Long-term risk of psychiatric disorders in women with endometriosis: A retrospective cohort study

BACKGROUND: Endometriosis is a chronic, estrogen-dependent condition associated with substantial physical and psychological burden. Although psychiatric comorbidities are frequently reported, large-scale real-world data remain limited. METHODS: We conducted a retrospective cohort study using the TriNetX U.S. Collaborative Network, including women aged 21-60 diagnosed with endometriosis between 2001 and 2020. Patients were matched 1:1 with controls without endometriosis using propensity score matching (PSM) based on age, race, nicotine dependence, alcohol abuse, obesity, infertility, delivery history, insomnia, and menopause. Psychiatric outcomes included depressive episodes, recurrent major depressive disorder, anxiety disorders, and substance use disorders. Subgroup analyses assessed differences by race, age, and postoperative hormonal therapy use. RESULTS: After PSM, each group included 7563 patients. Endometriosis was significantly associated with increased risks of several psychiatric disorders, including depressive episodes (HR = 1.35, 95 % CI: 1.24-1.47), recurrent major depressive disorder (HR = 1.30, 95 % CI: 1.10-1.53), anxiety disorders (HR = 1.39, 95 % CI: 1.29-1.49), phobic anxiety disorder (HR = 1.47, 95 % CI: 1.01-2.13), and substance use disorders (HR = 1.43, 95 % CI: 1.30-1.56). The composite outcome of all assessed psychiatric disorders-including depressive episodes, recurrent major depressive disorder, anxiety disorders, phobic anxiety disorder, mental and behavioral disorders due to psychoactive substance use, and suicidal ideation-was also significantly elevated in the endometriosis group (HR = 1.38, 95 % CI: 1.30-1.46). These associations were most pronounced among White patients, while Black patients showed elevated risks for recurrent depression and anxiety disorders only. No significant associations were observed among Asian patients. Additionally, postoperative hormonal therapy did not significantly reduce the risk of psychiatric disorders compared to surgery alone. CONCLUSIONS: Women with endometriosis face elevated risks of psychiatric disorders, with notable racial disparities. Hormonal therapy may not mitigate these mental health risks. Our findings underscore the importance of integrated gynecologic and psychological care in the management of endometriosis.