A mixed-methods study of coping and depression in adolescent girls with polycystic ovary syndrome

Abstract

Background and purpose: Polycystic ovary syndrome (PCOS) is a complex metabolic disorder associated with clinical manifestations that could be psychologically distressing to adolescent girls considering the concern of body image during the developmental stage of adolescence. Poor psychological functioning is related to increased mortality, higher health care costs, and negative health outcomes. Coping has been identified as impacting health and adaptation to illness; therefore, the purpose was to examine coping and depression in adolescent girls with PCOS. Methods: Adolescent girls, aged 13–18 years and diagnosed with PCOS completed questionnaires regarding coping and depression and participated in interviews. A convergent, parallel, mixed-method design was used. Conclusions: Girls perceived very little control over the aspects of PCOS, with menstrual irregularities and the threat of infertility reported as the most stressful and least controllable aspects of PCOS. Lower control was a predictor of greater depression among the participants. Implications for practice: Providers should strive to establish rapport with adolescent girls and ask specifically about their concerns surrounding PCOS to provide meaningful health education. Providers should also be aware of the risk for depression among this population and should routinely screen patients and keep channels of communication open regarding the symptoms of depression.

Quality of life in adolescent girls with polycystic ovary syndrome

“…19,20 It is well known that weight plays a key role in PCOS 35 and this was a recurring theme among the studies investigating QoL in adolescent girls with PCOS. Weight issues continued to be an area of concern for adolescent girls in the majority of studies included, 14,[29][30][31][32][33] which has previously been reported in similar studies in adult women. 36,37 Weight was also a driving influence in QoL scores in the study by Trent et al, 24 the largest study to date of QoL in adolescent girls with PCOS and healthy adolescents, in which the majority of adolescent girls with PCOS were overweight or obese (76%).…”

“…24 Further analyses in a subgroup of the cohort identified that adolescent girls with PCOS were 3.4 times more likely to answer yes to having concerns about infertility than their healthy counterparts and these adolescent girls also scored lower in some key measures of QoL including general health perceptions, self-esteem, social emotional, physical and behavioural roles and mental health ( Table 1). 25 Three studies evaluated QoL related to PCOS: one was a crosssectional study that used an unvalidated questionnaire 29 and two were RCT studies that used the PCOSQ. 30,31 The cross-sectional study investigated those areas that were perceived to be the most stressful for adolescent girls with PCOS and the following areas of body weight, irregular periods, hirsutism, acne and infertility overlapped with the PCOSQ.…”

“…30,31 The cross-sectional study investigated those areas that were perceived to be the most stressful for adolescent girls with PCOS and the following areas of body weight, irregular periods, hirsutism, acne and infertility overlapped with the PCOSQ. 14,29 The study reported that adolescent girls with PCOS scored highest on the issues of weight, menstrual irregularities and the threat of future infertility, which were suggested to affect QoL. The two RCTs in adolescent girls with PCOS indicated that a life-style intervention improved PCOS-specific QoL.…”

“…A total of seven studies evaluated QoL in general and four studies evaluated QoL related to PCOS in this review, although only two of those studies used a validated questionnaire (PCOSQ). 30,31 Despite not using the validated PCOSQ, Hopkins et al 29 assessed adolescent girls' concerns about acne, hirsutism, weight and irregular periods, which addressed similar domains to those included in the PCOSQ. Trent et al 25 reported an increase in concerns about infertility in adolescent girls with PCOS when compared to girls without the condition.…”

“…12,13 An additional limitation of this review was the fact that the studies used multiple diagnostic criteria to diagnose the adolescent girls with PCOS, two studies did not specify diagnostic criteria and only one study reported on age of menarche, which is an important factor to determine menstrual irregularity (one of the diagnostic criteria for PCOS). Despite this, most of the studies (n = 6) used commonly accepted criteria, including menstrual irregularity and hyperandrogenism, 24,25,28,29,31,34 and only three studies 26,30,33 used Rotterdam criteria, 6 including pelvic ultrasound, which is no longer recommended for diagnosis of PCOS until 8 years post-menarche. Research including larger sample sizes of better-defined populations, as recently described, is required in adolescent girls with PCOS, but further research in the area of emotional well-being is also required.…”