Mental health, pain symptoms and systemic comorbidities in women with endometriosis: a cross-sectional study

Abstract

Introduction: Endometriosis is a gynecological disease with a severe impact on quality of life. The aim of this study is to assess mental health status in a group of women with endometriosis, investigating their clinical history, pain symptoms and systemic comorbidities.

Methods: An observational cross-sectional study was performed on a group of Italian Caucasian women with endometriosis (n = 134). All patients filled the ‘Patient Health Questionnaire’ (PHQ), a self-administered screening tool for mental health disorders. The characteristics of endometriosis, pain symptoms and their severity, the presence and types of comorbid systemic disorders were added into the same survey.

Results: According to PHQ algorithms, 59% of patients were affected by at least one psychiatric disorder, with a significant correlation with pain symptoms (p = 0.0026). Patients with severe pain showed a higher incidence of multiple psychiatric disorders (p = 0.026) and somatoform disorder than those with mild pain (p = 0.0009). There was no correlation between the presence of psychiatric disorders and age, BMI, parity, infertility, need for surgery, number of intervention, localization of endometriotic lesions and systemic comorbidities.

Discussion: Women with endometriosis showed a high frequency of PHQ results positive for psychiatric disorders, with a significant association with pain severity.

Keywords:

• Endometriosis
• mental health
• psychiatric disorders
• somatoform disorder
• pelvic pain

Acknowledgements

The Authors thank the association ‘APE’ Onlus, for contributing to the collection of data for the present study.

Disclosures statement

No potential conflict of interest was reported by the authors.

Funding

The authors declare no relationship with funding sources or sponsorships.

Current knowledge on the subject

• Endometriosis is a gynecological disease characterized by pain and infertility, with a severe impact on quality of life.

• Previous studies provided mixed findings on psychopathological variables and their prevalence by using different tools and scales.

• Endometriosis patients have a higher risk of systemic comorbidities than general population, however it is still unknown if these comorbidities, including psychiatric disorders, are a consequence of endometriosis or arise from the same background of risk factors.

What this study adds

• Patients with endometriosis have a high prevalence of psychiatric symptoms, assessed by PHQ, a well-validated self-administered questionnaire to investigate mental health.

• More than half patients with endometriosis have a PHQ positive for at least one psychiatric disorder and one-fourth showed from two to four different psychiatric disorders, including depressive, anxiety, somatoform and eating disorders.

• A positive PHQ may be an alert to identify women with endometriosis to send for a psychiatric assessment.

• The presence of psychiatric comorbidities correlates with severity of pain but not with patients’ characteristics, infertility, endometriosis surgery or lesions localization.

• A high prevalence of systemic comorbidities (83.5%) was observed in our population, however no association was showed with psychiatric symptoms.