Suicide Risk 8-Fold Higher After Common Reproductive Disorder Diagnosis

Suicidality was substantially higher among women diagnosed with polycystic ovary syndrome (PCOS), according to a Taiwanese population-based cohort study.

PCOS-diagnosed patients had an 8.47-fold (95% CI 7.54-9.51) higher risk of attempted suicide compared with women without PCOS, Mu-Hong Chen, MD, PhD, of Taipei Veterans General Hospital in Taiwan, and colleagues found.

Incidence of suicide attempts for women with PCOS was 3.0%, compared with 0.3% among matched controls, the researchers reported in the Annals of Internal Medicine.

“These findings emphasize the importance of clinician vigilance in monitoring the mental well-being and suicide risk of patients diagnosed with PCOS,” Chen’s group wrote, pointing out that PCOS affects an estimated 6% to 10% of reproductive-age women. They advised that women with PCOS at high risk for suicide be referred to a psychologist, psychiatrist, or social worker.

The elevated risk seen in the study remained significant across all age groups, but was especially high for young adults with PCOS:

• Adolescents: HR 5.38 (95% CI 3.93-7.37)
• Adults under age 40: HR 9.15 (95% CI 8.03-10.42)
• Adults 40 and older: HR 3.75 (95% CI 2.23-6.28)

Common fluctuations in hormone levels typical of PCOS may be one driving factor behind the significantly higher suicide risk, the researchers explained. These women likely also have to deal with other issues like weight gain, acne, and excess hair growth, which may hurt their body image and self-confidence.

But particularly for the young-adult age bracket, the researchers suggested suicidality “may be related to the persistence of psychological distress, body dissatisfaction, and reproductive concerns in this age group,” on top of all the other challenges these individuals may be more likely to face, such as unemployment, financial difficulties, and relationship problems.

That the magnitude of this excess risk was attenuated with age might reflect partial resolution of hyperandrogenism in older women with PCOS due to ovarian and adrenal aging and reduced androgen production, Chen’s group explained. “The improvement in hormonal levels and clinical symptoms may partially explain the lower suicide risk observed in older adults with PCOS than in younger patients with PCOS.”

The models were adjusted for demographic characteristics, psychiatric comorbid conditions, Charlson Comorbidity Index scores, and frequency of all-cause clinical visits.

In this cohort, the 18,960 women with PCOS ranged in age from 12 to 64 during the study period from 1997 to 2012 and had at least two ICD-9 codes for PCOS as diagnosed by a board-certified gynecologist. None of the women had a history of suicide attempt at the time of diagnosis.

These women were each matched with 10 controls who did not have a history of PCOS diagnosed by any type of physician, ovarian dysfunction, or suicide attempt before enrollment. Women were matched for psychiatric diagnoses with potentially high suicide risk (schizophrenia, bipolar disorder, depression, and substance and alcohol use disorders) plus income level and urbanization of residence.

Across the cohort, incidences of psychiatric disorders were 0.4% for schizophrenia, 0.3% for bipolar disorder, 7.7% for depressive disorder, 0.7% for alcohol use disorder, and 0.8% for substance use disorder.

Beyond a higher incidence of suicide attempts, women with PCOS also had higher Charlson Comorbidity Index (1.21 vs 0.72), a younger age at the time of suicide attempt (31.19 vs 34.48 years), a shorter time between enrollment and the occurrence of a suicide attempt (4.34 vs 6.77 years), and a higher frequency of all-cause clinical visits (12.02 vs 6.49 times per year).

Because all diagnoses were identified by ICD-9 codes, the researchers acknowledged that the prevalence of PCOS and mental disorders may have been underestimated. On top of that, they were lacking data on other factors that may have played into these associations, such as severity of depressive symptoms, BMI, lifestyle or environmental factors, and prior undocumented suicide attempts.

The researchers said that future studies should aim to delve deeper into the associations between suicide risk and factors such as stigma, hormone imbalance severity, clinical PCOS symptoms, and the extent of support from family or the environment in order to provide a more comprehensive understanding of these relationships.

If you or someone you know is considering suicide, call or text 988 or go to the 988 Suicide and Crisis Lifeline website.

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