The risk of attempted suicide is increased among individuals with polycystic ovary syndrome (PCOS), according to a recent study published in Annals of Internal Medicine.1
Takeaways
- Individuals diagnosed with polycystic ovary syndrome (PCOS) face a significantly higher risk of suicide attempts compared to the general population, as indicated by a study utilizing data from a Taiwanese nationwide database.
- The heightened risk of suicide attempts associated with PCOS varies across age groups, with adolescents, young adults, and older adults exhibiting different hazard ratios.
- Given the increased suicide risk, it is crucial to prioritize mental health management for individuals with PCOS. This includes regular screening, appropriate interventions, and support services to address psychological well-being.
- The development and utilization of condition-specific instruments such as the Polycystic Ovary Syndrome Questionnaire (PCOSQ) are essential for assessing health-related quality of life (HRQoL) in PCOS patients. The PCOSQ-50, a widely used version, encompasses multiple domains reflecting the multifaceted impact of PCOS on HRQoL.
- There's a need to refine HRQoL assessment tools for PCOS patients, as indicated by findings suggesting potential improvements in factor models. Separating domains like obesity and menstrual disorders could enhance the accuracy and depth of assessment, leading to better understanding and management of PCOS.
Data for the study was obtained from the Taiwanese nationwide database and included 18,960 patients diagnosed with PCOS between 1997 and 2002. These patients were matched 1:10 with controls based on psychiatric comorbid conditions, age, income, and urbanization level.
Cox regression models were used to analyze suicide attempts, with hazard ratios (HRs) used to measure suicide risk. The HR for a suicide attempt was 8.47 among participants with PCOS, indicating an 8.47-fold increased risk. Among adolescents, young adults, and older adults, the HRs were 5.38, 9.15, and 3.75, respectively.
Investigators concluded mental health and suicide risk should be managed in patients with PCOS. To improve health-related quality-of-life (HRQoL) in impacted patients, a condition-specific instrument is necessary for monitoring HRQoL.2
The first PCOS-specific HRQoL instrument was the Polycystic Ovary Syndrome Questionnaire (PCOSQ), a 26-item tool assessing HRQoL on a 7-point Likert scale, with higher scores indicating improved function. A more commonly applied version of this instrument is the PCOSQ-50, which includes 50 items across 6 domains: psychological, fertility, sexual function, obesity/menstrual disorders, hirsutism, and coping.
The HRQoL in women with PCOS aged 18 to 42 years was evaluated in a cross-sectional study. PCOS-specific HRQoL was determined using a cross-sectional internet-based survey using Research Electronic Data Capture.
Race, age, educational attainment, geographic location, number of children and comorbid conditions, and marital, employment and insurance status were determined during a demographic questionnaire. PCOS diagnosis was self-reported and had strong concordance with electronic medical records.
The PCOSQ-50 measures these items on a 5-point Likert sale, with the total score calculated as the sum of all answers divided by the number of answered items. Improved HRQoL is determined by decreased scores.
There were 935 participants included in the final analysis, aged 31.0 ± 5.8 years. Of participants, 72% were White, 56% had a college degree, 69% were married, and 65% were employed full-time. The presence of 1 or more chronic condition such as type 2 diabetes, hypertension, hypothyroidism, and arthritis was reported alongside PCOS in 74% of participates.
The lowest average standard deviation (SD) among the subscales was 1.36 how the fertility item “In the past 4 weeks, how often have you experienced fear of divorce or separation?” The highest SD was 3.27 for the obesity/menstrual disorders item “In the past 4 weeks, how often have you felt concerned about being overweight?”
An acceptable Kaiser-Meyer-Olkin measure of sampling adequacy for the model of 0.93 was reported. While this indicated the model was adequate, confirmatory factor analysis found improved results from a 7-factor model compared to the currently used 6-factor model.
Currently, obesity and menstrual conditions are included in a single domain. Separating these factors may improve accuracy and allow for greater assessment of PCOS in women.
Reference
- Hsu T, Kao Y, Tsai S, et al. Suicide attempts after a diagnosis of polycystic ovary syndrome. Annals of Internal Medicine. 2024. doi:10.7326/M23-2240
- Wright PJ, Tavakoli AS, Dawson RM. Exploratory factor and confirmatory analyses of the polycystic ovary syndrome health-related quality of life questionnaire (PCOSQ-50). Health Qual Life Outcomes. 2024;22(1):15. doi:10.1186/s12955-024-02228-z
