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Wu JR, Chen VCH, Fang YH, Hsieh CC, Wu SI. The associates of anxiety among lung cancer patients: Dehydroepiandrosterone (DHEA) as a potential biomarker. BMC Cancer 2024; 24:476. [PMID: 38622547 PMCID: PMC11021003 DOI: 10.1186/s12885-024-12195-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/27/2024] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVE Anxiety is a prevalent comorbidity in lung cancer (LC) patients associated with a decline in quality of life. Dehydroepiandrosterone (DHEA), a neuroactive steroid, levels rise in response to stress. Prior research on the association between DHEA and anxiety has yielded contradictory results and no study has investigated this association in LC patients. METHODS A total of 213 patients with LC were recruited from a general hospital. Data on demographic and cancer-related variables were collected. Using the Chinese version of the Hospital Anxiety and Depression Scale (HADS), the degree of anxiety was determined. Cortisol, DHEA, and Dehydroepiandrosterone sulfate (DHEA-S) levels in saliva were measured. Adjusting for confounding variables, a multivariate regression analysis was conducted. RESULTS 147 men and 66 women comprised our group with an average age of 63.75 years. After accounting for demographic and treatment-related factors, anxiety levels were significantly correlated with, post-traumatic stress symptoms (PTSSs) (β = 0.332, p < 0.001) and fatigue (β = 0.247, p = 0.02). Association between anxiety and three factors, including DHEA, PTSSs, and fatigue, was observed in patients with advanced cancer stages (III and IV) (DHEA β = 0.319, p = 0.004; PTSS β = 0.396, p = 0.001; fatigue β = 0.289, p = 0.027) and those undergoing chemotherapy (DHEA β = 0.346, p = 0.001; PTSS β = 0.407, p = 0.001; fatigue β = 0.326, p = 0.011). CONCLUSIONS The association between anxiety and DHEA remained positive in advanced cancer stages and chemotherapy patients. Further study is necessary to determine whether DHEA is a potential biomarker of anxiety in LC patients.
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Affiliation(s)
- Jia-Rong Wu
- Department of Psychiatry, Chang Gung Memorial Hospital, 6, Sec. West Chia-Pu Road, 613, Pu-Zi City, Chiayi County, Taiwan
| | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chang Gung Memorial Hospital, 6, Sec. West Chia-Pu Road, 613, Pu-Zi City, Chiayi County, Taiwan
- School of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan Tao-Yuan, Taiwan
| | - Yu-Hung Fang
- Division of Thoracic Oncology, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, 6, Sec. West Chia-Pu Road, 613, Pu-Zi City, Chiayi County, Taiwan
| | - Ching-Chuan Hsieh
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang-Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan Tao-Yuan, Taiwan
- Department of Surgery, Chang-Gung Memorial Hospital, 6, Sec. West Chia-Pu Road, 613, Pu-Zi City, Chiayi County, Taiwan
| | - Shu-I Wu
- Department of Medicine, Mackay Medical College, No.46, Sec.3, Zhongzheng Rd., Sanzhi Dist, 25245, New Taipei City, Taiwan.
- Department of Psychiatry, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., 104, Taipei City, Taiwan.
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Hu R, Geng Y, Huang Y, Liu Z, Li F, Dong H, Ma W, Song K, Zhang M, Zhang Z, Song Y. New insights into the interaction between polycystic ovary syndrome and psychiatric disorders: A narrative review. Int J Gynaecol Obstet 2024; 164:387-420. [PMID: 37458179 DOI: 10.1002/ijgo.14988] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 01/15/2024]
Abstract
Polycystic ovary syndrome (PCOS) is a prevalent endocrine disease characterized by hyperandrogenism, ovulatory dysfunction, and ovarian polycystic changes, which combines with reproductive problems, metabolic disorders, and psychological disorders to exhibit a far-reaching impact on the physical and mental health of women. We reviewed previous research and discovered that psychiatric disorders are more common in PCOS patients and their children, potentially exacerbating the condition and creating a vicious loop. To understand the reasons, relevant articles were collected following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines from PubMed, Web of Science, and Cochrane Library, through December 2022. Evidence suggested that PCOS-related clinical manifestations, hyperandrogenism, insulin resistance, obesity, gut dysbiosis, and other variables may increase the risk of psychiatric disorders in patients. In turn, psychiatric disorders may aggravate the pathologic process of PCOS and increase the difficulty of the treatment. We systematically reported the mechanisms underlying the psychiatric disorders-PCOS interactions, intending to provide potential ways to break the vicious cycle and lay the groundwork for future research. However, research on PCOS and psychiatric disorders were still in initial stages, which limited the scope of this review. More studies are needed to further verify our findings.
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Affiliation(s)
- Runan Hu
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuli Geng
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanjing Huang
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhuo Liu
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fan Li
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haoxu Dong
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenwen Ma
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kunkun Song
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mingmin Zhang
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhuo Zhang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yufan Song
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Standeven LR, Ho A, Hantsoo L. Bridging the Gap: Integrating Awareness of Polycystic Ovary Syndrome Into Mental Health Practice. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:53-62. [PMID: 38694159 PMCID: PMC11058927 DOI: 10.1176/appi.focus.20230024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age. Individuals with PCOS report reduced quality of life compared with those without PCOS, with possible contributing factors including infertility, hirsutism, irregular menses, and weight gain. Recent literature also supports increased associations between PCOS and co-occurring psychiatric conditions, particularly depression, anxiety, bipolar disorder, and eating disorders. It is concerning that a higher prevalence of suicidal ideation has been observed in individuals with PCOS. Given the high rates of psychiatric burden among those with PCOS, psychiatric care providers are well suited to be on the front lines of screening for psychiatric symptoms as well as initiating treatment. Current interventions include lifestyle changes (improving exercise and nutrition), pharmacological treatments (e.g., insulin-sensitizing agents, oral contraceptives, and psychotropic drugs), and psychotherapeutic interventions (e.g., cognitive-behavioral therapy and mindfulness-based therapy). This review provides an overview of recent research on the prevalence of comorbid psychiatric conditions, a foundation in PCOS-specific symptom screening and diagnosis, and an overview of treatments for psychiatric symptoms among individuals with PCOS.
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Affiliation(s)
- Lindsay R Standeven
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore
| | - Annie Ho
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore
| | - Liisa Hantsoo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore
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Polo-Kantola P, Toffol E. The Relationship Between Mood and Sleep in Different Female Reproductive States. Sleep Med Clin 2023; 18:385-398. [PMID: 38501512 DOI: 10.1016/j.jsmc.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Mood and sleep are tightly interrelated. Mood and sleep symptoms and disorders are more common in women than in men and often associated with reproductive events. This article reviews the current literature on the reciprocal relationships between mood and sleep across reproductive phases in women, such as menstrual cycle and related disorders, pregnancy, climacteric, and use of hormonal contraception and hormone replacement therapy. Mood and sleep symptoms seem to covary in relation to physiologic and pathologic reproductive conditions, although the relationship seems more clear for subjective than objective sleep.
