Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2023 Aug 3:12:e85338.
doi: 10.7554/eLife.85338.

Direct economic burden of mental health disorders associated with polycystic ovary syndrome: Systematic review and meta-analysis

Surabhi Yadav  1 , Olivia Delau  1 , Adam J Bonner  2 , Daniela Markovic  3 , William Patterson  4 , Sasha Ottey  4 , Richard P Buyalos  5 , Ricardo Azziz  2   6   7   8
Affiliations
Meta-Analysis

Direct economic burden of mental health disorders associated with polycystic ovary syndrome: Systematic review and meta-analysis

Surabhi Yadav et al. Elife. .

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.

Methods: Following PRISMA reporting guidelines for systematic review, we searched 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 Excluded were studies not in humans, without controls, without original data, or not peer reviewed.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 (PRs) for the associations between PCOS and these MH disorders and then calculated the excess direct costs 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.

Results: We screened 78 articles by title/abstract, assessed 43 articles in full text, and included 25 articles. Pooled PRs were 1.42 (95% confidence interval [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 were estimated to be $4.261 billion/yr in 2021 USD.

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 costs 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.

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.

Keywords: PCOS; economic burden; epidemiology; female reproduction; global health; human; medicine; mental health.

Plain language summary

Polycystic Ovary Syndrome (PCOS) affects one in seven reproductive-age women worldwide. PCOS impacts women’s physical and mental health, and it may also have detrimental effects on their social lives, academic achievement and careers. Studies show women with PCOS have higher rates of depression, anxiety, eating disorders, infertility and postpartum depression compared with women without the condition. The economic burden of PCOS is enormous. Previous studies show PCOS-related economic costs totals billions of dollars. But few studies have examined the costs associated with PCOS-associated mental health care. Learning more about these costs may help policymakers and clinicians allocate resources for mental health care for women with PCOS. Yadav et al. analyzed the results of 25 studies to assess the mental health impact of PCOS and its costs. The analysis found that women with PCOS are 60% more likely to have depression or anxiety compared to women without the condition. They were also twice as likely to have eating disorders. Caring for these mental health issues in PCOS patients increases US healthcare costs by approximately $4.2 billion yearly. These costs raise the healthcare-related economic burden of treating PCOS and associated conditions to $15 billion in the United States each year. The analysis suggests that earlier recognition and better treatment of PCOS could reduce associated healthcare costs and improve the quality of life for women with PCOS. The results may help policymakers and clinicians understand the condition's impact and prioritize resources for PCOS care. More research on the condition is necessary to reduce the enormous economic and personal burden caused by it.

PubMed Disclaimer

Conflict of interest statement

SY, OD, AB, DM, RB No competing interests declared, WP is a Director of Public Affairs, Study Recruitment and Patient Registry Manager, and Intern Preceptor for PCOS Challenge: The National Polycystic Ovary Syndrome Association. The author has no other competing interests to declare, SO received honoraria from Institute for Family Centeredness; has received travel support for attendance at Women's Health Innovation Summit; and is Executive Director for PCOS Challenge: The National Polycystic Ovary Executive Director Syndrome Association. The author has no other competing interests to declare, RA received a grant from Ferring Pharmaceuticals; has received royalties from Wolters Kluwer Health, Johns Hopkins University Press, Springer, and McGraw Hill; has received honoraria from Davidson-Mestman course; has participated on a data safety monitoring board for University of Michigan and Guangzhou Medical University; has held a leadership or fiduciary role at American Society for Reproductive Medicine; holds stock at Martin Imaging and Arora Forge; has received consulting fees from Spruce Biosciences, Fortress Biotech, Rani Therapeutics, Core Access Surgical for PCOS, female reproduction and gynecologic surgery; and serves as Senior Editor at eLife. The author has no other competing interests to declare

Figures

Figure 1.
Figure 1.. Flow diagram of the literature search and study selection process.
Figure 2.
Figure 2.. Meta-analyses of the prevalence of mental health disorders in women with polycystic ovary syndrome (PCOS).
Forest plots (random effects model) of risk of mental health disorders in women with PCOS, including anxiety (A), depression (B), eating disorders (C), and postpartum depression (D). See text for abbreviations.
Figure 2—figure supplement 1.
Figure 2—figure supplement 1.. Trim and fill funnel plots for the meta-analysis of anxiety.
Trim and fill funnel plots (X axis is the log prevalence ratio/risk ratio; Y axis is the standard error of the log prevalence ratio/risk ratio) include 10 high-quality studies for anxiety. Observed studies are indicated by solid circles, and ‘filled’ studies are indicated by open circles.
Figure 2—figure supplement 2.
Figure 2—figure supplement 2.. Trim and fill funnel plots for the meta-analysis of depression.
Trim and fill funnel plots (X axis is the log prevalence ratio/risk ratio; Y axis is the standard error of the log prevalence ratio/risk ratio) include 10 high-quality studies for depression. Observed studies are indicated by solid circles, and ‘filled’ studies are indicated by open circles.
Figure 2—figure supplement 3.
Figure 2—figure supplement 3.. Trim and fill funnel plots for the meta-analysis of eating disorders.
Trim and fill funnel plots (X axis is the log prevalence ratio/risk ratio; Y axis is the standard error of the log prevalence ratio/risk ratio) include six high-quality studies for eating disorders. Observed studies are indicated by solid circles, and ‘filled’ studies are indicated by open circles.
See this image and copyright information in PMC

Update of

  • doi: 10.1101/2023.01.05.23284220

References

    1. Adali E, Yildizhan R, Kurdoglu M, Kolusari A, Edirne T, Sahin HG, Yildizhan B, Kamaci M. The relationship between clinico-biochemical characteristics and psychiatric distress in young women with polycystic ovary syndrome. The Journal of International Medical Research. 2008;36:1188–1196. doi: 10.1177/147323000803600604. - DOI - PubMed
    1. Alur-Gupta S, Chemerinski A, Liu C, Lipson J, Allison K, Sammel MD, Dokras A. Body-image distress is increased in women with polycystic ovary syndrome and mediates depression and anxiety. Fertility and Sterility. 2019;112:930–938. doi: 10.1016/j.fertnstert.2019.06.018. - DOI - PMC - PubMed
    1. Alur-Gupta S, Boland MR, Barnhart KT, Sammel MD, Dokras A. Postpartum complications increased in women with polycystic ovary syndrome. American Journal of Obstetrics and Gynecology. 2021;224:280. doi: 10.1016/j.ajog.2020.08.048. - DOI - PMC - PubMed
    1. Asik M, Altinbas K, Eroglu M, Karaahmet E, Erbag G, Ertekin H, Sen H. Evaluation of affective temperament and anxiety-depression levels of patients with polycystic ovary syndrome. Journal of Affective Disorders. 2015;185:214–218. doi: 10.1016/j.jad.2015.06.043. - DOI - PubMed
    1. Azziz R, Marin C, Hoq L, Badamgarav E, Song P. Health care-related economic burden of the polycystic ovary syndrome during the reproductive life span. The Journal of Clinical Endocrinology & Metabolism. 2005;90:4650–4658. doi: 10.1210/jc.2005-0628. - DOI - PubMed

Publication types