Experience of mental health in women with Polycystic Ovary Syndrome: a descriptive phenomenological study

Abstract

Purpose: This study aims to investigate the experiences, emotional coping strategies, and help-seeking needs of women with PCOS from their perspective, considering common psychological issues such as stress, anxiety, and depression that are prevalent among individuals with PCOS. Materials and Methods: The study recruited 14 women with PCOS for semi-structured interviews between October and November 2022, using a descriptive phenomenology method design. The interviews were analyzed using NVivo 12 software. Results: Four themes and eleven subthemes were derived from the semi-structured interviews: (1) Negative Mental Health Status; (2) Four Patterns of Emotion Regulation; (3) The Psychological Double-Edged Sword: Family Social Network; (4) Strong Demands for Psychological Counseling and Lifestyle Guidance. Conclusion: The study suggests that interventions should focus on fostering internalized self-efficacy and emotional expression, promoting constructive familial support, and providing psychological counseling and lifestyle recommendations to alleviate psychological distress experienced by women with PCOS.

Keywords:

• Polycystic ovary syndrome
• mental health
• emotional expression
• social support
• descriptive phenomenological study

Introduction

Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine and metabolic disorder affecting women of reproductive age [1]. Its primary clinical manifestations include menstrual irregularities (such as irregular periods or amenorrhea), infertility, hirsutism, facial acne, and obesity [2]. Studies have shown that the prevalence of PCOS in women worldwide is 8%-13%, and 50–70% of patients with anovulatory infertility are PCOS [3]. While the prevalence of PCOS can vary depending on the diagnostic criteria, age, and population surveyed, numerous studies have shown that the incidence of PCOS is increasing annually [4,5]. Currently, PCOS is a significant reproductive endocrine issue affecting modern women and threatens their health.

Polycystic Ovary Syndrome not only leads to significant psychological distress and emotional problems but also profoundly impacts patients’ quality of life, fertility, and long-term prognosis [6,7]. Studies have revealed that PCOS patients are more likely to experience psychological distress, such as stress, anxiety, and depression [8]. A case-control study by Sulaman et al. [9] showed that PCOS patients had a significantly increased risk of anxiety and anxiety disorders. Cooney et al.’s [10] meta-analysis indicated that women with PCOS were more likely to suffer from depression (OR: 3.78; 95% CI: 3.03–4.72) and anxiety disorders (OR: 5.62; 95% CI: 3.22–9.80) compared to women without PCOS, and that PCOS is a risk factor for anxiety and depression, particularly for moderate to severe depression. Furthermore, PCOS patients often exhibit negative body image dissatisfaction [11]. Negative body image perceptions among PCOS patients can include feelings of dissatisfaction with their appearance, a loss of femininity, and reduced perceived sexual attractiveness [12,13]. Despite the significant psychological problems faced by women with PCOS, only 5% of these patients have received professional psychotherapy [14]. International evidence-based guidelines for the assessment and management of PCOS recommend that mental health problems should be assessed and managed by healthcare professionals [15]. Therefore, it is important to provide effective emotional management to treat these psychological and emotional issues in PCOS patients.

Emotion regulation refers to the influence individuals exert on the production and experience of emotions and their expression [16]. This process encompasses not only changing emotions themselves but also other psychological factors such as cognition, behavior, and social interactions [17]. According to Thompson [18], emotion regulation involves perceiving, evaluating, modifying, and expressing emotions to attain specific goals. Emotion regulation is seen as a complex and dynamic process from a process-oriented perspective [19]. It involves individuals perceiving their emotions, understanding how they are generated, and assessing how they impact emotional expression. Implementing corresponding strategies is necessary for this process. Previous research on emotion regulation suggests that it is not just a reflection of ability but also a process of individual integration. It entails the experience, regulation, and expression of various emotions to achieve a dynamic balance. Therefore, emotion regulation plays a crucial role in the overall process of emotion regulation in patients, and altering negative emotions is a crucial step in helping patients manage their emotions. However, there is still lack of studies on how women with PCOS deal with their psychological distress through emotional regulation.