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Affiliation(s)
- Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku, Finland.
| | - Elena Toffol
- Department of Public Health, University of Helsinki, PO Box 20, Helsinki 00014, Finland
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Santos IK, Pichini GS, Daniel d. Ferreira C, Dantas PB, Browne RAV, de Queiros V, Soares GM, Gonçalves AK, Cabral BG, Maranhão TMO, Dantas PMS. Effects of high-intensity interval training in combination with detraining on mental health in women with polycystic ovary syndrome: A randomized controlled trial. Front Physiol 2022; 13:948414. [PMID: 36246128 PMCID: PMC9556821 DOI: 10.3389/fphys.2022.948414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
This study aimed to investigate the effects of high-intensity interval training (HIIT) and detraining on the quality of life and mental health of 23 women with polycystic ovary syndrome (PCOS). Participants were randomly assigned to the HIIT group (n = 12) [26.0 ± 3.92] and the control group (n = 11) [26.6 ± 4.68]. HIIT sessions comprised 40-60 min, 3 days a week for 12 weeks, followed by detraining for 30 days. We assessed the quality of life using the Short Form Health Survey (SF-36) and mental health by the Depression, Anxiety, and Stress Scale (DASS-21), and we compared group changes on these variables at three time points: 1) at baseline, 2) after 12 weeks of HIIT (or no training), and 3) after 30 days of detraining (or no training). The participants were classified as overweight and had a high percentage of body fat (41.5%) and irregular menstrual cycles (amenorrhea) (66.7%). Throughout training, participants in the HIIT group reported improvements in domains of the quality of life: functional capacity (M = 80.4 ± 3.4 vs. M = 87.0 ± 3.1), physical role functioning (M = 72.5 ± 9.4 vs. M = 81.8 ± 9.7), and general health perception (M = 48.6 ± 4.6 vs. M = 69.0 ± 5.8). Regarding anxiety symptoms (M = 6.4 ± 1.6 vs. M = 3.7 ± 0.7) and depression symptoms (M = 6.7 ± 1.6 vs. M = 3.8 ± 0.9), those reduced significantly after HIIT. After a 30-day detraining period, there was an increase in the significant change in the quality of life; however, domains of mental health showed instability. In summary, the HIIT program promoted improvements in the quality of life and mental health in women with PCOS. The 30 days of detraining changed the benefits in the quality of life and stability in the changes in mental health domains.
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Polycystic ovary syndrome and postpartum depression among Hispanics and non-Hispanics: a population-based study. AJOG GLOBAL REPORTS 2022; 2. [PMID: 36060826 PMCID: PMC9438401 DOI: 10.1016/j.xagr.2022.100070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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PCOS and Depression: Common Links and Potential Targets. Reprod Sci 2021; 29:3106-3123. [PMID: 34642910 DOI: 10.1007/s43032-021-00765-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 10/04/2021] [Indexed: 12/16/2022]
Abstract
PCOS or polycystic ovary syndrome is a common endocrine disorder that occurs during the reproductive age in females. It manifests in the form of a wide range of symptoms including (but not limited to) hirsutism, amenorrhea, oligomenorrhea, obesity, acne vulgaris, infertility, alopecia, and insulin resistance. The incidence of depression in PCOS population is increasing as compared to the general population. Increased depression in PCOS significantly alters the quality of life (QOL) of affected females. Also, self-esteem is found to be low in both depression and PCOS. The loss in self-esteem in such patients can be largely attributed to the associated factors including (but not limited to) obesity, acne, androgenic alopecia, and hirsutism. The reason behind the occurrence of depression in PCOS remains elusive to date. Literature suggests that there is an overlap of clinical symptoms between depression and PCOS. As the symptoms overlap, there is a possibility of common associations between depression, PCOS, and PCOS-associated abnormalities including insulin resistance (IR), obesity, CVD, and androgen excess. Studies demonstrate that depression is an inflammatory disorder marked with increased levels of inflammatory markers. On the other hand, PCOS is also regarded as a pro-inflammatory state that is characterized by increased levels of pro-inflammatory markers. Thus, there is a possibility of an inflammatory relationship existing between depression and PCOS. It is also possible that the inflammatory markers in PCOS can cross the blood-brain barrier (BBB) leading to the development of depression. Through the present review, we have attempted to shed light on common associations/shared links between depression and PCOS with respect to the levels of cortisol, androgen, vitamin D, neurotransmitters, monoaminoxidase (MAO), and insulin-like growth factor-1 (IGF-1). Tracking down common associations between depression and PCOS will help find potential drug therapies and improve the QOL of females with depression in PCOS.
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8
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Fatima I, Yaqoob S, Jamil F, Butt A. Relationship between loci of control and health-promoting behaviors in Pakistani women with polycystic ovary syndrome: coping strategies as mediators. BMC WOMENS HEALTH 2021; 21:356. [PMID: 34627210 PMCID: PMC8502314 DOI: 10.1186/s12905-021-01489-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 09/24/2021] [Indexed: 11/17/2022]
Abstract
Background/Objectives Understanding the factors that promote healthy lifestyle behaviors in women with polycystic ovary syndrome is of substantial importance. Health-promoting lifestyle behaviors (HPLB) have been observed to be effective in managing various symptoms related to PCOS. This study aimed to examine the relationship between loci of control and health-promoting lifestyle behaviors in Pakistani women with polycystic ovary syndrome and the mediating role of coping strategies. Method A correlational study was carried out with 145 unmarried women with polycystic ovary syndrome diagnosed by a gynecologist using the Rotterdam Criteria of 2003 (M age = 24.75 years). Participants were recruited from public sector hospitals in Lahore, Punjab, Pakistan and a series of hierarchical regression analyses were used to analyze results. Results Findings suggest that women with internal and powerful others locus of control use more active practical coping strategies and less active distractive coping strategies. These women also get more involved in health-promoting behaviors. On the other hand, those with a high level of chance locus of control use less active practical coping strategies and more active distractive coping strategies. In turn, they engage less in health-promoting behaviors. Conclusion Health professionals should consider the effects of different types of locus of control and coping strategies when planning interventions for women with polycystic ovary syndrome.
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Affiliation(s)
- Iram Fatima
- Institute of Applied Psychology, University of the Punjab, Canal Road, Quaid-e-Azam Campus, Lahore, Pakistan.
| | - Sahar Yaqoob
- Institute of Applied Psychology, University of the Punjab, Canal Road, Quaid-e-Azam Campus, Lahore, Pakistan
| | - Farhat Jamil
- Institute of Psychology, Beaconhouse National University, Lahore, Pakistan
| | - Amna Butt
- Institute of Psychology, Beaconhouse National University, Lahore, Pakistan
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9
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Yin MXC, Du LB, Zou XN, Fung YL, Sun YY, Chan CHY, Chan CLW. Can Psychosocial Intervention Suppress Testosterone and Triglycerides Among Women With Polycystic Ovary Syndrome? A Feasibility Trial. Front Psychol 2021; 12:690539. [PMID: 34367014 PMCID: PMC8339270 DOI: 10.3389/fpsyg.2021.690539] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/25/2021] [Indexed: 11/13/2022] Open
Abstract
Women with polycystic ovary syndrome (PCOS) suffer significant psychological distress, which may activate the hypothalamus-pituitary-ovary axis and further affect their physiological state. They often experience elevated levels of testosterone and triglycerides. Considering reports of psychological distress among women with PCOS, this study aimed to develop a psychosocial intervention to improve their emotional and physical health, particularly in Chinese society. This pilot study employed the Integrative Body-Mind-Spirit (I-BMS) intervention model for women with PCOS in China. After a 2 h health information session, 18 participants were randomly assigned to the I-BMS group (9) or the control group (9). The intervention group received 6 weekly, 3 h I-BMS sessions. Pre- and post-blood tests and psychosocial questionnaires were collected from all participants. Retention to treatment was high with 79.6% treatment adherence gained and an overall average of five sessions completed. Compared with the control group, depression and anxiety symptoms reduced significantly for those in the intervention group (d = -1.24, p < 0.05 and d = -1.33, p < 0.01), their health-related quality of life improved significantly (d = 1.02, p < 0.01) both at post-intervention and 3 month follow-up, and their testosterone and triglycerides levels reduced significantly (d = -0.97, p < 0.001 and d = -0.41, p < 0.05) after joining the intervention. The I-BMS model is feasible and appears promising in improving psychological health, and reducing testosterone and triglyceride levels, in women with PCOS in China. Clinical Trial Registration: www.chictr.org.cn, identifier ChiCTR1900027606.
