Metformin Improves the Depression Symptoms of Women with Polycystic Ovary Syndrome in a Lifestyle Modification Program

Figures & data

Table 1 Baseline Characteristics of the Study’s Cohort

Characteristics	Treatment Groups		P	Total (N = 86)
	Metformin and Lifestyle Modifications (n = 53)	Lifestyle Modifications Only (n = 33)
Age (years, mean ± SD)	27.64 ± 6.28	28.9± 7.01	0.386	28.13 ± 6.55
BMI (mean ± SD)	28.25 ± 5.75	29.12 ± 7.21	0.537	28.58 ± 6.33
Education
No formal education, n (%)	4 (7.55)	0 (0)	0.265	4 (4.65)
High school, n (%)	29 (54.72)	22 (66.67)		51 (59.30)
College, n (%)	20 (37.74)	11 (33.33)		31 (36.05)
Health Literacy
Limited, n (%)	3 (5.66)	0 (0)	0.282	3 (3.48)
Adequate, n (%)	50 (94.34)	33 (100.00)		83 (96.52)
Marital Status
Single, n (%)	24(45.28)	18(54.55)	0.403	42(48.84)
Married, n (%)	29(54.72)	15(45.45)		44(51.16)
Menstrual Cycle
Irregular, n (%)	30 (56.6%)	22 (66.6%)	0.353	52(60.47)
Regular, n (%)	23 (43.3%)	11 (33.3%)		34(39.53)
Comorbidities
None, n (%)	49 (92.45)	30 (90.91)	1.00	79 (91.86)
Hypertension, n (%)	1 (1.89)	1 (3.03)		2 (2.33)
Dyslipidemia, n (%)	1 (1.89)	0 (0)		1 (1.16)
Seizure, n (%)	1 (1.89)	1 (3.03)		2 (2.33)
Asthma, n (%)	1 (1.89)	1 (3.03)		2 (2.33)

Abbreviation: BMI, body mass index.

Table 2 Baseline and Follow-Up Scores for Patient-Reported Outcomes

Self-Reported Measure	Metformin and Lifestyle Modifications (n = 53)				Lifestyle Modifications Only (n = 33)
	Baseline	3-Month Follow-Up	Mean Difference^§	P	Baseline	3-Month Follow-Up	Mean Difference^§	P
PHQ-9	9.66 ± 6.34	6.92 ± 5.68	−2.75 ± 6.16	0.002*	9.79 ± 6.34	9.09 ± 5.53	−0.702 ± 4.52	0.378
GAD-7	7.58 ± 4.55	6.37 ± 4.66	−1.21 ± 5.32	0.104	9.55 ± 5.62	9.56 ± 5.06	0.0176 ± 6.13	0.987
SF-36
Physical functioning	86.61 ± 16.10	86.91 ± 18.57	0.297 ± 17.52	0.902	85.36 ± 18.24	85.07 ± 17.14	−0.296 ± 22.21	0.939
Role limitations due to physical health	80.52 ± 33.51	87.66 ± 18.15	7.14 ± 33.35	0.125	61.89 ± 43.74	90.05 ± 14.00	28.15 ± 37.73	<0.001*
Role limitations due to emotional problems	61.47 ± 44.99	83.27 ± 19.06	21.80 ± 48.15	0.002*	55.23 ± 47.56	76.70 ± 23.65	21.47 ± 49.44	0.018*
Energy/fatigue	47.56 ± 19.05	56.02 ± 16.84	8.46 ± 25.12	0.017*	45.99 ± 16.86	48.31 ± 18.51	2.31 ± 19.76	0.506
Emotional well-being	58.64 ± 17.09	68.21 ± 15.86	9.57 ± 19.7	<0.001*	54.32 ± 18.35	54.58 ± 17.93	0.259 ± 22.36	0.947
Social functioning	85.21 ±  21.45	85.14 ± 21.29	−0.063 ± 26.98	0.986	76.05 ± 23.58	80.84 ± 22.54	4.78 ± 23.14	0.243
Pain	79.37 ± 23.31	83.21 ± 22.14	3.83 ± 21.48	0.200	66.44 ± 31.56	77.79 ± 26.18	11.36 ± 42.63	0.136
General health	70.29 ± 18.64	74.31 ± 20.92	4.01 ± 22.67	0.202	64.04 ± 14.03	73.79 ± 17.87	9.75 ± 17.86	0.004*

Notes: Data are expressed as mean ± SD. *P<0.05. ^§Improvement is indicated by a negative mean difference in the PHQ-9 and GAD-7 scores, and a positive mean difference in the SF-36 scores.

Abbreviations: PHQ-9, Patient Health Questionnaire-9; GAD-7, Generalized Anxiety Disorder-7; SF-36, 36-Item Short Form Survey.

Table 3 Logistic Regression Analyses for the Association Between Treatment with Metformin and Scores on the Patient Health Questionnaire 9-Items (PHQ-9)

Variable	Odds Ratio	P-value	95% Confidence Interval
			Lower	Upper
Model I, adjusted for the baseline PHQ-9 score
Metformin Use	0.309	0.036*	0.103	0.931
Model II, adjusted for the baseline PHQ-9 score and age
Metformin Use	0.291	0.031*	0.095	0.893
Model III, adjusted for the baseline PHQ-9 score and other comorbidities
Metformin Use	0.308	0.031*	0.102	0.928
Model IV, adjusted for the baseline PHQ-9 score and education
Metformin Use	0.303	0.038*	0.098	0.906
Model V, adjusted for the baseline PHQ-9 score and BMI
Metformin Use	0.303	0.034*	0.100	0.918
Model VI, adjusted for the baseline PHQ-9 score and marital status
Metformin Use	0.334	0.055	0.109	1.023
Model VII, adjusted for the baseline PHQ-9 score and health literacy
Metformin Use	0.310	0.039	0.102	0.946
Model VIII, adjusted for the baseline PHQ-9 score, age, number of comorbidities, education, health literacy, marital status, and BMI
Metformin Use	0.302	0.045*	0.093	0.976

Note: *P<0.05.

Table 4 Multiple Logistic Regression Analyses for the Association Between Treatment with Metformin and Scores on the Generalized Anxiety Disorder 7-Item (GAD-7) Scale

Variable	Odds Ratio	P-value	95% Confidence Interval
			Lower	Upper
Model I, adjusted for the baseline GAD-7score
Metformin Use	0.413	0.068	0.160	1.069
Model II, adjusted for the baseline GAD-7score and age
Metformin Use	0.446	0.106	0.168	1.189
Model III, adjusted for the baseline GAD-7score and other comorbidities
Metformin Use	0.413	0.068	0.159	1069
Model IV, adjusted for the baseline GAD-7 score and education
Metformin Use	0.385	0.055	0.145	1.021
Model V, adjusted for the baseline GAD-7 score and BMI
Metformin Use	0.434	0.094	0.163	1.153
Model VI, adjusted for the baseline GAD-7 score and marital status
Metformin Use	0.388	0.054	0.148	1.020
Model VII, adjusted for the baseline GAD-7 score and health literacy
Metformin Use	0.361	0.041*	0.136	0.961
Model VIII, adjusted for the baseline GAD-7 score, age, other comorbidities, education, health literacy, marital status, and BMI
Metformin Use	0.344	0.052	0.117	1.011

Note: *P<0.05.