Direct Economic Burden of Mental Health Disorders Associated with Polycystic Ovary Syndrome: Systematic Review and Meta-analysis

Abstract

BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common hormone disorder affecting about one in seven reproductive-aged women worldwide and approximately 6 million women in the United States (U.S.). PCOS can be a significant burden to those affected and is associated with an increased prevalence of mental health (MH) disorders such as depression, anxiety, eating disorders, and postpartum depression. We undertook this study to determine the excess economic burden associated with MH disorders in women with PCOS, in order to allow for a more accurate prioritization of the disorder as a public health priority. <br />METHODS: Followed PRISMA reporting guidelines for systematic review, we searched 60 PubMed, Web of Science, EBSCO, Medline, Scopus, and PsycINFO through July 16, 2021, for studies on MH disorders in PCOS. Excluded were studies not in humans, without controls, without original data, or not peer reviewed. As anxiety, depression, eating disorders, and postpartum depression were by far the most common MH disorders assessed by the studies, we performed our meta-analysis on these disorders. Meta-analyses were performed using the DerSimonian-Laird random-effects model to compute pooled estimates of prevalence ratios (PR) for the associations between PCOS and these MH disorders, and then calculated the excess direct costs of related to these disorders in U.S. dollars (USD) for women suffering from PCOS in the U.S. alone. The quality of selected studies was assessed using the Newcastle Ottawa Scale. <br />RESULTS: We screened 78 articles by title/abstract, assessed 43 articles in full-text, and included 25 articles. Pooled PRs were 1.42 (95% CI: 1.32-1.52) for anxiety, 1.65 (95% CI: 1.44- 1.89;) for depression, 1.48 (95% CI: PR: 1.06-2.05) for eating disorders, and 1.20 (95% CI: 0.96-1.50) for postpartum depression, for PCOS relative to controls. In the U.S, the additional direct healthcare costs associated with anxiety, depression and eating disorders in PCOS were estimated to be $1.939 billion/yr., 1.678 billion/yr., and $0.644 billion/yr. in 2021 USD, respectively. Postpartum depression was excluded from the cost analyses due to the non-significant meta-analysis result. Taken together, the additional direct healthcare costs associated with anxiety, depression and eating disorders in PCOS was estimated to be $4.261 billion/yr. in 2021 USD. <br />CONCLUSIONS: Overall, the direct healthcare annual costs for the most common MH disorders in PCOS, namely anxiety, depression, and eating disorders exceeds $4 billion in 2021 USD for the U.S. population alone. Taken together with our prior work, these data suggest that the healthcare-related economic burden of PCOS exceeds $15 billion yearly, considering the costs of PCOS diagnosis, and cost related to PCOS-associated MH, reproductive, vascular, and metabolic disorders. As PCOS has much the same prevalence across the world, the excess economic burden attributable to PCOS globally is enormous, mandating that the scientific and policy community increase its focus on this important disorder. <br />FUNDING: The study was supported, in part, by PCOS Challenge: The National Polycystic Ovary Syndrome Association and by the Foundation for Research and Education Excellence

Increased Prevalence of Adverse Health Outcomes Across the Lifespan in Those Affected by Polycystic Ovary Syndrome: A Canadian Population Cohort

“…137 The healthcare costs associated with anxiety, depression, and eating disorders in the US were estimated to be $4.26 billion per year in 2021. 29 Our data show that dementia-related symptomology coded in the administrative database was increased 2-fold in those with PCOS and that it occurs 19 years earlier in those with PCOS, compared to the age in controls. This finding requires further investigation into the symptoms vs the early onset of cognitive decline specific to dementia or Alzheimer’s disease.…”

“…This prevalence of eating disorders is relatively high compared to that found in other population studies that report a 0.3%-2.45% prevalence in those with PCOS. 31 , 126 , 129 , 130 However, in meta-analyses, a prevalence ratio of 1.2 and an odds ratio of 3.8 have been reported for eating disorders in those with PCOS, compared to controls, 29 , 131 and in case control studies, the prevalence of an eating disorder has been reported to range from 11% to 62%. 132 , 133 , 134 , 135 , 136 We have reported that the eating disorders seen in those with PCOS are most commonly bulimia nervosa and binge eating disorder.…”

“…Our data showed that mental health and psychiatric disorders had a 30% higher prevalence in those with PCOS, consistent with findings of previous population cohort studies. 6 , 29 , 31 , 32 , 126 , 127 In particular, the prevalence of depression and anxiety in those with PCOS has been reported to be markedly elevated, with a 30%-50% prevalence and an odds ratio of 1.4 to > 2.5 in those with PCOS. 7 , 29 , 32 , 127 , 128 Eating disorders can be a product of depression and anxiety in the PCOS patient, and we have shown that eating disorders have a 5.7% prevalence in those with PCOS, and a 40% higher prevalence, as compared to non-PCOS controls.…”

“… 6 , 29 , 31 , 32 , 126 , 127 In particular, the prevalence of depression and anxiety in those with PCOS has been reported to be markedly elevated, with a 30%-50% prevalence and an odds ratio of 1.4 to > 2.5 in those with PCOS. 7 , 29 , 32 , 127 , 128 Eating disorders can be a product of depression and anxiety in the PCOS patient, and we have shown that eating disorders have a 5.7% prevalence in those with PCOS, and a 40% higher prevalence, as compared to non-PCOS controls. This prevalence of eating disorders is relatively high compared to that found in other population studies that report a 0.3%-2.45% prevalence in those with PCOS.…”

“… 19 , 21 , 22 , 25 , 26 , 27 In addition, women with PCOS have an increased prevalence of mental health disorders, and an increased psychosocial and economic burden attributable to anxiety, depression, and eating disorders. 2 , 7 , 28 , 29 , 30 …”