Delineating sociodemographic, medical and quality of life factors associated with psychological distress in individuals with endometriosis
Authors: Sullivan-Myers C , Sherman K A , Beath A P , Duckworth T J , Cooper M J W 
Published: May 2021

Abstract

STUDY QUESTION
What is the relationship between specific quality of life domains and depression, anxiety and stress in the endometriosis population?

SUMMARY ANSWER
Psychosocial domains of quality of life, such as a perception of social support and self-image, are more strongly associated with depression, anxiety and stress than pain and medical factors.

WHAT IS KNOWN ALREADY
Prior research indicates a high prevalence of anxiety and depression in individuals with endometriosis. Pain is thought to be critical in the development of psychological distress, however prior research has investigated this association without consideration of psychosocial quality of life domains such as social functioning, perceived social support and self-image.

STUDY DESIGN, SIZE, DURATION
This study is a cross-sectional analysis of baseline data collected in a longitudinal study exploring psychological distress in endometriosis (n = 584).

PARTICIPANTS/MATERIALS, SETTING, METHODS
Individuals living with endometriosis participated in this study and were recruited via online platforms of community organizations and support groups. Demographic and medical information concerning endometriosis treatment and diagnosis was self-reported. Psychological distress and quality of life was measured using the Depression, Anxiety and Stress Scale (DASS-21), Endometriosis Health Profile-30 (EHP-30) and the Short Form Survey (SF-36v2). A series of linear regression analyses explored the relationship between specific quality of life domains and the primary outcomes of depression, anxiety and stress.

MAIN RESULTS AND THE ROLE OF CHANCE
Approximately half of the participants in this sample reported moderate to severe anxiety, depression and stress. Quality of life domains, particularly perceived social support, social functioning and self-image, were more strongly associated with psychological distress than medical or demographic factors. Pain was associated with anxiety, but not depression or stress. A greater number of endometriosis symptoms was only associated with depression.

LIMITATIONS, REASONS FOR CAUTION
These data are cross-sectional and, therefore, causality cannot be inferred from this analysis. Information about endometriosis diagnosis and treatment was self-reported, and not verified against medical records.

WIDER IMPLICATIONS OF THE FINDINGS
This study indicates that psychosocial factors may be more salient factors underlying depression, anxiety and stress in the endometriosis population than pain and medical factors. There is a need for interventions that target psychological distress in this population with a focus on the broader impact of endometriosis beyond pain and physical symptomatology.

STUDY FUNDING/COMPETING INTEREST(S)
This research was supported by the Research Training Program (RTP) Scholarship awarded to C.S.M. by Macquarie University. The remaining authors have nothing to declare.

TRIAL REGISTRATION NUMBER
ACTRN12619001508167.