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Affiliation(s)
- Margaret X. C. Yin
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - L. B. Du
- Reproductive Medicine Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - X. N. Zou
- Kids Caring Corner, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Y. L. Fung
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Y. Y. Sun
- Kids Caring Corner, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Celia H. Y. Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong, China
| | - Cecilia L. W. Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong, China
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Standeven LR, Olson E, Leistikow N, Payne JL, Osborne LM, Hantsoo L. Polycystic Ovary Syndrome, Affective Symptoms, and Neuroactive Steroids: a Focus on Allopregnanolone. Curr Psychiatry Rep 2021; 23:36. [PMID: 33881645 PMCID: PMC8060230 DOI: 10.1007/s11920-021-01244-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW To provide an overview of existing studies on alterations in gonadal and neuroactive steroids (NASs) and mood symptoms among women with polycystic ovary syndrome (PCOS). RECENT FINDINGS Recent studies have demonstrated a previously underappreciated association between PCOS and comorbid depression and anxiety. However, most studies on affective symptoms among women with PCOS have been cross-sectional, limiting our knowledge about fluctuations in symptoms over the menstrual cycle and reproductive lifespan for women with PCOS, as well as the potential interplay between NAS alterations and mood symptoms. Changes in the NAS allopregnanolone (ALLO) have been implicated in several reproductive-related psychiatric disorders (e.g., premenstrual dysphoric disorder (PMDD) and postpartum depression (PPD)) as well as in normal reproductive functioning, warranting further investigation for its potential role in the psychiatric symptoms observed in women with PCOS. Prospective studies evaluating associations between psychiatric symptoms and NAS are needed to elucidate the biological causes of the increased rates of psychiatric symptoms among women with PCOS and inform clinical treatment. ALLO, with its role in normal reproductive function, menstrual dysregulation among women with PCOS, and reproductive-related psychiatric conditions, makes it a particularly intriguing candidate for future investigation.
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Affiliation(s)
- Lindsay R Standeven
- Women's Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Elizabeth Olson
- School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Nicole Leistikow
- Department of Psychiatry, University of Maryland, Baltimore, MD, USA
| | - Jennifer L Payne
- Women's Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lauren M Osborne
- Women's Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Liisa Hantsoo
- Women's Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Yang Y, Deng H, Li T, Xia M, Liu C, Bu XQ, Li H, Fu LJ, Zhong ZH. The mental health of Chinese women with polycystic ovary syndrome is related to sleep disorders, not disease status. J Affect Disord 2021; 282:51-57. [PMID: 33388474 DOI: 10.1016/j.jad.2020.12.084] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/27/2020] [Accepted: 12/22/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Mental health disorders are highly prevalent in polycystic ovary syndrome (PCOS) cases. The etiology for anxiety/depression in women with PCOS still remains unclear, due to conflicting results. AIM To examine whether an association exists between the mental health of Chinese women with PCOS and various indicators such as their disease characteristics, biochemistry results and sleep status. METHODS During July 2018 and January 2020, our study included a total of 433 women diagnosed with PCOS at Chongqing Hospital of Traditional Chinese Medicine. Sleep-related variables were evaluated by the Pittsburgh Sleep Quality Index (PSQI), anxiety and depression values were quantified by the Hospital Anxiety and Depression Scale (HADS), and biochemistry results were collected from the medical records of the patients. RESULTS 26.6% patients resulted as positive anxiety and 23.6% as positive depression. We found significant associations between anxiety/depression status and sleep conditions of PCOS patients. More specifically, anxiety significantly associated with sleep quality OR (95%CI) = 1.611 (1.147-2.261), sleep disturbance 2.326 (1.468-3.685) and daytime dysfunction 1.457 (1.122-1.891). Similarly, depression significantly associated with sleep quality 1.467 (1.043-2.063), sleep disturbance 1.624 (1.030-2.561) and daytime dysfunction 1.406 (1.077-1.836). There was no association detected between mental health and disease characteristics, as well as reproductive and metabolic indicators in PCOS. LIMITATION Cross-sectional nature of the data prevents causal associations, selection bias of a hospital-based population. CONCLUSIONS Sleep-related disorders might be involved in the etiology and development of the anxiety/depression observed in PCOS cases. We propose that management of sleep disorders should be an integral part of the disease management of women with PCOS.
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Affiliation(s)
- Yin Yang
- Department of Epidemiology, School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Hui Deng
- Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China; The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tian Li
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Min Xia
- Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Chang Liu
- Joint International Research Laboratory of Reproduction and Development, Department of Reproductive Biology, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Xiao-Qing Bu
- Department of Epidemiology, School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Hang Li
- Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Li-Juan Fu
- Department of Herbal Medicine, School of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China..
| | - Zhao-Hui Zhong
- Department of Epidemiology, School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China.
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12
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Gnawali A, Patel V, Cuello-Ramírez A, Al Kaabi AS, Noor A, Rashid MY, Henin S, Mostafa JA. Why are Women With Polycystic Ovary Syndrome at Increased Risk of Depression? Exploring the Etiological Maze. Cureus 2021; 13:e13489. [PMID: 33777576 PMCID: PMC7990040 DOI: 10.7759/cureus.13489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a complex and common multisystemic disorder. Women with PCOS have up to eight times higher prevalence of depression than control groups. This paper aims to explore the underlying risk factors for developing depression in this high-risk group. Studies indicate an interplay of multiple mechanisms that place women with PCOS at an increased risk for depression. The pathophysiology thought to play a role includes disturbances in the endocrine axes and changes to the metabolic pathway. The risk of depression is independently linked to insulin resistance and obesity in this population. However, rates of depression were still higher than control groups when accounting for these variables, demonstrating that they are not the only mechanism causing depression. The clinical manifestations of hyperandrogenism and menstrual abnormalities may compound negative views and lower self-esteem and negatively impact mood. Many of these women also struggle with infertility, and due to the added external pressures like societal beliefs and culture, they may be further negatively impacted and worsen their depressive symptoms. The prevalence of depression in women with PCOS is high; thus, this paper highlights the essential understanding of the underlying mechanisms at play. This is to better aid in addressing the fundamental cause of depression in this high-risk group effectively.
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Affiliation(s)
- Anupa Gnawali
- Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Viral Patel
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Anoud S Al Kaabi
- Neonatology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Asfa Noor
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mohammed Y Rashid
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Shereen Henin
- Internal Medicine, Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Jihan A Mostafa
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Yoshida T, Saito K, Kawamura T, Ishikawa T, Kato T, Matsubara K, Miyasaka N, Miyado M, Fukami M. Circulating steroids and mood disorders in patients with polycystic ovary syndrome. Steroids 2021; 165:108748. [PMID: 33141064 DOI: 10.1016/j.steroids.2020.108748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/27/2020] [Accepted: 10/04/2020] [Indexed: 10/23/2022]
Abstract
Aberrant androgen metabolism is a characteristic feature of polycystic ovary syndrome (PCOS). Various androgens as well as their precursors and metabolites can accumulate in the blood of PCOS patients. Although these steroids include neuroactive steroids, such as allopregnanolone and androstenedione (Δ4A), it remains unknown whether altered blood steroid levels contribute to the high risk of mood disorders in PCOS. In this study, we measured blood levels of 11 steroids in 25 PCOS patients using liquid chromatography-tandem mass spectrometry and chemiluminescent enzyme immunoassay, and assessed the psychological status of these patients using the Hospital Anxiety and Depression Scale (HADS) questionnaire. We also examined age and the degree of metabolic abnormalities of each patient. Steroid values of the patients were compared to our previous data from 31 eumenorrheic women. As a result, 20 patients exhibited aberrant blood levels of one or more of the 11 tested steroids. In most cases, Δ4A and allopregnanolone levels were within or close to the reference ranges. Levels of four steroids were negatively correlated with patients' age, while no correlation was observed between steroid values and metabolic conditions. Seven patients showed high HADS scores. HADS scores were correlated with blood Δ4A levels even after stratifying by body mass indexes, but not with the levels of other steroids or clinical data. These results indicate that the high frequency of anxiety and depression in PCOS patients cannot be ascribed to altered blood levels of a specific steroid, although there may be a weak association between circulating Δ4A levels and psychological conditions of the patients.
