Dr. Rashmi Dilip Joshi is practicing Psychiatrist in Mumbai. She did her under-graduation (M.B.B.S.) from B.J.G.M.C. and Sassoon General Hospitals, Pune and post-graduation M.D Psychiatry from Seth G.S.M.C. and K.E.M. Hospital, Parel, Mumbai. She has also qualified her DNB examination in Psychiatry. She has working experience as Senior Medical Of f icer at L.T.M.M.C. and G.H., Sion, and K.B. Bhabha hospital, Bandra (w), Mumbai. She has presented award posters and papers in various conferences. She held position of second runner up in Torrent young scholar award in year 2017 during her residency. She has good clinical skills, teaching experience, is self motivated and has strong interpersonal and communication skills.
Background Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age with increased incidence of emotional disturbances and other psychopathology. We undertook this research to study the prevalence and severity of depression and anxiety as well as understand body image disturbances and self-esteem of the women of PCOS. We studied the relationship of depressive symptoms with self-esteem and body image disturbances.
Method A total of 105 patients diagnosed as PCOS were recruited from gynecology OPD after informed consent and ethics approval. A proforma along with Beck’s Depression Inventory, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Body Image Concern Inventory and Rosenberg’ s Self-Esteem Scale were administered to patients for further assessment.
Results In total, 54 (51.43%) patients of PCOS had depression on BDI, 12( 11.43%) patients had body image disturbances an d 23 (21.90%) patients had a low self-esteem. A total of 21 patients( 20%) had mild and moderate depression while 5% had severe depression. Majority 53 (50.48%) of our patients had mild anxiety whereas severe to extreme anxiety was seen in about 31% of patients. Body image disturbances were seen in only 12(11.43%) patients and low self-esteem was present in 23 patients. No statistically significant correlation of depression was seen with body image or self-esteem.
Conclusions The results of this study indicate that there is a high prevalence of depression and anxiety in patients of PCOS than body image concerns and low self-esteem. Prognosis for patients would improve by liaison between gynecologist and psychiatrist.
Keywords : PCOS · Depression · Anxiety · Body Image · Self-Esteem
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age occurring in about 5 -10% of women [1]. In a recent systemic review and meta analysis Brutacalo et al. [2] reported that PCOS was associated with increased risk of diagnosis of depression, anxiety, bipolar disorder and OCD. Various researchers have reported prevalence of depression to be ranging from 13. 3–53% in their studies [3–6], with anxiety seen in about 41.9% of the patients [7]. Most patients of anxiety had higher levels of generalized and social anxiety symptoms [8]. Among Indian studies, the prevalence for depression was found to be 39% [9, 10] and 25% [11]. Chaudhari et al. [11] found mild, moderate, and severe anxiety on HARS in 62.90%, 29.60%, and 7.40%, of their sample, respectively, whereas Kaur et al. [12] using the GAD7 scale found the prevalence of anxiety to be 56%.
Women with PCOS also have greater body dissatisfaction than healthy control women with regular cycles, even after adjustment for body mass index (BMI) [13]. Experiencing high self-esteem may serve as a protective factor in coping with new and chronic illnesses, whereas low self-esteem is associated with anxiety, depression and increased reports of somatic symptoms [14, 15]. We undertook this study as there are very few Indian studies on these various aspects of PCOS. Our aim was to study the prevalence of depression, anxiety, body image disturbances and self-esteem in patients of PCOS. We also wanted to study the relationship of depressive symptoms with self-esteem and body image disturbances.
The study was a cross-sectional, observational study conducted in the outpatient department of gynecology of a general municipal hospital done over a period of one year after institutional ethics committee approval. The sample size was calculated as per the formula Z2⋅p ⋅ (100 − p) ÷ d2 ⋅p ⋅ (100 − p) ÷ d2 , where p = 38%, q = (100 − p) = 62%; Z = 1.96 ~ 2; d = Absolute error = 10%; non-responder correction -10%. The sample size of our study was 105 patients. All patients enrolled and included in the study were diagnosed by the gynecologists to be having PCOS by Rotterdam diagnostic criteria [16], patients were in the age group 18–50 years (to reduce any potential confounding effects of menopause with average age of onset being 51 years) and did not have previous history of any psychiatric illness. Patients with incomplete diagnosis of PCOS, those already under treatment for any psychiatric illness or women who were pregnant /menopausal or those having hirsutism due to related disorders like congenital adrenal hyperplasia, Cushing´s syndrome and androgen secreting tumors were excluded from the study.
Conflict of interest The authors declare that they have no conflict of interest.
Ethical statement The study was initiated after institutional ethics committee approval of Seth GSMC & KEM Hospital with reference number: IEC/14/7 /15 dated 19th Nov 2015.
Informed consent Informed consent was obtained from all individual participants included in the study. Patient consent statement was taken from each patient as per institutional ethics committee approval along with consent taken for participation in the study and publication of the scientific results/clinical information /image without revealing their identity, name or initials. The patient is aware that though confidentiality would be maintained anonymity cannot be guaranteed.
Consent for Publication Taken from all authors.
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