PCOS is the most common cause of female infertility. Infertile women not only face external societal pressure, but also feel shame due to internalized responsibility [20,21]. In the cultural context of China, family social support plays a crucial role in the psychological well-being of women with PCOS. Moreover, due to the strong desire for childbearing, infertile women are more likely to avoid societal discussions about reproduction. Behaviors or comments from family members can unintentionally cause harm and increase feelings of shame and self-injury among infertile women [22]. Therefore, understanding the relationship between social support, family interactions, and psychological distress among women with PCOS is crucial for developing effective intervention plans.

To address the psychological distress and emotional issues of women with PCOS, it is urgent to develop feasible and patient-accepted intervention programs for effective emotional management. Therefore, it is crucial to comprehensively and deeply understand the psychological distress experiences of women with PCOS, their emotion regulation strategies, social support, and their need for psychological help-seeking. However, there is currently a lack of research on the mental health experiences, emotional coping strategies, social support, and help-seeking needs of women with PCOS. Therefore, this study aims to use a descriptive phenomenological approach through in-depth interviews to examine the mental health experiences, emotional coping strategies, social support, and help-seeking needs of women with PCOS, in order to provide a basis for the development of scientifically sound and targeted psychological intervention plans.

Methods

This study employed a descriptive phenomenological method, which focuses on "returning to the thing itself" [23]. This approach was used to gain insight into women with PCOS's mental health experiences and coping strategies. In-depth interviews were conducted to explore and understand these experiences.

Sampling and participants

From October 2022 to November 2022, we used purposive sampling to recruit women with PCOS from the outpatient department of the Gynecology and Reproductive Medicine Center of a tertiary hospital affiliated with a university in China. Inclusion criteria included meeting Rotterdam criteria [15]: oligomenorrhea or amenorrhea, together with clinical or biochemical hyperandrogenism, polycystic ovaries, or both. All participants voluntarily attended this study and gave written informed consent to participate. Exclusion criteria included the presence of related disorders with similar clinical presentation, such as congenital adrenal hyperplasia and Cushing’s syndrome.

Data collection

During participant recruitment, we followed the principle of maximum diversity and used convenience sampling. All participants were recruited from the outpatient department of the Obstetrics and Gynecology and Reproductive Medicine Center affiliated with a university in China. Due to the COVID-19 pandemic, the first author, trained in qualitative methods, conducted individual interviews either face-to-face at the hospital in a quiet and confidential place or by telephone, depending on the participant’s preferences. Before the interviews, all participants were invited to complete a brief demographic questionnaire and informed consent form. An interview outline (Table 1) was developed and revised in consultation with relevant experts from the study advisory group to meet the purpose of the study. A semi-structured in-depth interview method was used to provide rich data and better understand their experiences of mental health distress and coping strategies [24]. Each interview lasted between 30 to 60 min, during which the interviewer took notes. All interviews were audio-taped with participants’ permission, transcribed verbatim, and the recordings were then deleted. Interviews were stopped when no new themes emerged, and theme saturation was reached [25]. In total, 14 participants were recruited for the semi-structured in-depth interview, and none refused or quit. The definitions of overweight and obesity in China were 24–28 and ≥ 28 kg/m² [26].

Table 1. Outline of the interview.

1. Please share with me your thoughts and experiences related to the diagnosis and treatment of Polycystic Ovary Syndrome (PCOS).

2. Can you describe how PCOS affects you? (Physically, psycho-emotionally, and in terms of quality of life)

3. How have you coped with the impacts of PCOS on you? (Physically, psycho-emotionally, and in terms of quality of life)

4. What is your perspective on the impact of PCOS on your life?

5. How has the support from your husband/family/friends been since your diagnosis with PCOS?

6. What kind of help do you need now to manage the effects of PCOS on your life?

Data analysis

We followed Braun and Clarke’s [27] six-phase thematic analysis approach: familiarization, generating initial codes, searching for themes, reviewing themes, identifying, naming themes, and reporting. Thematic analysis was conducted using NVivo 12 to code and categorize the data. After each interview, the researcher conducting the interviews documented all initial thoughts and ideas. The transcripts were read multiple times to ensure familiarity with and to gain a deeper understanding of the data, resulting in the initial codes. Data codes were then collated to generate initial themes (i.e. patterns within the dataset). Finally, the transcripts were reread to ensure that the themes accurately represented the data and that there were no other applicable themes. Two uniformly trained researchers performed all data analysis and coding together, with discrepancies resolved through a review of transcripts and audio recordings and ultimately discussed and determined by the team members.