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Affiliation(s)
- Tomoko Yoshida
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan; Department of Advanced Pediatric Medicine, Tohoku University School of Medicine, Tokyo, Japan
| | - Kazuki Saito
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan; Department of Pediatrics, Perinatal and Maternal Medicine (Ibaraki), Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Tomonori Ishikawa
- Department of Pediatrics, Perinatal and Maternal Medicine (Ibaraki), Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsuguhiko Kato
- Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Keiko Matsubara
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Naoyuki Miyasaka
- Department of Comprehensive Reproductive Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mami Miyado
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Maki Fukami
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
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14
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Mulligan EM, Hajcak G, Crisler S, Meyer A. Increased dehydroepiandrosterone (DHEA) is associated with anxiety in adolescent girls. Psychoneuroendocrinology 2020; 119:104751. [PMID: 32559611 PMCID: PMC7423745 DOI: 10.1016/j.psyneuen.2020.104751] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 05/26/2020] [Accepted: 05/30/2020] [Indexed: 01/02/2023]
Abstract
The pubertal period is a time of rapid increase in the incidence of anxiety disorders, and thus, pubertal hormones may play a role in the precipitation of anxious psychopathology. DHEA, a steroid hormone that surges in adolescence, has been previously linked to anxiety, although the direction of this effect has been mixed. Using a cross-sectional design in a sample of 286 adolescent girls, the present study examined associations between salivary DHEA concentrations and self-report and interview-based measures of anxiety while controlling for pubertal status, menarche status, assessment time of day, and other hormones including testosterone, estradiol, and progesterone. Increased salivary DHEA concentrations were associated with more self-reported anxiety symptoms, increased anxiety symptom counts based on clinical interview, and increased probability of an anxiety disorder. Out of all anxiety symptom domains examined, generalized anxiety disorder symptoms were the best predictor of salivary DHEA concentrations after controlling for pubertal development. Collectively, our findings suggest relevance for DHEA in the development of anxiety in the pubertal period, as well as a robust relationship between DHEA and emerging symptoms of pathological worry during adolescence. The present study underscores the importance of examining associations between DHEA concentrations and anxiety in longitudinal designs.
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Affiliation(s)
| | - Greg Hajcak
- Florida State University Department of Psychology Tallahassee, FL 32304,Florida State University Department of Biomedical Sciences Tallahassee, FL 32306
| | - Sierah Crisler
- Florida State University Department of Psychology Tallahassee, FL 32304
| | - Alexandria Meyer
- Florida State University Department of Psychology Tallahassee, FL 32304
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15
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Scaruffi E, Franzoi IG, Civilotti C, Guglielmucci F, La Marca L, Tomelini M, Veglia F, Granieri A. Body image, personality profiles and alexithymia in patients with polycystic ovary syndrome (PCOS). J Psychosom Obstet Gynaecol 2019; 40:294-303. [PMID: 30398405 DOI: 10.1080/0167482x.2018.1530210] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aim: Polycystic ovary syndrome (PCOS) is a common endocrine-metabolic disorder. It affects women's physical well-being and leads to great psychological distress. Indeed, women with PCOS show a compromised quality of life as well as impaired emotional well-being. The aim of this study is to assess personality characteristics, body image and alexithymia in women with PCOS. Materials and methods: A total of 59 women with PCOS and 38 healthy controls were administered the Toronto Alexithymia Scale (TAS), the Body Uneasiness Test (BUT) and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Results: The PCOS group showed higher values of alexithymia and a higher body uneasiness. They also showed higher values on many clinical, content and supplementary scales of the MMPI-2. Discussion: It seems that physical appearance and bodily function have a central place in the minds of women with PCOS, as well as in their relationships. However, it is a body they find it hard to feel and with which they mostly feel uncomfortable. Their approach to the outside world seems to be characterized by a certain degree of immaturity, anger, hostility and distrust. Low self-esteem also seems to be connected to a certain tendency toward introversion and withdrawal. This leads to problems in social, professional and intimate relationships.
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Affiliation(s)
| | | | | | | | - Luana La Marca
- Faculty of Human Sciences, UKE - Kore University of Enna, Cittadella Universitaria , Enna , Italy
| | - Michela Tomelini
- Department of Medical Sciences, Division of Endocrinology and Metabolism, University of Turin , Turin , Italy
| | - Fabio Veglia
- Department of Psychology, University of Turin , Turin , Italy
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16
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Fliegner M, Richter-Appelt H, Krupp K, Brunner F. Sexual Function and Socio-Sexual Difficulties in Women with Polycystic Ovary Syndrome (PCOS). Geburtshilfe Frauenheilkd 2019; 79:498-509. [PMID: 31148850 PMCID: PMC6529231 DOI: 10.1055/a-0828-7901] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 12/23/2018] [Accepted: 01/02/2019] [Indexed: 01/23/2023] Open
Abstract
Introduction
PCOS is the most common endocrine syndrome in women of the reproductive age that has manifold effects on the life of affected women. Little scientific attention has been devoted to these womenʼs sexual lives.
Aim
To investigate sexual quality of life in women with PCOS.
Methods
The sample size was n = 44. Measures employed were: An extended list of sexual dysfunctions and perceived distress based on DSM-IV-TR, Female Sexual Function Index (FSFI), German Questionnaire on Feelings of Inadequacy in Social and Sexual Situations (FUSS), Rosenberg Self-Esteem Scale (RSE), Brief Symptom Inventory (BSI) subscale depression. The relationships of these components were examined including further variables (body mass index, degree of hirsutism using the Ferriman-Gallwey Score, wish for a child). An open question about what participants see as the source of their sexual problems was presented.
Results
Only moderate impairment in sexual function was detected, but feelings of inadequacy in social and sexual situations were markedly elevated and positively correlated with the degree of hirsutism. Depression showed to be a major problem.
Conclusion
Patients with PCOS should be screened for socio-sexual difficulties and emotional problems. Specialized psychological and sexological counselling can complement patient care.
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Affiliation(s)
- Maike Fliegner
- Institut für Sexualforschung und Forensische Psychiatrie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Hertha Richter-Appelt
- Institut für Sexualforschung und Forensische Psychiatrie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Kerstin Krupp
- Institut für Sexualforschung und Forensische Psychiatrie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Brunner
- Institut für Sexualforschung und Forensische Psychiatrie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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17
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Peecher DL, Binder AK, Gabriel KI. Rodent models of mental illness in polycystic ovary syndrome: the potential role of hypothalamic-pituitary-adrenal dysregulation and lessons for behavioral researchers. Biol Reprod 2019; 100:590-600. [PMID: 30388193 DOI: 10.1093/biolre/ioy233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/04/2018] [Accepted: 10/31/2018] [Indexed: 12/20/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most commonly diagnosed endocrine disorder in women of reproductive age, with phenotypes including ovarian and metabolic dysfunctions. Women with PCOS also show increased rates of mental illness, dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, and altered responsiveness to stressors that may contribute to the higher rates of mental illness, specifically depression and anxiety. Animal models of PCOS have provided insight into the ovarian and metabolic mechanisms that underlie the syndrome, and several models have been used to study the behavioral consequences associated with PCOS in the laboratory. Several studies in rodent models of PCOS demonstrate changes in anxiety-like behavior, but researchers often neglect to report procedural details or behavioral data crucial to interpreting the differences observed in those studies. Additionally, the impact of potential HPA dysregulation in animal models of PCOS may influence behavioral findings, although only three studies to date have examined this. As such, researchers should consider and report stress-associated variables (e.g., time of day, light/dark cycle, light intensity, housing, and procedures to control experimenter and litter effects) that may influence depression- and anxiety-like behaviors in rodents. This review will summarize the behavioral and HPA-related studies in women with PCOS and rodent models of the disease, and provide considerations for future studies.
