Does PCOS Increase Depression and Anxiety Symptoms?

A diagnosis of polycystic ovary syndrome (PCOS) is associated with an increased risk for moderate to severe depression or anxiety, requiring increased screening for these conditions, according to research published in Human Reproduction.

Laura G. Cooney, MD, from the department of obstetrics and gynecology at the Hospital of the University of Pennsylvania in Philadelphia, and colleagues, conducted a systematic review and meta-analysis of 63 studies of women with PCOS to determine whether a PCOS diagnosis is linked to an increased prevalence of moderate to severe depressive and anxiety symptoms.

Systematic Review

In total, 30 studies met the inclusion criteria for the systematic review; a total of 3050 participants with PCOS and 3858 controls were examined for depressive symptoms, while a total of 1910 participants with PCOS and 1639 controls were examined for anxiety symptoms.

Of the studies included, 26 used Rotterdam criteria and 4 used National Institutes of Health (NIH) criteria to make a PCOS diagnosis. The most commonly used screening tools for anxiety and depression were the Beck Depression/Anxiety Inventory (BDI/BAI) and the Hospital Anxiety and Depression Scale (HADS); 2 studies used diagnosis by a psychiatrist.

In all participants, mean body mass index (BMI) fell within the overweight range (25 to 29.9 kg/m²) for patients with PCOS, but was within the normal range (18.5 to 24.9 kg/m²) for the control group. Participants in both groups were between aged 20 and 30 years. The majority of these studies found a significantly higher prevalence of depressive and anxiety symptoms or scores (25 out of 30 studies and 16 out of 18 studies, respectively) in participants with PCOS vs controls.

Meta-Analysis

For the meta-analysis, 18 studies were used to estimate the pooled association between PCOS and depression; 9 studies were used to estimate the pooled association between PCOS and anxiety.

Median prevalence of depression in these studies was 36.6% (interquartile range [IQR]: 22.3; 50%) vs 14.2% (IQR: 10.7, 22.2%) for the PCOS vs control group. The meta-analysis also indicated that women with PCOS had “significantly increased odds” of depressive symptoms vs controls (odds ratio [OR] 3.78; 95% CI, 3.03-4.72). Of the 11 studies indicating prevalence of moderate or severe depressive symptoms, 4.18-increased odds were noted vs controls (95% CI, 2.68-6.52).

The median prevalence of anxiety was 41.9% (IQR: 13.6, 52%) vs 8.5% (IQR: 3.3, 12%) in the PCOS vs control groups. Significantly increased odds of anxiety were noted compared with controls (OR 5.62; 95% CI, 3.22-9.80). Odds of moderate and severe anxiety were “similarly high” (OR 6.55; 95% CI, 2.87-14.93; 5 studies).

“Our data support the consideration of implementation of these guidelines [routine screening as recommended by the US Preventive Services Task Force, The PCOS Australian Alliance, etc.] to women with PCOS around the world,” the researchers concluded. “Future studies should focus on the longitudinal follow-up of women with PCOS and the long-term impact of PCOS-related treatments on depressive and anxiety symptoms in this high-risk population.”

Study Limitations

• All studies included in the systematic review and meta-analysis were cross-sectional; therefore the researchers could “only hypothesize that the diagnosis of PCOS precedes the diagnosis of depression and anxiety.”
• Large variations in methodologies were noted among the studies, especially in the anxiety screenings.

Reference 

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(5):1075-1091. doi:10.1093/humrep/dex044