P-469 Tackling Anxiety and Depression in Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome: The role of chronic illness-related shame, self-compassion and psychological flexibility
Authors: Galhardo A , Carolino N , Nogueira F , Vilar A , Fialho R , Marques J , Cunha M 
Published: July 2024

Abstract

Study question
What predicts depressive and anxiety symptoms in Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome?

Summary answer
Chronic illness-related shame emerged as the only significant predictor of depressive and anxiety symptoms in women with an MRKH diagnosis.

What is known already
An MRKH diagnosis may elicit a range of emotions, such as depression, sadness, anxiety, shock and shame. Feelings of being different may induce shame, which has been associated with psychopathological symptoms. Depression and anxiety are more prevalent in women facing an MRKH diagnosis when compared to women without this condition. Younger age and a more recent diagnosis are risk factors for developing depressive and anxiety symptoms. Although emotion regulation processes, as self-compassion and psychological flexibility, have proven to ameliorate the impact of chronic illnesses on the mental health of those affected, studies addressing these processes in MRKH patients are scarce.

Study design, size, duration
Cross-sectional study. Several European patients’ associations disseminated the study through their social media platforms. The online invitation to participate encompassed detailed information regarding the study’s aims and procedures, inclusion criteria, and the voluntary and anonymous nature of the participation. Informed consent was mandatory. Data collection occurred between February and September 2023.

Participants/materials, setting, methods
75 women aged 18-60 (M=31.04, SD=9.70), presenting an MRKH syndrome diagnosis for 14.07 years (SD=10.17). Most participants had undergone medical treatment (n=47, 62.70%). Participants completed online a set of standardized self-report measures: Depression, Anxiety and Stress Scales-21 (DASS-21), Chronic Illness-related Shame Scale (CISS), Compassion, Engagement and Actions Scales (CEAS) and Psy-Flex. Regression analyses using chronic illness-related shame, self-compassion and psychological flexibility as independent variables and depressive and anxiety symptoms as dependent variables were conducted.

Main results and the role of chance
Depressive symptoms showed a significant negative correlation with age (r=-.35, p=.002) and time since diagnosis (r=.31, p=.006). Depressive symptoms were also positively and significantly correlated with the CISS (r=.43, p&lt;.001) and negatively significantly with the actions subscale of the CEAS (r =-.29, p=.010) and with the Psy-Flex (r=-.42, p&lt;.001). Anxiety symptoms were positively correlated with the CISS (r=.48, p&lt;.001) and negatively significantly with the actions subscale of the CEAS (r =-.25, p = .029) and with the Psy-Flex (r=-.37, p=.001). The linear regression model was significant [r2=.25; F(1, 71)=15.19; p&lt;.001], explaining 25% of depressive symptoms. The only significant predictor was chronic illness-related shame (β=.29; p=.013). The regression model considering anxiety symptoms as the dependent variable was also significant [r2=.22; F(1, 73)=22.30; p&lt;.001]. A similar pattern was found with chronic illness-related shame (β=.39; p&lt;.001) also emerging as the only significant predictor of anxiety. Women who underwent medical treatment revealed significantly less depressive symptoms and chronic illness-related shame when compared with those who did not.

Limitations, reasons for caution
The cross-sectional design does not allow for causal inferences. Results should also be interpreted cautiously due to limitations derived from the recruitment and data collection procedures (e.g., sampling bias, self-selection concerns, exclusion of participants not using social media or online platforms), restricting the possibility of making generalizations.

Wider implications of the findings
When working with women presenting an MRKH diagnosis it is important to consider the role of chronic illness-related shame, given it may contribute to a higher vulnerability of developing depressive and anxiety symptoms. These findings suggest that psychological interventions targeting shame may be adequate approaches for MRKH patients.

Trial registration number
not applicable