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Affiliation(s)
- Danielle L Peecher
- Department of Psychology, Central Washington University, Ellensburg, Washington, USA.,Center for Reproductive Biology, Washington State University, Pullman, Washington, USA
| | - April K Binder
- Center for Reproductive Biology, Washington State University, Pullman, Washington, USA.,Department of Biological Sciences, Central Washington University, Ellensburg, Washington, USA
| | - Kara I Gabriel
- Department of Psychology, Central Washington University, Ellensburg, Washington, USA
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18
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Brutocao C, Zaiem F, Alsawas M, Morrow AS, Murad MH, Javed A. Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis. Endocrine 2018; 62:318-325. [PMID: 30066285 DOI: 10.1007/s12020-018-1692-3] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/21/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE Polycystic ovary syndrome (PCOS) is a common disorder affecting up to 15% of women in the reproductive age. Prior studies suggest that PCOS can be associated with mood and psychiatric disorders. The purpose of this study is to examine the prevalence of any psychiatric disorder in women with PCOS. METHODS We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through February 08, 2017 for studies that examined the prevalence of any psychiatric disorder in adolescents or adults with a clinical or biochemical diagnosis of PCOS. We used a random-effects model to generate pooled estimates and 95% confidence intervals (CI). RESULTS We included 57 studies reporting on 172,040 patients. The majority of studies addressed depression and anxiety. Studies had fair methodological quality although most estimates were unadjusted. Women with PCOS were more likely to have a clinical diagnosis of depression (odds ratio (OR), 2.79; 95% CI, 2.23-3.50), anxiety (OR, 2.75; 95% CI, 2.10-3.60), bipolar disorder (OR, 1.78; 95% CI, 1.43-2.23) and obsessive compulsive disorder (OCD) (OR, 1.37; 95% CI 1.22-1.55), but not social phobia or panic disorder. Using various scales, the severity of symptoms of depression, anxiety, obsessive compulsive disorder, and somatization disorders were higher compared to women without PCOS. CONCLUSIONS PCOS is associated with an increased risk of diagnosis of depression, anxiety, bipolar disorder, and obsessive compulsive disorder. It is associated with worse symptoms of depression, anxiety, OCD, and somatization. Screening for these disorders to allow early intervention may be warranted.
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Affiliation(s)
- Claire Brutocao
- Mayo Clinic School of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Feras Zaiem
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Mouaz Alsawas
- Evidence-Based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Allison S Morrow
- Evidence-Based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - M Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Asma Javed
- Division of Pediatric and Adolescent Gynecology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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19
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Greenwood EA, Pasch LA, Cedars MI, Legro RS, Eisenberg E, Huddleston HG. Insulin resistance is associated with depression risk in polycystic ovary syndrome. Fertil Steril 2018; 110:27-34. [PMID: 29908775 DOI: 10.1016/j.fertnstert.2018.03.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 02/27/2018] [Accepted: 03/08/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To test the hypothesis that insulin resistance is associated with depression risk in polycystic ovary syndrome (PCOS). DESIGN Secondary analysis of data from a multicenter randomized trial. SETTING Multicenter university-based clinical practices. PATIENT(S) Seven hundred thirty-eight women with PCOS by modified Rotterdam criteria seeking pregnancy enrolled in a randomized clinical trial comparing clomiphene citrate versus letrozole. INTERVENTION(S) The Primary Care Evaluation of Mental Disorders Patient Health Questionnaire was self-administered to identify depression using a validated algorithm at enrollment. Demographic and anthropometric data were collected, and serum assays were performed. Insulin resistance was estimated using the homeostatic model of insulin resistance (HOMA-IR), with a cutoff of >2.2 considered abnormal. MAIN OUTCOME MEASURE(S) Demographic, endocrine, and metabolic parameters associated with depression. RESULT(S) In a univariate logistic regression analysis, elevated HOMA-IR was associated with 2.3-fold increased odds of depression (odds ratio [OR] = 2.32; 95% confidence interval [CI], 1.28-4.21). This association remained significant after controlling for age and body mass index (adjusted OR [aOR] = 2.23; 95% CI, 1.11-4.46) and in a model including additional potential confounders (aOR = 2.03; 95% CI, 1.00-4.16). CONCLUSION(S) Insulin resistance has a strong and independent association with depression in PCOS and may serve as a physiologic mediator. Our findings corroborate a growing body of evidence linking insulin resistance to depressed mood. The association between insulin resistance and depressed mood warrants further investigation to elucidate mechanisms and identify potential therapeutic targets.
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Affiliation(s)
- Eleni A Greenwood
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco, San Francisco, California.
| | - Lauri A Pasch
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco, San Francisco, California
| | - Marcelle I Cedars
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco, San Francisco, California
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey, Pennsylvania
| | - Esther Eisenberg
- Fertility and Infertility Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland
| | - Heather G Huddleston
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco, San Francisco, California
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20
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Dokras A, Stener-Victorin E, Yildiz BO, Li R, Ottey S, Shah D, Epperson N, Teede H. Androgen Excess- Polycystic Ovary Syndrome Society: position statement on depression, anxiety, quality of life, and eating disorders in polycystic ovary syndrome. Fertil Steril 2018; 109:888-899. [PMID: 29778388 DOI: 10.1016/j.fertnstert.2018.01.038] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/26/2018] [Accepted: 01/29/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To formulate clinical consensus recommendations for screening depression, anxiety, health-related quality of life (HRQoL), and disordered eating symptoms in women with polycystic ovary syndrome (PCOS) and review prevalence based on phenotypes and ethnicity, changes over time, etiology, and impact of treatment. DESIGN Systematic reviews and preparation of position statement. SETTING Not applicable. PATIENT(S) Women with PCOS and controls screened using validated tools. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Depressive symptoms, anxiety symptoms, disordered eating, and HRQoL scores. RESULT(S) Several studies demonstrate that women with PCOS have an increased prevalence of higher depression and anxiety scores and higher odds of moderate and severe depressive and anxiety symptoms compared with controls. Obesity, hyperandrogenism, and fertility have a weak association with these symptoms. HRQoL scores are consistently reduced in PCOS, with infertility and weight concerns having the most significant impact. Some studies suggest an increased prevalence of disordered eating in women with PCOS compared with controls. The few studies that have evaluated the impact of PCOS-related treatments (lifestyle interventions and pharmacotherapy) show no detrimental effect or some improvement in depressive and anxiety symptoms and HRQoL scores. CONCLUSION(S) In women with PCOS, screening for depressive and anxiety symptoms should be offered at the time of diagnosis and screening for disordered eating should be considered. Further research is required across PCOS phenotypes, in longitudinal cohorts and on impact of therapy on depressive and anxiety syptoms, HRQOL, and disordered eating.
