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Outcomes of a Mindfulness-Based Healthy Lifestyle Intervention for Adolescents and Young Adults with Polycystic Ovary Syndrome
Abstract
Study Objective
The purpose of this study was to examine feasibility, acceptability, and preliminary efficacy of a mindfulness-based healthy lifestyle self-management intervention with adolescents and young adults diagnosed with polycystic ovary syndrome (PCOS).
Design
A pilot randomized controlled trial using a pre-post design was used.
Setting
Central Texas. Participants: Individuals aged 14-23 with a diagnosis of PCOS.
Interventions
The PCOS Kind Mind Program integrates a manualized mindfulness training program (Taming the Adolescent Mind) with health education in four key areas of self-management and health promotion; (1) medication adherence, (2) nutrition, (3) physical activity, and (4) sleep.
Main Outcome Measures
Psychological distress, mindfulness, physical activity strategies, nutrition and exercise self-efficacy.
Results
Linear regression models revealed that those in the PCOS Kind Mind condition reported significantly higher nutrition self-efficacy (β = 6.50, 95% CI = 1.71 – 11.28, p = 0.013, d = 0.48), physical activity strategies (β = 0.41, 95% CI = 0.04 – 0.79, p = 0.040, d = 0.67), and physical activity self-efficacy (β = 0.48, 95% CI = 0.07 – 0.88, p = 0.028, d = 0.46).
Conclusion
The PCOS Kind Mind Program improved self-efficacy in the key areas of nutrition and physical activity and increased physical activity strategies in adolescents and young people with PCOS. These findings are encouraging and suggest the need for larger scale, randomized controlled trials with longer-term follow-up in order to more robustly evaluate the PCOS Kind Mind Program on the psychological and physiological health of adolescents and young people with PCOS.
... There were thirteen studies, including six randomized controlled trials (RCTs) [15,[21][22][23][24][25], two quasiexperimental studies [17,26], two case reports [27,28], one prospective study [29], one predictive correlation study [30], and one field trial study [31]. The sample size of the included studies varied from 1 to 117 patients. ...
... MBSR Salajegh (2023) [17] The mean score of worry in women with PCOS in the IG decreased. MBI Young (2021) [25] The IG reported significantly higher nutrition self-efficacy and higher physical activity self-efficacy. TPB Hajivandi (2021) [31] The attitude toward disease-related nutrition behavior in the IG was significantly improved compared with the CG. ...
... All six studies validated the effectiveness of psychotherapy in adolescents with PCOS. Two studies [23,25] reported that mindfulness interventions significantly reduced anxiety, depression, and stress in adolescents with PCOS. In addition, one of the studies [25] reported that patients' nutritional self-efficacy improved significantly with the MBI, indicating that mindfulness interventions may treat eating disorders in adolescent girls with PCOS. ...
Objectives:
This study aimed to summarize nonpharmacological mental health interventions that are beneficial for adolescent patients with polycystic ovary syndrome (PCOS) and to identify the limitations of existing studies.
Material and methods:
Following the recommendations of the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-SCR), we conducted a scoping review of nonpharmacological interventions aimed at improving mental health in adolescents with PCOS.
Results:
Six randomized controlled trials (RCTs), two quasiexperimental studies, two case reports, one prospective study, one predictive correlation study, and one field trial study were included, resulting in 13 articles. Nonpharmacological interventions encompass a range of psychotherapies, dietary modifications, physical exercise, and traditional Chinese medicine therapies. Except for one study that has not yet reported findings, all included studies reported significant improvements in patients' mental health through nonpharmacological interventions.
Conclusions:
The evidence summarized in this study suggests that nonpharmacological interventions may be efficacious in improving the mental well-being of adolescent patients with PCOS. However, existing studies have limitations, including small sample sizes, the limited use of outcome indicators, and a lack of postintervention follow-up evaluations. Therefore, further RCTs should be conducted to validate the effectiveness and safety of current or alternative nonpharmacological interventions.