Validity and reliability

This study ensured trustworthiness based on Lincoln and Guba’s criteria, namely, credibility, dependability, confirmability, and transferability [28]. The first author conducted all interviews to ensure reliability and credibility. Analyst triangulation was used to establish credibility by inviting nursing experts and team members to participate in the data analysis process to ensure that the results truly reflected the views of the participants. A purposeful sampling strategy was adopted to maximize the scope of relevant information and the diversity of participants, thus ensuring transferability. All interviews were audio-recorded to avoid recall bias. To ensure that the codes and themes accurately reflected the true experiences of the participants, new data were constantly compared with existing data and checked with the respondents. An audit trail was used to ensure that findings were based on the participants’ perspectives without the authors’ bias, thus establishing confirmability. COREQ, a checklist that provides reporting guidance for qualitative research [29], was used in this study.

Ethical considerations

This study was approved by the Institutional Review Board of **************** (the institutional review board approval number: ********). Before the interview, the content and purpose of the study were fully explained to the participants, and the confidentiality of the interview content was ensured. Participants ' names were replaced by numbers (P1-P14). Each participant obtained written informed consent and permission to record. All data collected was securely stored and can only be accessed by the project team.

Results

This study involved interviewing fourteen women with PCOS, and the participant demographics are outlined in Table 2. Four main themes and eleven subthemes emerged from the semi-structured interviews: (1) Negative Mental Health Status; (2) Four Patterns of Emotion Regulation; (3) The Psychological Double-Edged Sword: Family Social Network; (4) Strong Demand for Psychological Counseling and Lifestyle Guidance (Table 3). Our findings reveal that women with PCOS commonly experience severe psychological distress, such as anxiety, depression, and dissatisfaction with their body image. In terms of coping with psychological distress, women with PCOS who have high emotional self-regulation efficacy and positive coping styles, such as emotional expression, can effectively manage their distress. However, the use of negative coping styles, such as inhibiting emotional expression, can worsen psychological distress. Family social network can also have both positive and negative effects on the mental health of women with PCOS. Women with PCOS can alleviate psychological distress by adopting positive coping strategies, seeking emotional support from their partners/families, and accessing medical support to reduce the physical, psychological, and social impacts of PCOS.

Table 2. Characteristics of participants.

Characteristics	Women with PCOS (n = 14)
Age range (years)	19–35
BMI range (Kg/m^2)	18.82–29.38
Studying/working
Studying	5
Working	9
Educational level
Less than Junior High School degree	3
High school degree	4
Undergraduate	5
Graduate student and above	2
Marital status
Never married	7
Married	11
Duration of menstrual disorders(years)
No	2
<5	8
5–10	5
>10	3
Duration of diagnosis of PCOS (years)
<1	6
1–5	8
>5	4
Childbearing needs
No	10
Yes	8

Table 3. Themes and sub-themes identified in interviews.

Themes	Sub-Themes
1. Negative Mental Health Status	1.1. Menstrual Disorders and Infertility as Sources of Anxiety
	1.2. Body Image Dissatisfaction Induces Psychological Distress
	1.3. Depressive Symptoms and Suicidal Ideation
2. Four patterns of emotion regulation	2.1. High Emotion Regulation Self-Efficacy Reduces Psychological Distress
	2.2. Low Emotion Regulation Self-Efficacy Increases Psychological Distress
	2.3. Emotional Expression Can Relieve Psychological Distress
	2.4. Expressive Suppression Leads to Psychological Distress
3. The Psychological Double-edged Sword: Family Social Network	3.1. Family Tolerance and Support
	3.2. Family Social Network Reaction Force
4. Strong Demand for Psychological Counseling and Lifestyle Guidance.	4.1. Women with PCOS Lack Knowledge of Exercise and Diet
	4.2. Women with PCOS Have Strong Demand for Psychological Help-Seeking.