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Affiliation(s)
- Anuja Dokras
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | | | - Bulent O Yildiz
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Hacettepe University School of Medicine, Hacettepe, Ankara, Turkey
| | - Rong Li
- Department of Obstetrics and Gyneocology, Reproductive Medical Center, Peking University Third Hosptal, Bejing, People's Republic of China
| | | | | | - Neill Epperson
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University and Monash Health, Clayton, Victoria, Australia
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21
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Böttcher B, Fessler S, Friedl F, Toth B, Walter MH, Wildt L, Riedl D. Health-related quality of life in patients with polycystic ovary syndrome: validation of the German PCOSQ-G. Arch Gynecol Obstet 2018; 297:1027-1035. [PMID: 29249009 PMCID: PMC5849657 DOI: 10.1007/s00404-017-4623-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/06/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE Patients with polycystic ovary syndrome (PCOS) report a decreased health-related quality of life (HRQOL) and higher levels of psychological distress. Validated questionnaires are necessary to assess the impact of PCOS on patients' lives. The aim of the present study was to evaluate the German "Polycystic Ovary Syndrome Questionnaire" (PCOSQ-G). METHODS The psychometric properties of the PCOSQ-G were investigated in PCOS patients with item-total correlation, internal consistency and test-retest reliability. Correlations with the Short-Form-36 Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS-D) were calculated to evaluate the validity of the PCOSQ-G. Discriminatory validity was investigated through a receiver operating characteristic curve and independent sample t tests compared with healthy controls. RESULTS Good psychometric properties were found for most items. Acceptable to high internal consistency was found for the total score (α = 0.94-0.95) and all subscales (α = 0.70-0.97). High test-retest reliability was found for the total score (0.86) and all subscales (0.81-0.90). The validity analyses showed that the PCOSQ-G total score was positively correlated with both SF-36 summary scales and was negatively correlated with both HADS subscales. Patients reported significantly lower values for the PCOSQ-G total score (p < 0.001) and all subscales, and the PCOSQ-G discriminated well between patients and healthy controls (AUC = 0.81, p < 0.001). CONCLUSIONS PCOSQ-G is a reliable and valid tool to assess the HRQOL in patients with PCOS and can be used in future clinical research. Patients with PCOS exhibited an impaired HRQOL, which indicates the need for psychosomatic counseling.
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Affiliation(s)
- B Böttcher
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - S Fessler
- Department of Psychology, University of Innsbruck, Bruno-Sander-Haus, Innrain 52f, 6020, Innsbruck, Austria
| | - F Friedl
- Department of Psychology, University of Innsbruck, Bruno-Sander-Haus, Innrain 52f, 6020, Innsbruck, Austria
| | - B Toth
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - M H Walter
- Department of Psychology, University of Innsbruck, Bruno-Sander-Haus, Innrain 52f, 6020, Innsbruck, Austria
| | - L Wildt
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - D Riedl
- University Clinic of Medical Psychology, Medical University Innsbruck, Schöpfstr. 23a, 6020, Innsbruck, Austria.
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22
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Sanchez N. Suitability of the National Health Care Surveys to Examine Behavioral Health Services Associated with Polycystic Ovary Syndrome. J Behav Health Serv Res 2018; 45:252-268. [PMID: 27966057 PMCID: PMC5869872 DOI: 10.1007/s11414-016-9543-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The National Institutes of Health, Office of Disease Prevention, has described polycystic ovary syndrome (PCOS) as a major public health problem for women in the USA. This study examines the suitability of the National Health Care Surveys, collected by the Centers for Disease Control and Prevention, to understand patient demographics and behavioral health services associated with PCOS-related medical visits. Data were from the 2005-2010 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. PCOS-related medical visits were identified using the International Classification of Diseases, 9th Revision, Clinical Modification code 256.4. Items on mental health and health education ordered or provided did not meet the National Center for Health Statistics criteria necessary to produce reliable national estimates (i.e., at least 30 unweighted records and a relative standard error <30%). Findings underscore the need to strengthen national surveillance to further understand behavioral health care for patients with PCOS.
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Affiliation(s)
- Ninive Sanchez
- School of Social Work, University of Missouri, 712 Clark Hall, Columbia, MO, 65211, USA.
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23
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Tan RY, Grigg J, Kulkarni J. Borderline personality disorder and polycystic ovary syndrome: A review of the literature. Aust N Z J Psychiatry 2018; 52:117-128. [PMID: 28891300 DOI: 10.1177/0004867417730650] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This review examines the existing evidence for the relationship between borderline personality disorder and polycystic ovary syndrome, and to identify commonalities in etiological mechanisms of borderline personality disorder and polycystic ovary syndrome that might explain the relationship between these seemingly disparate disorders. METHODS A search of Medline, EMBASE and Cochrane Central was undertaken on 5 December 2016 to identify studies investigating women with borderline personality disorder and polycystic ovary syndrome (or symptoms and markers specific to polycystic ovary syndrome). RESULTS Nine studies were identified, including three cross-sectional studies investigating symptoms of polycystic ovary syndrome in women with borderline personality disorder, two cross-sectional and one cohort study examining the prevalence of psychiatric diagnoses in women with polycystic ovary syndrome and three case reports of comorbid borderline personality disorder and polycystic ovary syndrome. CONCLUSION Overall, the literature shows women with borderline personality disorder to have higher than expected serum androgen levels and incidence of polycystic ovaries, which can be key features of polycystic ovary syndrome. However, this research is still in its infancy, which limits our understanding of this potential comorbid phenomenon. Given the emerging anecdotal and empirical evidence to date, a theoretical discussion of the potential psychoneuroendocrinological mechanism underlying the borderline personality disorder and polycystic ovary syndrome comorbidity is provided. Further rigorous studies using standardized diagnostic criteria for polycystic ovary syndrome are warranted. Specifically, the use of prospective controlled cohort studies may be able to determine the causality and temporality of observed comorbid borderline personality disorder and polycystic ovary syndrome.
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Affiliation(s)
- Raelene Ym Tan
- 1 Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia.,2 Monash University, Melbourne, VIC, Australia
| | - Jasmin Grigg
- 1 Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia
| | - Jayashri Kulkarni
- 1 Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia
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24
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Özdemir O, Kurdoglu Z, Yıldız S, Özdemir PG, Yilmaz E. The relationship between atypical depression and insülin resistance in patients with polycystic ovary syndrome and major depression. Psychiatry Res 2017; 258:171-176. [PMID: 28168992 DOI: 10.1016/j.psychres.2016.11.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/19/2016] [Accepted: 11/27/2016] [Indexed: 10/20/2022]
Abstract
In this study, we aimed to examine the relationship between atypical depression and insulin resistance (IR) in patients with polycystic ovary syndrome (PCOS) and major depression. A total of 176 subjects (69 patients with PCOS, 58 patients with depression, and 49 healthy controls) were included in the study. The Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Beck Hopelessness Scale (BHS), and the Scale for Suicide Ideation (SSI) were administered. Data concerning their height, weight, fasting a.m. serum levels of insulin, glucose level, and total testosterone level were collected from all participants. The body mass index (BMI) and the Homeostasis Model Assessment Insulin Resistance index (HOMA-IR) were both calculated. 34 (49.3%) of the PCOS patients met the criteria for depression. 26 (76.5%) of them had atypical depression, 8 (23.5%) had non-atypical depression. 27 (46.6%) of the 58 depressed patients had atypical depression. Insulin resistance was higher in the PCOS patients than in the control subjects and the depression patients. There was no association between atypical depression and IR in patients with PCOS and depression. We concluded that there is no relationship between IR and atypical depression.
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Affiliation(s)
- Osman Özdemir
- Yuzuncu Yil University, Faculty of Medicine, Department of Psychiatry, Van, Turkey.
| | - Zehra Kurdoglu
- Department of Obstetrics and Gynecology, Ankara Training and Research Hospital, Ankara, Turkey.
| | - Saliha Yıldız
- Yuzuncu Yil University, Faculty of Medicine, Department of Endocrinology, Van, Turkey.
| | - Pınar Güzel Özdemir
- Yuzuncu Yil University, Faculty of Medicine, Department of Psychiatry, Van, Turkey.
| | - Ekrem Yilmaz
- Yuzuncu Yil University, Faculty of Medicine, Department of Psychiatry, Van, Turkey.
