بررسی ارتباط سطوح هورمونهای آندروژن، هیرسوتیسم و آکنه با افسردگی و اضطراب در زنان مبتلا به سندرم تخمدان پلی‌کیستیک

نوع مقاله: اصیل پژوهشی

نویسندگان

1 دانشجوی کارشناسی ارشد بهداشت باروری و مامایی، دانشکده علوم پزشکی، دانشگاه تربیت مدرس، تهران، ایران.

2 استادیار گروه بهداشت باروری و مامایی، دانشکده علوم پزشکی، دانشگاه تربیت مدرس، تهران، ایران.

3 استاد گروه آمار زیستی، دانشکده علوم پزشکی، دانشگاه تربیت مدرس، تهران، ایران.

چکیده

مقدمه: سطح کیفیت زندگی بیماران مبتلا به سندرم تخمدان پلی­کیستیک تحت تأثیر متغیرهای گسترده‌ای می­باشد. مطالعات مختلف نشان داده‌اند که این بیماران در معرض خطر بالای اختلال افسردگی و اضطراب قرار دارند. مهم­ترین علائم تخمدان پلی­کیستیک، هیرسوتیسم، آکنه و افزایش هورمون آندروژن است. مطالعه حاضر با هدف بررسی ارتباط سطوح هورمون‌های آندروژن، هیرسوتیسم و آکنه با افسردگی و اضطراب در زنان مبتلا به سندرم تخمدان پلی‌کیستیک انجام شد.
روش‌کار: این مطالعه مورد- شاهدی در سال 95-1394 بر روی 53 بیمار مبتلا به سندرم تخمدان پلی­کیستیک که بر اساس معیارهای تشخیصی روتردام انتخاب شدند و 50 زن سالم به‌عنوان گروه کنترل در بیمارستان آرش تهران انجام شد. ابزار گرد­آوری داده­ها، پرسشنامه­ای شامل مشخصات فردی و پرسشنامه افسردگی و اضطراب بک، مقیاس فریمن گالوی جهت بررسی درجه هیرسوتیسم، مقیاس جهانی درجه­بندی آکنه و ویژگی­های بالینی هیپرآندروژنیسم و نتایج آزمایشات (تستوسترون تام، تستوسترون آزاد، گلوبولین متصل به هورمون‌های جنسی) بود. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه 21) و آزمون‌های تی­تست، کای­دو و ضریب همبستگی پیرسون انجام گرفت. میزان p کمتر از 05/0 معنی­دار در نظر گرفته شد.
یافته­ها: میانگین نمرات آکنه (02/0=p)، هیرسوتیسم (001/0>p)، توتال تستوسترون (008/0=p) و تستوسترون آزاد (01/0=p) در گروه بیمار به‌طور معنی­داری بالاتر از گروه کنترل بود. میانگین سطح SHBG در گروه مورد و گروه شاهد اختلاف آماری معنی­داری نداشت (3/0=p). میانگین نمرات افسردگی (001/0=p) و اضطراب (01/0=p) در گروه بیمار (82/9±35/20 و 44/10±35/17) به­طور معنی­داری بیش­تر از گروه کنترل (40/8±46/14 و 65/9±40/12) بود. بین نمرات کلی اضطراب و افسردگی با آکنه، هیرسوتیسم، توتال تستوسترون، تستوسترون آزاد و گلوبولین متصل به هورمون‌های جنسی ارتباط آماری معنی­داری مشاهده نشد (05/0<p).
نتیجه‌گیری: افزایش معنی‌دار در میزان نمرات اضطراب و افسردگی در گروه بیمار نسبت به گروه کنترل می‌تواند بیانگر خلق افسرده و مضطرب در مبتلایان به سندرم تخمدان پلی­کیستیک باشد.

