Archives of Women's Mental Health最新文献

{"title":"Informed consent and contraception when prescribing valproate to individuals of childbearing potential: a quality improvement project","authors":"Mariella Suleiman,&nbsp;Natalie Jarahzadeh,&nbsp;Anna Belikova,&nbsp;Himani Jani,&nbsp;Maria Bodic,&nbsp;Paulette Ginsburg,&nbsp;Theresa Jacob,&nbsp;Sara V. Carlini","doi":"10.1007/s00737-025-01639-1","DOIUrl":"10.1007/s00737-025-01639-1","url":null,"abstract":"<div><h3>Purpose</h3><p>Valproate is an efficacious treatment for several neurologic and psychiatric disorders, but it carries a grave risk of teratogenicity. Despite warnings from regulatory bodies, prescribing guidelines from professional associations, and expert opinion against the practice, the medication continues to be commonly prescribed to persons with childbearing potential for psychiatric indications.</p><h3>Methods</h3><p>A quality improvement focused educational intervention on the conduct and documentation of informed consent and contraceptive counseling when prescribing the teratogen valproate to individuals aged 12–55 who may become pregnant was implemented in the Psychiatry Department of an urban community hospital. Documentation from 3 months before and after the intervention was qualitatively assessed for notation of informed consent, including the patient’s expressed understanding of risks as well as specific counseling on teratogenicity and the need for contraception, in acute care and outpatient charts that had a prescription from a psychiatric provider for valproate in that time frame.</p><h3>Results</h3><p>While statistically significant improvement was found in the documentation of general informed consent and patients’ responses to counseling in outpatient charts, there was no improvement in acute care charts and no significant increase in valproate-specific counseling in charts from either care setting.</p><h3>Conclusion</h3><p>The minimal impact of an educational initiative on documentation of informed consent in the present study suggests that education alone may not be sufficient to address the crucial safety concern of valproate prescribing practices in psychiatric patients who may become pregnant.</p></div>","PeriodicalId":8369,"journal":{"name":"Archives of Women's Mental Health","volume":"29 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145983210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trauma, knowledge, and survival: epistemic and decolonial lessons from Yazidi women survivors","authors":"Serhat Yildirim,&nbsp;Hana Abbasian,&nbsp;Bilal Irfan,&nbsp;Theresa S Betancourt","doi":"10.1007/s00737-025-01660-4","DOIUrl":"10.1007/s00737-025-01660-4","url":null,"abstract":"","PeriodicalId":8369,"journal":{"name":"Archives of Women's Mental Health","volume":"29 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145958750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trimesters induced changes in pharmacokinetic parameters of antipsychotics","authors":"Ida Adhayanti,&nbsp;Robiyanto Robiyanto,&nbsp;Muh. Akbar Bahar,&nbsp;Elly Wahyudin","doi":"10.1007/s00737-025-01665-z","DOIUrl":"10.1007/s00737-025-01665-z","url":null,"abstract":"<div><h3>Purpose</h3><p>There is a need to balance maternal mental health treatment with fetal safety when prescribing antipsychotic medications during pregnancy. Physiological changes during pregnancy markedly influence drug pharmacokinetics, making it difficult to achieve therapeutic efficacy without compromising on the risks.</p><h3>Methods</h3><p>A systematic review was performed to identify trimester-specific physiological changes impacting antipsychotic pharmacokinetics. A retrieval of relevant studies published between inception to October 3, 2023 was conducted through PubMed, Web of Science, Cochrane Library, and Embase. Key pharmacokinetic parameters examined include bioavailability, volume of distribution, clearance, half-life, and area under the curve.</p><h3>Results</h3><p>Pregnancy-related physiological changes, such as increased plasma volume, enhanced hepatic blood flow, and altered protein binding, can significantly affect the pharmacokinetics of antipsychotics. For instance, plasma concentrations of Haloperidol, a first generation antipsychotic (FGA), have been reported to decrease by up to 52% in the third trimester. Similarly, Quetiapine and Aripiprazole, both second generation antipsychotics (SGAs), show substantial reductions in plasma levels during the same period, by 76.2% and 76.8%, respectively. These findings suggest a potential need for dose adjustments to maintain therapeutic drug exposure as pregnancy progresses. Physiologically based pharmacokinetic (PBPK) models further support this adjustment to ensure continued clinical efficacy.