PubMed PubMed Central
7. Kerchner, A, Lester, W, Stuart, SP, Dokras, A. Risk of depression and other mental health disorders in women with polycystic ovary syndrome: a longitudinal study. Fertil Steril 2009;91:207–12. https://doi.org/10.1016/j.fertnstert.2007.11.022.Search in Google Scholar PubMed
8. Zehravi, M, Maqbool, M, Ara, I. Depression and anxiety in women with polycystic ovarian syndrome: a literature survey. Int J Adolesc Med Health 2021;33:367–73. https://doi.org/10.1515/ijamh-2021-0092.Search in Google Scholar PubMed
9. Delanerolle, G, Ayis, SA, Barzilova, V, Phiri, P, Yutain, Z, Ranaweera, S, et al.. A systematic review and meta-analysis of polycystic ovary syndrome and mental health among black asian and minority ethnic populations; medRxiv; 2022. Available from: https://europepmc.org/article/ppr/ppr465640#impact10.1101/2022.03.05.22271948Search in Google Scholar
10. Wang, Y, Ni, Z, Li, K. The prevalence of anxiety and depression of different severity in women with polycystic ovary syndrome: a meta-analysis. Gynecol Endocrinol 2021;37:1072–8. https://doi.org/10.1080/09513590.2021.1942452.Search in Google Scholar PubMed
11. Cooney, LG, Lee, I, Sammel, MD, Dokras, A. High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod 2017;32:1075–91. https://doi.org/10.1093/humrep/dex044.Search in Google Scholar PubMed
12. Blay, SL, Aguiar, JV, Passos, IC. Polycystic ovary syndrome and mental disorders: a systematic review and exploratory meta-analysis. Neuropsychiatr Dis Treat 2016;12:2895–903. https://doi.org/10.2147/ndt.s91700.Search in Google Scholar
13. Veltman-Verhulst, SM, Boivin, J, Eijkemans, MJ, Fauser, BJ. Emotional distress is a common risk in women with polycystic ovary syndrome: a systematic review and meta-analysis of 28 studies. Hum Reprod Update 2012;18:638–51. https://doi.org/10.1093/humupd/dms029.Search in Google Scholar PubMed
14. Dokras, A, Clifton, S, Futterweit, W, Wild, R. Increased risk for abnormal depression scores in women with polycystic ovary syndrome: a systematic review and meta-analysis. Obstet Gynecol 2011;117:145–52. https://doi.org/10.1097/ogx.0b013e318227fc6a.Search in Google Scholar
15. Naz, MSG, Tehrani, FR, Majd, HA, Ahmadi, F, Ozgoli, G, Fakari, FR, et al.. The prevalence of polycystic ovary syndrome in adolescents: a systematic review and meta-analysis. Int J Reprod Biomed 2019;17:533–42. https://doi.org/10.18502/ijrm.v17i8.4818.Search in Google Scholar PubMed PubMed Central
16. Çoban, ÖG, Tulacı, ÖD, Adanır, AS, Önder, A. Psychiatric disorders, self-esteem, and quality of life in adolescents with polycystic ovary syndrome. J Pediatr Adolesc Gynecol 2019;32:600–4. https://doi.org/10.1016/j.jpag.2019.07.008.Search in Google Scholar PubMed
17. Varanasi, LC, Subasinghe, A, Jayasinghe, YL, Callegari, ET, Garland, SM, Gorelik, A, et al.. Polycystic ovarian syndrome: prevalence and impact on the wellbeing of Australian women aged 16-29 years. Aust N Z J Obstet Gynaecol 2018;58:222–33. https://doi.org/10.1111/ajo.12730.Search in Google Scholar PubMed
18. Almis, H, Orhon, F, Bolu, S, Almis, BH. Self-Concept, depression, and anxiety levels of adolescents with polycystic ovary syndrome. J Pediatr Adolesc Gynecol 2021;34:311–6. https://doi.org/10.1016/j.jpag.2020.12.011.Search in Google Scholar PubMed
19. Sadeeqa, S, Mustafa, T, Latif, S. Polycystic ovarian syndrome-related depression in adolescent girls: a review. J Pharm BioAllied Sci 2018;10:55–9. https://doi.org/10.4103/jpbs.jpbs_1_18.Search in Google Scholar
20. Liberati, A, Altman, DG, Tetzlaff, J, Mulrow, C, Gøtzsche, PC, Ioannidis, JP, et al.. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009;339:b2700. https://doi.org/10.1136/bmj.b2700.Search in Google Scholar PubMed PubMed Central
21. Group REA-SPCW. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:19–25. https://doi.org/10.1016/j.fertnstert.2003.10.004.Search in Google Scholar PubMed
