(104) Polycystic Ovary Syndrome and Mental Health Co-Morbidities in Adolescents

Background: Mental health disorders (MHDs) have been associated with polycystic ovary syndrome (PCOS), but few studies have focused on the interplay between PCOS treatment modalities and MHDs in adolescents. This cohort study explored the prevalence of MHDs, the effect of hormonal treatment (HT) and 1,25-dihydroxyvitamin D3 (VitD) supplements on MHDs, biochemical characteristics of PCOS, and ultrasonographic measurements.

Methods: This IRB-approved retrospective cohort study included female subjects ages 12-21 years, seen at the Adolescent Gynecology & Endocrinology Clinic at a tertiary children’s hospital between 2016 and 2023. Subjects were included if they met two 2023 modified Rotterdam criteria, being defined as “at risk for PCOS” if < 8 years from menarche and as having PCOS if 8 years post menarche. Exclusion criteria were menstrual age 2 years and hormonal treatment for other reasons, such as gender affirming treatment. Ultrasound imaging was re-interpreted by two radiologists. Continuous variables were compared using Wilcoxon Rank Sum Test for two groups and Kruskal Wallis Test for more than two groups. Tests of association were Chi-Square or Fisher’s Exact Test for small samples.

Results: We included 181 subjects with or at risk for PCOS; 25.4% (46/181) were on VitD and 67.9% (123/181) were on HT, with 20.4% (37/181) on both. In the cohort, 40.9% (74/181) of subjects had anxiety and 32.6% (59/181) had depression. When comparing VitD supplementation vs. no VitD, fewer patients on VitD supplement had an anxiety diagnosis (p=0.044). VitD levels were higher in subjects taking any type of HT (26.1 v. 23.3 ng/mL, p=0.04). Fewer patients on HT compared to patients not on HT had an anxiety diagnosis (p=0.042). In line with other studies, free and total testosterone levels were lower in patients taking any type of HT compared to no HT (mean 7.1 v. 8.5 pg/mL, p< 0.01; 48.0 v. 51.5 ng/dL, p=0.03). There were no differences in other biochemical characteristics, ovarian volume, or other MHDs among patients taking HT. Though not statistically significant, patients on either VitD or HT trended towards fewer depression diagnoses (VitD: 23.9% v. 35.6% p=0.146, HT: 30.1% v. 37.9%, p=0.293).

Conclusions: In this study we demonstrated an association between VitD supplements, HT and anxiety. We also report the high prevalence of anxiety and depression among adolescents with or at risk for PCOS. A possible beneficial use of HT and VitD supplementation in patients with anxiety and PCOS warrants further research. This study emphasizes the importance of a multi-disciplinary care model, including evaluation of mental health symptoms, among adolescents with PCOS.