Negative Mental Health Status

Women with PCOS frequently suffer from common and severe mental health concerns, including anxiety, depression, and dissatisfaction with their body image. These mental health issues are related to symptoms of menstrual irregularities, infertility, obesity, and acne. Additionally, negative body image and dissatisfaction with their appearance often serve as the underlying cause of psychological distress.

Menstrual disorders and infertility as sources of anxiety

Women with PCOS commonly experience frequent and severe menstrual irregularities, infertility, and difficulties with conception, which can increase anxiety levels. The absence of regular menstruation can also trigger significant anxiety symptoms in women with PCOS.

P03: I think my bad mood is due to menstrual disorders, which always reminds me that I have PCOS. This makes me feel anxious.

P07: When my period is late, I become particularly anxious. I've been struggling with this, and I often ask myself why it hasn’t come yet.

During treatment, failure of pregnancy preparation and failure to grow follicles after ovulation induction is the main causes of anxiety symptoms in women with PCOS.

P02: I induced ovulation twice but did not grow follicles, and I felt like I was in a hurry to die. I blamed myself for not being able to grow follicles, and it put me in a bad mood.

P06: I think I was anxious; for instance, when I failed to prepare for pregnancy again this month, my mood plummeted and had a negative effect on my overall mood.

Body image dissatisfaction induces psychological distress

Furthermore, women with PCOS often report low satisfaction with their body image, as obesity, acne, and hirsutism contribute to this dissatisfaction. The weight gain that is often associated with PCOS can cause psychological distress, which can have a detrimental effect on mental health.

P11: I am dissatisfied with my body image due to obesity. Before, I was able to wear S-size clothing, but now I have to wear M-size or even L-size clothing. I can no longer wear the clothes I used to wear.

P13: I am anxious about my body image, as my dress style is now limited. I no longer wear skirts or shorts, instead opting for loose pants or long skirts. This makes me feel inferior to others.

Some participants suggested that improved body image, such as weight loss and clear skin, can help reduce psychological distress.

P04: If the acne wasn’t so bad, or if I could lose weight, I think these would be very helpful in relieving my anxiety.

P12: Which girl would want to be obese? I don’t want to be overweight or obese. If I'm thin, I feel more comfortable.

Depressive symptoms and suicidal ideation

Women with PCOS may be susceptible to emotional instability and struggle with managing their emotions. Some patients may exhibit symptoms of depression and, in severe cases, experience suicidal thoughts, which is consistent with previous quantitative research findings [30].

P01: Some women may be prone to splitting hairs and experiencing depression due to Polycystic Ovary Syndrome (PCOS).

P05: As I am more extreme, I know what I can do to cope: self-harm.

P08: From the end of 2020 to the beginning of 2021, I could not control my emotions. My family members tried to prevent me from staying alone, as I was having suicidal thoughts. During this period, my mood was very low, and I felt depressed.

Four patterns of emotion regulation

Women with PCOS frequently experience common and intense psychological distress and exhibit varying levels of emotional regulation self-efficacy and different coping styles. High emotional regulation self-efficacy and positive coping methods can reduce or alleviate psychological distress, whereas low emotional regulation self-efficacy and negative coping strategies can increase the intensity of psychological distress.

High emotion regulation Self-Efficacy reduces psychological distress

There is a strong correlation between the emotional regulation self-efficacy of women with PCOS and their mental health. Women with higher levels of emotional self-efficacy are more capable of handling stress and negative emotions, leading to a lower degree of psychological distress.

P10: When I have negative emotions, I feel like I'm better at managing and controlling them than I used to be. My mood has improved significantly.

P11: I can control my emotions well because I like to talk to people. I usually call my friends, talk to my parents, and chat with my sister. Having more people to talk to helps me not to feel overwhelmed and keeps my stress levels low.