22. Zawadeski, J, Dunaif, A. Diagnostic criteria for PCOS: towards a more rational approach. PCOS Boston: Blackwell Scientific; 1992:377–84 pp.Search in Google Scholar
23. Wells, GA, Wells, G, Shea, B, Shea, B O’Connell, D, Peterson, J, et al.. The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2014. Corpus ID: 79550924. Available from: https://www.semanticscholar.org/paper/The-Newcastle-Ottawa-Scale-(NOS)-for-Assessing-the-Wells-Wells/c293fb316b6176154c3fdbb8340a107d9c8c82bfSearch in Google Scholar
24. Serghiou, S, Goodman, SN. Random-effects meta-analysis: summarizing evidence with caveats. JAMA 2019;321:301–2. https://doi.org/10.1001/jama.2018.19684.Search in Google Scholar PubMed
25. Emeksiz, HC, Bideci, A, Nalbantoğlu, B, Nalbantoğlu, A, Çelik, C, Yulaf, Y, et al.. Anxiety and depression states of adolescents with polycystic ovary syndrome. Turk J Med Sci 2018;48:531–6. https://doi.org/10.3906/sag-1708-131.Search in Google Scholar PubMed
26. Kogure, GS, Ribeiro, VB, Lopes, IP, Furtado, CLM, Kodato, S, Silva de Sá, MF, et al.. Body image and its relationships with sexual functioning, anxiety, and depression in women with polycystic ovary syndrome. J Affect Disord 2019;253:385–93. https://doi.org/10.1016/j.jad.2019.05.006.Search in Google Scholar PubMed
27. Guidi, J, Gambineri, A, Zanotti, L, Fanelli, F, Fava, GA, Pasquali, R. Psychological aspects of hyperandrogenic states in late adolescent and young women. Clin Endocrinol 2015;83:872–8. https://doi.org/10.1111/cen.12783.Search in Google Scholar PubMed
28. Ghazeeri, G, Fakih, A, Abbas, HA, Harajly, S, Awwad, J. Anxiety, cognitive, and depressive assessment in adolescents with polycystic ovarian syndrome: a pilot study. J Pediatr Adolesc Gynecol 2013;26:269–73. https://doi.org/10.1016/j.jpag.2013.04.005.Search in Google Scholar PubMed
29. Adali, E, Yildizhan, R, Kurdoglu, M, Kolusari, A, Edirne, T, Sahin, HG, et al.. The relationship between clinico-biochemical characteristics and psychiatric distress in young women with polycystic ovary syndrome. J Int Med Res 2008;36:1188–96. https://doi.org/10.1177/147323000803600604.Search in Google Scholar PubMed
30. Sari, SA, Celik, N, Cicek, AU. Body perception, self-esteem, and comorbid psychiatric disorders in adolescents diagnosed with polycystic ovary syndrome. J Pediatr Adolesc Gynecol 2020;33:691–6. https://doi.org/10.1016/j.jpag.2020.08.018.Search in Google Scholar PubMed
31. Laggari, V, Diareme, S, Christogiorgos, S, Deligeoroglou, E, Christopoulos, P, Tsiantis, J, et al.. Anxiety and depression in adolescents with polycystic ovary syndrome and Mayer-Rokitansky-Küster-Hauser syndrome. J Psychosom Obstet Gynaecol 2009;30:83–8. https://doi.org/10.1080/01674820802546204.Search in Google Scholar PubMed
32. Gul, A, Gul, H, Ergur, AT, Ozen, NE. Anxiety-anger relationship in hyperandrogenemia: a comparative study with polycystic ovary syndrome (PCOS) and healthy control adolescents. Psychiatry Behav Sci 2018;8:26. https://doi.org/10.5455/jmood.20180206055429.Search in Google Scholar
33. Zachurzok, A, Pasztak-Opilka, A, Malecka-Tendera, E. Is there the relationship between anxiety and depression level and clinical presentation of polycystic ovary syndrome in adolescent girls? ESPE Abstracts 2019;92:P1–131.10.1155/2018/3269618Search in Google Scholar PubMed PubMed Central
34. Duman, M, Durgun Ozan, Y. A comparison of physical anxiety levels in adolescent and young women with polycystic ovary syndrome and in other healthy adolescent and young women in a university hospital, Turkey. J Health Res 2020;34:515–22. https://doi.org/10.1108/jhr-08-2019-0189.Search in Google Scholar
35. Barry, JA, Kuczmierczyk, AR, Hardiman, PJ. Anxiety and depression in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod 2011;26:2442–51. https://doi.org/10.1093/humrep/der197.Search in Google Scholar PubMed