</p><h3>Conclusions</h3><p>Significant changes in pharmacokinetics are observed for antipsychotic drugs during pregnancy, underlining the importance of developing a personalized dosing strategy and therapeutic drug monitoring to maximize therapeutic efficacy and at the same time keep the treatment safe for mother and fetus.</p></div>","PeriodicalId":8369,"journal":{"name":"Archives of Women's Mental Health","volume":"29 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145958762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reproductive coercion and violence against women with unplanned pregnancies in Turkiye","authors":"Ruşen Öztürk,&nbsp;Özlem Güner,&nbsp;Elmin Emi̇nov","doi":"10.1007/s00737-025-01668-w","DOIUrl":"10.1007/s00737-025-01668-w","url":null,"abstract":"<div><h3>Purpose</h3><p>This study aimed to examine the effects of reproductive coercion and violence on women with unplanned pregnancies in Türkiye.</p><h3>Methods</h3><p>This descriptive and cross-sectional study was conducted between 2021 and 2022 with women who applied to the obstetrics and gynecology outpatient clinic. Data were collected using the “Descriptive Information Form,” the “Women Abuse Screening Tool (WAST),” and the “Reproductive Coercion Scale (RCS).</p><h3>Results</h3><p>A total of 380 women were included in the study. It was found that 18.7% of women had experienced reproductive coercion, and 17.1% had been exposed to violence. A significant difference was observed between scores on the Reproductive Coercion Scale and the Violence Scale (<i>X</i>² = 25.173, <i>p</i> &lt; 0.001). Spouse’s alcohol consumption, reproductive coercion, residence, marital status, type of marriage, and pregnancy status together explained 27.8% of the variance in participants’ levels of violence.</p><h3>Conclusion</h3><p>The study demonstrated that women in Türkiye experienced reproductive coercion during their reproductive years and that there was an association between violence against women and reproductive coercion. Notably, reproductive coercion and violence appeared to be significantly influenced by regional and cultural factors, reflecting variations observed across different countries and societies.</p></div>","PeriodicalId":8369,"journal":{"name":"Archives of Women's Mental Health","volume":"29 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00737-025-01668-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145930479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antipsychotic drug use during pregnancy and neonatal outcomes: a systematic review and meta-analysis","authors":"Dervla Quinn,&nbsp;Michael Donnelly,&nbsp;Ciaran O’Neill","doi":"10.1007/s00737-025-01651-5","DOIUrl":"10.1007/s00737-025-01651-5","url":null,"abstract":"<div><h3>Purpose</h3><p>The use of antipsychotics during pregnancy has increased over the past two decades, primarily driven by an increase in the use of second-generation antipsychotic drugs. However, knowledge regarding the reproductive safety of antipsychotic drugs remains limited. This systematic review and meta-analysis investigated the associations between in utero antipsychotic drug exposure and congenital malformations and other neonatal outcomes.</p><h3>Methods</h3><p>A systematic search of MEDLINE, Embase, and PsycInfo was conducted from database inception to February 2024 for cohort and case-control (English language) studies that examined maternal antipsychotic exposure and reported risk estimates for one or more of the following outcomes: congenital malformation, preterm birth, low birth weight, stillbirth, or neonatal intensive care unit admission. Study quality was assessed using the Newcastle-Ottawa Scale, and reporting was guided by the PRISMA statement and MOOSE guidelines. Pooled estimates were calculated using a random-effects model.</p><h3>Results</h3><p>Twelve studies (comprising over 10 million pregnancies across 12 countries) met the inclusion criteria. A pooled meta-analysis of eight studies indicated borderline evidence of an association between the risk of congenital malformations and in utero antipsychotic drug exposure, with moderate heterogeneity (odds ratio [OR] 1.27; 95% confidence interval [CI] 0.996–1.624, <i>p</i> = 0.0535; I² = 53%). No association was observed when limited to second-generation antipsychotics (OR 1.16; 95% CI 0.78–1.72, <i>p</i> = 0.47). Regarding the outcome of preterm birth, antipsychotic exposure was associated with an increase in risk (OR 1.35; 95% CI 1.13–1.62, <i>p</i> &lt; 0.01), though there was moderate to high heterogeneity (I² = 70%). There was insufficient data to perform a meta-analysis for the other outcomes.