Uterine fibroids and risk of depression, anxiety, and self-directed violence

Cohort study participants were selected from the Optum Clinformatics commercial insurance claims database in Eden Prairie, Minnesota between May 1, 2000 and March 1, 2020 in order to evaluate the mental health risks of UF.

Stephanie E Chiuve, ScD, general medicine and neuroscience therapy area head, global epidemiology, at AbbVie Pharmaceutical Research and Development in North Chicago, Illinois and colleagues compared 313,754 women aged 18-50 that had been diagnosed with UF with 627,539 who did not have fibroids.

Women with UF were matched 1:2 with women who were not diagnosed with UF based on age and calendar time. Women with a prior diagnosis of depression, anxiety, self-violence, or who had been prescribed anti-anxiety or anti-depressant medication were excluded from the study.

Other exclusionary categories included cancer diagnosis, prior hysterectomy, and women who did not have UF who did not start follow up or had incomplete cases. Researchers also conducted a secondary analysis in 50,525 women who had a hysterectomy to see if these women were also at higher risk.

Researchers reported a median follow up time of 596 days for anxiety, 608 days for depression, and 665 days for self-directed violence. After confounder adjustment, researchers reported that women who had been diagnosed with UF had higher rates of anxiety (HR: 1.12; 95% CI 1.10 to 1.13), depression n (HR:1.12; 95% CI 1.10 to 1.13), and self-directed violence (HR: 1.46; 95% CI 1.29 to 1.64).¹

For women with heavy menstrual bleeding and pain, the HR for depression that compared women with diagnosed UF to women without was 1.21 (95% CI 1.18 to 1.25), 1.68 (95% CI 1.35 to 2.09) for self- directed violence, and 1.18 (95% CI 1.15 to 1.21) for anxiety, according to researchers.

In addition, Chiuve and colleagues wrote, “Among women with diagnosed UF, the HR comparing women who underwent a hysterectomy to women who did not was 1.22 (95% CI 1.17 to 1.27) for depression, 1.13 (95% CI 1.09 to 1.17) for anxiety and 1.86 (95% CI 1.39 to 2.49) for self- directed violence.”¹

Researchers said there may be a link between chronic pain and depression due to similar biological mechanisms, and noted the higher rates of both anxiety and depression in patients with chronic pain conditions.

Chiuve and colleagues also noted higher rates of UF in Black women, whom they said have higher rates of UF at younger ages, experience worse symptoms, and are more likely to have hysterectomies.

Researchers added that these hysterectomies were also more likely to be abdominal than laparoscopic.

They said that while Black women experience these greater health challenges related to UF, “rates of diagnosed depression and anxiety were not elevated in Black women.”¹

According to Chiuve and colleagues, this could be due to the stigma of mental health issues for Black women, who may not report symptoms even though they have higher loads of stressors than White women due to racial disparities, researchers reported.

“Additional research is needed to understand whether these observed differences are due to differences in disease burden, clinical or cultural presentation of symptoms and/or access to healthcare,” they said.¹

“Obstetricians and gynecologists can play an important role in early detection, prevention and treatment of mood disorders by screening for symptoms at routine examinations,” researchers concluded.¹ They recommended a multidisciplinary approach to better manage depression, anxiety, and self-violence in women with UF.

Reference

1. Chiuve SE, Huisingh C, Petruski-Ivleva N, Owens C, Kuohung W, Wise LA. Uterine fibroids and incidence of depression, anxiety and self-directed violence: a cohort study. J Epidemiol Community Health. 2022;76(1):92-99. doi:10.1136/jech-2020-214565