Delineating sociodemographic, medical and quality of life factors associated with psychological distress in individuals with endometriosis

Abstract

STUDY QUESTION What is the relationship between specific quality of life domains and depression, anxiety and stress in the endometriosis population? SUMMARY ANSWER Psychosocial domains of quality of life, such as a perception of social support and self-image, are more strongly associated with depression, anxiety and stress than pain and medical factors. WHAT IS KNOWN ALREADY Prior research indicates a high prevalence of anxiety and depression in individuals with endometriosis. Pain is thought to be critical in the development of psychological distress, however prior research has investigated this association without consideration of psychosocial quality of life domains such as social functioning, perceived social support and self-image. STUDY DESIGN, SIZE, DURATION This study is a cross-sectional analysis of baseline data collected in a longitudinal study exploring psychological distress in endometriosis (n = 584). PARTICIPANTS/MATERIALS, SETTING, METHODS Individuals living with endometriosis participated in this study and were recruited via online platforms of community organizations and support groups. Demographic and medical information concerning endometriosis treatment and diagnosis was self-reported. Psychological distress and quality of life was measured using the Depression, Anxiety and Stress Scale (DASS-21), Endometriosis Health Profile-30 (EHP-30) and the Short Form Survey (SF-36v2). A series of linear regression analyses explored the relationship between specific quality of life domains and the primary outcomes of depression, anxiety and stress. MAIN RESULTS AND THE ROLE OF CHANCE Approximately half of the participants in this sample reported moderate to severe anxiety, depression and stress. Quality of life domains, particularly perceived social support, social functioning and self-image, were more strongly associated with psychological distress than medical or demographic factors. Pain was associated with anxiety, but not depression or stress. A greater number of endometriosis symptoms was only associated with depression. LIMITATIONS, REASONS FOR CAUTION These data are cross-sectional and, therefore, causality cannot be inferred from this analysis. Information about endometriosis diagnosis and treatment was self-reported, and not verified against medical records. WIDER IMPLICATIONS OF THE FINDINGS This study indicates that psychosocial factors may be more salient factors underlying depression, anxiety and stress in the endometriosis population than pain and medical factors. There is a need for interventions that target psychological distress in this population with a focus on the broader impact of endometriosis beyond pain and physical symptomatology. STUDY FUNDING/COMPETING INTEREST(S) This research was supported by the Research Training Program (RTP) Scholarship awarded to C.S.M. by Macquarie University. The remaining authors have nothing to declare. TRIAL REGISTRATION NUMBER ACTRN12619001508167.

Psychosocial factors associated with pain and health‐related quality of life in Endometriosis: A systematic review

“…Perceived stress was linked with worse HRQoL total score ( rho = −0.55, p < 0.001) and with impaired physical ( rho = −0.34, p < 0.001) and mental HRQoL ( rho = −0.64, p < 0.001) (Márki et al, 2017). In line with, Sullivan‐Myers et al (2021) also reported that stress was linked with impaired HRQoL and was significantly correlated with multiple HRQoL domains: pain ( r = 0.32, p < 0.01), control/powerlessness ( r = 0.34, p < 0.01), social ( r = 0.44, p < 0.01), self‐image ( r = 0.37, p < 0.01), physical function ( r = −0.20, p < 0.01), role physical ( r = −0.26; p < 0.01), vitality ( r = −0.41, p < 0.01) and social functioning ( r = −0.42, p < 0.01).…”

“…Márki et al (2017) found that anxiety impairs general HRQoL ( rho = −0.60, p < 0.001), physical HRQoL ( rho = −0.42, p < 0.001) and mental HRQoL ( rho = −0.70, p < 0.001). Finally, Sullivan‐Myers et al (2021) reported that anxiety was impaired the following domains of HRQoL: pain ( r = 0.38, p < 0.01), control/ powerlessness ( r = 0.34, p < 0.01), social ( r = 0.44, p < 0.01), self‐image ( r = 0.36, p < 0.01), physical function ( r = −0.26, p < 0.01), role physical ( r = −0.28; p < 0.01), vitality ( r = −0.26, p < 0.01) and social functioning ( r = −0.38, p < 0.01).…”

“…Roomaney et al (2020) included various aspects of HRQoL assessed by the EHP-30 (Jones et al, 2001) and found that depression was associated with worse physical functioning (r = −40, p < 0.001) and more negative feelings about infertility (r = 0.20, p < 0.05) and sexual relationships (r = 0.30, p < 0.001). Similarly, Sullivan-Myers et al (2021) found that depression was linked with multiple domains of HRQoL assessed by EHP-30 (pain, r = 0.35; control/ powerlessness, r = 0.40; social, r = 0.48; self-image, r = 0.38; ps <0.01) and SF-36 (physical function, r = −0.31; role physical, r = −0.30; vitality, r = −0.47; social functioning, r = −0.49; ps <0.01).…”

The State of Health and the Quality of Life in Women Suffering from Endometriosis

“…The quality of life of women suffering from endometriosis is influenced by many factors. The most significant is unpredictable pain, occurring periodically, with different degrees of severity, which causes about 38% reduction of work productivity [ 26 , 27 , 28 ]. Several working days missed generate direct and indirect costs comparable to diabetes, migraine, asthma, or rheumatoid arthritis [ 29 , 30 ].…”

Internet-based cognitive behavioral therapy for improving health-related quality of life in patients with endometriosis: study protocol for a randomized controlled trial

“…There is an ongoing need for an evaluated, standardized, effective intervention for improving QoL in patients with endometriosis [ 39 ], although the exact interaction between physical and psychological symptoms is still to be further investigated. CBT teaches restructuring of unhelpful thoughts and core beliefs as well as behavioral activation and relaxation, leading to greater self-efficacy and enabling patients to display improved health behavior [ 40 ].…”