Thursday, September 26, 2002

This presentation is part of : Depression and Stress in Vulnerable Populations

Predictors of Depression and Uncertainty in Women with Polycystic Ovarian Syndrome: Hyperandrogenic Symptoms are Associated with Emotional Distress

Gail Schoen Lemaire, RN, PhD, CS-P, assistant professor, University of Maryland, School of Nursing, Cockeysville, MD, USA

Objective: The purpose of this study was to determine the: (a) frequency, severity, and interference with daily activities of self-reported symptoms associated with polycystic ovarian syndrome(PCOS); (b) prevalence of psychosocial distress including anxiety, depression,and decreased quality of life and social support, and perceived uncertainty;(c)interrelationships of PCOS symptoms and anxiety, depression, and perceived uncertainty; and (d) predictors of depression and perceived uncertainty.

Design: This cross-sectional, correlational study examined frequency, severity and interference of PCOS-associated symptoms, anxiety, depression, psychosocial distress, and perceived uncertainty.

Population, Sample, Setting, Years: A convenience sample of 61 women who reported having been diagnosed with PCOS participated in the study. Participants ranged in age from 18 to 47 years (M=32.43) and were attending a fall 2000 PCOS educational program sponsored by the Polycystic Ovarian Syndrome Association. Participants were white (83.6%), married (59.7%), college educated (88.5%), and employed full time (70.5%) with nearly one-half (48.4%) reporting incomes greater than $61,000.

Variables Studied Together: Evidence suggests that hyperandrogenism contributes to depression in women. PCOS, a common, complex endocrine condition results in hyperandrogenism and associated symptoms of anovulation, hirsutism, infertility, acne, and obesity. The etiology of PCOS is unknown. Although some symptoms can be alleviated, treatment results vary and there is no cure. Women's responses to PCOS and their degree of emotional distress have been minimally examined. PCOS may increase women's risk for anxiety and depression due to direct effects of hormonal dysregulation, or indirectly due to women's coping responses. Since little is known about PCOS and treatment outcomes are variable, women may experience uncertainty, which may further increase risk for anxiety and depression.

Methods: Data was collected by the administration of a self-report survey including the 23-item, community version of the Mishel Uncertainty in Illness Scale-Community Form (MUIS-C) to measure participant’s perceived uncertainty about PCOS and items developed by the investigator to assess PCOS-related symptoms, and psychosocial distress including anxiety, depression, quality of life, and social support. Descriptive statistics, Pearson’s r correlations and multiple stepwise regression analyses were used to analyze the data. Cronbach’s alpha coefficients were obtained for scales to provide evidence of reliability.

Findings: Women reported multiple symptoms (M=14.31). The majority of participants reported experiencing hyperandrogenic physical symptoms most of the time in the last 12 months, including facial hair (67.2%), obesity (65.6%), irregular periods (65.6%) and weight gain (50.8%). Depression and anxiety were reported to occur some or most of the time in 83.6% and 64% of women respectively. Uncertainty was relatively high (M=69.39, SD=14.92) when compared to previously studied individuals with chronic illness. Hyperandrogenic physical symptoms were significantly associated with anxiety (r=.36, p=.005), depression (r=.46, p < .0001), and uncertainty (r=.37, p=.003). Depression was significantly associated with anxiety (r=.84, p=.0001), uncertainty (r=.54, p=.0001), and negatively correlated with age (r=-.34, p=.007). Two variables, anxiety and hyperandrogenic physical symptoms predicted 74% of the variance in depression (F (2, 58)=80.99, p < .0001. Anxiety and overall distress during the past month predicted 45% of the variance in perceived uncertainty (F (2, 58)=23.37, p < .0001).

Conclusions: Women reported multiple symptoms associated with PCOS and relatively high levels of uncertainty about their condition. Anxiety and depression appeared to be significant problems for women in this study. The presence of anxiety and hyperandrogenic physical symptoms predicted depression. Anxiety and current level of overall distress were important predictors of women’s perception of uncertainty about their condition.

Implications: Previous findings have suggested that anxiety and depression are associated with abnormal hormone levels rather than women’s perceptions of their hyperandrogenic symptoms. Results of this descriptive study of a nonprobability sample should be interpreted with caution but suggest that anxiety and depression were problems for study participants and that these outcomes were significantly related to women’s perceptions of their hyperandrogenic symptoms. While further study is needed to determine the prevalence of anxiety and depression in women with PCOS and to clarify the relationship of these variables to abnormal hormone levels, findings do suggest that women with PCOS require support and intervention for anxiety and depression as well as for perceived uncertainty.

Back to Depression and Stress in Vulnerable Populations
Back to The Advancing Nursing Practice Excellence: State of the Science