Depression, anxiety and stress symptoms in women with polycystic ovary syndrome with and without fertility treatment and in non-PCOS controls: a cross-sectional comparative study

Abstract Background Polycystic ovary syndrome (PCOS) is a common endocrine disorder of reproductive-aged women that has been linked to psychological difficulties such as depressive and anxiety symptoms. We compared Depression Anxiety Stress Scale-21 (DASS-21) scores between women with PCOS and non-PCOS controls and, within the PCOS group, between women beginning fertility treatment for PCOS-related infertility and women not receiving fertility treatment. Methods In this single-center, cross-sectional comparative study, 130 women attending the gynecology and reproductive medicine outpatient clinics of a tertiary center were enrolled (PCOS, n = 85; non-PCOS controls, n = 45). The PCOS group comprised women beginning fertility treatment for PCOS-related infertility ( n = 39; assessed before treatment initiation) and women not receiving fertility treatment ( n = 46). Psychological symptoms were screened with the DASS-21. Groups were compared with the Mann–Whitney U and chi-square tests; Benjamini–Hochberg false-discovery-rate (FDR) correction was applied, and multivariable linear regression (HC3 robust standard errors) was used to adjust for age and body mass index (BMI), with median-regression and education-adjusted sensitivity analyses. Results Women with PCOS had higher depression, anxiety and stress scores than controls ( p = 0.028, p = 0.028 and p < 0.001; all remained significant after FDR correction), and these differences persisted after adjustment for age and BMI. Within the PCOS group, depressive symptom scores were markedly higher in the fertility-treatment subgroup and remained independently significant after adjustment (B = 8.89; 95% CI 4.48–13.29; p < 0.001) and in sensitivity analyses, whereas the differences in anxiety and stress were no longer significant after adjustment. Above-normal DASS-21 depressive symptom scores were most frequent in the fertility-treatment subgroup (71.8%, vs. 37.0% in untreated PCOS and 44.4% in controls). Conclusions Women with PCOS had higher DASS-21 depression, anxiety and stress scores than non-PCOS controls, and, within the PCOS group, women beginning fertility treatment for PCOS-related infertility had higher depressive symptom scores than women not receiving fertility treatment. Because of the cross-sectional design and the inability to separate infertility-related distress from treatment-related factors, no causal interpretation can be made; in addition, the control group was clinic-based rather than community-based, which should be considered when interpreting control-group symptom levels. The findings support prioritizing depression and anxiety screening in women with PCOS receiving fertility care.