Enduring depression in polycystic ovary syndrome: results of a longitudinal study

Abstract

Cross-sectional data reveal an increased prevalence of depressive symptoms in women with polycystic ovary syndrome (PCOS). The trajectory of symptoms over time has not been described due to a lack of longitudinal studies. We sought to describe the course of depressive symptoms over time and to identify predictors of enduring depression risk in PCOS using a longitudinal design. Longitudinal cohort study Rigorously characterized women with PCOS-Rotterdam ages 16-44 were enrolled in a cohort study between 2006 and 2017 following a visit to a multi-disciplinary clinic. The Beck Depression Inventory Fast Screen (BDI-FS) was self-administered to identify depression risk using a cut-off score of >4 at the baseline visit. A follow-up survey was distributed via email in 2017 to determine interval changes and the BDI-FS was repeated. Women with positive depression risk at baseline were divided into two groups on the basis of whether they screened positive or negative for depression risk at follow-up. Kruskall-Wallis, chi-square and Fischer’s exact testing compared parameters between groups. Multivariate logistic regression modeling evaluated factors associated with odds of enduring depression during the study period. A 42% response rate (179/423) yielded 163 women with complete BDI-FS data at baseline and follow-up. At baseline, median age was 29.0 years (IQR 25.2, 32.2) and BMI was 28.3 kg/m2 (IQR 24.1, 35.2). Follow-up interval was 5.5 years (IQR 2.4, 8.1). 59/163 women screened positive for depression risk at baseline (36%); 52 women (32%) screened positive at follow-up. Median change in BDI-II score was 0 (IQR -2, 1) over the study period. Of the 59 women with depression risk at baseline, 37% were not depressed at follow-up (Resolved group), while 63% had enduring depressive symptoms (Enduring group). For subjects with depression risk at baseline, participants with enduring depression had higher total and LDL cholesterol, lower HDL and a trend toward higher BMI at baseline compared to subjects with resolved depression risk. Serum androgens and hirsutism scores did not differ between groups. In a multivariate logistic regression model controlling for baseline age, baseline BDI-FS score and follow-up interval, each additional unit of BMI at baseline increased odds of enduring depression by 9% (aOR 1.09, 95% CI 1.00, 1.18, p=0.05). Similarly, compared to women with normal body weight, women in the obese range at baseline (BMI >30 kg/m2) had a five-fold increased risk of enduring depression at follow-up (aOR 4.81, 95% CI 0.94, 24.6, p=0.058). Women with PCOS are at high risk of mood disorders. We found that the prevalence of depression was relatively stable over time in a cohort of women followed longitudinally, and that elevated BMI is a hallmark of enduring depression risk. These results may assist providers in developing targeted intervention strategies to reduce the prevalence of women with long-term depressive symptoms.