Association between psychiatric and reproductive disorders

Association between psychiatric and reproductive disorders | Image Credit: © motortion - © motortion - stock.adobe.com.

An association has been observed between psychiatric and reproductive disorders, though data is limited, according to a recent study published in JAMA Network Open.

Psychiatric and reproductive disorders are common morbidities among women of reproductive age, with a high rate of co-occurrence. Potential causes of this co-occurrence include interference from psychotropic medications, quality of life impacts from reproductive system disorders, and stress affecting reproductive function.

This study was conducted to determine the association between psychiatric and reproductive disorders. Participants included women of reproductive age, defined as 13 to 55 years, or determined by onset of puberty or menopause.

Studies with psychiatric or reproductive disorders as case or control ascertainment criterion were included in the review. Psychiatric or reproductive disorders triggered by life events were excluded, as were disorders caused by physical trauma, substance use, childbirth, sexual dysfunction, infertility, and artificial reproduction.

Psychotic, affective, anxiety, behavioral syndrome, personality, neurodevelopmental, and other early onset psychiatric disorder diagnoses were evaluated, alongside reproductive diagnoses including female pelvic organ inflammatory diseases, female genital tract noninflammatory disorders, and ovarian dysfunction.

There were 4 comparisons made during the study, starting with a comparison of lifetime risk of a psychiatric disorder in women with lifetime diagnosis of a reproductive system disorder. The second comparison made was of lifetime risk of specific lifetime psychiatric disorders when diagnosed with specific reproductive disorders.

The third comparison was of lifetime risk of a reproductive system disorder among women with a lifetime psychiatric disorder diagnosis, and the fourth was of lifetime risk of specific reproductive disorders when diagnosed with specific psychiatric disorders.

Studies used were observational studies published from January 1980 to December 2019 with peer-review and a publish date by December 2019. Studies from 2020 and beyond were excluded because of uncertain effects from the COVID-19 pandemic on psychiatric and reproductive outcomes.

Distiller SR software was used to search for relevant studies, which were then independently screened by 2 authors. Data extraction was performed through prespecified forms.

Of the 1197 records identified, 50 met inclusion criteria for qualitative synthesis and 31 for quantitative synthesis. Odds of psychiatric disorders were about 2 to 3 times greater in women with reproductive disorders overall.

Increased odds of a psychiatric disorder were associated with a reproductive disorder diagnosis, with a lower bound odds ratio (OR) of 2 and an upper bound OR of 2.88. As a great number of studies were outside the expected 95% CI, there is a risk of publication bias associated with them.

Excluding data lines with under 10 cases or controls, the lower bound OR decreased to 1.42 and the upper bound OR to 2.41. Positive associations were mostly seen for diagnosis pairs of psychiatric and reproductive disorders.

For reproductive disorders in patients with a psychiatric diagnosis, slightly increased odds of polycystic ovary syndrome (PCOS) were seen in patients with autism spectrum disorder.When evaluating clinical studies, the combined odds of depression in women with PCOS were 2.58 and anxiety disorders 2.85 compared to women without PCOS.

Reasons for increased anxiety and depression in women with PCOS include the impact of physical manifestations on body satisfaction, adverse effects on mood for medications to manage PCOS, the role of androgens, and shared underlying genetic factors. Bipolar disorder did not see differences in odds based on PCOS status.

For women with chronic pelvic pain (CPP), depression-related disorders had a combined odds of 3.91, and anxiety-related disorders 2.33. There were also 13 articles with associations outside of PCOS, CPP, and affective disorders. Diagnosis pairs in these articles were nearly all positively associated.

Positive associations were made between psychiatric and reproductive disorders overall, but the study was limited by a narrow scope of research and an overrepresentation of small, clinically ascertained samples. Investigators recommended further research on these associations to ascertain their accuracy.

Reference

Zaks N, Batuure A, Lin E, et al. Association between mental health and reproductive system disorders in women: asystematic review and meta-analysis. JAMA Netw Open. 2023;6(4):e238685. doi:10.1001/jamanetworkopen.2023.8685