Association Between Mental Health and Reproductive System Disorders in Women: A Systematic Review and Meta-analysis

Abstract

Importance: Reproductive system and mental health disorders are commonly comorbid in women. Although the causes of this overlap remain elusive, evidence suggests potential shared environmental and genetic factors associated with risk.

Objective: To investigate the comorbidity between psychiatric and reproductive system disorders, both as broad diagnostic categories and among specific pairs of diagnoses.

Data source: PubMed.

Study selection: Observational studies published between January 1980 and December 2019 assessing prevalence of psychiatric disorders in women with reproductive system disorders and prevalence of reproductive system disorders in women with psychiatric disorders were included. The study did not include psychiatric and reproductive disorders triggered by life events (eg, trauma, infection, surgery) to address potential confounding.

Data extraction and synthesis: A search yielded 1197 records, of which 50 met the inclusion criteria for the qualitative and 31 for the quantitative synthesis in our study. A random-effects model was used for data synthesis and Egger test and I2 to assess study bias and heterogeneity. Data were analyzed from January to December 2022. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline.

Main outcomes and measures: Psychiatric and reproductive system disorders.

Results: A total of 1197 records were identified, of which 50 met the inclusion criteria for qualitative and 31 for quantitative synthesis. Diagnosis of a reproductive system disorder was associated with a 2- to 3-fold increased odds of having a psychiatric disorder (lower bound odds ratio [OR], 2.00; 95% CI, 1.41-2.83; upper bound OR; 2.88; 95% CI, 2.21-3.76). The analysis focused on specific diagnoses described in the literature and found that polycystic ovary syndrome was associated with increased odds of depression (population-based studies OR, 1.71; 95% CI, 1.19-2.45; clinical studies OR, 2.58; 95% CI, 1.57-4.23) and anxiety (population-based studies OR, 1.69; 95% CI, 1.36-2.10; clinical studies OR, 2.85; 95% CI, 1.98-4.09). Chronic pelvic pain was also associated with both depression (OR, 3.91; 95% CI, 1.81-8.46) and anxiety (OR, 2.33; 95% CI, 1.33-4.08). Few studies investigated risk of other reproductive system disorders in women with psychiatric disorders, or reverse associations (risk of reproductive system disorder among women with a psychiatric diagnosis).

Conclusions and relevance: In this systematic review and meta-analysis, a high rate of reported co-occurrence between psychiatric and reproductive disorders overall was observed. However, data for many disorder pairs were limited. The available literature focused overwhelmingly on affective disorders in polycystic ovary syndrome, overlooking a substantial portion of disease overlap. As such, the associations between the majority of mental health outcomes and conditions of the female reproductive system are largely unknown.

Figure 1.. Flowchart of Included Articles

PRISMA diagram of study selection.

Figure 2.. Meta-analysis of Studies on Affective Disorders in Women With Polycystic Ovary Syndrome (PCOS)

Forest plots displaying odds of affective disorders in women with PCOS. Studies are grouped by study population type. An odds ratio (OR) of more than 1 indicates increased odds of each respective affective disorder in women with PCOS compared with women without PCOS.

Figure 3.. Meta-analysis of Studies on Affective Disorders in Women With Chronic Pelvic Pain (CPP)

Forest plots displaying odds of affective disorders in women with CPP. An odds ratio (OR) of more than 1 indicates increased odds of each respective affective disorder in women with CPP compared with women without CPP.

Figure 4.. Summary of Associations Between Other Reproductive System Disorders and Psychiatric Disorders

Forest plots displaying odds of psychiatric disorders in women with reproductive system disorders. An odds ratio (OR) of more than 1 indicates increased odds of each respective psychiatric disorder in women with reproductive system disorders compared with women without reproductive system disorders. ADHD indicates attention-deficit/hyperactivity disorder; ASD, autism spectrum disorder; CPP, chronic pelvic pain; PCOS, polycystic ovary syndrome.