Low emotion regulation Self-Efficacy increases psychological distress

On the other hand, women with PCOS who have limited emotional management skills and lower levels of self-efficacy are more likely to exhibit negative emotions, present a poorer emotional state, and experience relatively worse mental health.

P04: If I can control my emotions when I am feeling them, I will not feel out of control. Sometimes, my mood can appear suddenly, and I cannot control it. I want to be able to regulate my emotions, but I am unable to do so.

P14: I am particularly bad at managing my emotions; I have a bad temper, and this leads to me feeling more psychological distress.

Emotional expression can relieve psychological distress

During times of negative mood, some women with PCOS turn to communication with family and friends or express their emotions directly. This is referred to as emotional expression in this study. Following appropriate emotional expression, their moods are significantly improved, and their psychological distress is reduced.

P04: I'll be fine once I express my negative emotions. If I'm not allowed to vent, I'll keep them bottled up inside. Eventually, I won’t be able to contain them anymore, and I'll go crazy.

P10: I enjoy talking to my husband and friends about my problems. I find it very therapeutic to express my unpleasant feelings, and it always helps to improve my mood.

Expressive suppression leads to psychological distress

However, some women with PCOS suppress their negative emotions and choose to keep them bottled up. This suppression of emotions eventually has a negative impact on their mental health.

P01: I would keep my feelings to myself and not express them. If I am particularly depressed, I will cry alone, but I won’t tell my friends or family; I will bear it on my own.

P08: I used to be positive, but now I'm feeling pessimistic. I don’t want to communicate with others anymore. When I was first diagnosed with PCOS, I was still open to communicating with others. However, over time I gradually felt that no one could truly understand my pain, so I stopped wanting to communicate with them.

The Psychological Double-edged Sword: Family Social Network

The family support network can be both beneficial and detrimental to the mental health of women with PCOS. Positive family support, particularly from a spouse or family members, can reduce and alleviate the psychological distress of women with PCOS. However, too much negative family support can create psychological pressure on patients and lead to psychological distress. The lack of family support and understanding is a major source of psychological distress in women with PCOS.

Family tolerance and support

Family tolerance and support can be seen as a stabilizer and ballast for the mental health of women with PCOS, which can maintain their emotional stability and play a positive role in alleviating their emotions.

P02: Infertility caused by PCOS is inseparable from the support and understanding of one’s family. If my husband had not supported me during my multiple ovulation induction and pregnancy failures, I would have found it difficult to cope.

P03: I will not be anxious if I have the support and understanding of my family. Even if I cannot conceive, their support and understanding can positively impact me, helping me to remain calm.

P09: The support of one’s husband is important. He can help me manage my emotions and give me a different perspective. With him around, I can be more emotionally stable.

P11: My husband is especially supportive of me. When I am feeling down, he can comfort me, help me to relieve negative emotions, and adjust my mentality, which has a more positive effect.

Family Social Network reaction force

Contrarily, the family support network can sometimes worsen the psychological distress of women with PCOS. When family members are unable to comfort or understand these women, they may instead add more pressure, exacerbating their psychological distress

P01: I am married, and my husband is very eager to have a child. The pressure he puts on me affects my mood, and even if I tell him I'm feeling down, he doesn’t offer much comfort. So, I choose not to say anything.

P02: For example, if my family finds out that I have been diagnosed with PCOS (which makes it difficult or even impossible for me to get pregnant), they don’t support me, don’t understand me, and even dislike me. This will definitely cause me psychological harm and make me feel uncomfortable.

Strong Demand for psychological Counseling and Lifestyle guidance

The findings of this study reveal that women with PCOS have a strong desire to seek help. On the one hand, they lack knowledge about proper exercise and diet. On the other hand, they often experience psychological distress, which increases their likelihood of seeking professional psychological counseling and guidance.

Women with PCOS lack knowledge of exercise and diet

Most participants reported a lack of knowledge regarding exercise and diet related to PCOS. They expressed a desire for clinicians or nurses to provide guidance and assistance.