کلیدواژه‌ها


عنوان مقاله [English]

Relationship between levels of androgen hormones, hirsutism and acne with depression and anxiety in women with polycystic ovary syndrome

نویسندگان [English]

  • Saeideh Mehrabadi 1
  • Shahideh Jahanian Sadatmahalleh 2
  • Anoshirvan Kazemnejad 3
1 M.Sc. Student, Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
2 Assistant Professor, Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
3 Professor, Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
چکیده [English]

Introduction: The quality of life in patients with polycystic ovary syndrome is affected by wide variables. Various studies have shown that these patients are at high risk of depression and anxiety. The most important symptoms of polycystic ovary syndrome include hirsutism, acne, and increased androgen hormones. This study was performed with aim to evaluate the relationship between levels of androgen hormones, hirsutism, and acne with depression and anxiety in women with polycystic ovary syndrome.
Methods: This case-control study was performed on 53 patients with polycystic ovary syndrome selected by Rotterdam criteria, and 50 healthy women as control group in Tehran Arash Hospital in 2015-2016. The tools of data collection were questionnaire of demographic information, Beck Depression and Anxiety questionnaire, Ferriman - Gallwey Score to assess the degree of hirsutism, Global Acne Grading System, clinical features of hyperandrogenism and laboratory tests’ results (Total testosterone, free testosterone, sex hormone binding globulin). Data were analyzed by SPSS software (version 21) and T-test, Chi-square, and Pearson Correlation Coefficient. P<0.05 was considered statistically significant.
Results:Mean scores of acne (p=0.02), hirsutism (p<0.001), total testosterone (p=0.008), and free testosterone (p=0.01) were meaningfully higher in patient group than control group. Mean Sex Hormone Binding Globulin level was not significant different in case and control groups (p=0.3). Mean scores of depression (p=0.001) and anxiety (p=0.01) in patient group (20.35±9.82 and 17.35±10.44) were significantly higher than control group (14.46±8.40 and 12.40±9.65). No significant relationship was found between total scores of acne, hirsutism, total testosterone, free testosterone and sex hormone binding globulin with depression and anxiety (p>0.05).
Conclusion: Significant increase in the scores of anxiety and depression in patient group compared to control group can be indicative of depressed and anxious mood in patients with polycystic ovary syndrome.

کلیدواژه‌ها [English]

