Frequency of Depressive Symptoms in Women with Polycystic Ovary Syndrome and Obesity versus Women with Polycystic Ovary Syndrome without Obesity

Polycystic Ovary Syndrome

adult women with PCOS for 25 years found consistently higher scores for depression symptoms, as measured by the Center for Epidemiologic Studies-Depression (CES-D) scale, in comparison to women not diagnosed with PCOS [5].The study indicated that women with PCOS were twice as likely to screen positively for depression compared to those without the condition.The underlying reasons for the heightened prevalence of depressive symptoms among women with PCOS are still not entirely understood but could be related to the severity of physical symptoms like hirsutism, metabolic issues, and infertility problems.Additionally, it is hypothesized that symptoms of depression might be involved in the development of PCOS, possibly via stress-related behavioral and physiological pathways [6].While research has been conducted on the prevalence of depression in adult women with PCOS, there is a gap in knowledge about the extent and contributing factors of depression in younger individuals with PCOS.In Pakistan, around 11% of adolescents are diagnosed with depression, and girls are two to three times more likely to suffer from major depressive disorder than boys [7].For girls dealing with obesity or metabolic issues, the incidence of depression ranges from 12% to 21% [8].Hamman et al., revealed that young individuals with obesity and Type 2 Diabetes (T2D) had higher depressive symptoms, as measured by the CES-D scale, compared to those with Type 1 Diabetes (T1D) who were not obese [9].A considerable number of these adolescents with T2D had CES-D scores exceeding the threshold of 16, signaling signi cant depressive symptoms and necessitating further evaluation for depression [10].Likewise the Copeland et al., study which included 704 young people with T2D aged between 10 and 17 and with a BMI in the 85th percentile or higher, found that 17% of the girls had elevated levels of depressive symptoms [11].Given these heightened rates of depression among adolescents with obesity and T2D, along with the increased risk of depression in adult females with PCOS, there's a critical need to study the prevalence of depression in young individuals with both PCOS and obesity, a demographic yet to be adequately studied in Pakistan.The rationale of this study was to explore whether adolescent girls with PCOS and obesity would demonstrate similar levels of depression symptoms as girls without obesity.Therefore, the objectives of this study were to compare depressive symptoms among women with obesity and without obesity that have PCOS.

R E S U L T S
The mean age of women with PCOS and obesity was 25.5 ± 3.2 years, while those with PCOS without obesity had a slightly higher 26.0 ± 2.8 years.The average BMI value for women with PCOS and obesity was substantially 30.4 ± 2.7, compared to those without obesity, who had an average BMI value of 22.3 ± 2.1.In terms of education level, a similar distribution was observed in both groups, with a signi cant proportion holding a Bachelor's degree.Employment status showed that a higher percentage of women with PCOS and without obesity were employed compared to those with PCOS and obesity.with age range between 11 and 17 years and having presence of polycystic ovaries or irregular menses.The participants were chosen via non-probability purposive sampling.Females with already established psychiatric diagnosis, having Cushing syndrome or metabolic disorder were excluded from the study.Sample size was calculated using Open Epi sample size calculator via taking prevalence of PCOs in obese female adolescents in Pakistan as 23.3% with 5% margin of error and 90% con dence interval [2].The diagnosis of PCOs was made in accordance with the guidelines established by the Endocrine Society (including criteria such as oligomenorrhea lasting for more than 2y e a r s h i s t o r y o f a m e n o r r h e a a n d b i o c h e m i c a l hyperandrogenism, with no other underlying cause for oligomenorrhea or elevated androgens).Ultrasound of all women was done to assess the number of cysts in the ovaries.Girls were categorized into obese and non-obese on the basis of BMI.The depressive symptoms were assessed by CES-D.The data were analyzed via SPSS version 24.0.Mean ± SD was calculated for quantitative variables while frequency and percentages were calculated for qualitative variables.This study unearths the complex relationship among PCOS, obesity, and depressive symptoms.The study found out that women with PCOS and obesity appear to be at a higher risk of experiencing clinically signi cant depressive symptoms.Healthcare providers should consider the mental health needs of this population, emphasizing a multidisciplinary approach to care.al., in 2011 in the United States found that women with both PCOS and obesity are more likely to experience depression compared to those who are not obese [21].Similarly, research by Cooney et al., in Australia in 2017 also discovered a higher occurrence of depression among women with both PCOS and obesity [22].However, it's important to recognize that the link between PCOS, obesity, and depressive symptoms is intricate and in uenced by various factors.This may include biological aspects related to hormonal imbalances, psychological factors tied to body image and self-esteem, and sociocultural factors impacting how women perceive and manage their condition.

Table 2
reveals that the duration of PCOS was similar in both groups, with women in the PCOS with obesity group having 5.7 ± 1.2 years, and those without obesity having 5.3 ± 1.0 years.Notably, hyperandrogenism was more prevalent among women with PCOS and obesity, with 75.6% of this group exhibiting this clinical characteristic compared to Table3presents the scores for depressive symptoms, as measured by the CES-D (Center for Epidemiologic Studies-Depression) scale.Women diagnosed with both PCOS and obesity showed a higher average CES-D score of 22.8 (with a standard deviation of 4.7).In contrast, those without obesity had a lower average score, registering at 18.5 (with a standard deviation of 3.9).The median CES-D score for women with PCOS and obesity was 23 (IQR: 20-26), while for those without obesity, it was 19 (IQR: 16-22).Additionally, a notably higher percentage of women with both PCOS and obesity, speci cally 75.6%, had CES-D scores of 16 or above.This score is a marker for signi cant depressive symptoms.On the other hand, only 46.2% of women without obesity reached this threshold for depression.
Azziz et al., in 2016OS, obesity, and hormone imbalances are all connected.Other studies have seen similar patterns.For example,Azziz et al., in 2016pointed out how having too much male hormone is a big part of PCOS, and obesity can make it worse[16].

Table 2 :
Clinical Characteristics 0% in the PCOS without obesity group.Oligomenorrhea was also more common in the PCOS with obesity group, with 91.1% experiencing it, while 73.1% of women without obesity had this condition.Hirsutism was observed in 66.7% of women with PCOS and obesity, whereas it was present in 34.6% of women without obesity.