</p><h3>Conclusion</h3><p>Meta-analyses did not indicate strong evidence that in utero antipsychotic exposure is a major teratogen; and although an association was observed between maternal antipsychotic use and preterm birth, there was significant heterogeneity across studies. The decision to continue antipsychotic use during pregnancy involves a complex balancing of risks and benefits for women and their healthcare professionals. Any potential risks to the developing foetus must be weighed against the risks of discontinuing treatment, including the possibility of relapse in women with severe mental illness, which can have serious consequences for a woman and her infant. Finally, there is a need for further robustly designed studies.</p></div>","PeriodicalId":8369,"journal":{"name":"Archives of Women's Mental Health","volume":"29 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00737-025-01651-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145930262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parental care in adolescence and women’s later postpartum psychosocial wellbeing: a 20-year prospective preconception cohort study","authors":"Stephanie R. Aarsman,&nbsp;S Ghazaleh Dashti,&nbsp;Genevieve Le Bas,&nbsp;Jacqui A. Macdonald,&nbsp;Christopher J. Greenwood,&nbsp;Delyse M. Hutchinson,&nbsp;Ebony J. Biden,&nbsp;Jessica A. Kerr,&nbsp;Tina Kretschmer,&nbsp;Lisa Ritland,&nbsp;Kimberly C. Thomson,&nbsp;Craig A. Olsson,&nbsp;Elizabeth A. Spry","doi":"10.1007/s00737-025-01641-7","DOIUrl":"10.1007/s00737-025-01641-7","url":null,"abstract":"<div><h3>Purpose</h3><p>Prior retrospective evidence links parental care when growing up to later mental health in the perinatal period, but prospective evidence on a broader range of perinatal outcomes is limited. This study aimed to estimate the effect of low parental care (maternal, paternal, or both) during adolescence on psychosocial wellbeing in women at one year postpartum.</p><h3>Methods</h3><p>We emulated a target trial using observational data from a preconception cohort study, the Victorian Intergenerational Health Cohort Study (<i>N</i> = 398 women, 609 infants). At age 16 years, adolescents reported on care from their parental figures. After becoming parents themselves, up to 20 years later, they were assessed at one year postpartum on psychosocial wellbeing outcomes (social support, partner coercive control, depressive symptoms, parenting anxiety, and parenting self-efficacy). Generalised estimating equations were used to estimate relative risks of each outcome by low parental care, adjusted for potential baseline confounders.</p><h3>Results</h3><p>Low parental care was associated with a number of aspects of women’s social and psychological wellbeing at one year postpartum. The strongest evidence was observed for low maternal care and high family social support (aRR = 0.84, 95%CI 0.72–0.97), high partner coercive control (aRR = 1.38, 95%CI 1.05–1.83), and high depressive symptoms (aRR = 2.03, 95%CI 1.07–3.86). For most outcomes, effect sizes for one low-care caregiver were similar to effect sizes for two low-care caregivers.</p><h3>Conclusions</h3><p>Women who report one or more primary caregiver relationships characterised by low care in adolescence may face increased risk for psychological difficulties within a context of fewer social supports after becoming parents.</p></div>","PeriodicalId":8369,"journal":{"name":"Archives of Women's Mental Health","volume":"29 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145930260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Which therapy works best for maternal depressive symptoms? A network meta-analysis of psychotherapeutic interventions","authors":"Hakan Öztürk,&nbsp;Rüveyda Yüksel,&nbsp;Ayça Balmumcu","doi":"10.1007/s00737-025-01658-y","DOIUrl":"10.1007/s00737-025-01658-y","url":null,"abstract":"<div><h3>Purpose</h3><p>Maternal depression is a significant public health concern that can adversely affect both mothers and their children. Although various psychotherapeutic interventions have been proposed, their relative comparative efficacy remains unclear. This network meta-analysis (NMA) aimed to evaluate and compare the efficacy of different psychotherapeutic interventions in reducing maternal depressive symptoms.