... Among the 14 trials, nine trials were RCTs (12 citations) (34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45), four were single-arm trials (46-49) and one was a quasiexperimental trial (50). The distribution of trials across geographical locations included six trials (9 citations) conducted in India (34-37, 39, 44, 46, 47, 49), four in the USA (40,42,45,48), and one each in China (41), Iran (50), Greece (38) and Slovenia (43). ...
... Among the 14 trials, nine trials were RCTs (12 citations) (34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45), four were single-arm trials (46-49) and one was a quasiexperimental trial (50). The distribution of trials across geographical locations included six trials (9 citations) conducted in India (34-37, 39, 44, 46, 47, 49), four in the USA (40,42,45,48), and one each in China (41), Iran (50), Greece (38) and Slovenia (43). Refer to Table 1 for a summary of available evidence. ...
... Age ranges varied across trials, with one trial specifically involving individuals aged 15 to 18 years (34)(35)(36)(37). Three trials involved both adolescent and adult participants, with one study involving individuals aged 15 to 40 years (38), another involving individuals aged 14 to 23 years (42), and a third study involving individuals aged 15 to 45 years (50). The remaining ten trials focused on participants aged 18 and above. ...
Polycystic Ovary Syndrome (PCOS) presents multifaceted challenges affecting women’s reproductive, metabolic, and psychological systems, consequently impacting their psychological and emotional well-being. The utilization of meditation and mindfulness interventions (MMIs) is found to be increasing for the management of PCOS. This scoping review systematically explored the current literature to identify the type and application of MMIs for PCOS management. A systematic search of literature was conducted using CINAHL, PsycINFO, Scopus, MEDLINE, and PubMed databases for identifying studies conducted on the usage of MMIs in women diagnosed with PCOS, irrespective of age. The comprehensive search identified 14 trials (comprising 17 citations) meeting inclusion criteria, involving 723 participants across various age groups. Among these, nine were randomized controlled trials (RCTs), while the remaining comprised non-RCTs. Several types of MMIs, including Rajayoga of Brahmakumaris, Yoga Nidra, OM cyclic meditation, unspecified forms of meditation, mindfulness-based stress reduction programs, mindful yoga, and mindfulness-based activities, were used. Outcomes were predominantly assessed in psychological domains (n=11), followed by anthropometric (n=9), quality of life (n=7), and metabolic metrics (n=7). The review findings suggest the integration of meditation with conventional treatment modalities. Preliminary data indicate that MMIs have the potential to improve psychosocial well-being and quality of life among PCOS-affected women. However, adequately powered studies with extended follow-up periods are required to investigate the mechanisms and therapeutic efficacy of MMIs, particularly concerning reproductive outcomes and weight management. Furthermore, diligent monitoring and reporting of adverse events and adherence are essential for a comprehensive understanding of MMI utilization in PCOS management.
... Enterprises can conduct mindfulness training courses within the organization. Due to the positive prediction of employees' subjective vitality during the day, individuals with higher levels of mindfulness have higher levels of vitality (Young et al., 2022). In enterprises, managers can invite professional mindfulness trainers to conduct mindfulness stress relief training courses, strengthen employees' mindfulness meditation, provide time management guidance, and incorporate it into the partner system to enhance accountability for adhering to planned activities. ...
... In enterprises, managers can invite professional mindfulness trainers to conduct mindfulness stress relief training courses, strengthen employees' mindfulness meditation, provide time management guidance, and incorporate it into the partner system to enhance accountability for adhering to planned activities. Research has shown that adhering to exercise and a healthy diet is also beneficial for managing stress reducing the frequency of drinking or smoking due to stress (Young et al., 2022). Eating more fruits and healthy vegetables cultivating a healthy lifestyle, is more conducive to improving mindfulness (Kra¨geloh et al., 2019;Young et al., 2022). ...
