Depression, Anxiety and Endometriosis: A systematic review and
meta-analysis.
Abstract
Background: The extent of endometriosis is not directly related to the
degree of symptoms, and recurrence of symptoms occurs frequently. Given
that, an association with psychological distress, as in depression and
anxiety disorders, is suggested. Objective: To explore the strength of
the associations between endometriosis and depression or anxiety and to
review potential correlating factors. Search Strategy: A literature
search was carried out using the electronic databases Embase, PubMed,
Web-of-science and PsycINFO. Search terms related to depression, anxiety
and endometriosis were combined resulting in 1,837 records. Selection
criteria: Articles describing an association between endometriosis and
depression or anxiety by using validated assessment tools, structured
psychiatric interviews or a documented diagnosis were included. Data
collection and Analysis: With 47 articles a systematic qualitative
review was performed. Seventeen studies were eligible for meta-analysis.
Main Results: In the meta-analysis, endometriosis patients experienced
significantly more symptoms of depression (SMD of 0.71 (95%CI 0.36,
1.06) and anxiety (SMD 0.60 (95%CI 0.35, 0.84)) compared to healthy
controls, but no differences were found comparing endometriosis patients
with chronic pelvic pain patients without endometriosis. Besides the
effect of pain, other correlating factors included age, quality of life,
quality of sleep, fatigue, sexual function, gastrointestinal symptoms,
comorbidity, self-esteem, emotional self-efficacy, coping style, social
adjustment, pain imagery and pain sensitization. Conclusion:
Endometriosis is associated with depression and anxiety. Therefore, an
integrated patient-centred approach to medical, psychological and sexual
issues is suggested as this may positively influence the perception of
symptoms, treatment adherence, quality of life, prognosis and health
care costs.