Depression in Turner Syndrome: A Systematic Review

Abstract

Turner syndrome (TS) is a genetic condition characterized by partial or complete monosomy X. Alterations in hormonal function, height, and peer relationships, among other features and correlates of TS, appear to be risks for depressive illness. In order to summarize what is known about depression in Turner syndrome, with the aim of determining if individuals with TS are at increased risk for depression, a literature search and analysis was conducted. In total, 69 studies were identified and 35 met criteria of being peer-reviewed English language articles that collected original data on the experience of depression in individuals with TS. Most studies used patient or parent questionnaires to evaluate depressive symptoms. These studies, a majority of which examined adults and half that examined adolescents, found that individuals with TS experienced more frequent and severe depressive symptoms than individuals without TS diagnoses. Articles studying children with TS did not demonstrate a difference in their depressive experience compared to individuals without TS. Three articles used clinician administered scales, such as the Structured Clinical Interview for DSM-IV; all diagnosed depression in those with TS at higher rates than others. Five studies relied on expert opinion to evaluate depression. The remaining eight articles were case reports or case series that relied on expert opinion. From these data, we conclude that adolescents and adults with TS are at risk for depression and adulthood appears to be the period of highest risk. Studies in the last 12 years show consistently more severe depressive symptoms in individuals with TS than in previous years. Implications, risk factors, and recommendations for future research are discussed.

Improving Anxiety Screening in Patients with Turner Syndrome

“…Differences in development of the dorsolateral prefrontal cortex, orbitofrontal cortex, amygdala, and hippocampus have been described as drivers of this neurocognitive phenotype [2][3][4][5]. This phenotype includes difficulties with visual-spatial skills, nonverbal problem solving, social cognition (i.e., perceiving and processing social cues), and executive functioning [2,[6][7][8][9][10]. Additionally, prior studies have demonstrated an increased prevalence of mood disorders, including depression and anxiety, in TS individuals with a lifetime prevalence around 50% [2,7].…”

The contribution of Xp22.31 gene dosage to Turner and Klinefelter syndromes and sex-biased phenotypes

“…Unpartnered women with TS report very low-level sexual functioning and delayed sexual activity, but in partnered women with TS, sexual function appears similar to that in women without the condition (Cardona Attard et al, 2020;Pavlidis et al, 1995;Sheaffer et al, 2008). Consistent with the quality of life findings, TS is associated with higher rates of mood and anxiety disorders which tend to onset after adolescence (Anam et al, 2007;Cardoso et al, 2004;de Vries et al, 2019;Hutaff-Lee et al, 2019;Kilic et al, 2005;Liedmeier et al, 2020;Moonga et al, 2017;Morris et al, 2020), and related traits such as irritability ; severe postpartum depression with psychotic features has been described in one patient with TS who gave birth following egg donation (Shea and Wolfman, 2017). There is some evidence that individuals with Turner syndrome, particularly mosaic subjects, are at increased risk of schizophrenia, a psychotic disorder with neurodevelopmental antecedents (Jung et al, 2014;Lee et al, 2018;Mavrogiorgou et al, 2019;Prior et al, 2000;Roser and Kawohl, 2010).…”

Neurodevelopmental and Mental Health Screening for Patients with Turner Syndrome in Pediatric Endocrine Clinics: Results of a Pediatric Endocrine Society Survey

“…Each of the sections solicited the pediatric endocrinology provider's perspective on the following outcomes: (1) are patients with TS being screened and if so, what does this look like? (2) what are the barriers to screening? (3) could a short, validated screening tool be implemented in the pediatric endocrine clinic setting?…”

“…Girls with TS are at a greater risk for neurodevelopmental (ND) delays and/or MH diagnoses than the general population, with potential adverse effects observed in all health domains. Up to 75% of girls with TS have a learning disability, ∼25% have attentiondeficit hyperactivity disorder, and over half will experience symptoms of anxiety and/or depression [1,2]. Despite how prevalent these conditions are and their known effect on academic achievement and quality of life, symptom recognition is often delayed or missed altogether in girls with TS.…”