Direct economic burden of mental health disorders associated with polycystic ovary syndrome: Systematic review and meta-analysis
- School of Global Public Health, New York University, United States
- Department of Obstetrics and Gynecology, Heersink School of Medicine, University of Alabama at Birmingham, United States
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, United States
- PCOS Challenge: The National Polycystic Ovary Syndrome, United States
- Department of Obstetrics and Gynecology, University of California, Los Angeles, United States
- Department of Health Policy, Management and Behavior, University at Albany, State University of New York, United States
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, United States
- Department of Healthcare Organization and Policy, School of Public Health, University of Alabama at Birmingham, United States
Figures
Figure 1
Flow diagram of the literature search and study selection process.
Figure 2 with 3 supplements
Meta-analyses of the prevalence of mental health disorders in women with polycystic ovary syndrome (PCOS).
Forest plots (random effects model) of risk of mental health disorders in women with PCOS, including anxiety (A), depression (B), eating disorders (C), and postpartum depression (D). See text for abbreviations.
Figure 2—figure supplement 1
Trim and fill funnel plots for the meta-analysis of anxiety.
Trim and fill funnel plots (X axis is the log prevalence ratio/risk ratio; Y axis is the standard error of the log prevalence ratio/risk ratio) include 10 high-quality studies for anxiety. Observed studies are indicated by solid circles, and ‘filled’ studies are indicated by open circles.
Figure 2—figure supplement 2
Trim and fill funnel plots for the meta-analysis of depression.
Trim and fill funnel plots (X axis is the log prevalence ratio/risk ratio; Y axis is the standard error of the log prevalence ratio/risk ratio) include 10 high-quality studies for depression. Observed studies are indicated by solid circles, and ‘filled’ studies are indicated by open circles.
Figure 2—figure supplement 3
Trim and fill funnel plots for the meta-analysis of eating disorders.
Trim and fill funnel plots (X axis is the log prevalence ratio/risk ratio; Y axis is the standard error of the log prevalence ratio/risk ratio) include six high-quality studies for eating disorders. Observed studies are indicated by solid circles, and ‘filled’ studies are indicated by open circles.
Tables
Table 1
Estimates of the excess prevalence and economic burden associated with mental health (MH) morbidities of polycystic ovary syndrome (PCOS) as of 2021 in the United States.
MH morbidities | Excess prevalence of morbidity in PCOS (%) | Annual costs in billions in 2021 USD (% of total costs in category) |
|---|---|---|
| Anxiety | 3.84 | $1.939 (45.5) |
| Depression | 5.79 | $1.678 (39.4) |
| Eating disorders | 1.15 | $0.644 (15.1) |
| Total excess cost of MH disorders in PCOS | 4.261 (100) |
Table 2
Direct healthcare-related economic burden in polycystic ovary syndrome (PCOS) as of 2021 in the United States.
Process/disorder | Original year economic burden published (reference) | Economic burden year of publication (in billions)* | Economic burden in 2021 USD (in billions) | % of total economic burden |
|---|---|---|---|---|
| Initial evaluation | 2004 (2) | $0.093 | 0.166 | 1.09 |
| Menstrual dysfunction/AUB | 2004 (2) | $1.350 | 2.408 | 15.88 |
| Infertility care | 2004 (2) | $0.533 | 0.951 | 6.27 |
| Hirsutism | 2004 (2) | $0.622 | 1.109 | 7.31 |
| GDM† | 2020 (3) | $0.672† | 0.684 | 4.51 |
| gHTN† | 2021 (3) | $0.208† | 0.212 | 1.40 |
| Preeclampsia† | 2022 (3) | $0.137† | 1.400 | 9.23 |
| T2DM | 2023 (3) | $1.500 | 1.527 | 10.07 |
| Stroke | 2024 (3) | $2.400 | 2.445 | 16.12 |
| Anxiety | 2021 | Present study | 1.939 | 12.79 |
| Depression | 2021 | Present study | 1.678 | 11.07 |
| Eating disorders | 2021 | Present study | 0.644 | 4.25 |
| Total | 15.163 | 100.00 |
-
*
Updated for inflation using medical CPI (https://www.in2013dollars.com/Medical-care-services/price-inflation).
-
†
Estimates of economic burden in prior publication updated for inflation using medical CPI (https://www.in2013dollars.com/Medical-care-services/price-inflation).
Additional files
-
MDAR checklist
- https://cdn.elifesciences.org/articles/85338/elife-85338-mdarchecklist1-v2.pdf
-
Supplementary file 1
Search terms used for systematic review.
- https://cdn.elifesciences.org/articles/85338/elife-85338-supp1-v2.xlsx
-
Supplementary file 2
Characteristics and quality of studies included.
(a) Characteristics of included studies categorized by anxiety; (b) characteristics of included studies categorized by depression; (c) characteristics of included studies categorized by eating disorders; (d) characteristics of included studies categorized by postpartum depression; and (e) quality scores of studies using Newcastle-Ottawa Scale.
- https://cdn.elifesciences.org/articles/85338/elife-85338-supp2-v2.xlsx
-
Supplementary file 3
Sensitivity analysis and Egger’s test for studies included.
(a) Sensitivity analysis: all studies including self-reported polycystic ovary syndrome (PCOS); (b) sensitivity analysis: excluding studies with self-reported PCOS; and (c) Egger’s test results for assessing funnel plot asymmetry.
- https://cdn.elifesciences.org/articles/85338/elife-85338-supp3-v2.xlsx
Download links
A two-part list of links to download the article, or parts of the article, in various formats.
Downloads (link to download the article as PDF)
Open citations (links to open the citations from this article in various online reference manager services)
Cite this article (links to download the citations from this article in formats compatible with various reference manager tools)
Direct economic burden of mental health disorders associated with polycystic ovary syndrome: Systematic review and meta-analysis
eLife 12:e85338.
https://doi.org/10.7554/eLife.85338
