Faculty of Psychology, Catholic University of Milan, Largo A. Gemelli 1, Milan 20123, Italy.
Department of Clinical Sciences and Community Health, Università degli Studi, and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 12, Milan 20122,Italy.
Hum Reprod. 2017 Sep 1;32(9):1855-1861. doi: 10.1093/humrep/dex249.
What factors affect the mental health of women with endometriosis?
Not only pelvic pain, but also individual characteristics (i.e. self-esteem, body esteem and emotional self-efficacy), time from diagnosis and intimate relationship status influence the psychological health of endometriosis patients.
The negative impact of endometriosis on mental health has been widely demonstrated by the research literature, along with the fact that presence and severity of pelvic pain are associated with anxiety and depression. However, endometriosis is a complex multidimensional disease and factors other than pelvic pain, including individual differences, may contribute to explain the variability in women's mental health.
STUDY DESIGN, SIZE, DURATION: This cross-sectional study was conducted between 2015 and 2017 at an Italian academic department of obstetrics and gynaecology.
PARTICIPANTS/MATERIALS, SETTING, METHODS: A total of 210 consecutive endometriosis patients (age: 36.7 ± 7.0 years) were included. Demographic and endometriosis-related information was collected. Individual differences were assessed using validated measures evaluating self-esteem, body esteem and emotional self-efficacy. The Hospital Anxiety and Depression Scale (HADS) and the Ruminative Response Scale (RRS) were used to evaluate mental health.
Based on the extant literature, we identified three categories of putative predictors (demographic variables, endometriosis-related factors and individual differences i.e. 'self'), whose psychological impact was examined using a hierarchical multiple regression approach. Being in a stable relationship (coded 1 ['yes'] or 0 ['no']) was associated with decreased rumination (RRS: β = -0.187; P = 0.002). A shorter time from diagnosis was associated with greater anxiety (HADS-A: β = -0.177; P = 0.015). Pelvic pain severity and 'self' were associated with all mental health variables (Ps < 0.01). Greater self-esteem, body esteem, and emotional self-efficacy were correlated with better psychological outcomes (Ps < 0.01).
Sexual functioning, pregnancy, infertility, cultural differences and gender beliefs have been found to be important in women with endometriosis. In our regression model, we did not test the psychological impact of these variables and this should be acknowledged as an important limitation. Moreover, the cross-sectional (rather than longitudinal) nature of this study does not allow a full examination of the temporal relationship between endometriosis and psychological outcomes.
Factors other than pelvic pain can significantly affect the mental health of women with endometriosis, and the role of individual differences requires further investigation. Targeted multidisciplinary interventions should include evaluation and enhancement of self-esteem and self-efficacy to improve women's psychological health.
STUDY FUNDING/COMPETING INTEREST(S): None.
Not applicable.
哪些因素会影响子宫内膜异位症女性的心理健康？
除了盆腔疼痛，个人特征（即自尊、身体形象和情绪自我效能感）、诊断后时间和亲密关系状况也会影响子宫内膜异位症患者的心理健康。
研究文献广泛证明了子宫内膜异位症对心理健康的负面影响，以及盆腔疼痛的存在和严重程度与焦虑和抑郁有关。然而，子宫内膜异位症是一种复杂的多维疾病，除了盆腔疼痛之外，其他因素（包括个体差异）可能有助于解释女性心理健康的可变性。
研究设计、规模、持续时间：本横断面研究于 2015 年至 2017 年在意大利一家妇产科学术部门进行。
参与者/材料、设置、方法：共纳入 210 例连续的子宫内膜异位症患者（年龄：36.7±7.0 岁）。收集人口统计学和子宫内膜异位症相关信息。使用评估自尊、身体形象和情绪自我效能感的经过验证的测量方法评估个体差异。使用医院焦虑和抑郁量表（HADS）和反刍反应量表（RRS）评估心理健康。
根据现有文献，我们确定了三类潜在的预测因素（人口统计学变量、子宫内膜异位症相关因素和个体差异，即“自我”），使用分层多元回归方法检查了它们的心理影响。处于稳定关系（编码为 1['是']或 0['否']）与反刍减少相关（RRS：β=-0.187；P=0.002）。诊断后时间较短与焦虑增加相关（HADS-A：β=-0.177；P=0.015）。盆腔疼痛严重程度和“自我”与所有心理健康变量相关（P<0.01）。较高的自尊、身体形象和情绪自我效能感与较好的心理结果相关（P<0.01）。
局限性/谨慎的原因：性功能、怀孕、不孕、文化差异和性别观念已被发现对子宫内膜异位症女性很重要。在我们的回归模型中，我们没有测试这些变量的心理影响，这应该被认为是一个重要的局限性。此外，本研究的横断面（而非纵向）性质不允许充分检查子宫内膜异位症和心理结果之间的时间关系。
除了盆腔疼痛之外，其他因素也会显著影响子宫内膜异位症女性的心理健康，个体差异的作用需要进一步研究。有针对性的多学科干预措施应包括评估和增强自尊和自我效能感，以改善女性的心理健康。
研究资金/利益冲突：无。
不适用。
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