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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; 32:1075-1091. [DOI: 10.1093/humrep/dex044] [Citation(s) in RCA: 224] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/17/2017] [Indexed: 01/16/2023] Open
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Abstract
Polycystic ovary syndrome (PCOS) is a complex endocrinopathy affecting a remarkable proportion of premenopausal women. Different studies have shown that stress is widely encountered in women with PCOS. Areas covered: As PCOS is a multifaceted disorder, 'stress' incorporates different translations. We performed a literature review, focusing on the most recent data, regarding the multipotent role of stress in the syndrome. Expert commentary: Stress is believed to be an important component of PCOS. It encompasses different definitions that are all equivalent, like metabolic, inflammatory, oxidative and emotional stress. However, the type of stress that distinguishes PCOS is metabolic stress. It becomes evident early in life and constitutes the pathophysiological heart of the syndrome. Metabolic stress along with the other types of stress are the progenitors of severe long-term health implications, which exacerbate further the reproductive, metabolic and psychological derangements of the syndrome, leading to an endless cycle of chronic illness.
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Affiliation(s)
- Olga Papalou
- a Department of Internal Medicine , 'Elpis' Hospital , Athens , Greece
| | - Evanthia Diamanti-Kandarakis
- b Internal Medicine & Endocrinology, Department of Endocrinology, Diabetes & Metabolism , Euroclinic , Athens , Greece
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Özdil Demiryürek E, Tekin A, Çakmak E, Temizkan O, Karamustafalıoğlu O, Gökova S, Demiryürek E. Correlations between impulsiveness and biochemical parameters in women with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol 2016; 207:5-10. [PMID: 27770705 DOI: 10.1016/j.ejogrb.2016.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 08/01/2016] [Accepted: 09/07/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the relationship between anger, impulsiveness, and biochemical parameters (testosterone, insulin, insulin resistance) in women with polycystic ovary syndrome. STUDY DESIGN We recruited 84 women diagnosed with polycystic ovary syndrome according to the Rotterdam diagnostic criteria. Psychiatric interviews were performed using the Structured Clinical Interview for DSM-IV Axis I Disorders. The Barratt Impulsiveness Scale and the State Trait Anger Expression Inventory were also administered to each participant. Lastly, the women's biochemical parameters, which included total testosterone, free androgen index, dehydroepiandrosterone sulfate, insulin and insulin resistance, thyroid functions, and prolactin, were measured. RESULTS A statistically significant correlation was found between participants' increasing total testosterone levels and total impulsiveness scores, and their increasing free androgen index levels and motor and non-planning-related impulsiveness (r=0.24, p=0.027; r=0.27, p=0.015; and r=0.26, p=0.017, respectively). High insulin and insulin resistance levels were associated with high non-planning-related impulsiveness scores (r=0.26, p=0.018; and r=0.26, p=0.019). Lastly, high trait anger and anger expression scores were related to high total testosterone and insulin and insulin resistance levels. CONCLUSION Androgens and glucose dysregulation seemingly affect anger expression as well as the attentional, motor, and non-planning-related impulsiveness of women with polycystic ovary syndrome.
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Affiliation(s)
- Esra Özdil Demiryürek
- Psychiatry Department, Sakarya University, Sakarya Training and Research Hospital, Turkey
| | - Atilla Tekin
- Psychiatry Department, Bolu Mental and Psychiatric Disease Hospital, Turkey.
| | - Engin Çakmak
- Psychiatry Department, Şişli Hamidiye Etfal Training and Research Hospital, Turkey
| | - Osman Temizkan
- Gynaecology and Obstetrics Department, Şişli Hamidiye Etfal Training and Research Hospital, Turkey
| | | | - Sibel Gökova
- Gynaecology and Obstetrics Department, Şişli Hamidiye Etfal Training and Research Hospital, Turkey
| | - Enes Demiryürek
- Neurology Department, Sakarya University, Sakarya Training and Research Hospital, Turkey
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Sanchez N, Jones H. "Less Than A Wife": A Study of Polycystic Ovary Syndrome Content in Teen and Women's Digital Magazines. J Med Internet Res 2016; 18:e89. [PMID: 27255809 PMCID: PMC4911514 DOI: 10.2196/jmir.5417] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 01/31/2016] [Accepted: 02/16/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a major public health problem that affects women's physical and mental health. According to the US National Institutes of Health Office of Disease Prevention, there is a need to improve public awareness of the syndrome among health care providers and the public. Women's magazines are a type of "edutainment" that publish health content in addition to beauty, fashion, and entertainment content. These media have the potential to expose primarily female readers to content on PCOS and influence readers' beliefs and attitudes about women with PCOS. OBJECTIVE The objective of this study was to explore how digital (online) teen and women's magazines portray women with PCOS. METHODS We used data from the Alliance for Audited Media to identify popular digital teen and women's magazines with circulation rates ≥1,000,001. We also included magazines with circulation rates 100,001-1,000,000 directed toward racial and ethnic minority readers. A search of magazine websites over a 1-month period in 2015 yielded 21 magazines (eg, Glamour, Cosmopolitan en Español, Essence, and O, The Oprah Magazine) and 170 articles containing "PCOS" and "polycystic ovary syndrome." Textual analysis using a grounded theory approach was used to identify themes. RESULTS Articles depicted PCOS symptoms as a hindrance to women's social roles as wives and mothers and largely placed personal responsibility on women to improve their health. To a lesser extent, women were depicted as using their personal experience with PCOS to advocate for women's health. Experiences of Latina and African American women and adolescents with PCOS were absent from women's magazine articles. CONCLUSIONS The findings can inform health education programs that teach women to be critical consumers of PCOS-related content in digital women's magazines. Future research on PCOS content in digital teen and women's magazines can help researchers, patients, and consumer groups engage with the media to increase public awareness of PCOS.
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Affiliation(s)
- Ninive Sanchez
- School of Social Work, University of Missouri, Columbia, MO, United States.
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IRAK L, ÇINAR YAVUZ H, AYÇİÇEK DOĞAN B, METE T, BERKER D, GÜLER S. Depression, anxiety, and their relation with clinical parametersand androgen levels in hirsute women. Turk J Med Sci 2016; 46:245-50. [DOI: 10.3906/sag-1405-72] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 07/12/2015] [Indexed: 11/03/2022] Open
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Zhu G, Yin Y, Xiao CL, Mao RJ, Shi BH, Jie Y, Wang ZW. Serum DHEAS levels are associated with the development of depression. Psychiatry Res 2015. [PMID: 26205628 DOI: 10.1016/j.psychres.2015.05.093] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of study was to evaluate the association between serum DHEAS levels and depression with a case-control study together with a meta-analysis. Radioimmunoassay (RIA) was performed to measure the serum DHEAS levels of all participants before and after treatment. Depression Patients were divided into mild depression and severe depression based on Hamilton depression scale (HAMD24) and received 5-hydroxytryptamine (5-HT) and citalopram (20mg/d) for 8 weeks. Case-control studies related to our study theme were enrolled for meta-analysis and Comprehensive Meta-analysis 2.0 (CMA 2.0) was used for statistical analysis. After treatment, DHEAS levels in depression patients were significantly increased, while before and after treatment, DHEAS levels were all lower in depression patients than in controls (all P<0.001); further analysis on age revealed that DHEAS levels were decreased with the rising of age. Meta-analysis results suggested that serum DHEAS levels (ng/mL) were significantly higher in healthy controls compared to depression patients (SMD=0.777, 95%CI=0.156-1.399, P=0.014). In conclusion, our study suggests that serum DHEAS levels are associated with the development of depression and it decreased with the rising of age.
