Depression symptoms and body dissatisfaction association among polycystic ovary syndrome women,☆☆

https://doi.org/10.1016/j.jpsychores.2011.02.005Get rights and content

Abstract

Objective

One publication reported that lower body satisfaction and lower education were independent predictors of depression in polycystic ovary syndrome (PCOS) in women. This study replicates that analysis using different instruments, and adds androgen levels to the model.

Methods

Cross-sectional analysis of questionnaires (Quick Inventory of Depressive Symptomatology-Self-Report, Body Esteem Scale) and serum androgens from a community cohort with (n=94) and without (n=96) PCOS, matched by BMI category. Non-parametric tests, Spearman correlations, and negative binomial regression models were analyzed.

Results

Depression symptoms were common (40–60% in lean, overweight and obese BMI categories) in the PCOS cohort, albeit generally of mild severity. The PCOS women had similar depression symptom severity (P > .20) and similar body dissatisfaction (P  .25) as the regularly cycling women in total and stratified by BMI category. In both the PCOS and non-PCOS cohorts, depression symptom severity was positively correlated with dissatisfaction with physical appearance and physical conditioning (P < .02). Body dissatisfaction (especially perception of physical conditioning) was strongly associated with more severe depression symptoms in non-obese PCOS women (BMI < 30, P < .04) before and after controlling for age, testosterone and free testosterone. In contrast, for obese women with PCOS, depression was unrelated to body dissatisfaction after controlling for age.

Conclusions

Among non-obese PCOS women, their subjective body image was strongly associated with the severity of their depression symptoms. Most of the obese PCOS cohort had low body satisfaction and depression symptoms, therefore individual differences in the body dissatisfaction scores were not helpful in identifying depression symptom severity. Neither testosterone nor free testosterone was associated with depression symptom severity in PCOS women after controlling for body dissatisfaction and age.

Introduction

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of reproductive age women [1]. Approximately 6.5% of women of reproductive age have PCOS [2], [3], which is characterized by irregular or absent menstrual periods and hyperandrogenic manifestations such as acne and hirsutism [4]. The prevalence of depression and depression symptoms is significant in women with PCOS (29% [5] to 50% [6] in small cohorts). In one recent report, women with PCOS were found to have a 3.8 times higher lifetime incidence of depressive episodes (per clinical interviews) than age-, but not BMI-, matched women [7].

An association between elevated testosterone levels and depression has been reported among non-PCOS premenopausal women [8], [9] and women undergoing the menopausal transition [10], although reports of no association exist among postmenopausal women [11] and African-American women aged 49–65[12]. Free testosterone has been reported to have an inverse association with depression symptoms in elderly women [13] and in women with anorexia nervosa [14]. Lower serum dehydroepiandrosterone sulfate (DHEAS) has been linked with increased depression symptoms in African-American women aged 49–65 [12]. Several studies of women with PCOS (with modest sample sizes) have failed to find an association between depression and serum levels of DHEAS [6], sex hormone binding globulin (SHBG) [6], [15], [16], and testosterone [6], [15], [16], [17], [18]. In contrast, a study by Weiner et al. [15] did find a curvilinear relationship between free testosterone and the depression scores among PCOS women (depression scores were lower for women with very high or very low free testosterone). The solitary publication on a possible relationship between excess androgens and body dissatisfaction within the PCOS population reported that lower body satisfaction was associated with hyperandrogenism (free androgen index > 4.5) before and after adjustment for psychological measures (self-esteem and negative appearance scales, P < .03, no comparison group) [19].

PCOS women have lower body satisfaction compared with controls [15], [20], [21]. One publication reported that lower body satisfaction, lower satisfaction with appearance, and lower education were independent predictors of depression in PCOS women after controlling for age and body mass index (BMI) [20]. Two other studies collected body satisfaction and depression data in PCOS women [15], [21], but did not analyze the relationship between those parameters. Among females who received medical care at a centralized facility [22] and individuals in a weight loss facility [23], body image dissatisfaction mediated the association between obesity and depression.

The goals of this report are to quantify among women with PCOS the relationship between depression symptom severity and body dissatisfaction, and to determine if the inclusion of androgen levels improves the ability to predict depression symptom severity. Our a priori hypothesis was that there was a positive association between depression symptom severity and body dissatisfaction based on one prior report [20]; there was no initial expectation for the addition of androgens to the model.

Section snippets

Methods

This study was approved by the University of Virginia's Internal Review Board. The population studied consisted of n=94 untreated women diagnosed with PCOS and a comparison sample of n=96 women with regular menses. This publication is a cross-sectional analysis of baseline data.

Results

Among the PCOS participants, the mean BMI was 30.3 and the mean age was 27.2 years (Table 1). All three BMI groups contained women aged under 25 years and over 35 years, and non-Caucasian women. The comparison cohort was somewhat older than the PCOS cohort, with a mean age in the 30–34 year bracket (P < .01). There were no differences between the PCOS and comparison cohorts by race (P > .29). Among the PCOS cohort, 49% self-reported acne and 73% self-reported hirsutism (data not displayed). Note that

Summary

Our investigation revealed a strong positive association between depression symptom severity and dissatisfaction with their physical appearance (“weight concern” subscale) and physical conditioning in women with PCOS (P  .003). The prevalence and severity of depression symptoms was greater in obese than lean women with PCOS. Higher BMI was associated with greater body dissatisfaction with physical appearance (P < .001).

These associations were also found in a comparison cohort of primarily

Conflict of interest statement

There are no conflicts of interest.

Acknowledgments

We thank Christopher Williams, MD, for overseeing the PCOS diagnosis for all study participants. This work was supported by the National Center for Complementary and Alternative Medicine at the National Institutes of Health (grant R21AT002520 to LMP), and the National Center for Research Resources (grant M01RR000847). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources, or the National

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    This work was presented orally at the 2009 Androgen Excess Society Annual Meeting (June, Washington DC).

    ☆☆

    US Clinical Trials government registry, www.clinicaltrials.gov, NCT00602940.

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