In the Journals

'Enduring risk' for depression persists in PCOS throughout lifespan

A cohort of women with polycystic ovary syndrome recruited in early adulthood reported elevated depressive symptoms throughout 30 years of follow-up when compared with healthy controls, regardless of whether women sought treatment for PCOS-related symptoms, according to findings published in The Journal of Clinical Endocrinology & Metabolism.

Eleni A. Greenwood

“Women living with PCOS in the community — and not just coming to clinic for PCOS-related complaints — are at elevated risk for depression,” Eleni A. Greenwood, MD, MSc, a fellow in the department of obstetrics, gynecology and reproductive sciences at University of California, San Francisco, told Endocrine Today. “This risk persists as women age, even though the reproductive aspects of PCOS, such as irregular menses or infertility, become less relevant to women. Taken together, our data support the idea that something intrinsic to PCOS pathophysiology itself predisposes to depression risk.”

Greenwood and colleagues analyzed data from 1,127 women aged 18 to 30 years at an initial visit between 1985-1986 for the CARDIA study, a prospective, 30-year study of cardiovascular risk factor development in black and white young adults in the United States. Women attended exams at years 2 and 16, when PCOS was diagnosed based on the presence of biochemical and clinical hyperandrogenism and oligomenorrhea (n = 83; 60% white). Depressive symptoms were assessed via the 20-item Center for Epidemiologic Studies Depression Scale (CES-D), which was self-administered at years 5, 10, 15, 20, 25 and 30 (score range, 0-60; higher scores indicate greater depressive symptom burden). Researchers used mixed effects models to evaluate the association between depression scores and PCOS.

During follow-up, the rate of completion of depression questionnaires was 85% or higher at each study interval, according to researchers. At all time points, women with PCOS had higher depression scores than controls.

In mixed effects models, a PCOS diagnosis was associated with a 2.5-point higher lifetime CES-D score (95% CI, 1.49-3.54), with results persisting after adjustment for age, BMI, race, education, physical activity and study center. In analyses stratified by race, white women had on average a 1.8-point lower lifetime CES-D score than black women (95% CI, –2.41 to –1.2); however, researchers did not observe an interaction between PCOS diagnosis and race.

Researchers also assessed the trajectory of depression scores in women with and without PCOS in a mixed effects model. There was no between-group difference in depression symptom trajectory across the lifespan, which decreased by an average of 0.1 point per year for women with and without PCOS.

In a sensitivity analysis, researchers also found that women with PCOS were twice as likely to score positively for depression, defined as a cut-off CES-D score of at least 16, as women without PCOS (OR = 2.11; 95% CI, 1.24-3.58).

The researchers noted that the findings reinforce the notion that depressed mood is a long-term psychological comorbidity of PCOS pathophysiology.

“Clinicians should acknowledge the enduring risk of depression across the lifespan in aging women with PCOS,” Greenwood said. “Depression does not appear limited to women of reproductive age seen in the setting of a PCOS clinic visit. A major source of morbidity, depression should be promptly recognized and treated, to promote both quality of life and efforts at self-care, which are important for cardiometabolic health.” – by Regina Schaffer

For more information:

Eleni A. Greenwood, MD, MSc, can be reached at University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Reproductive Endocrinology and Infertility, 499 Illinois St., San Francisco, CA 94158; email: eleni.greenwood@ucsf.edu.

Disclosures: The authors report no relevant financial disclosures.

A cohort of women with polycystic ovary syndrome recruited in early adulthood reported elevated depressive symptoms throughout 30 years of follow-up when compared with healthy controls, regardless of whether women sought treatment for PCOS-related symptoms, according to findings published in The Journal of Clinical Endocrinology & Metabolism.

Eleni A. Greenwood

“Women living with PCOS in the community — and not just coming to clinic for PCOS-related complaints — are at elevated risk for depression,” Eleni A. Greenwood, MD, MSc, a fellow in the department of obstetrics, gynecology and reproductive sciences at University of California, San Francisco, told Endocrine Today. “This risk persists as women age, even though the reproductive aspects of PCOS, such as irregular menses or infertility, become less relevant to women. Taken together, our data support the idea that something intrinsic to PCOS pathophysiology itself predisposes to depression risk.”

Greenwood and colleagues analyzed data from 1,127 women aged 18 to 30 years at an initial visit between 1985-1986 for the CARDIA study, a prospective, 30-year study of cardiovascular risk factor development in black and white young adults in the United States. Women attended exams at years 2 and 16, when PCOS was diagnosed based on the presence of biochemical and clinical hyperandrogenism and oligomenorrhea (n = 83; 60% white). Depressive symptoms were assessed via the 20-item Center for Epidemiologic Studies Depression Scale (CES-D), which was self-administered at years 5, 10, 15, 20, 25 and 30 (score range, 0-60; higher scores indicate greater depressive symptom burden). Researchers used mixed effects models to evaluate the association between depression scores and PCOS.

During follow-up, the rate of completion of depression questionnaires was 85% or higher at each study interval, according to researchers. At all time points, women with PCOS had higher depression scores than controls.

In mixed effects models, a PCOS diagnosis was associated with a 2.5-point higher lifetime CES-D score (95% CI, 1.49-3.54), with results persisting after adjustment for age, BMI, race, education, physical activity and study center. In analyses stratified by race, white women had on average a 1.8-point lower lifetime CES-D score than black women (95% CI, –2.41 to –1.2); however, researchers did not observe an interaction between PCOS diagnosis and race.

Researchers also assessed the trajectory of depression scores in women with and without PCOS in a mixed effects model. There was no between-group difference in depression symptom trajectory across the lifespan, which decreased by an average of 0.1 point per year for women with and without PCOS.

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In a sensitivity analysis, researchers also found that women with PCOS were twice as likely to score positively for depression, defined as a cut-off CES-D score of at least 16, as women without PCOS (OR = 2.11; 95% CI, 1.24-3.58).

The researchers noted that the findings reinforce the notion that depressed mood is a long-term psychological comorbidity of PCOS pathophysiology.

“Clinicians should acknowledge the enduring risk of depression across the lifespan in aging women with PCOS,” Greenwood said. “Depression does not appear limited to women of reproductive age seen in the setting of a PCOS clinic visit. A major source of morbidity, depression should be promptly recognized and treated, to promote both quality of life and efforts at self-care, which are important for cardiometabolic health.” – by Regina Schaffer

For more information:

Eleni A. Greenwood, MD, MSc, can be reached at University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Reproductive Endocrinology and Infertility, 499 Illinois St., San Francisco, CA 94158; email: eleni.greenwood@ucsf.edu.

Disclosures: The authors report no relevant financial disclosures.