Women with polycystic ovary syndrome are more likely to be diagnosed with mental health conditions, including depression, anxiety and bipolar disorder, when compared with similar women without PCOS, according to findings published in the Journal of Clinical Endocrinology & Metabolism.
In a retrospective analysis of nearly 17,000 women diagnosed with PCOS, researchers also found that children born to mothers with PCOS were at greater risk for developing attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder vs. children born to mothers without PCOS.
“The findings suggest that women with PCOS should be screened for mental health disorders to ensure early diagnosis and treatment and, ultimately, improve their quality of life,” Aled Rees, MD, PhD, MBBCh, FRCP, a consultant endocrinologist at the Neuroscience and Mental Health Research Institute at Cardiff University School of Medicine, United Kingdom, told Endocrine Today. “Further research is needed to confirm the neurodevelopmental effects of PCOS, and to address whether all or some types of patients with PCOS are exposed to mental health risks.”
Rees and colleagues analyzed data from 16,986 women diagnosed with PCOS between 2000 and 2014 from the Clinical Practice Research Datalink, a longitudinal research database from 674 primary care practices in the United Kingdom. Researchers matched women with PCOS 1:1 with two cohorts of women without PCOS (controls): one group of women matched by age and BMI (n = 16,938) and a second group of women additionally matched by history of prior mental health disorder (n = 16,355; depression, anxiety, bipolar disorder, schizophrenia, disordered eating, autism or ADHD). Primary outcome was the incidence of mental health disorder. Secondary outcomes were the prevalence of autism or ADHD in children of mothers with PCOS (children identified via mother-baby link within the database). Births before and after the mother’s index diagnosis date were included in the study to maximize patient numbers, according to researchers. Researchers used Cox proportional hazard models to assess crude rates of progression to each outcome among cases and controls and logistic regression analysis to examine the association between PCOS status in mothers and risk for autism spectrum disorder and ADHD among children.
For control set 1, mean follow-up time was 3.87 years for cases and 2.81 years for controls. For control set 2, mean follow-up time was 3.88 years for cases and 3.07 years for controls. For both sets of matched women, the women with PCOS had increased primary care contacts in the year prior to the index date and an increased proportion of extreme obesity vs. controls (6.7% vs. 3.9% for control set 1, and 6.3% vs. 3.8% for control set 2).
In control set 1, women with PCOS were more likely to be previously diagnosed with depression vs. controls 19.32% of controls (23.1% vs. 19.32%; P < .00001), anxiety (11.55% vs. 9.32%; P < .00001), bipolar disorder (3.16% vs. 1.45%; P < .00001) and disordered eating (1.55% vs. 1.03%; P = .00003). There were no between-group differences in prevalence of schizophrenia, autism spectrum disorder or ADHD, according to researchers.
In analyzing incidence of mental health disorders following the index diagnosis date, women with PCOS in control set 1 had a higher incidence of depression (42.62 vs. 34.45 per 1,000 patient years), anxiety (21.99 vs. 17.61 per 1,000 patient years), bipolar disorder (4.83 vs. 3.64 per 1,000 patient years) and disordered eating (7.57 vs. 4.36 per 1,000 patient years). In control set 2, women with PCOS similarly had a higher incidence of depression, anxiety, bipolar disorder and disordered eating.
For women with PCOS in control set 1, HR was 1.26 for time to depression (95% CI, 1.19-1.32), 1.2 for time to anxiety (95% CI, 1.11-1.29), 1.21 for time to bipolar disorder (95% CI, 1.03-1.42). For women with PCOS in control set 2, HR was 1.38 for time to depression (95% CI, 1.3-1.45), 1.39 for time to anxiety (95% CI, 1.29-1.51), 1.44 for time to bipolar disorder (95% CI, 1.21-1.71).
Children born to mothers with PCOS were more likely to be diagnosed with both autism spectrum disorder and ADHD in control set 1 (OR = 1.54 and 1.64, respectively) and in control set 2 (OR = 1.76 and 1.34, respectively).
“PCOS is one of the most common conditions affecting young women today, and the effect on mental health is still underappreciated,” Rees said in a press release announcing the findings. “This is one of the largest studies to have examined the adverse mental health and neurodevelopmental outcomes associated with PCOS, and we hope the results will lead to increased awareness, earlier detection and new treatments.” – by Regina Schaffer
For more information:
Aled Rees, MD, PhD, can be reached at the Neuroscience and Mental Health Research Institute, Cardiff University School of Medicine, Health Park, Cardiff CF24 4HQ, United Kingdom; email: email@example.com.
Disclosures: The researchers report no relevant financial disclosures.