</p><h3>Methods</h3><p>A systematic search was conducted in the Web of Science Core Collection (Science Citation Index Expanded and Social Sciences Citation Index) to identify randomized controlled trials (RCTs) published between 1 February 2021 and 1 February 2025. Eligible studies included mothers aged ≥ 18 years who were assessed for maternal depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) and received any form of psychotherapy. Data were extracted using a predefined format (PROSPERO ID: CRD420251010916). Random-effects models were used to perform the NMA in R, reporting mean differences (MD) with 95% confidence intervals (CIs) and P-scores.</p><h3>Results</h3><p>A total of 8 RCTs involving 2,919 participants were included. Cognitive behavioral therapy (CBT) was the only intervention that showed a statistically significant reduction in depressive symptoms compared to treatment as usual (TAU) (MD = -3.22, 95%CI: -5.91 to -0.54; <i>p</i> = 0.019; P-score = 0.92). Other interventions showed trends toward improvement, but these were not statistically significant (<i>p</i> &gt; 0.05).</p><h3>Conclusion</h3><p>CBT emerged as the most efficacious psychotherapeutic approach in both direct and indirect comparisons, supported by statistical evidence from the NMA.</p></div>","PeriodicalId":8369,"journal":{"name":"Archives of Women's Mental Health","volume":"29 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00737-025-01658-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145930263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender and income disparities in World Psychiatry Congress participation (2023–2024)","authors":"Imran Gokcen Yilmaz-Karaman,&nbsp;Mariana Pinto da Costa,&nbsp;Betul Koseoglu,&nbsp;Asli Ugur Oktar,&nbsp;Florence Thibaut,&nbsp;Ann Færden","doi":"10.1007/s00737-025-01646-2","DOIUrl":"10.1007/s00737-025-01646-2","url":null,"abstract":"<div><h3>Purpose</h3><p>Although the number of women in psychiatry has increased substantially, gender disparities remain in leadership and visibility at scientific meetings. Country income level also affects academic participation, but its impact within the field of psychiatry remains underinvestigated. This study examined gender and income disparities at the country level, as well as gender and income disparities within countries, at two consecutive World Congresses of Psychiatry (WCPs), held in Austria (2023) and Mexico (2024).</p><h3>Methods</h3><p>The scientific programs of WCP 2023 and WCP 2024 were systematically reviewed to identify all speakers and chairs. Data were extracted on gender, role, session type, and country income level, classified according to World Bank criteria. Gender was determined from congress profiles, photographs, pronouns, or the Gender API. Statistical analyses included chi-square tests with Bonferroni corrections, with significance set at <i>p</i> &lt; 0.05.</p><h3>Results</h3><p>WCP 2023 featured 999 speakers/chairs, and WCP 2024 featured 574. Women’s representation increased significantly from 37.4% in 2023 to 43.4% in 2024 (<i>χ²</i> = 5.382, <i>df</i> = 1, <i>p</i> = 0.020). Participation from low- and middle-income countries also rose in 2024, while men’s representation from high-income countries declined. Several session types in 2024 reached or exceeded gender parity, including Distinguished Lectures (58.3%), Panel Discussions (50%), and Early Career Psychiatrist Sessions (60%).</p><h3>Conclusions</h3><p>Women’s representation at WCPs has shown encouraging improvement, although parity has not yet been achieved, and differences are evident by country income level. Hosting congresses in middle-income countries may support broader participation. Continued monitoring, mentorship initiatives, and inclusive conference policies can further strengthen gender equality and global representation in psychiatry.</p></div>","PeriodicalId":8369,"journal":{"name":"Archives of Women's Mental Health","volume":"29 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00737-025-01646-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vitamin D levels and perinatal anxiety in an anxiety-focused behavioral intervention program in Pakistan","authors":"Semra Etyemez,&nbsp;Kruti Mehta,&nbsp;Jennifer Faiz,&nbsp;Mehrose Ahmad,&nbsp;Ahmed Zaidi,&nbsp;Najia Atif,&nbsp;Atif Rahman,&nbsp;Abid Malik,&nbsp;Kristin M. Voegtline,&nbsp;Pamela J. Surkan,&nbsp;Lauren M. Osborne","doi":"10.1007/s00737-025-01653-3","DOIUrl":"10.1007/s00737-025-01653-3","url":null,"abstract":"<div><h3>Purpose</h3><p>This study investigates Vitamin D levels across the perinatal period and relationships with perinatal anxiety and immune markers in women in Pakistan.