Assessment of Depression Among Adolescent Indian Girls With PCOS

Background: Prevalence of PCOS is increasing among Indian women due to growing changes in environment and lifestyle and also due to awareness of symptoms and willingness to seek medical help. Six out of ten females diagnosed with PCOS are teenage girls. Studies have shown that the women with PCOS often suffer from psychiatric comorbidities including depression but the data regarding the prevalence of depression in adolescent Indian girls with PCOS are scarce. Aim: To find out the prevalence of depression and its associations among adolescent Indian girls with PCOS. Methods: This was a cross sectional, case-control study conducted in the Endocrinology department of a speciality hospital of North India. We evaluated 160 newly diagnosed adolescent PCOS girls aged between 13-19 years, diagnosed by Revised Rotterdam criteria. Control group included 80 healthy, age matched, non-PCOS girls. Detailed history, Anthropometric measurements and standard hormonal evaluation were done. Depression was assessed by administering Patient Health Questionnaire-Adolescents (PHQ-A), a self-administered questionnaire based on DSM IV criteria. PHQ-A score of >10 was considered as the threshold for significant depression. Statistical evaluation was done with SPSS and P value of <0.05 was significant. Results: Mean age of the patients was 16.3 +/- 3.2yrs. The frequencies of significant depression in PCOS and control groups were 36.5% and 11.9% respectively. PCOS adolescents having higher HOMA-IR value (p-0.03), higher hirsutism score (P-0.01) and higher BMI (p-<0.01) had a higher risk of significant depression. Menstrual irregularity, acne, dyslipidaemia, serum testosterone, 17-OHP, prolactin and serum TSH levels had no significant correlation with depression. Discussion: PCOS commonly prevails during adolescence, a phase when girls are more concerned about their physiology and physical health. Negative body image and chronic stress can lead to disturbed mental health. Our study by using a simple and patient friendly clinical tool the PHQ-A has found higher prevalence of depression (almost 3 times) in Indian adolescent PCOS girls as compared to controls and it significantly corelates with insulin resistance, hirsutism and obesity. PCOS puts tremendous burden, on both physical as well as mental health, especially in adolescents, due to its effects on physical appearance, self-esteem, fertility and also due to other long term metabolic complications associated with it. PCOS is an urgent health problem that needs careful assessment and appropriate treatment of its all aspects. Timely recognition of mental health issues in these girls can help with early interventions including referral to mental health specialists (if needful) and add to the wellbeing of these young girls. Conclusion: The initial evaluation of PCOS in adolescent girls should also include the assessment of mental health disorders.