... Research has shown that adhering to exercise and a healthy diet is also beneficial for managing stress reducing the frequency of drinking or smoking due to stress (Young et al., 2022). Eating more fruits and healthy vegetables cultivating a healthy lifestyle, is more conducive to improving mindfulness (Kra¨geloh et al., 2019;Young et al., 2022). In addition, mindfulness can also be improved through yoga training, which requires a wholehearted focus on the present during training. ...
The use of Internet tools virtually increases the work connectivity behavior after-hours (WCBA), is becoming increasingly common. Previous studies have found that WCBA has a double-edged sword effect on turnover intention (TI), but the configuration effect had been ignored. To investigate the configuration effect of WCBA, internal factors (i.e., psychological capital and mindfulness), and external factors (i.e., family-to-work conflict and social support), on TI. A total of 305 participants have been collected using convenience sampling. A questionnaire that covers six personal and contextual scales of the WCBA, psychological capital (PsyCap), mindfulness, family-to-work conflict (FWC), social support (SS), and TI, was used to gather data. Adhering to configurational theory, the study was conducted using fuzzy-set qualitative comparative analysis (fsQCA). it was revealed that seven antecedent configurations could achieve high TI, among them, WCBA existed in S4 and S6 but was absent in S5 and S7. Moreover, WCBA can exist and be absent in S1-S3 simultaneously; and for the 13 configurations that achieve low level of TI, WCBA can exist or not. Therefore, although the achievement of low level of TI is to some extent influenced by WCBA, it relies more on the influence of other factors (i.e., PsyCap, mindfulness, ∼ FWC, and SS). The study proves that WCBA has a double-edged effect on TI. The absence of FWC and existence of SS, PsyCap, and mindfulness are critical variables to buffer the loss of psychological resources caused by WCBA and recover psychological resources in time. These results may be helpful to recognize the negative effect of WCBA existence, accompanied with the absence of mindfulness on TI; also, the absence of SS was as crucial as the existence of FWC in the process of achieving high level of TI.
... SD ¼ 1.59). Recruitment was almost exclusively carried out via university-affiliated hospitals, and disease specific-clinics and centers (k ¼ 17), in some cases, combined with social media (Lovas et al., 2017;Young et al., 2022), and k ¼ 1 study recruited pupils enrolled at a specialized school for children with chronic pain conditions (Lagor et al., 2013). Demographic information was collected, such as race and ethnicity (k ¼ 8 studies), and study samples included participants who were White (n ¼ 114), Asian (n ¼ 20), African American and Black (n ¼ 17), multiracial (n ¼ 2), Hispanic Latino/Latina (n ¼ 4), American Indian or Alaskan Native (n ¼ 2), and 'unknown' or 'other' (n ¼ 17). ...
... Ten studies reported significant improvements in measures of anxiety, and six reported significant improvements in depression following participation in MBIs. All studies reported effect sizes, but Andreotti et al. (2017) did not specify which effect size calculation was used, and only one study (Young et al., 2022) ...
... Similar findings were reported by Ruskin et al. (2015) and no significant differences were reported for negative emotionality following MBI. Young et al. (2022) found no significant differences after MBI for depression, anxiety, stress, mindfulness, or self-esteem in adolescents with polycystic ovary syndrome. Similarly, Malboeuf-Hurtubise et al. (2016) found no significant differences between groups of adolescents with cancer for mood from preto post-intervention, but did report a significant different in levels of negative emotionality pre-to postintervention in the control group (p ¼ .04). ...
Objectives:
This systematic review aimed to identify and appraise studies investigating the efficacy of mindfulness-based interventions (MBIs) for improving depression, anxiety and parental stress in families affected by childhood physical illnesses, as well as feasibility and acceptability.
Methods:
Embase, PsycINFO, Scopus, Medline, and PubMed were searched between February 2 and 17, 2021, and updated on August 5, 2022. Studies investigating MBIs with children and adolescents (<18 years) with physical health conditions were included, and results are presented with narrative synthesis.
Results:
Eighteen studies met eligibility criteria. Studies included children and adolescents with chronic pain, headaches, cancer, heart conditions, esophageal atresia, inflammatory bowel disease, and polycystic ovary syndrome. Most studies reported mindfulness was feasible and acceptable, although findings for different health conditions were mixed. Some studies encountered difficulties with attrition, resulting in findings being underpowered.