</p><h3>Methods</h3><p>We analyzed plasma levels of 25-hydroxyvitamin D and cytokines and chemokines from 117 participants from the “Happy Mother-Healthy Baby” trial, which evaluated a non-specialist delivered cognitive behavioral therapy intervention for perinatal anxiety. Blood samples were collected at four timepoints: T1 (10–22 weeks), T2 (22–26 weeks), T3 (34–38 weeks), and T4 (six weeks postpartum). Participants were categorized into anxiety groups using K-means clustering. Mixed-effect models were used to examine Vitamin D trajectories, and moderation analysis explored the impact of immune markers on the Vitamin D-anxiety relationship.</p><h3>Results</h3><p>Vitamin D levels were severely deficient across all timepoints (&lt; 5 ng/ml) and declined significantly from T1 to T2 (β = -0.549, <i>p</i> = .006) before rebounding postpartum (β = 1.492, <i>p</i> &lt; .0001). Despite this widespread Vitamin D deficiency, no significant differences in Vitamin D trajectories were observed across anxiety groups. Higher innate immune activity correlated with higher Vitamin D levels at T1. IL-6 and CXCL-8 levels moderated the Vitamin D and anxiety relationship at T2 (IL-6: β = 2.98, <i>p</i> = .015; CXCL-8: β = 0.72, <i>p</i> = .030); among those with higher levels of IL-6 and CXCL-8, higher Vitamin D levels were associated with higher levels of anxiety.</p><h3>Conclusions</h3><p>These findings indicate the need for further research on maternal Vitamin D deficiency and its relationship with immune function in low- and middle-income countries.</p></div>","PeriodicalId":8369,"journal":{"name":"Archives of Women's Mental Health","volume":"29 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological stress and functional ovarian suppression in women with PCOM: an observational study of FHA-like neuroendocrine phenotypes","authors":"Vanessa Silva,&nbsp;Sérgio Soares,&nbsp;Rui Miguelote","doi":"10.1007/s00737-025-01657-z","DOIUrl":"10.1007/s00737-025-01657-z","url":null,"abstract":"<div><h3>Propose</h3><p> To examine how chronic psychological stress alters gonadotropin dynamics and disrupts ovarian endocrine function in women with polycystic ovarian morphology (PCOM), and to discuss the modulatory role of leptin in this process.</p><h3>Methods</h3><p> In this cross-sectional study of 134 women, participants were classified into four groups: three subgroups of women with oligomenorrhea—PCOM with stress, PCOM without stress, and NON-PCOM/NON-STRESS—and a comparison group of eumenorrheic controls. Psychological stress was assessed with validated psychometric instruments (STAI, HADS, PSS-10), and a composite Stress Index was derived. PCOM was defined according to the 2023 International Evidence-based Guideline for PCOS. Stress status was classified using established cut-offs for each instrument, with non-stress cohorts defined by scores consistently below clinical thresholds. Hormonal profiling included LH, FSH, estradiol, AMH, leptin, cortisol, and ACTH. Mediation and moderation models were employed to examine the relationships among stress, leptin, the LH/FSH ratio, and ovarian endocrine markers, as AMH and estradiol.</p><h3>Results</h3><p> Women in the PCOM–STRESS group exhibited significantly lower LH levels, LH/FSH ratios, and AMH concentrations compared to PCOM–NON–STRESS, despite similar ovarian morphology and preserved FSH levels. Mediation analysis revealed that the LH/FSH ratio significantly mediated the effect of psychological stress on both estradiol and AMH levels. Moderation analysis indicated that leptin modulated the impact of stress on the LH/FSH ratio (interaction p = 0.004), with more pronounced suppressive effects of psychological stress under low leptin levels. Despite high psychological stress, women in the PCOM–STRESS group showed no activation of the HPA axis, suggesting neuroendocrine resilience or adaptation. These findings highlight the clinical value of assessing both psychological and metabolic context in women with ambiguous ovulatory dysfunction.</p><h3>Conclusion</h3><p> Chronic psychological stress in women with PCOM is associated with functional suppression of LH and ovarian endocrine output, reflecting an attenuation of the typical PCOS endocrine phenotype despite the polycystic ovarian morphology. Leptin modulates individual susceptibility to stress-induced reproductive suppression, acting as a potential permissive signal of hypothalamic resilience. Assessing gonadotropin ratios and metabolic context may improve diagnostic accuracy in women with ambiguous ovulatory dysfunction.</p></div>","PeriodicalId":8369,"journal":{"name":"Archives of Women's Mental Health","volume":"29 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00737-025-01657-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}