(73) Mental Health Disorders in Adolescent PCOS: Results from the CALICO multi-center database

Background: Psychological vulnerability is a significant but under-explored comorbidity of polycystic ovary syndrome (PCOS). A recent meta-analysis of adolescents and young adults with PCOS found increased rates of depressive and anxiety symptoms. Other data has demonstrated heightened body image dissatisfaction, disordered eating, and bulimic risk. The study objective was to assess the prevalence of mental health disorders in an ethnically diverse, nationally representative sample of adolescents with PCOS.

Methods: The Clinical Adolescent Polycystic Ovary (CALICO) Database includes data from adolescents with PCOS per 2023 international guidelines from 15 US sites. The main study outcomes were the prevalence of mental health disorders (anxiety, depression, binge or restrictive eating disorders, and ADHD) documented at the time of diagnostic visit for PCOS. Prevalence data was compared to the national prevalence of each mental health disorder respectively. Descriptive statistics included medians (interquartile range, IQR) and counts (percentages).

Results: Among 787 individuals included in the current analyses, median age at PCOS diagnosis was 15.3 years (IQR, 14.2, 16.4), median BMI was 33.6 (IQR, 28.2, 38.8) and median BMI percentile was 98.3 (IQR 95.4, 99.2). 65.7% were Caucasian, 34.6% Hispanic, 20.5% African American, 3.5% Asian, and 10.3% other race. 50.3% had public insurance. Depression screening with a standardized tool was documented in 30 (3.8%) of patients at the PCOS diagnostic visit. At the time of the PCOS diagnostic visit, 16% had a prior diagnosis of anxiety, 19% depression, 0.8% binge eating disorder, 0.2% restrictive eating disorder, and 6.8% ADHD. These rates of mental health disorders were lower than national prevalences for each condition (e.g. anxiety 32%, depression 29%, binge eating disorder 1.6%, restrictive eating disorder 0.3%, and ADHD 9%). Ninety-nine (12.6%) patients were reported as currently receiving anti-depressants or anti-anxiety medication, with 30 (3.8%) receiving ADHD medication.

Conclusions: In this nationally representative sample of adolescents with PCOS, we found lower rates of mental health disorders than in the general population. Given prior data demonstrating higher rates of psychological burden in this population, patients are likely being under-diagnosed prior to PCOS diagnosis, and a minority received standardized screening at diagnostic visit. Our findings underscore the need for a full mental health evaluation at the time of PCOS diagnosis. A recommended standardized screening protocol for this population would likely benefit clinical care.