Anxiety, depression, and body image among infertile women with and without polycystic ovary syndrome
Authors: Jannink T , Bordewijk E M , Aalberts J , Hendriks J , Lehmann V , Hoek A , Goddijn M , van Wely M ,   ANDES study group, de Bruin J P , Jansen C A H , Koks C , de Krom G , Lambeek A F , Lambers M J , Maarsen M L , Munster J M , Tanahatoe S J , Verberg M , Vermeulen M 
Published: February 2024

Abstract

STUDY QUESTION
In women undergoing fertility treatment, do those with polycystic ovary syndrome (PCOS) have a higher prevalence of symptoms of anxiety and depression and lower body appreciation than women without PCOS?

SUMMARY ANSWER
Having PCOS was not associated with symptoms of anxiety and depression but was associated with somewhat lower body appreciation.

WHAT IS KNOWN ALREADY
PCOS has been associated with a higher chance to develop mental health problems, like anxiety, and body image concerns. The International Guidelines on PCOS recommend that all women with PCOS should routinely be screened for anxiety and depressive disorders. In most studies in this field, the comparison group included healthy women without fertility problems.

STUDY DESIGN, SIZE, DURATION
We conducted a cross-sectional survey study between May 2021 and July 2023, using an online questionnaire. We informed women about this study at fertility clinics in the Netherlands through posters and leaflets and on the websites of the Dutch patient organizations Freya and Stichting PCOS.

PARTICIPANTS/MATERIALS, SETTING, METHODS
This study included women with infertility, with and without PCOS, who were undergoing fertility treatment. Women completed two assessment tools: the Hospital Anxiety and Depression Scale (HADS) and the Body Appreciation Scale-2 (BAS-2). Primary outcomes were clinically relevant symptoms of anxiety (score ≥ 11) and depression (score ≥ 11), and BAS-2 scores. Secondary outcomes were mean anxiety and depression scores and anxiety and depression scores of 8 and higher. Dichotomous outcomes and continuous outcomes were analysed using logistic and linear regression analyses adjusted for age, BMI, and duration of infertility.

MAIN RESULTS AND THE ROLE OF CHANCE
A total of 1025 women currently undergoing infertility treatment participated, of whom 502 (49.0%) had PCOS and 523 (51.0%) had other infertility diagnoses. We found self-reported clinically relevant symptoms of anxiety in 33.1% of women with PCOS and in 31.0% of women with other infertility diagnoses (adjusted OR: 0.99, 95% CI 0.74–1.31). Clinically relevant symptoms of depression were reported in 15.5% of women with PCOS versus 14.5% of women with other infertility diagnoses (adjusted OR: 1.04, 95% CI 0.71–1.50). Women with PCOS reported slightly less body appreciation (adjusted mean difference: −1.34, 95% CI −2.32 to −0.36).

LIMITATIONS, REASONS FOR CAUTION
Results are based on self-report and may have been affected by sampling bias.

WIDER IMPLICATIONS OF THE FINDINGS
Although guidelines recommend screening women with PCOS, feelings of anxiety and depression can be present in any woman undergoing fertility treatments. We advise fertility clinics to be aware of women’s mental health issues and to offer support accordingly, as a part of routine care.

STUDY FUNDING/COMPETING INTEREST(S)
This study did not receive specific funding. All authors report no conflict of interest related to the current research.

TRIAL REGISTRATION NUMBER
This study was pre-registered at OSF: https://osf.io/qbeav.