Direct economic burden of mental health disorders associated with Polycystic ovary syndrome: systematic review and meta-analysis

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Abstract

Background: Polycystic ovary syndrome (PCOS) is the most common hormone disorder affecting about one in seven reproductive-aged women worldwide and approximately 6 million women in the United States (U.S.). PCOS can be a significant burden to those affected and is associated with an increased prevalence of mental health (MH) disorders such as depression, anxiety, eating disorders, and postpartum depression. We undertook this study to determine the excess economic burden associated with MH disorders in women with PCOS in order to allow for a more accurate prioritization of the disorder as a public health priority.

Methods: Following PRISMA reporting guidelines for systematic review, we searched PubMed, Web of Science, EBSCO, Medline, Scopus, and PsycINFO through July 16, 2021, for studies on MH disorders in PCOS. Excluded were studies not in humans, without controls, without original data, or not peer reviewed. As anxiety, depression, eating disorders, and postpartum depression were by far the most common MH disorders assessed by the studies, we performed our meta-analysis on these disorders. Meta-analyses were performed using the DerSimonian-Laird random-effects model to compute pooled estimates of prevalence ratios (PR) for the associations between PCOS and these MH disorders and then calculated the excess direct costs related to these disorders in U.S. dollars (USD) for women suffering from PCOS in the U.S. alone. The quality of selected studies was assessed using the Newcastle-Ottawa Scale.

Results: We screened 78 articles by title/abstract, assessed 43 articles in full-text, and included 25 articles. Pooled PRs were 1.42 (95% CI: 1.32-1.52) for anxiety, 1.65 (95% CI: 1.44-1.89;) for depression, 1.48 (95% CI: PR: 1.06-2.05) for eating disorders, and 1.20 (95% CI: 0.96-1.50) for postpartum depression, for PCOS relative to controls. In the U.S., the additional direct healthcare costs associated with anxiety, depression, and eating disorders in PCOS were estimated to be $1.939 billion/yr., 1.678 billion/yr., and $0.644 billion/yr. in 2021 USD, respectively. Postpartum depression was excluded from the cost analyses due to the non-significant meta-analysis result. Taken together, the additional direct healthcare costs associated with anxiety, depression, and eating disorders in PCOS were estimated to be $4.261 billion/yr. in 2021 USD.

Conclusions: Overall, the direct healthcare annual costs for the most common MH disorders in PCOS, namely anxiety, depression, and eating disorders, exceeds $4 billion in 2021 USD for the U.S. population alone. Taken together with our prior work, these data suggest that the healthcare-related economic burden of PCOS exceeds $15 billion yearly, considering the costs of PCOS diagnosis, and costs related to PCOS-associated MH, reproductive, vascular, and metabolic disorders. As PCOS has much the same prevalence across the world, the excess economic burden attributable to PCOS globally is enormous, mandating that the scientific and policy community increase its focus on this important disorder.

Funding: The study was supported, in part, by PCOS Challenge: The National Polycystic Ovary Syndrome Association and by the Foundation for Research and Education Excellence.

Data availability

The data is available at: Azziz, Ricardo. (2023). Direct Economic Burden of Mental Health Disorders Associated with Polycystic Ovary Syndrome: Systematic Review and Meta-analysis (Rev. 3). https://doi.org/10.5281/zenodo.8122261

Article and author information

Author details

Surabhi Yadav

School of Global Public Health, New York University, New York, United States

Competing interests
No competing interests declared.
Olivia Delau

School of Global Public Health, New York University, New York, United States

Competing interests
No competing interests declared.
Adam J Bonner

Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, United States

Competing interests
No competing interests declared.
Daniela Markovic

Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, United States

Competing interests
No competing interests declared.
William Patterson

PCOS Challenge, Atlanta, United States

Competing interests
William Patterson, is a Director of Public Affairs, Study Recruitment and Patient Registry Manager, and Intern Preceptor for PCOS Challenge: The National Polycystic Ovary Syndrome Association. The author has no other competing interests to declare..
Sasha Ottey

PCOS Challenge, Atlanta, United States

Competing interests
Sasha Ottey, received honoraria from Institute for Family Centeredness; has received travel support for attendance at Women's Health Innovation Summit; and is Executive Director for PCOS Challenge: The National Polycystic Ovary Executive Director Syndrome Association. The author has no other competing interests to declare..
Richard P Buyalos

Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, United States

Competing interests
No competing interests declared.
Ricardo Azziz

Department of Health Policy, Management and Behavior, University at Albany, State University of New York, Rensselaer, United States

For correspondence
razziz67@gmail.com

Competing interests
Ricardo Azziz, received a grant from Ferring Pharmaceuticals; has received royalties from Wolters Kluwer Health, Johns Hopkins University Press, Springer, and McGraw Hill; has received honoraria from Davidson-Mestman course; has participated on a data safety monitoring board for University of Michigan and Guangzhou Medical University; has held a leadership or fiduciary role at American Society for Reproductive Medicine; holds stock at Martin Imaging and Arora Forge; has received consulting fees from Spruce Biosciences, Fortress Biotech, Rani Therapeutics, Core Access Surgical for PCOS, female reproduction and gynecologic surgery; and serves as Senior Editor at eLife. The author has no other competing interests to declare..

"This ORCID iD identifies the author of this article:" 0000-0002-3917-0483

Funding

Foundation for Research and Education Excellence (N/A)

Ricardo Azziz

PCOS Challenge: The National Polycystic Ovary Syndrome Association (N/A)

Surabhi Yadav

The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

Reviewing Editor

Eduardo L Franco, McGill University, Canada

Version history

Received: December 3, 2022
Preprint posted: January 5, 2023 (view preprint)
Accepted: July 28, 2023
Accepted Manuscript published: August 3, 2023 (version 1)
Version of Record published: August 31, 2023 (version 2)

Copyright

This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.