Improving care for women with polycystic ovary syndrome - Fertility and Sterility

Depression is one of the leading causes of global disease burden, with a prevalence of 3%–8% worldwide. In a 2016 survey reported by the National Institute of Mental Health, the prevalence of major depressive episodes was higher in females compared with males (8.5% vs. 4.5%) and highest in Caucasians and adults between 18 and 25 years of age (1x1National Institute of Mental Health. Major depression. Available at: https://www.nimh.nih.gov/health/statistics/major-depression.shtml. Google ScholarSee all References)(1). A significant proportion of adults (64%) reported impairment with a major depressive episode, and 34% received no treatment. Among adolescent females, the prevalence of depression was 19.4%, and 60% reported receiving no treatment. It is not surprising that the health care burden of depression-related care in the United States in 2010 was estimated to be $210.5 billion. Collectively these findings support the United States Preventive Services Task Force recommendation to screen for depression in the general adult population, including pregnant and postpartum women. Women with polycystic ovary syndrome (PCOS) usually present with gynecological and dermatological complaints, but they frequently have cardiometabolic risk factors that increase with age and obesity and during pregnancy. In addition, it is now recognized that they have an increased prevalence of depressive symptoms (28%–46%). We recently published an updated meta-analysis that confirmed significantly increased odds of depressive symptoms associated with PCOS (odds ratio [OR] = 3.21; 95% confidence interval [CI], 2.65–3.89), and this risk persisted independent of age and obesity (2x2Cooney, L.G., Lee, I., Sammel, M.D., and Dokras, A. High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2017; 32: 1075–1091 Crossref | PubMed | Scopus (36) | Google ScholarSee all References)(2). More importantly, the risk of moderate and severe depressive symptoms, assessed using validated screening tools, was also increased (OR = 4.15; 95% CI, 2.62–6.56). The studies included in this meta-analysis primarily surveyed women seeking medical or fertility-related care for PCOS, and few surveyed community-based populations. Most reported mean depression scores, and only a few studies assessed clinically diagnosed depression based on in-person interviews. Concomitantly, the prevalence of moderate and severe anxiety symptoms was also noted to be increased (34%–57%). Unfortunately, a large proportion of