The Association Between Endometriosis Treatments and Depression and/or Anxiety in a Population-Based Pathologically Confirmed Cohort of People with Endometriosis

Emma Goodwin; Helena Abreu do Valle; Amanda Nitschke; Joseph Puyat; Paul J Yong; Gillian E Hanley

doi:10.1089/whr.2023.0068

Endometriosis · Associated Conditions

The Association Between Endometriosis Treatments and Depression and/or Anxiety in a Population-Based Pathologically Confirmed Cohort of People with Endometriosis

Goodwin E, Abreu do Valle H, Nitschke A, Puyat J, Yong PJ, Hanley GE

Published November 20, 2023 Women's health reports (New Rochelle, N.Y.)

DOI 10.1089/whr.2023.0068 PMID 38023374 PMC PMC10664573

RRM Academy Synopsis

Endometriosis with depression or anxiety links to more reoperation

A Vancouver study of 3815 people with surgically confirmed endometriosis found that those with depression or anxiety more often had repeat surgery and pain care. About 16 out of 100 had depression or anxiety before surgery. The study used past records and shows a link only.

Key Findings

Of 3815 patients, 603 (15.8%) had depression and/or anxiety during the two years before their first endometriosis surgery.
Afterward, 26.5% of the depression and/or anxiety group had an endometriosis-related reoperation, against 22.2% of the others (adjusted OR 1.32, 95% CI: 1.07-1.61).
From 3 to 24 months after surgery, 30.7% of the depression and/or anxiety group saw a physician for pelvic pain, against 20.2% of the others.
From 3 to 24 months after surgery, 35.7% of the depression and/or anxiety group filled NSAID prescriptions, against 21.5% of the others.
Between 3 and 24 months after surgery, the depression and/or anxiety group had adjusted odds of 2.06 (95% CI: 1.53-2.77) for filling an opioid prescription.

Interpretation

The study is a retrospective cohort built from linked health records in one region, with follow-up to 2017. The authors state that they cannot comment on causality. Diagnostic codes identified depression and anxiety, and the authors report some misclassification. The records show prescriptions filled and cannot show whether patients took them. The cohort entered through surgery, so people with endometriosis who did not have surgery fall outside the results. The authors suggest that the group with depression and anxiety may have had worse symptoms.

RRM Context

The authors write that endometriosis calls for care as a systemic condition. They say clinicians should consider depression and anxiety when assessing endometriosis and chronic pelvic pain. Restorative reproductive medicine takes a whole-person view of pelvic pain. The paper's main text does not compare excision with ablation. Across the cohort, 22.9% had a reoperation.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

Endometriosis patients have a high rate of co-occurring anxiety and depression. There is currently no literature investigating how this may affect endometriosis treatment and outcomes. This study examines the prevalence of depression and anxiety in a pathologically confirmed population-based endometriosis cohort and examines how endometriosis treatments and outcomes differ by the presence of co-occurring depression and/or anxiety.

Methods

This retrospective cohort study using population-based administrative data sets included pathologically confirmed endometriosis patients identified from the complete pathology records of Vancouver Coastal Health Authority (British Columbia, Canada) between 2000 and 2008. These data were linked with population-based health data for follow-up to 2017. Bivariate analyses assessed differences between patients with depression and/or anxiety and those without. Odds ratios (ORs) were calculated to assess the odds of binary postsurgical outcomes.

Results

Our final cohort consisted of 3815 patients. There were 603 patients (15.8%) with depression and/or anxiety. They were more likely to visit a physician for pelvic pain, more likely to take some hormonal medications, and more likely to fill prescription-level analgesics, including opioids both before and after surgery. They also had a significantly higher risk of reoperation for their endometriosis than people without co-occurring depression and/or anxiety (OR 1.32, 95% confidence interval [CI]: 1.07-1.61).

Conclusion

Endometriosis patients with co-occurring depression and/or anxiety used more health services for pain, including prescription-level analgesics, and were more likely to have an endometriosis reoperation. We recommend that future study should aim to better understand the direction of this association between depression and/or anxiety and increased health services use.

Topics

Endometriosis › Associated Conditions › Comorbid Conditions · General Gynecology › Pelvic Pain › Chronic Pelvic Pain · Mental Health and Psychosocial Care › Mood and the Cycle › Hormonal Medication and Mood

Emma Goodwin, Helena Abreu do Valle, Amanda Nitschke, Joseph Puyat, Paul J Yong, Gillian E Hanley

E Goodwin, H Valle, A Nitschke, Joe Puyat, Joey Puyat, J Puyat, P Yong, G Hanley

PMID 38023374 38023374 DOI 10.1089/whr.2023.0068 10.1089/whr.2023.0068 Goodwin et al. 2023, Goodwin 2023

The Association Between Endometriosis Treatments and Depression and/or Anxiety in a Population-Based Pathologically Confirmed Cohort of People with Endometriosis

Endometriosis with depression or anxiety links to more reoperation

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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