Depression in Girls With Obesity and Polycystic Ovary Syndrome and/or Type 2 Diabetes

Abstract

Objectives: Polycystic ovary syndrome (PCOS) is a common reproductive/metabolic condition associated with obesity, type 2 diabetes (T2D) and depression in adult women. Depression in adults is related to PCOS dermatologic manifestations. Adolescents with obesity with or without T2D have elevated depression symptoms, but data from youth with PCOS and obesity with/without T2D are limited.

Methods: Our study included girls, aged 11 to 17 years, with obesity and PCOS, PCOS+T2D or T2D, who were newly seen in an obesity complications clinic after March 2016. All participants had Center for Epidemiologic Studies-Depression (CES-D, 20 items) scores obtained within 6 months of PCOS or T2D diagnosis. Data on history of psychiatric diagnosis and treatment, metabolic syndrome and severity of acne and hirsutism were collected through chart review.

Results: One hundred five girls (47 with PCOS, 14 with PCOS+T2D, 44 with T2D) had similar age (15±1.8 years) and body mass index z scores (2.2±0.4). CES-D scores ≥16, indicating elevated depression symptoms, and CES-D scores ≥24, indicating severe depression symptoms, were observed in 60% and 30% of girls with PCOS, 78% and 71% of those with PCOS+T2D and 39% and 21% of those with T2D, respectively (p<0.0001 for both cutpoints). A higher CES-D score was not associated with severity of hirsutism or acne (p>0.05 for both).

Conclusions: Adolescents with PCOS and obesity have higher rates of elevated depression symptoms compared with girls with T2D, which is not related to worse dermatologic symptoms. Because depression may impact both PCOS and T2D management and adherence to therapy, greater efforts should be made to screen for and address mental health in adolescents with PCOS and obesity, especially if T2D is present.

Keywords: adolescentes; adolescents; depression; diabète de type 2; dépression; polycystic ovary syndrome; syndrome des ovaires polykystiques; type 2 diabetes.

Figure 1:. CES-D scores and percentage of scores in depressive range

A. CES-D scores for each patient are shown per category. The scores were different across the groups, and also between groups. B. The overall percentage of scores ≥ 16 is shown with the percentage noted above the bar. The shaded area represents the percentage of scores which were ≥ 24. For PCOS, 30% are mild and 30% severe, for PCOS +T2D, 7 % are mild and 71% severe and for T2D, 18% are mild and 21% severe.