Psychosocial interventions for women with polycystic ovary syndrome: a systematic review of randomized controlled trials

Abstract

Objective To synthesize the effects of psychosocial interventions to improve depression, anxiety, quality of life (QOL), and other psychological outcomes in adult women living with polycystic ovary syndrome (PCOS). Evidence Review On the basis of the guidelines for the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we conducted a systematic review in the following databases: Ovid MEDLINE ALL; Embase; Cochrane Central Library; Cochrane Database of Systematic Reviews; American Psychological Association PsycInfo; and Elton B. Stephens CO (company) Cumulated Index to Nursing and Allied Health Literature. A study was included if it was a randomized controlled trial that examined the effect of psychosocial interventions to improve psychological outcomes (primary or secondary) in adult women (aged ≥18 years) diagnosed with PCOS. Study screening, data extraction, and assessment of methodological quality was conducted by 3 independent reviewers through a systematic process. The Cochrane risk-of-bias assessment for randomized controlled trials was used to assess the risk-of-bias and methodological quality. The results were combined and summarized in a narrative synthesis, and factors that may explain differences in the direction or effect sizes were considered and discussed. Results Of the 127 studies that met the initial inclusion criteria, we included 7 studies for full-text review, with an average sample size of 83 participants in the initial randomization. Across the 3 studies that reported race and ethnicity, an average of 57% of participants identified as White. There was significant heterogeneity across studies in terms of PCOS criteria followed, variation in outcome measures, variation in reporting of outcomes, and small sample sizes in each outcome, limiting our ability to estimate the magnitude of effects or standardized mean differences. Psychosocial interventions were cognitive behavioral therapy, acceptance and commitment therapy, mindfulness-based stress reduction, cognitive behavioral therapy combined with lifestyle modifications, or multicomponent behavioral modification program. Within the intervention groups, significant durations of effects from baseline to postintervention were observed for depression, anxiety, QOL, fatigue and sleep-related impairments, self-esteem, body image, perceived stress, and patient-reported outcomes for psychological distress and positive and negative affect. These findings demonstrate proof of concept that psychosocial interventions improve PCOS-related mental health issues. Significant results, however, between the intervention and control groups were inconsistent. Significant postintervention or 8-week outcomes were found in some, but not all, studies for depression, QOL, fatigue or sleep issues, self-esteem, body image, perceived stress, mindfulness, and negative affect. Further, only 2 studies found significant long-term or maintenance effects for body image and perceived stress. No studies found significant postintervention effects for anxiety or long-term effects for depression, anxiety, and QOL. Heterogeneity and poor methodological quality of studies likely explain inconsistency of significant postintervention and long-term results, compromising generalizability of results. Conclusion This review concludes that significant improvements in PCOS research for mental health assessment and treatments remain urgently needed, which has implications for the translation of evidence into clinical practice. Future research and recommendations are provided to improve the methodological quality of research and comprehensive care for this common yet underrecognized condition impacting women’s health and well-being. To synthesize the effects of psychosocial interventions to improve depression, anxiety, quality of life (QOL), and other psychological outcomes in adult women living with polycystic ovary syndrome (PCOS). On the basis of the guidelines for the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we conducted a systematic review in the following databases: Ovid MEDLINE ALL; Embase; Cochrane Central Library; Cochrane Database of Systematic Reviews; American Psychological Association PsycInfo; and Elton B. Stephens CO (company) Cumulated Index to Nursing and Allied Health Literature. A study was included if it was a randomized controlled trial that examined the effect of psychosocial interventions to improve psychological outcomes (primary or secondary) in adult women (aged ≥18 years) diagnosed with PCOS. Study screening, data extraction, and assessment of methodological quality was conducted by 3 independent reviewers through a systematic process. The Cochrane risk-of-bias assessment for randomized controlled trials was used to assess the risk-of-bias and methodological quality. The results were combined and summarized in a narrative synthesis, and factors that may explain differences in the direction or effect sizes were considered and discussed. Of the 127 studies that met the initial inclusion criteria, we included 7 studies for full-text review, with an average sample size of 83 participants in the initial randomization. Across the 3 studies that reported race and ethnicity, an average of 57% of participants identified as White. There was significant heterogeneity across studies in terms of PCOS criteria followed, variation in outcome measures, variation in reporting of outcomes, and small sample sizes in each outcome, limiting our ability to estimate the magnitude of effects or standardized mean differences. Psychosocial interventions were cognitive behavioral therapy, acceptance and commitment therapy, mindfulness-based stress reduction, cognitive behavioral therapy combined with lifestyle modifications, or multicomponent behavioral modification program. Within the intervention groups, significant durations of effects from baseline to postintervention were observed for depression, anxiety, QOL, fatigue and sleep-related impairments, self-esteem, body image, perceived stress, and patient-reported outcomes for psychological distress and positive and negative affect. These findings demonstrate proof of concept that psychosocial interventions improve PCOS-related mental health issues. Significant results, however, between the intervention and control groups were inconsistent. Significant postintervention or 8-week outcomes were found in some, but not all, studies for depression, QOL, fatigue or sleep issues, self-esteem, body image, perceived stress, mindfulness, and negative affect. Further, only 2 studies found significant long-term or maintenance effects for body image and perceived stress. No studies found significant postintervention effects for anxiety or long-term effects for depression, anxiety, and QOL. Heterogeneity and poor methodological quality of studies likely explain inconsistency of significant postintervention and long-term results, compromising generalizability of results. This review concludes that significant improvements in PCOS research for mental health assessment and treatments remain urgently needed, which has implications for the translation of evidence into clinical practice. Future research and recommendations are provided to improve the methodological quality of research and comprehensive care for this common yet underrecognized condition impacting women’s health and well-being.