Division Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands.
Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, The Netherlands.
PLoS One. 2020 Jun 1;15(6):e0233876. doi: 10.1371/journal.pone.0233876. eCollection 2020.
Many women with Polycystic Ovary Syndrome (PCOS) report high depression rates. The relationship between PCOS and these high depression rates is unclear. Two-component lifestyle interventions have revealed short-term effects on depression scores in this group of women. In general, 3-component interventions including diet, exercise, and cognitive behavioral therapy (CBT) are more effective in the long-term to improve emotional well-being. This has not yet been studied in women with PCOS. This study examined the effect of 20 CBT lifestyle (LS) sessions combined with a healthy diet and physical therapy with or without 9 months additional feedback through Short Message Service (SMS) via mobile phone, compared to care as usual (CAU, involving advice to lose weight). In this secondary analysis, 155 women with PCOS and a BMI above 25 kg/m2 were eligible. Depression scores decreased significantly in the LS programme compared to CAU (P = 0.045). In both the LS programme without SMS (P = 0.036) and the LS programme with SMS (P = 0.011) depression scores decreased while no change was observed in CAU (P = 0.875). Self-esteem scores improved significantly in the LS programme compared to CAU (P = 0.027). No differences in body image scores were observed in LS participants compared to CAU (P = 0.087), although body image improved significantly in both the LS without SMS (P = 0.001) and with SMS (P = 0.008) study arms. We found no significant mediating role by androgens in the relationship between LS participants and emotional well-being. Only weight-loss mediated the relationship between LS and self-esteem. To conclude, a three-component lifestyle intervention programme with or without additional SMS resulted in significant improvements in depression and self-esteem compared to CAU, in women with PCOS, obesity, and a wish to achieve a pregnancy. Testosterone, androstenedione, DHEA, insulin, HOMA-IR, and cortisol did not mediate this effect. Weight loss mediated the effects on self-esteem but not on depression and body-image. This suggests that lifestyle treatment independent of weight loss can reduce depression and body-image, but both lifestyle treatment and weight loss can improve self-esteem. Thus, a three-component lifestyle intervention based on CBT could prove successful in improving mood in women with PCOS who are overweight or obese and attempting to become pregnant.
许多多囊卵巢综合征 (PCOS) 患者报告抑郁发生率较高。PCOS 与这些高抑郁率之间的关系尚不清楚。两部分生活方式干预已显示出对该组女性抑郁评分的短期影响。一般来说，包括饮食、运动和认知行为疗法 (CBT) 的三部分干预措施在长期内更有效地改善情绪健康。这在 PCOS 患者中尚未得到研究。本研究检查了 20 次 CBT 生活方式 (LS) 课程与健康饮食和物理治疗相结合的效果，或不结合 9 个月的额外短信服务 (SMS) 通过手机反馈，与常规护理 (CAU，包括减肥建议) 相比。在这项二次分析中，符合条件的 155 名 PCOS 患者和 BMI 超过 25kg/m2 的患者。LS 方案中的抑郁评分与 CAU 相比显著降低（P=0.045）。在没有 SMS 的 LS 方案中（P=0.036）和有 SMS 的 LS 方案中（P=0.011），抑郁评分降低，而 CAU 中没有观察到变化（P=0.875）。LS 方案中自尊评分与 CAU 相比显著提高（P=0.027）。LS 参与者的身体形象评分与 CAU 相比没有差异（P=0.087），尽管在没有 SMS 的 LS 组（P=0.001）和有 SMS 的 LS 组（P=0.008）中，身体形象都显著改善。我们没有发现雄激素在 LS 参与者与情绪健康之间的关系中起中介作用。只有体重减轻在 LS 与自尊之间起中介作用。总之，与 CAU 相比，有或没有额外 SMS 的三部分生活方式干预方案可显著改善 PCOS、肥胖和希望怀孕的女性的抑郁和自尊。睾酮、雄烯二酮、脱氢表雄酮、胰岛素、HOMA-IR 和皮质醇并未介导这种作用。体重减轻介导了自尊的影响，但不能介导抑郁和身体形象的影响。这表明，独立于减肥的生活方式治疗可以减轻抑郁和身体形象，但生活方式治疗和减肥都可以提高自尊。因此，基于 CBT 的三部分生活方式干预可能有助于改善超重或肥胖且试图怀孕的 PCOS 女性的情绪。