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Affiliation(s)
- Guang Zhu
- Department of Psychiatry, Shanghai Hongkou District Mental Health Center, Shanghai 200083, PR China.
| | - You Yin
- Department of Neurology, Shanghai Changzheng Hospital, Secondary Military Medical University, Shanghai 200003, PR China
| | - Chun-Lan Xiao
- Department of Psychiatry, Shanghai Hongkou District Mental Health Center, Shanghai 200083, PR China
| | - Rong-Jie Mao
- Department of Psychiatry, Shanghai Hongkou District Mental Health Center, Shanghai 200083, PR China
| | - Bo-Hai Shi
- Department of Psychiatry, Shanghai Hongkou District Mental Health Center, Shanghai 200083, PR China
| | - Yong Jie
- Department of Psychiatry, Shanghai Hongkou District Mental Health Center, Shanghai 200083, PR China
| | - Zuo-Wei Wang
- Department of Psychiatry, Shanghai Hongkou District Mental Health Center, Shanghai 200083, PR China
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Hung JH, Hu LY, Tsai SJ, Yang AC, Huang MW, Chen PM, Wang SL, Lu T, Shen CC. Risk of psychiatric disorders following polycystic ovary syndrome: a nationwide population-based cohort study. PLoS One 2014; 9:e97041. [PMID: 24816764 PMCID: PMC4016227 DOI: 10.1371/journal.pone.0097041] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/15/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among women of reproductive age. A higher prevalence of psychiatric comorbidities, including depressive disorder, anxiety disorder, and bipolar disorder has been proved in patients with PCOS. However, a clear temporal causal relationship between PCOS and psychiatric disorders has not been well established. OBJECTIVE We explored the relationship between PCOS and the subsequent development of psychiatric disorders including schizophrenia, bipolar disorder, depressive disorder, anxiety disorder, and sleep disorder. METHODS We identified patients who were diagnosed with PCOS by an obstetrician-gynecologist in the Taiwan National Health Insurance Research Database. A comparison cohort was constructed of patients without PCOS who were matched according to age and sex. The occurrence of subsequent new-onset psychiatric disorders was evaluated in both cohorts based on diagnoses made by psychiatrists. RESULTS The PCOS cohort consisted of 5431 patients, and the comparison cohort consisted of 21,724 matched control patients without PCOS. The incidence of depressive disorder (hazard ratio [HR] 1.296, 95% confidence interval [CI] 1.084-.550), anxiety disorder (HR 1.392, 95% CI 1.121-1.729), and sleep disorder (HR 1.495, 95% CI 1.176-1.899) were higher among the PCOS patients than among the patients in the comparison cohort. In addition, a higher incidence of newly diagnosed depressive disorder, anxiety disorder, and sleep disorder remained significantly increased in all of the stratified follow-up durations (0-1, 1-5, ≥5 y). CONCLUSIONS PCOS might increase the risk of subsequent newly diagnosed depressive disorder, anxiety disorder, and sleep disorder. The risk of newly diagnosed bipolar disorder, which has often been reported in the literature to be comorbid with PCOS, was not significantly elevated.
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Affiliation(s)
- Jeng-Hsiu Hung
- Department of Obstetrics and Gynecology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Li-Yu Hu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Albert C. Yang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Center for Dynamical Biomarkers and Translational Medicine, National Central University, Chungli, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Min-Wei Huang
- Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
| | - Pan-Ming Chen
- Department of Psychiatry, Yuanshan Branch, Taipei Veterans General Hospital, Yilan, Taiwan
| | - Shu-Li Wang
- Department of Dental Laboratory Technology, entral Taiwan University of Science and Technology, Taichung, Taiwan
| | - Ti Lu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Cheng-Che Shen
- Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
- Department of information magagement, National Chung-Cheng University, Chiayi, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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Scaruffi E, Gambineri A, Cattaneo S, Turra J, Vettor R, Mioni R. Personality and psychiatric disorders in women affected by polycystic ovary syndrome. Front Endocrinol (Lausanne) 2014; 5:185. [PMID: 25429283 PMCID: PMC4228916 DOI: 10.3389/fendo.2014.00185] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 10/12/2014] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder among fertile women. Studies show reduced quality of life, anxiety, depression, body dissatisfaction, eating disorder, and sexual dysfunction, but the etiology of these disturbs remains still debated. The aim of our study is to verify whether this hyperandrogenic syndrome characterizes a strong psycho(patho)logical personality. METHOD Sixty PCOS subjects (mean age 25.8 ± 4.7 years) were evaluated by anthropometric, metabolic, hormonal, clinical, and psychological parameters. After the certainty of the diagnosis of PCOS, the Rorschach test, according to Exner's comprehensive system (CS) and the Millon Clinical Multiaxial Inventory-III (MCMI-III) were administered to each patient. The control group, on which the comparison was carried out, was composed by 40 healthy and aged compared women who were exclusively administered the Rorschach test according to CS. RESULTS MCMI-III evidenced axis II DSM-IV personality disorders [4.1% schizoid, depressive, sadistic, negativistic (passive-aggressive), and masochistic, 6.1% avoiding, 12.2% dependent, 20.4% histrionic, 16.3% narcissistic, 2.0% obsessive-compulsive], and axis I DSM-IV psychiatric disorders: 10.2% anxiety, 2.0% somatoform disorder and bipolar disorder, 16.3% major depressive disorder. Finally, we found 44.9% delusional disorder and 4.1% thought disorder. Rorschach test's results show 53.1% reduced coping abilities and social skills, 55.1% depression, 30.6% perceptual distortion and cognitive slippage, 24.5% constantly alert and worry, 8.1% at risk for suicide, and finally about 50% of our patients had chronic stress. CONCLUSION PCOS women have relevant personality and psychiatric disorders, when compared with normal subjects.
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Affiliation(s)
| | - Alessandra Gambineri
- Division of Endocrinology, Department of Internal Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Stefania Cattaneo
- Scuola Universitaria Interfacoltà in Scienze Motorie (SUISM), University of Turin, Turin, Italy
| | - Jenni Turra
- Clinical Medical 3, Department of Medicine, Hospital of Padua, University of Padua, Padua, Italy
| | - Roberto Vettor
- Clinical Medical 3, Department of Medicine, Hospital of Padua, University of Padua, Padua, Italy
| | - Roberto Mioni
- Clinical Medical 3, Department of Medicine, Hospital of Padua, University of Padua, Padua, Italy
- *Correspondence: Roberto Mioni, Clinica Medica 3, Università di Padova, 9th floor Monoblocco, Azienda Ospedaliera di Padova Via Giustiniani 2, Padova 35128, Italy e-mail:
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Axis I and Axis II diagnoses in women with PCOS. Gen Hosp Psychiatry 2013; 35:508-11. [PMID: 23726743 DOI: 10.1016/j.genhosppsych.2013.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 03/29/2013] [Accepted: 04/01/2013] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The objective was to determine the current prevalence of Axis I and Axis II psychiatric diagnoses in patients with polycystic ovary syndrome (PCOS). METHOD The study sample included 73 patients with PCOS and 73 control subjects. Psychiatric disorders were determined by structured clinical interviews. RESULTS The rate of any Axis I psychiatric disorder (28.8% vs. 15.1%), social phobia (13.7% vs. 2.7%), generalized anxiety disorder (11.0% vs. 1.4%), any Axis II psychiatric disorder (23.3% vs. 9.6%) and avoidant personality disorder (12.3% vs. 1.4%) was significantly more common in the patient group compared to the control group. Of women with PCOS, 21 (28.8%) had at least one Axis I and 17 (23.3%) had at least one Axis II diagnosis. The most common Axis I disorder was social phobia (13.7%) and the most common Axis II disorder was avoidant personality disorder (12.3%) in women with PCOS. Social phobia, generalized anxiety disorder, and avoidant personality disorder were significantly more common in the patient group compared to the control group. CONCLUSION Our results suggest that a considerable proportion of women with PCOS also present with anxiety and personality disorders.
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