Women with PCOS Have Increased Risk for Suicide Attempts

Tien-Wei Hsu, MD

Credit: ResearchGate

Participants with polycystic ovary syndrome (PCOS) have an 8.47-fold increased risk for suicide attempts than the control group, a new study found.¹

PCOS is the most prevalent reproductive endocrine disorder, affecting 6% to 10% of women. Since limited data existed on the risk of suicide attempts in individuals with PCOS, a cohort study, led by Tien-Wei Hsu, MD, from the E-DA Hospital in Kaohsiung, Taiwan, evaluated the risk when adjusting for psychiatric comorbid conditions and age group.

“The elevated risk was evident across both the adolescent and adult age groups, and our results were still robust when excluding the first year or the first 3 years of observation,” investigators wrote.

A previous meta-analysis found women with PCOS were more likely to have psychiatric disorders, such as depression, with an odds ratio of 2.79 (95% CI, 2.2 – 3.50).2 Additionally, studies found women with PCOS have an increased risk of suicide, which could be attributed to several factors, including fluctuations in hormonal levels for androgens and testosterone.1 These individuals may deal with weight gain, acne, and excess hair growth, which could affect their body image and self-confidence.

In the new study, Hsu and colleagues leveraged data from the Taiwanese nationwide database from 1997 – 2012. In total, they had a cohort of 18,960 female patients diagnosed with PCOS aged 12 – 64 years old by board-certified gynecologists on ≥ 2 occasions. Participants could not have a suicide attempt before the enrollment time.

The team matched PCOS participants with control participants in a 1:10 ratio by age, psychiatric comorbid conditions—such as schizophrenia (0.4%), bipolar disorder (0.3%), depressive disorder (7.7%), and substance (0.8%) and alcohol use disorder (0.7%)—urbanization level, and income. Controls did not have a history of suicide attempts or a diagnosis of either PCOS or ovarian dysfunction.

Investigators evaluated suicide attempts through Cox regression models. They also conducted age-stratified sub-analyses to evaluate 3 age groups: adolescents aged < 20 years, young adults aged 20 to < 40 years, and older adults aged ≥ 40 years.

Overall, the investigators found participants with PCOS had an 8.47-fold increase in suicide attempt risk compared to the control group (hazard ratio [HR], 8.47; 95% CI, 7.54 – 9.51) after adjusting for demographic characteristics, psychiatric comorbid conditions, Charlson Comorbidity Index scores, and the frequency of all-cause clinical visits.

Compared to controls, women with PCOS had greater Charlson Comorbidity Index scores (1.21 vs. 0.72), greater prevalence of suicide attempts (3% vs. 0.3%), were younger at the time of suicide attempt (31.19 vs. 34.48 years), had a shorter time between enrollment and a suicide attempt (4.34 vs. 6.77 years), and a greater frequency of all-cause clinical visits (12.02 vs. 6.49 times per year).

In their age-stratified sub-analysis, the team found adolescents (HR, 5.38; 95% CI, 3.93 – 7.37), young adults (HR, 9.15; 95% CI, 8.03 – 10.42), and older adults (HR, 3.75; 95% CI, 2.23 – 6.28) with PCOCS all had an increased risk for suicide attempts. However, adolescents and young adults had greater suicide attempt risks than older adults.

Sensitivity analyses that excluded data from the first year or the first 3 years of observation demonstrated similar results. Furthermore, a survival analysis showed, during the 16-year follow-up, women with PCOS have a greater risk for suicidal attempts than controls.

Limitations the investigators pointed out included possible underestimation of PCOS and mental health prevalence because diagnoses were identified using ICD-9-CM in administrative claims data, lack of data on BMI, depressive symptoms, lifestyle, and environmental factors, and not assessing the confounding effect of valproic acid exposure.

“These findings emphasize the importance of clinician vigilance in monitoring the mental well-being and suicide risk of patients diagnosed with PCOS,” investigators concluded. “Increased awareness and destigmatization of PCOS are essential in the general community and among girls and women.”

^References

1. ^{Hsu TW, Kao YC, Tsai SJ, et al. Suicide Attempts After a Diagnosis of Polycystic Ovary Syndrome: A Cohort Study. Ann Intern Med. Published online February 6, 2024. doi:10.7326/M23-2240}
2. ^{Brutocao C, Zaiem F, Alsawas M, Morrow AS, Murad MH, Javed A. Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis. Endocrine. 2018;62(2):318-325. doi:10.1007/s12020-018-1692-3}