Prevalence of Anxiety and Depression among PCOS Patients Seen in a Tertiary Government Hospital Using the Hospital Anxiety and Depression Scale - English/Pilipino Version (HADS/HADS-P).

Abstract

Background: PCOS is a common gynecologic disorder and recent studies have found that they are more prone in developing depression and anxiety compared to the general population. The Hospital Anxiety and Depression Scale (HADS) is a popular and simple self-administered instrument reliable for detecting states of anxiety and depression. Using this simple screening tool, it may lead to the identification of such mental disorders that may warrant timely psychiatric referral.

Objectives: The study aims to determine the prevalence of anxiety and depression among PCOS patients using the HADS-P questionnaire and to determine the association between depression and anxiety and disease characteristics.

Methods: Convenience sampling was done to recruit PCOS patients >18 years old in Philippine General Hospital. Cross-sectional design was used for the prevalence of depression and anxiety, while nested case control design for the evaluation of the predictors of depression and anxiety. The HADS-P, a self-administered rating scale with independent subscales for anxiety and depression, was administered to the participants after securing consent. A cut-off score of >8 points on either of the depression and anxiety subscale was used to determine their respective prevalence. Logistic regression analysis was used to determine the association of clinical variables with anxiety or depression.

Results: A total of 253 patients with PCOS were recruited. On the basis of a HADS-P score of >8.0 per category, the prevalence of PCOS patients who were suggestive to have anxiety was 46.25% (n: 117, 95% CI: 39.98-52.60%), while 9.09% (n: 23, 95% CI: 5.85-13.33%) of them were suggestive to have depression. Crude logistic regression identified presence of depression, infertility, impaired glucose tolerance, and prominent acne as predictors of anxiety; whereas low parity, hirsutism, and presence of anxiety were predictors of depression. Adjusted logistic regression identified only presence of depression and infertility were significant predictors of anxiety (n: 116, LR χ² (5): 15.46, p<0.01); while presence of anxiety increased the odds of depression by 2- to 13-fold, it was not statistically significant (n: 116, LR χ² (5): 9.79, p: 0.08).

Conclusion: There is a high prevalence of anxiety and depression among PCOS patients. The factors that were seen to be significantly associated with the development of anxiety were the presence of depression, impaired glucose tolerance, infertility and prominent acne, while for the development of depression were the presence of anxiety, hirsutism, and low parity. Screening for anxiety and depression is of paramount importance and physicians should be vigilant for the need of possible psychiatric intervention.