Illness uncertainty and stigma: factors positively associated with symptoms of depression and anxiety in women with spontaneous 46,xx primary ovarian insufficiency (premature ovarian failure)

Abstract

To assess levels of depression and anxiety in women with primary ovarian insufficiency and to examine the association of these symptoms with the degree of illness uncertainty and perceived stigma associated with the diagnosis. Controlled cross-sectional. We recruited women with spontaneous primary ovarian insufficiency (n = 100) and control women (n = 60) between 18 and 42 years of age. Outcome measures: Center of Epidemiologic Studies Depression Scale (CES-D), state anxiety subscale of the State-Trait Anxiety Inventory (STAI), Illness Uncertainty and an adapted Stigma scale. Statistical methods included t-test for continuous variables, chi square or exact test for categorical variables, Kruskal-Wallis test for singly-ordered contingency tables, and Pearson correlation. Patients and controls did not differ significantly with regard to age, race/ethnicity, marital status, or education. Women with spontaneous primary ovarian insufficiency had a significantly higher mean (±SD) score on both the depression scale (14.9 ± 10.5 vs. 9.1 ± 8.1, P<0.001) and the anxiety scale (40.9 ± 10.6 vs. 33.5 ± 9.9, P<0.001). As compared to controls, patients were more likely to meet criteria for mild to moderate depression (14.4% vs. 10%) or severe depression (26.8% vs. 8.3%) (P<0.002). Nearly 23% of patients met criteria for high anxiety as compared to 8% of controls (P<0.001). For patients, depression scores were positively correlated with levels of Illness Uncertainty (r = 0.44, P<0.001) and Perceived Stigma (r = 0.53, P<0.001). State anxiety scores were also positively related to scores of both Illness Uncertainty (r = 0.52, P<0.001) and Perceived Stigma (r = 0.51, P<0.001). Women with primary ovarian insufficiency have increased prevalence of depression and anxiety compared to controls. Moreover, patients who feel more uncertain of and stigmatized by their medical condition also report higher levels of depression and anxiety symptoms. These findings suggest that strategies to reduce feelings of uncertainty and stigmatization regarding their condition should be investigated as a means to help women with primary ovarian insufficiency cope with the emotional sequelae of this diagnosis and to reduce associated symptoms of depression and anxiety.