Cupino-Arcinue Diana J, Banal-Silao Ma Jesusa
Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, College of Medicine and Philippine General Hospital, University of the Philippines Manila.
Acta Med Philipp. 2024 Jun 28;58(11):29-38. doi: 10.47895/amp.v58i11.8977. eCollection 2024.
PCOS is a common gynecologic disorder and recent studies have found that they are more prone in developing depression and anxiety compared to the general population. The Hospital Anxiety and Depression Scale (HADS) is a popular and simple self-administered instrument reliable for detecting states of anxiety and depression. Using this simple screening tool, it may lead to the identification of such mental disorders that may warrant timely psychiatric referral.
The study aims to determine the prevalence of anxiety and depression among PCOS patients using the HADS-P questionnaire and to determine the association between depression and anxiety and disease characteristics.
Convenience sampling was done to recruit PCOS patients >18 years old in Philippine General Hospital. Cross-sectional design was used for the prevalence of depression and anxiety, while nested case control design for the evaluation of the predictors of depression and anxiety. The HADS-P, a self-administered rating scale with independent subscales for anxiety and depression, was administered to the participants after securing consent. A cut-off score of >8 points on either of the depression and anxiety subscale was used to determine their respective prevalence. Logistic regression analysis was used to determine the association of clinical variables with anxiety or depression.
A total of 253 patients with PCOS were recruited. On the basis of a HADS-P score of >8.0 per category, the prevalence of PCOS patients who were suggestive to have anxiety was 46.25% (n: 117, 95% CI: 39.98-52.60%), while 9.09% (n: 23, 95% CI: 5.85-13.33%) of them were suggestive to have depression. Crude logistic regression identified presence of depression, infertility, impaired glucose tolerance, and prominent acne as predictors of anxiety; whereas low parity, hirsutism, and presence of anxiety were predictors of depression. Adjusted logistic regression identified only presence of depression and infertility were significant predictors of anxiety (n: 116, LR χ (5): 15.46, p<0.01); while presence of anxiety increased the odds of depression by 2- to 13-fold, it was not statistically significant (n: 116, LR χ (5): 9.79, p: 0.08).
There is a high prevalence of anxiety and depression among PCOS patients. The factors that were seen to be significantly associated with the development of anxiety were the presence of depression, impaired glucose tolerance, infertility and prominent acne, while for the development of depression were the presence of anxiety, hirsutism, and low parity. Screening for anxiety and depression is of paramount importance and physicians should be vigilant for the need of possible psychiatric intervention.
多囊卵巢综合征（PCOS）是一种常见的妇科疾病，最近的研究发现，与普通人群相比，PCOS患者更容易出现抑郁和焦虑。医院焦虑抑郁量表（HADS）是一种常用且简单的自评工具，可可靠地检测焦虑和抑郁状态。使用这种简单的筛查工具，可能会识别出需要及时转诊至精神科的此类精神障碍。
本研究旨在使用HADS-P问卷确定PCOS患者中焦虑和抑郁的患病率，并确定抑郁、焦虑与疾病特征之间的关联。
采用便利抽样法在菲律宾总医院招募年龄大于18岁的PCOS患者。采用横断面设计来确定抑郁和焦虑的患病率，而采用巢式病例对照设计来评估抑郁和焦虑的预测因素。在获得参与者同意后，向其发放HADS-P量表，这是一种具有独立的焦虑和抑郁分量表的自评量表。抑郁和焦虑分量表中任何一个得分大于8分的临界值用于确定各自的患病率。采用逻辑回归分析来确定临床变量与焦虑或抑郁的关联。
共招募了253例PCOS患者。根据HADS-P量表每类得分大于8.0分，提示有焦虑的PCOS患者患病率为46.25%（n = 117，95%CI：39.98 - 52.60%），而提示有抑郁的患者患病率为9.09%（n = 23，95%CI：5.85 - 13.33%）。粗逻辑回归分析确定抑郁、不孕、糖耐量受损和显著痤疮是焦虑的预测因素；而低产次、多毛症和焦虑的存在是抑郁的预测因素。调整后的逻辑回归分析确定只有抑郁和不孕是焦虑的显著预测因素（n = 116，LR χ(5)：15.46，p < 0.01）；虽然焦虑的存在使抑郁的几率增加了2至13倍，但差异无统计学意义（n = 116，LR χ(5)：9.79，p：0.08）。
PCOS患者中焦虑和抑郁的患病率较高。与焦虑发生显著相关的因素是抑郁、糖耐量受损、不孕和显著痤疮，而与抑郁发生相关的因素是焦虑、多毛症和低产次。筛查焦虑和抑郁至关重要，医生应警惕可能需要精神科干预的情况。