  • Androgen
  • Anxiety
  • Depression
  • Polycystic ovary syndrome
  1. Zafari Zangeneh F, Naghizadeh MM, Abedinia N, Haghollahi F. Risk factors in polycystic ovary syndrome. Iran J Obstet Gynecol Infertil 2012; 15(6):1-9. (Persian).
  2. Sayehmiri F, Kiani F, Maleki F, Ahmadi M, Shohani M. Prevalence of polycystic ovary syndrome in Iranian women: a systematic review and meta-analysis. Iran J Obstet Gynecol Infertil 2014; 17(115):11-21. (Persian).
  3. Naderi T, Akbarzadeh M, Manesh D, Hossein M, Tabatabaei H, Zareh Z. Frequency of facial and body acne in 14-to 18-year-old female high school students and its relationship to polycystic ovary syndrome. J Dermatol Cosmetic 2011; 2(2):124-31. (Persian).
  4. Shahbazian H, Zakerkish M, Heidari-Manesh N. Etiology of hirsutism in women referring to endocrinology clinic in Ahwaz. Zahedan J Res Med Sci 2013; 15(4):69-72.  
  5. Arshad M, Moradi S, Ahmmadkhani AR, Emami Z. Increased prevalence of depression in women with polycystic ovary syndrome. Iran J Endocrinol Metab 2012; 13(6):582-6. (Persian).
  6. Annagür BB, Tazegül A, Uguz F, Kerimoglu ÖS, Tekinarslan E, Celik Ç. Biological correlates of major depression and generalized anxiety disorder in women with polycystic ovary syndrome. J Psychosom Res 2013; 74(3):244-7.
  7. Amini L, Ghorbani B, Montazeri A. Iranian version of health-related quality of life for women with polycystic ovary syndrome (PCOSQ): translation, reliability and validity. Payesh 2012; 11(2):227-33. (Persian).
  8. Amini L, Ghorbani B, Seyedfatemi N. Mental health of women with polycystic ovary syndrome (PCOS) and some of its socio-demographic determinants. Iran J Nurs 2012; 25(78):34-41. (Persian).
  9. Bazarganipour F, Ziaei S, Montazeri A, Foroozanfard F, Kazemnejad A, Faghihzadeh S. Psychological investigation in patients with polycystic ovary syndrome. Health Qual Life Outcomes 2013; 11:141.
  10. Ching HL, Burke V, Stuckey BG. Quality of life and psychological morbidity in women with polycystic ovary syndrome: body mass index, age and the provision of patient information are significant modifiers. Clin Endocrinol 2007; 66(3):373-9.
  11. Kitzinger C, Willmott J. The thief of womanhood’: women’s experience of polycystic ovarian syndrome. Soc Sci Med 2002; 54(3):349-61.
  12. Eggers S, Kirchengast S. The polycystic ovary syndrome-a medical condition but also an important psychosocial problem. Coll Antropol 2001; 25(2):673-85.
  13. Dokras A, Clifton S, Futterweit W, Wild R. Increased risk for abnormal depression scores in women with polycystic ovary syndrome: a systematic review and meta-analysis. Obstet Gynecol. 2011 Jan;117(1):145-52.
  14. Shakerardekani Z, Nasehi A, Eftekhar T, Ghaseminezhad A, Ardekani MA, Raisi F. Evaluation of depression and mental health status in women with poly cystic ovary syndrome. J Fam Reprod Health 2011; 5(3):67-71.
  15. Cipkala-Gaffin J, Talbott EO, Song MK, Bromberger J, Wilson J. Associations between psychologic symptoms and life satisfaction in women with polycystic ovary syndrome. J Womens Health (Larchmt) 2012; 21(2):179-87.
  16. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004; 19(1):41-7.
  17. Ferrimanm D, Gallwey JD. Clinical assessment of body hair growth in women. J Clin Endocrinol Metab 1961; 21:1440-7.
  18. Lever WF, Schaumburg-Lever G. Acne vulgaris. Histopatbology of the Skin. 7th ed. Philadelphia: JB Lippincott; 1990. P. 218-9.
  19. Coffey S, Bano G, Mason HD. Health-related quality of life in women with polycystic ovary syndrome: a comparison with the general population using the polycystic ovary syndrome questionnaire (PCOSQ) and the Short Form-36 (SF-36). Gynecol Endocrinol 2006; 22(2):80-6.
  20. Dabson KS, Mohammad KP, Choulabi MO. Psychometrics characteristic of beck depression inventory-II in patients with Magor depressive disorder. J Rehabilit 2007; 8(29):82-8.
  21. Demehri F, Honarmand MM, Yavari AH. Depression and obsessive -compulsive as antecedent of guilt feeling and anxiety as consequences of it in university girl students. J Woman Culture 2011; 2(6):25-36. (Persian).
