Public Release: 

Women with PCOS should be screened for mental health disorders

Society for Endocrinology

Women with PCOS are more likely to suffer from mental health disorders and should be routinely screened for these during medical assessments, according to a study presented at the Society for Endocrinology annual conference in Harrogate. These findings support previous work showing that the condition may negatively affect mental health and highlight the importance of screening PCOS patients for mental health disorders.

PCOS is a common condition, affecting 5-10% of women globally, in which elevated male hormone levels can cause a range of distressing and life-limiting symptoms, including reduced fertility, irregular periods, excessive facial and body hair, and acne. Previous studies have suggested a link between PCOS and poor mental health in women but the studies were small and did not adequately take other factors that can affect mental health into consideration. In addition, high levels of testosterone during pregnancy have been reported to increase the risk of neurodevelopmental disorders, such as ADHD and autism, in children.

In this study, researchers from the Neuroscience and Mental Health Research Institute at Cardiff University retrospectively assessed the mental health history of over 17,000 women diagnosed with PCOS. The study followed these patients from PCOS diagnosis and across routine follow- up assessments, for a minimum of 6 months. When compared with unaffected women, matched for age, body mass index and geographical location, the study found that PCOS patients were more likely to be diagnosed with mental health disorders, including depression, anxiety and bipolar disorder. Children born to mothers with PCOS were also found to be at greater risk of developing ADHD and autism spectrum disorder. These findings suggest that women with PCOS should be screened for mental health disorders, to ensure early diagnosis and treatment and ultimately improve their quality of life.

Dr Aled Rees, study lead comments, "The effect of PCOS on mental health is under-appreciated. Our work shows that screening for mental health disorders should be considered during clinical assessments."

Dr Rees and his group now hope to investigate if genetic factors that contribute to the risk of PCOS, also contribute to the risk of autism and ADHD, which may help to reveal new biological pathways implicated in these disorders, and lead to new treatments.

Dr Rees says, "Further research is needed to confirm the neurodevelopmental effects of PCOS, and to address whether all or some types of patients with PCOS are exposed to mental health risks."

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Abstract

P353

Polycystic ovary syndrome is associated with adverse mental health and neurodevelopmental outcomes: a retrospective, observational study

Thomas Berni1, Christopher Morgan2, Ellen Berni1, Aled Rees3

1School of Mathematics, Cardiff University, Cardiff, United Kingdom, 2Pharmatelligence, Cardiff, United Kingdom, 3Neurscience and Mental Health Research Institute, Cardiff University, Cardiff, United Kingdom

Background

Polycystic ovary syndrome (PCOS) is characterised by hyperandrogenism, oligo/amenorrhoea and subfertility but the effects on mental health outcomes are unclear. Offspring neurodevelopment might also be influenced by gestational androgen exposure.

Aims

To determine if (i) there is an association between PCOS and psychiatric outcomes, and (ii) rates of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are higher in the offspring of mothers with PCOS.

Methods

Data were extracted from the Clinical Practice Research Datalink. Patients with a diagnosis of PCOS (2000-2014) were matched to two control sets (ratio 1:1) by age, BMI and primary care practice. Control set 2 were additionally matched on prior mental health status. Primary outcomes were the incidence of depression, anxiety and bipolar disorder. Secondary outcomes were the prevalence of ADHD or ASD in offspring. Rates of progression to each primary outcome were compared using Cox proportional hazard models. Prevalence of ADHD and ASD in offspring were compared using logistic regression.

Results

16,986 eligible PCOS patients were identified; 16,938 (99.7%) and 16,355 (96.3%) were matched to control sets 1 and 2 respectively. Compared to control set 1, baseline prevalence was 23.1% versus 19.3% for depression (p<0.001), 11.5% versus 9.3% for anxiety (p<0.001) and 3.2% versus 1.5% for bipolar disorder (p<0.001). The hazard ratio for time to each endpoint was 1.26 (95% CI 1.19-1.32; p<0.001), 1.20 (1.11-1.29 p<0.001), and 1.21 (1.03-1.42; p<0.001) for cohort 1 and 1.38 (1.30-1.45 p<0.001), 1.39 (1.29-1.51 p<0.001) and 1.44 (1.21-1.71) for cohort 2. The odds ratio for ASD and ADHD in offspring were 1.54 (1.12-2.11) and 1.64 (1.16-2.33) for cohort 1, and 1.76 (1.27-2.46) and 1.34 (0.96-1.89) for cohort 2.

Conclusions

PCOS is associated with psychiatric morbidity and increased risk of ADHD and ASD in the offspring. Screening for mental health disorders should be considered during assessment.

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