Predictors of Psychological Distress in Women with Endometriosis: The Role of Multimorbidity, Body Image, and Self-Criticism

Shulamit Geller,Sapir Ashkeloni,Ronit Avitsur,Sigal Levy,Bar Roeh,Ensherah Sbiet

doi:10.3390/ijerph18073453

Shulamit Geller, Sapir Ashkeloni + Show 4 more

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https://doi.org/10.3390/ijerph18073453

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Abstract

While large numbers of women report high levels of psychological distress associated with endometriosis, others report levels of distress that are comparable to those of healthy women. Thus, the aim of the current study was to develop an explanatory model for the effect of endometriosis on women’s psychological distress. Furthermore, it sought to further investigate the role of body image, self-criticism, and pain intensity on the psychological distress associated with endometriosis and establish the effect of chronic illness load on the development of this distress. This study comprised a total of 247 women aged 20–49 (M = 31.3, SD = 6.4)—73 suffering from endometriosis only, 62 suffering from endometriosis and an additional chronical illness (ACI), and 112 healthy peers (HP)—who completed the Patient Health Questionnaire, the Generalized Anxiety Disorder-Item Scale, the Body Appreciation Scale-2, and the Self-Criticism Sub-Scale. When comparing each endometriosis group to their HP’s, we found that the differences between HP and endometriosis ACI in depression and anxiety were mediated by body image (Betas = 0.17 and 0.09, respectively, p’s < 0.05) and self-criticism (Betas = 0.23 and 0.26, respectively, p’s < 0.05). When comparing endometriosis participants to endometriosis ACI participants, differences in depression were mediated by body image, self-criticism, and pain intensity (Betas = 0.12, 0.13, 0.13 respectively, p’s < 0.05), and the differences in anxiety were mediated by self-criticism and pain intensity (Betas = 0.19, 0.08, respectively, p’s < 0.05). Physicians and other health professionals are advised to detect women with endometriosis ACI who are distressed, and to offer them appropriate intervention.

Highlights

The aim of the current study is to develop an explanatory model that demonstrates that psychological distress associated with endometriosis can be mediated by body image perceptions, self-criticism, and pain intensity
We found that all groups differed from each other in depression, with depressive symptoms highest in the endometriosis additional chronical illness (ACI) group and lowest in the healthy peers (HP) group
We found that endometriosis participants with an additional chronic illness tended to suffer from poorer body image and greater self-criticism than HP, which, in turn, led to more psychological distress

Summary

Introduction

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Endometriosis is an inflammatory disease associated with pelvic pain and infertility that is characterized by lesions of endometrial-like tissue outside of the uterus [1]. It is an inexplicable condition involving an uncertain and contested etiology [2] that affects approximately 6–10% of all woman of reproductive age [3,4]. Common symptoms are heavy and/or painful periods, pelvic pain, fatigue, congestive dysmenorrhea, heavy menstrual bleeding, and deep dyspareunia [5,6] as well as infertility [7,8]

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