Impact of mild and severe pain intensity on mental health outcomes in women with endometriosis

Roxana Schwab, Kathrin Stewen, Annette Hasenburg
In: Geburtshilfe und Frauenheilkunde · 2022 · vol. 82(10) , pp. e160 · doi:10.1055/s-0042-1757045 · W4307892886
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This study evaluated the impact of moderate and severe pain on self-reported mental health outcomes in women with endometriosis using an online survey.

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This study evaluated the association between pain intensity and mental health outcomes in women with endometriosis using an online survey and validated psychological questionnaires. The results demonstrated that severe dysmenorrhea, lower back pain, and moderate to severe non-cyclic pain significantly increased the odds of depression, anxiety, and general psychological distress compared to low pain levels. The authors explicitly noted that patients experiencing these specific pain profiles should be screened for adverse psychological outcomes and managed by a multidisciplinary team addressing both physical and mental symptoms. This paper is centrally about endometriosis, specifically focusing on how varying degrees of pain severity correlate with mental health complications in affected women.

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Abstract

Objectives To evaluate the impact of moderate and severe pain symptoms on self-reported mental health in patients with endometriosis using an online survey.
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Objectives

To evaluate the impact of moderate and severe pain symptoms on self-reported mental health in patients with endometriosis using an online survey.

Materials and methods

Mental health was assessed by the PHQ-4 questionnaire, which combines a depression (PHQ-2) and an anxiety (GAD-2) scale. PHQ-2 and GAD-2 scores of ≥3 were cut-off points between the normal range and probable cases of major depression or generalized anxiety, and PHQ-4 ≥6 score served as a general marker of psychological distress. Pain intensity was assessed by the visual analogue pain scale (VAS; VAS=0-44: no or low pain; VAS=45-74: moderate pain; VAS=75-100: severe pain).

Results

Severe dysmenorrhea significantly increased the odds for depression (OR=3.446; 95% CI 1.845-6.437; p<0.001), anxiety (OR=3.446; 95% CI 1.845-6.437; p<0.001) and psychological distress (OR=3.651; 95% CI 1.938-6.876; p<0.001) compared to those with no or low pain intensity by using univariate logistic regression. Severe lower back pain significantly increased the odds for depression (OR=2.954; 95% CI 1.668-5.233; p<0.001), anxiety (OR=1.812; 95% CI 1.037-3.165; P=0.037) and psychological distress (OR=2.115; 95% CI 1.204-3.718; p=0.009) compared to those women with no or low pain intensity. Women with moderate and severe non-cyclic pain and dyschezia showed significantly increased odds (all OR>1.8; all p<0.05) for anxiety, depression and psychological distress, respectively.

Conclusion

Women with endometriosis who experience at least moderate non-cyclic pain or dyschezia, and those who experience severe dysmenorrhoea and lower back pain should be screened for adverse psychological outcomes. Treatment should be provided by a multidisciplinary team that addresses both physical and psychological complaints. Publication History Article published online: 11 October 2022 © 2022. Thieme. All rights reserved. Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany

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endometriosis

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