Psychiatric comorbidity among women with endometriosis: nationwide cohort study in Sweden

Menghan Gao, Koupil I, Ilona Koupil, Hugo Sjöqvist, Karlsson H, Håkan Karlsson, Sujata Lalitkumar, Lalitkumar S, Christina Dalman, Kyriaki Kosidou, Kosidou K
American journal of obstetrics and gynecology · 2020 · vol. 223(3) , pp. 415.e1–415.e16 · doi:10.1016/j.ajog.2020.02.033 · PMID:32112731 · W3008099814
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This nationwide Swedish cohort study investigated psychiatric comorbidities in women diagnosed with endometriosis.

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Abstract

BackgroundEndometriosis is a common gynecologic condition affecting women of reproductive age. It has been linked with greater rates of depression and anxiety in small, cross-sectional, and clinical studies. Other studies have reported that women with endometriosis have increased risk of bipolar disorder. These reports suggest that psychiatric disorders might be more common among women with endometriosis, contributing to increased burden of mental ill-health in this population of women. However, this hypothesis has not been adequately studied.ObjectivesIn this population-based study, we investigated the overall psychiatric comorbidity among women with endometriosis, and the role of familial liability.Study designSeveral Swedish national registers were linked and used to follow all women born in Sweden in 1973-1990 for diagnosed psychiatric disorders and endometriosis from age 14 years until year 2016. Sibling comparison analyses were performed in a subsample of 173,650 families.ResultsAfter adjustment for birth characteristics and education, women with endometriosis had an increased risk of being later diagnosed with depressive-, anxiety and stress-related disorders, alcohol/drug dependence, and attention-deficit hyperactivity disorder compared with the general population and with their sisters without endometriosis. The adjusted hazard ratios ranged from 1.56 (95% confidence interval, 1.29-1.88) for depressive disorders to 1.98 (95% confidence interval, 1.34-2.93) for attention-deficit hyperactivity disorder in the sibling analysis. Also, women with previous affective psychotic disorders, depressive-, anxiety and stress-related disorders, eating disorders, personality disorders, and attention-deficit hyperactivity disorder were more likely to be later diagnosed with endometriosis. The adjusted hazard ratios ranged from 1.51 (95% confidence interval, 1.30-1.76) for depressive disorders to 1.93 (95% confidence interval, 1.47-2.52) for personality disorders.ConclusionThese findings reveal a high degree of comorbidity between endometriosis and many psychiatric disorders that was not entirely explained by shared familial confounding. Clinical practice may consider psychosocial support to women with endometriosis and treating them from a multidisciplinary perspective.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Family Mental Disorders Adolescent Adult Cohort Studies Cross-Sectional Studies Female Humans Mental Disorders Mental Disorders Registries Sweden Sweden Young Adult

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