P01: I want to know what lifestyle changes I should make. How can I modify my daily habits to maintain a healthy and balanced diet? Is there any conflict between diet and PCOS treatment? I'm not sure.

P11: I believe that doctors or nurses should provide advice on PCOS diets. I don’t know which foods are suitable for me to eat and which are not, as PCOS symptoms can vary. Therefore, I think it is important to receive dietary advice from medical professionals.

P14: I think what I lack is knowledge about lifestyle and diet.

Women with PCOS have strong Demand for psychological Help-Seeking

In this study, most PCOS patients expressed a strong desire for professional psychological interventions to help them cope with and regulate their psychological distress.

P03: When I'm in a bad mood, I think the most effective way is for someone to listen to me. However, sometimes the mood is so bad that it’s not convenient to talk to friends or family. I think it would be beneficial if there were help available in psychotherapy.

P08: For example, hospital practitioners or professional teams can guide me on how to exercise and eat and then teach me how to regulate my emotions. I think this is what I need most.

Discussion

The study found that most women with PCOS generally experience more severe psychological distress, such as anxiety, depression, and dissatisfaction with their body image. This is partly due to the symptoms of PCOS, such as menstrual disorders and infertility. Infertility has been linked to psychological issues such as depression and anxiety [31], and PCOS may exacerbate these problems. The infertile stigma of PCOS is associated with "female identity problems," which can worsen psychological distress [13]. This result is supported by a study conducted by Li et al. [32]. Some participants reported experiencing common symptoms of depression and even had thoughts of suicide. Thus, PCOS-related treatment and infertility problems may be significant contributors to depressive symptoms in women with PCOS, which can have serious consequences for their mental health. Previous research has shown that approximately 40% of women with PCOS experience depression during their reproductive years, most often at a young age [33]. However, there is limited research on suicidal thoughts among women with PCOS, which is a concern that should attract the attention of healthcare professionals. Additionally, women with PCOS often report dissatisfaction with their body image, with problems such as obesity/overweight, acne, and hirsutism lowering their self-esteem and self-acceptance and causing anxiety, further affecting their mental health [34,35]. A recent qualitative study supports these findings, showing that women with PCOS experience an unstable body image, a sense of unrecognizable identity, and mental distress and that body image issues can negatively impact depression [36].

Self-efficacy refers to an individual’s confidence in their ability to control or manage their health outcomes when facing a disease [37]. This study found that women with PCOS have high emotional regulation self-efficacy, which can help reduce or mitigate their psychological distress. However, low emotional regulation self-efficacy leads to an increase in the severity of their psychological distress. Furthermore, psychological distress can undermine the self-efficacy of women with PCOS [38]. On the other hand, heightened self-efficacy leads to a greater acceptance of the disease by PCOS patients, thus reducing their anxiety and depressive symptoms [39]. As a result, effective PCOS treatment requires healthcare professionals to tap into patients’ self-motivation and self-efficacy.

Furthermore, the study showed that women with PCOS who adopt positive coping strategies experience a reduction in their psychological distress, whereas those with negative coping styles may experience greater distress. According to Lazarus and Folkman’s [40] stress coping theory, coping strategies can help individuals manage their emotions and deal with the stress that triggers these emotions. Adaptive and problem-focused coping strategies are effective in addressing stressors, while maladaptive coping styles, such as avoidance or suppression of expression, are less effective and linked to negative emotional outcomes [41]. Benson et al. [41] reported that women with PCOS often use maladaptive coping styles, including increased avoidance and suppression of expression, exacerbating their psychological distress. Our study also highlighted that expressive suppression, a negative coping style, hides the negative emotions of women with PCOS and gradually deteriorates their mental health. Previous research has also shown that women with maladaptive coping styles have higher levels of anxiety and depression symptoms [42]. Therefore, clinicians and nurses can help women with PCOS improve their psychological distress by teaching them positive coping styles, emotional regulation, and self-efficacy.