36. Maya, J, Siegel, J, Cheng, TQ, Rousseau-Pierre, T. Prevalence and risk factors of polycystic ovarian syndrome among an ethnically diverse overweight/obese adolescent population. Int J Adolesc Med Health 2022;34:20190109. https://doi.org/10.1515/ijamh-2019-0109.Search in Google Scholar PubMed
37. Naqvi, SH, Moore, A, Bevilacqua, K, Lathief, S, Williams, J, Naqvi, N, et al.. Predictors of depression in women with polycystic ovary syndrome. Arch Womens Ment Health 2015;18:95–101. https://doi.org/10.1007/s00737-014-0458-z.Search in Google Scholar PubMed
38. Himelein, MJ, Thatcher, SS. Depression and body image among women with polycystic ovary syndrome. J Health Psychol 2006;11:613–25. https://doi.org/10.1177/1359105306065021.Search in Google Scholar PubMed
39. Trent, M, Austin, SB, Rich, M, Gordon, CM. Overweight status of adolescent girls with polycystic ovary syndrome: body mass index as mediator of quality of life. Ambul Pediatr 2005;5:107–11. https://doi.org/10.1367/a04-130r.1.Search in Google Scholar
40. Franks, S. Polycystic ovary syndrome in adolescents. Int J Obes 2008;32:1035–41. https://doi.org/10.1038/ijo.2008.61.Search in Google Scholar PubMed
41. Weiner, CL, Primeau, M, Ehrmann, DA. Androgens and mood dysfunction in women: comparison of women with polycystic ovarian syndrome to healthy controls. Psychosom Med 2004;66:356–62. https://doi.org/10.1097/00006842-200405000-00011.Search in Google Scholar
42. Cooney, LG, Dokras, A. Depression and anxiety in polycystic ovary syndrome: etiology and treatment. Curr Psychiatry Rep 2017;19:83. https://doi.org/10.1007/s11920-017-0834-2.Search in Google Scholar PubMed
43. Rasgon, NL, Rao, RC, Hwang, S, Altshuler, LL, Elman, S, Zuckerbrow-Miller, J, et al.. Depression in women with polycystic ovary syndrome: clinical and biochemical correlates. J Affect Disord 2003;74:299–304. https://doi.org/10.1016/s0165-0327(02)00117-9.Search in Google Scholar PubMed
44. Weber, B, Lewicka, S, Deuschle, M, Colla, M, Heuser, I. Testosterone, androstenedione and dihydrotestosterone concentrations are elevated in female patients with major depression. Psychoneuroendocrinology 2000;25:765–71. https://doi.org/10.1016/s0306-4530(00)00023-8.Search in Google Scholar PubMed
45. Elsenbruch, S, Benson, S, Hahn, S, Tan, S, Mann, K, Pleger, K, et al.. Determinants of emotional distress in women with polycystic ovary syndrome. Hum Reprod 2006;21:1092–9. https://doi.org/10.1093/humrep/dei409.Search in Google Scholar PubMed
46. Dixon, JB, Dixon, ME, O’Brien, PE. Depression in association with severe obesity: changes with weight loss. Arch Intern Med 2003;163:2058–65. https://doi.org/10.1001/archinte.163.17.2058.Search in Google Scholar PubMed
47. Veldhuis, JD, Pincus, SM, Garcia-Rudaz, MC, Ropelato, MG, Escobar, ME, Barontini, M. Disruption of the joint synchrony of luteinizing hormone, testosterone, and androstenedione secretion in adolescents with polycystic ovarian syndrome. J Clin Endocrinol Metab 2001;86:72–9. https://doi.org/10.1210/jc.86.1.72.Search in Google Scholar
48. Jones, GL, Balen, AH, Ledger, WL. Health-related quality of life in PCOS and related infertility: how can we assess this? Hum Fertil 2008;11:173–85. https://doi.org/10.1080/14647270802078179.Search in Google Scholar PubMed
49. Ahmadi, M, Faramarzi, M, Basirat, Z, Kheirkhah, F, Chehrazi, M, Ashabi, F. Mental and personality disorders in infertile women with polycystic ovary: a case-control study. Afr Health Sci 2020;20:1241–9. https://doi.org/10.4314/ahs.v20i3.28.Search in Google Scholar PubMed PubMed Central
50. Siu, AL, Bibbins-Domingo, K, Grossman, DC, Baumann, LC, Davidson, KW, Ebell, M, et al.. Screening for depression in adults: US preventive services task force recommendation statement. JAMA 2016;315:380–7. https://doi.org/10.1001/jama.2015.18392.Search in Google Scholar PubMed
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