  22. Rafiei M. An investigation into the reliability and validity of beck anxiety inventory among the university students. Iran J Psychiatry Clin Psychol 2013; 7(27):43-50. (Persian).
  23. Kaviani H, Mousavi AS. Psychometric properties of the Persian version of Beck Anxiety Inventory (BAI). Tehran Univ Med J 2008; 66(2):136-40. (Persian).
  24. Ghoreishi A, Rahmanpour HA, Mousavinasab N. Evaluation of psychological problems in teenagers suffering from polycystic ovary syndrome. J Zanjan Univ Med Sci Health Serv 2010; 18(73):76-83. (Persian).   
  25. Zehra S, Arif A, Anjum N, Azhar A, Qureshi M. Depression and anxiety in women with polycystic ovary syndrome from Pakistan. Life Sci J 2015, 12(3):1-4.
  26. Kurtalić N, Hadžigrahić N, Tahirović H, Šadić S. Assessment of anxiety and depression in adolescents with acne vulgaris related to the severity of clinical features and gender. Acta Med Acad 2010; 39(2):159-64.
  27. Duman H, Topal IO, Kocaturk E, Duman MA. Evaluation of anxiety, depression, and quality of life in patients with acne vulgaris, and quality of life in their families. Dermatol Sinica 2016; 34(1):6-9.
  28. Shakoor A, Shaheen JA, Khan JI. Association of anxiety and depression with acne: evaluation of pathoplastic effect of adolescence on this comorbidity. J Pak Assoc Dermatol 2012; 22(4):336-41.
  29. Öztürk A, Deveci E, Bağcioğlu E, Atalay F, Serdar Z. Anxiety, depression, social phobia, and quality of life in Turkish patients with acne and their relationships with the severity of acne. Turk J Med Sci 2013; 43(4):660-6.
  30. Niemeier V, Kupfer J, Gieler U. Acne vulgarisepsychosomatic aspects. J Dtsch Dermatol Ges 2006; 4(12):1027-36.
  31. Fried RG, Wechsler A. Psychological problems in the acne patient. Dermatol Ther 2006; 19(4):237-40.
  32. Yazici K, Baz K, Yazici AE, Köktürk A, Tot S, Demirseren D, et al. Disease-specific quality of life is associated with anxiety and depression in patients with acne. J Eur Acad Dermatol Venereol 2004; 18(4):435-9.
  33. Aktan S, Ozmen E, Sanli B. Anxiety, depression, and nature of acne vulgaris in adolescents. Int J Dermatol 2000; 39(5):354-7.
  34. Erdemir AV, Bagcı SI, Inan EY, Turan E. Evaluation of social appearance anxiety and quality of life in patients with acne vulgaris. Istanbul Med J 2013; 14:35-40.
  35. Zangeneh FZ, Jafarabadi M, Naghizadeh MM, Abedinia N, Haghollahi F. Psychological distress in women with polycystic ovary syndrome from Imam Khomeini Hospital, Tehran. J Reprod Infertil 2012; 13(2):111-5.
  36. İrak L, Çinar Yavuz H, Ayçiçek Doğan B, Mete T, Berker D, Güler S. Depression, anxiety and their relation with clinical parameters and androgen  levels in hirsute women. Turk J Med Sci 2016; 46(2):245-50.
  37. Hodeeb Y, Dinary A, Hassan H, Samy D. Hirsutism and health related quality of life. Mod Chem Appl 2015; 2:170.
  38. Annagür BB, Tazegül A, Uguz F, Kerimoglu ÖS, Tekinarslan E, Celik Ç. Biological correlates of major depression and generalized anxiety disorder in women with polycystic ovary syndrome. J Psychosom Res 2013; 74(3):244-7.
  39. Månsson M, Holte J, Landin-Wilhelmsen K, Dahlgren E, Johansson A, Landén M. Women with polycystic ovary syndrome are often depressed or anxious--A case control study. Psychoneuroendocrinology 2008; 33(8):1132-8.
  40. Weiner CL, Primeau M, Ehrmann DA. Androgens and mood dysfunction in women: comparison of women with polycystic ovarian syndrome to healthy controls. Psychosom Med 2004; 66(3):356-62.
  41. Rasgon NL, Rao RC, Hwang S, Altshuler LL, Elman S, Zuckerbrow-Miller J, et al. Depression in women with polycystic ovary syndrome: clinical and biochemical correlates. J Affect Disord 2003; 74(3):299-304.
  42. McCook JG. The influence of obesity, androgenism and fertility status on the psychosocial health and wellbeing of women with polycystic ovary syndrome. Fertil Steril 2001; 76(3):S29.
  43. Pastore LM, Patrie JT, Morris WL, Dalal P, Bray MJ. Depression symptoms and body dissatisfaction association among polycystic ovary syndrome women. J Psychosom Res 2011; 71(4):270-6.
  44. Hollinrake E, Abreu A, Maifeld M, Van Voorhis BJ, Dokras A. Increased risk of depressive disorders in women with polycystic ovary syndrome. Fertil Steril 2007; 87(6):1369-76.