This study found that a family support network can be both beneficial and detrimental to the mental health of women with PCOS. On the one hand, positive support from family members, particularly spouses, can reduce psychological distress in these women. This aligns with previous research that shows a correlation between better social support and lower levels of depression and anxiety [43,44]. Social support directly affects mental health by promoting positive health behaviors, positive emotional communication, and emotional regulation [45] and indirectly by reducing physiological stress responses [46]. On the other hand, the family support network can also be a source of psychological distress for women with PCOS. Family members may not provide comfort or understanding but instead add to the pressure, leading to heightened psychological distress. This may be due to cultural expectations in which motherhood is considered the most important role for women [47]. As a result of traditional views on fertility, women with PCOS often face increased discussion and misunderstandings surrounding their infertility. For those with low economic income, frequent treatment for reproductive issues can add to the financial burden and increase fertility pressure and stigma [48,49]. Additionally, excessive attention to fertility problems from male relatives can also increase pressure. Therefore, it is crucial for healthcare providers to consider the psychological well-being of patients, encourage family involvement in treatment, and raise awareness about psychological support for those with low social support.

In this study, most women with PCOS expressed a strong desire for professional psychological support to help them manage psychological distress. The high prevalence of anxiety and depression among PCOS patients is well-documented, yet more than half of them do not receive emotional support or seek psychological counseling [14], highlighting the need for medical staff to give more attention to their psychological needs. Currently, although women with PCOS in China have a demand for psychological treatment, the majority of them have not received professional psychological help or treatment. On the one hand, most clinical doctors and nurses focus on the physical symptoms of PCOS, such as menstrual disorders, high androgen levels, and infertility, and do not screen patients for mental health problems. On the other hand, due to the influence of traditional culture, even if women have mental health problems, they often choose not to seek professional psychological help or treatment at a psychological clinic because of the stigma associated with seeking help [50]. Clinical practitioners should therefore conduct in-depth interviews with PCOS patients to better understand their psychological needs and develop targeted interventions. Additionally, clinicians and nurses should screen for anxiety and depression in PCOS patients and provide early psychological support for those experiencing distress to improve their anxiety, depression, and body image.

Limitations

Although this study has provided valuable insights into the mental health experiences and coping strategies of women with PCOS, there are several limitations that should be noted. Firstly, the study participants were recruited from a tertiary hospital, which may limit the generalizability of our findings to other populations of women with PCOS. It is important to note that even though we followed the principle of maximum diversity sampling in qualitative research, women who seek treatment at hospital-based clinics may represent a more severe and symptomatic subset of the population. Therefore, when interpreting our study results, it is essential to keep this limitation in mind. Secondly, the study relied on self-reported data, which may be subject to social desirability and recall biases. Thirdly, the study was conducted in a specific cultural context, which may not represent other cultural backgrounds. Fourthly, our study is qualitative research where women described their coping strategies, but no validated coping questionnaire was administered. Therefore, it is advised to interpret the conclusions regarding general coping strategies with caution. Finally, the qualitative study design does not allow for causal conclusions about the relationships between mental health, coping strategies, and family support. In conclusion, these limitations should be considered when interpreting the results and future research with larger sample sizes, using multiple methods, and involving women from different cultural backgrounds should be conducted to explore further the mental health experiences and coping strategies of women with PCOS.

Conclusions

This study sheds valuable light on the mental health concerns of women with PCOS. Based on the findings, psychological interventions should be implemented to address their psychological distress, including enhancing their self-efficacy in emotional regulation, promoting their emotional expression, establishing a multidisciplinary team to offer psychological and lifestyle support, and fostering a high level of emotional support from loved ones.

Acknowledgments

The authors frankly thank all participants involved in the interview and other staff members on the scene.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Raw qualitative data cannot be shared due to ethical restrictions; however, anonymized transcripts, interview schemes, and coding decisions are available upon reasonable request to the corresponding author.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported in part by funding from the Hunan Provincial Innovation Foundation for Postgraduate under Grant number: CX20220333, as well as the Fundamental Research Funds for the Central Universities of Central South University under Grant number: 2022ZZTS0251.