Risk for a Suicide Attempt Found 8-Fold Greater in Women with PCOS

Women diagnosed with polycystic ovary syndrome (PCOS) were found more than 8 times more likely to attempt suicide compared to a control population, according to startling findings from a new Taiwanese study.

Among the cohort of more than 18 000 women, the risk for attempted suicide was highest, 9-fold greater, among women younger than age 40 years, followed by adolescents who had a 5-fold greater risk, and older adults, whose risk was calculated at more than 3-fold greater than peers in matched control groups.

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PCOS affects up to 10% of women during their reproductive years. Any combination of the most common attributes, eg, infertility, acne, dysmenorrhea, hirsutism, and obesity, can significantly impair quality of life, the researchers wrote in the Annals of Internal Medicine. They also cite a large body of evidence that associates PCOS with increased risk for psychiatric disorders including depressive disorders, anxiety disorders, personality disorder, and schizoaffective disorder.

“Of note, persons diagnosed with PCOS face a heightened susceptibility to suicide attempts and self-harm compared with those without the condition,” Tien-Wei Hsu, MD, from the department of psychiatry at E-Da Dachang Hospital, in Taiwan, and colleagues wrote, but add that “evidence about the risk for suicide in persons diagnosed with PCOS remains inconclusive.”

For their study Hsu and colleagues tapped data from Taiwan’s National Health Insurance Research Database to develop a cohort of women aged 12 to 64 years diagnosed with PCOS by a board-certified gynecologist at least 2 times between 1997 and 2012 and who did not have a previous suicide attempt. Eligible participants were matched on psychiatric comorbid conditions, urbanization level, and annual income in a 1:10 ratio with women who had no history of PCOS or a suicide attempt.

Researchers used Cox regression analysis adjusted for demographic characteristics, psychiatric comorbid conditions, Charlton Comorbidity Index (CCI) scores, and frequency of all-cause clinical visits to compare suicide attempts between those with and without a PCOS diagnosis. They also conducted subanalyses stratified by 3 age groups: adolescents (younger than age 20 years), young adults (aged 20 to 40 years), and older adults (aged 40 years and older).

FINDINGS

A total of 18 960 women had a diagnosis of PCOS and were matched with 189 600 control participants.

The investigators found that, overall, the risk of a suicide attempt among study participants with PCOS was more than 8 times greater (HR 8.47; 95% CI, 7.54 – 9.51) than among the matched control participants and this after adjustment for demographic characteristics, psychiatric comorbid conditions, CCI scores, and frequency of all-cause clinical visits. For the individual age groups analyzed, the risks (HR) were:

•Adolescents 5.38 (95% CI, 3.93-7.37)

•Young adults 9.15 (95% CI, 8.03-10.42)

•Older adults 3.75 (95% CI, 2.23-6.28)

Hsu and team reported also that women with PCOS had higher CCI scores than those without the condition (1.21 vs 0.72) and that suicide attempts were more prevalent among them (3% vs 0.3%). Women with PCOS also were younger at the time of a suicide attempt (31.19 vs 34.48 years) and had a shorter time between study enrollment and a suicide attempt (4.34 vs 6.77 years). Women with PCOS also made more annual all-cause clinic visits (12.02) compared to those without (6.49)

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

The significantly elevated risk for a suicide attempt observed among young adults, Hsu and colleagues wrote, may be the result of persistent “psychological distress, body dissatisfaction, and reproductive concerns in this age group.” They point out, also, that adults at this age may have the added stress of unemployment, financial troubles, relationship problems, and other concerns that would increase vulnerability. The researchers note that the PCOS phenotype tends to show improvement with age, which could account for the slightly lower risk of attempted suicide among participants aged 40 years and older.

Among study limitations the authors described are possible underestimation of the prevalence of PCOS and mental health disorders based on the data source and failure to assess the potential confounding effect of treatment with valproic acid.

In concluding, Hsu and colleagues emphasized “the importance of clinician vigilance in monitoring the mental well-being and suicide risk of patients diagnosed with PCOS.”

“Increased awareness and destigmatization of PCOS are essential in the general community and among girls and women,” they wrote. “Referral to a psychologist, psychiatrist or social worker for medical assistance or case management is recommended for patients at high risk for suicide.”

Source: 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