Psychosocial factors associated with pain and health‐related quality of life in Endometriosis: A systematic review

Abstract

Background and Objective Endometriosis is associated with pain and impaired health‐related quality of life (HRQoL). Psychosocial factors have been associated with pain and HRQoL in other conditions, suggesting their potential relevance in Endometriosis. However, the role of psychosocial factors in this population has not been systematically explored yet. This systematic review aims to explore the association of psychosocial factors with pain intensity/severity and HRQoL in women with Endometriosis. Databases and Data Treatment Observational and experimental studies that explored the association of psychosocial factors with pain and HRQoL in women with Endometriosis were eligible. The following databases were searched: Medline, Embase, Cochrane library, Web of Science, PsychInfo and Cumulative index of nursing and allied health literature. The methodological quality was assessed, and findings were synthesized using narrative synthesis. Results Twenty‐seven studies were eligible for inclusion, which included 5419 women with Endometriosis. Catastrophising and anxiety were the factors most consistently associated with greater pain, whilst depression, anxiety and stress were related to worse HRQoL. Findings regarding depression and pain were mixed, and research on social factors was limited. Conclusions This systematic review highlights the role of psychosocial factors in Endometriosis. Anxiety, depression and catastrophising are suggested as potential treatment targets. The review also indicates the lack of research on other potentially important psychosocial factors, such as avoidance, perceived injustice and social support. Significance This systematic review explored the role of psychosocial factors in Endometriosis, suggesting that these are associated with pain and health‐related quality of life (HRQoL). Among the psychosocial factors included, anxiety, depression and catastrophising were the factors most often associated with pain and HRQoL in Endometriosis. These findings highlight the need to target psychological factors in the treatment of women with Endometriosis.

Anxiety-related behaviors without observation of generalized pain in a mouse model of endometriosis

“…Additionally, in the current ICD framework, endometriosis is characterized as “chronic visceral pain from persistent inflammation in the pelvic region” ( Aziz et al, 2019 ), and low-grade chronic inflammation has been attributed to anxiety and depression in patients ( Leonard, 2018 ). Kalfas et al (2022) , described a strong association between anxiety and pelvic pain in endometriosis patients. While we were not able to show generalized pain, it cannot be ruled out that EIM suffered from low chronic pelvic pain.…”

A qualitative exploration into the role of illness perceptions in endometriosis-related quality of life

“…Up to 64.4% and 63.5% of individuals diagnosed with the condition experience depression and anxiety respectively (Sepulcri & Amaral, 2009), whilst approximately 56% meet the clinical parameters for psychiatric diagnosis (Pope et al, 2015). Endometriosis is further associated with an adverse impact on quality of life (QoL; Della-Corte et al, 2020; Kalfas et al, 2022; Marinho et al, 2018), although there is ongoing debate surrounding the mechanisms by which endometriosis leads to reduced QoL.…”

A qualitative investigation into the role of illness perceptions in endometriosis-related quality of life

“…Up to 64.4% and 63.5% of individuals diagnosed with the condition experience depression and anxiety respectively (Sepulcri and Do Amaral, 2009), whilst approximately 56% meet the clinical parameters for psychiatric diagnosis (Pope et al, 2015). Endometriosis is further associated with an adverse impact on quality of life (QoL; Kalfas et al, 2022; Roomaney and Kagee, 2018), with 89% of individuals diagnosed with endometriosis describing a negative impact on their ability to lead life as they want (All Party Parliamentary Group, 2020). There is ongoing debate surrounding the mechanisms by which endometriosis leads to reduced QoL.…”