OP07.01: Impact of pain and feelings of infertility on depression, anxiety and stress symptoms in individuals with endometriosis: an international survey

P McClenahan, J.C. Zanardi, R.M. Rocha, Donna Ciccia, Vladan Starčević, M. Espada, Allie Eathorne, Mathew Leonardi, Mike Armour, G. Condous
In: Ultrasound in Obstetrics & Gynecology · 2024 · vol. 64(S1) , pp. 76 · doi:10.1002/uog.27924 · PMID:39250065 · W4402357661
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This international survey found direct linear relations between endometriosis pain severity, feelings of infertility, and depression, anxiety, stress, and PTSD symptoms.

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This international cross-sectional survey analyzed data from 3,449 individuals with self-reported endometriosis to model the relationship between physical symptoms and mental health outcomes. Using validated questionnaires including the EHP-30 and DASS-21, researchers found a direct linear association between pain severity, feelings of infertility, and increased scores for depression, anxiety, stress, and post-traumatic stress disorder. The study noted that prior pregnancy was associated with significantly lower mental health symptom scores, while fertility treatment access also reduced depression levels. This paper is centrally about endometriosis — specifically examining how pain and infertility perceptions correlate with psychiatric comorbidities in this patient population.

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Abstract

Mental health symptoms and pain symptoms often coincide in chronic disease. People with endometriosis been shown to have higher incidences of mental health symptoms over people with chronic pain alone. The degree and nature of the relation however is not well established. This study aims to use established endometriosis symptom and mental health metrics to model the relationship between these two areas of patient experience. Our cross-sectional international online survey conducted between March 2021 and May 2021. The survey utilised validated questionnaires, including the Endometriosis Health Profile (EHP-30), the Depression Anxiety Stress Scales-21 (DASS-21), and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). Pregnancy history was also recorded. Linear analysis was performed to assess relation between symptoms and mental health scores. 3,449 individuals with self-reported endometriosis participated in the survey. 118 were excluded. Most respondents (76.8%) were between the ages of 25 and 44, representing 81 different countries. There was a direct linear relation between pain severity, feelings of infertility, and depression, anxiety, stress and PTSD scores. There was an ‘interaction term’ between pain and infertility present for depression, stress and PTSD score. Mean DASS-21 scores were ‘normal’ however the mean PCL-5 score of 29.2 corresponds with moderate PTSD symptoms. Depression, anxiety and PCL-5 Scores were significantly less if prior pregnancy reported, P = 0.001, 0.006 and 0.006 respectively. Accessing fertility treatment reduced depression score (P = 0.014). Outcome of live birth versus no live birth did not alter this (P = 0.061). Severity of pain and feelings of infertility has a direct linear relation to DASS-21 and PCL-5 scores. Management of patients with self reported endometriosis may benefit from earlier evaluation and intervention from mental health specialists as part of the multi-disciplinary team.
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Objectives

Mental health symptoms and pain symptoms often coincide in chronic disease. People with endometriosis been shown to have higher incidences of mental health symptoms over people with chronic pain alone. The degree and nature of the relation however is not well established. This study aims to use established endometriosis symptom and mental health metrics to model the relationship between these two areas of patient experience.

Methods

Our cross-sectional international online survey conducted between March 2021 and May 2021. The survey utilised validated questionnaires, including the Endometriosis Health Profile (EHP-30), the Depression Anxiety Stress Scales-21 (DASS-21), and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). Pregnancy history was also recorded. Linear analysis was performed to assess relation between symptoms and mental health scores.

Results

3,449 individuals with self-reported endometriosis participated in the survey. 118 were excluded. Most respondents (76.8%) were between the ages of 25 and 44, representing 81 different countries. There was a direct linear relation between pain severity, feelings of infertility, and depression, anxiety, stress and PTSD scores. There was an ‘interaction term’ between pain and infertility present for depression, stress and PTSD score. Mean DASS-21 scores were ‘normal’ however the mean PCL-5 score of 29.2 corresponds with moderate PTSD symptoms. Depression, anxiety and PCL-5 Scores were significantly less if prior pregnancy reported, P = 0.001, 0.006 and 0.006 respectively. Accessing fertility treatment reduced depression score (P = 0.014). Outcome of live birth versus no live birth did not alter this (P = 0.061).

Conclusions

Severity of pain and feelings of infertility has a direct linear relation to DASS-21 and PCL-5 scores. Management of patients with self reported endometriosis may benefit from earlier evaluation and intervention from mental health specialists as part of the multi-disciplinary team.

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Outcome instruments

EHP-30

Condition tags

endometriosisinfertility

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