A population-based follow-up study shows high psychosis risk in women with PCOS

Salla Karjula,Terhi T. Piltonen,Jouko Miettunen,Juha S. Tapanainen,Riikka K. Arffman,Laure Morin-Papunen,Stephen Franks,Marjo-Riitta Järvelin

doi:10.1007/s00737-021-01195-4

Abstract

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting up to 18% of women. Besides metabolic and fertility aspects, attention has lately been directed towards the detrimental effect of PCOS on psychological health. The objective of the study was to investigate whether women with PCOS are at higher risk for psychotic disorders. The study population derives from the Northern Finland Birth Cohort 1966 (N = 5889 women). The women with PCOS were identified by two simple questions on oligo-amenorrhea and hirsutism at age 31. Women reporting both symptoms were considered PCOS (N = 124) and asymptomatic women as controls (N = 2145). The diagnosis of psychosis was traced using multiple national registers up to the year 2016. Symptoms of psychopathology were identified using validated questionnaires at age 31. Women with PCOS showed an increased risk for any psychosis by age 50 (HR [95% CI] 2.99, [1.52–5.82]). Also, the risk for psychosis after age 31 was increased (HR 2.68 [1.21–5.92]). The results did not change after adjusting for parental history of psychosis, nor were they explained by body mass index or hyperandrogenism at adulthood. The scales of psychopathology differed between women with PCOS and non-PCOS controls showing more psychopathologies among the affected women. PCOS cases were found to be at a three-fold risk for psychosis, and they had increased psychopathological symptoms. PCOS should be taken into consideration when treating women in psychiatric care. More studies are required to further assess the relationship between PCOS and psychotic diseases.

Highlights

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of women, affecting up to 18% of reproductive-aged women (March et al 2010)
The lifetime prevalence for psychoses other than schizophrenia was increased in PCOS: 5.6% vs. 1.6% (p = 0.006) (Fig. 2A)
There were no differences in diagnoses of schizophrenia between the PCOS group (0.8%) and controls (0.9%; p =0.96) during this period, whereas the incidence of other psychoses was 5.7% (Fig. 2B)

Summary

Introduction

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of women, affecting up to 18% of reproductive-aged women (March et al 2010). This complex, chronic condition often remains undiagnosed and untreated (Piltonen et al 2019; Teede et al 2018). Previous studies have shown that women with PCOS are at increased risk of psychological problems such as depression, anxiety, bipolar disorder, and disordered eating (Chen et al 2020b, 2020c; Cooney et al 2017; Karjula et al 2017; Teede et al 2018). The predisposing factors for these comorbidities remain unclear to date (Cooney et al 2017; Teede et al 2018).

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