PSYCHOLOGICAL FACTORS AND GYNECOLOGICAL DISEASE

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. OBJECTIVES: 1) To evaluate the prevalence and severity of psychological symptoms in gynecologic patients with chronic pelvic pain (CPP) or polycystic ovary syndrome (PCOS). 2) To correlate the severity of the psychological symptoms with clinical and laboratory measures of the severity of the gynecologic disease. RESEARCH PLAN: In this study we will administer the Havard Department of Psychiatry/National Depression Screening Day Scale (HANDS) psychological screening tool and/or the Center for Epidemiologic Studies-Depression (CES-D) scale to gynecologic patients. Women over 18 years of age seen in our gynecologic inpatient or outpatient settings or enrolled in ongoing studies will be invited to participate. METHODS: For the portion of the study involving PCOS, scores on the HANDS) screening tool and/or the CES-S scale will be compared to scores for age and body mass index (BMI) matched controls as well as for age-matched controls with infertility. HANDS) and/or CES-D score in PCOS patients will also be correlated with measures of disease severity including BMI, menstrual frequency, obstetric history, hirsutism score, serum androgens, serum gonadotropins and insulin resistance. These measures of severity will be obtained from patient charts. For the portion of the study involving CPP, the HANDS) screening tool will be administered to women with CPP undergoing diagnostic laparoscopy as part of routine clinical care. The screening tool will also be administered to two control groups: 1) women without pelvic pain undergoing elective laparoscopic sterilization and 2) women without pelvic pain seen in our patient clinics. Scores between groups will be compared. Scores will also be correlated with pathologic findings at laparoscopy. CLINICAL RELEVANCE: Half of gynecologic outpatients have a significant emotional disease. Psychiatric diagnoses are common features of many gynecologic diseases. For example, depression scores on screening tools are higher in women with polycystic ovary syndrome (PCOS) compared to age matched healthy controls, and depression is frequently reported in published series of women with chronic pelvic pain (CPP). While the existence of depression in gynecologic patients is clear, the comparison groups in studies are frequently not optimally selected. For example, since obesity and infertility are common features of PCOS and since depression may be more prevalent in these populations, obese women and infertile women may be better control groups. It is also unclear whether depression is a result of chronic pain or causally related. Depression has also been shown to correlate with clinical and biochemical markers of gynecologic disease, however, it is unknown whether treating the gynecologic disease improves depression. We hypothesize that psychological disorders, such as depression, anxiety and post-traumatic stress disorder (PTSD) are more common in certain gynecologic diseases, such as chronic pelvic pain (CPP) and polycystic ovary syndrome (PCOS), and these psychological disorders correlate with measures of severity in the gynecologic diseases.