Conclusions:
MBIs show promise for improving anxiety and depression in children with physical health conditions, but there is limited support for reducing stress in the family unit. A potential direction for future research might be the inclusion of parents. However, because of the heterogeneity of studies included in this review, findings must be cautiously interpreted.
... Practical barriers also impact the implementation of MBIs for adolescents with chronic illnesses. High time commitment and travel requirements have led to low participation and dropout rates in previous studies (Chadi et al., 2019;Ruskin et al., 2014;Young et al., 2022). One option to address these barriers are digital MBIs. ...
... Several studies found no effect on quality of life (Ali et al., 2017;Chadi et al., 2016;Lagor et al., 2013;Suc et al., 2022) while two studies found an effect on quality of life (Ahola Kohut et al., 2020;van der Gucht et al., 2017). Similarly, several uncontrolled studies and RCTs found no effect on depression, anxiety, or stress (Ahola Kohut et al., 2020;Chadi et al., 2016;Freedenberg et al., 2017;Malboeuf-Hurtubise et al., 2016;Ruskin et al., 2017;Young et al., 2022), while others found an effect on at least one of these outcomes (Ali et al., 2017;Andreotti et al., 2017;Chadi et al., 2019;Grazzi et al., 2022;Hesse et al., 2015;Lagor et al., 2013;Suc et al., 2022;van der Gucht et al., 2017). A discussion of secondary outcomes and mediation analyses is provided in Online Resource 9. ...
Objectives
Adolescents with chronic conditions are at an increased risk for psychopathology, which may impact their quality of life. Reviews suggest that mindfulness-based interventions (MBIs) are promising to support these adolescents. This pilot study investigated the effects of an MBI on emotional distress and quality of life and examined potential mechanisms in adolescents with chronic conditions using a randomized staggered within-subjects design.
Method
Twenty-two adolescents (14–18 years) with a chronic condition were randomized to a baseline phase of 14–28 days, followed by an MBI, consisting of four bi-weekly online group sessions. Outcomes were assessed by repeated measurements at the baseline, intervention, and follow-up phases, and by standardized questionnaires and experience sampling measures before randomisation, at post-intervention, and 3-month follow-up. Additionally, interviews were performed.
Results
Our main findings showed that stress levels significantly increased (b = 0.35, 95% CI [0.12, 0.61]) immediately after the MBI began. However, upon completion of the MBI, participants experienced significant decreases in both depression (b = − 0.44, 95% CI [− 0.72, − 0.21]) and stress (b = − 0.36, 95% CI [− 0.63, − 0.11]). Quantitative measures revealed no significant effects of the MBI on quality of life. In qualitative interviews, all participants reported that the MBI positively impacted aspects of their quality of life, including a reduction of stress and an improvement in emotional well-being.
Conclusions
Based on both quantitative data from repeated measurements and qualitative data from interviews, this pilot study provides preliminary evidence that MBIs are acceptable and safe, and can alleviate emotional distress in adolescents with chronic conditions. Larger, controlled studies are essential to validate and generalize these preliminary findings.
Preregistration
This study was preregistered on https://clinicaltrials.gov/ (NCT04359563).
... Individuals with low levels of mindfulness are more likely to compare their bodies with those of others. Recent studies have found a negative relationship between mindfulness and BMI, and mindfulnessbased interventions were found to be beneficial together with medical treatment for PCOS (Raja-Khan et al. 2015;Young et al. 2021). In addition, the mindfulness level can be affected by the presence of a chronic disease (Victorson et al. 2014). ...
... This can lead to difficulties in coping with the disease. Therefore, evaluation of mindfulness levels in PCOS patients during adolescence may be important for a better quality of life in adulthood (Young et al. 2021). Mindfulness in PCOS has been a hot topic in many studies (Raja-Khan et al. 2015;Stefanaki et al. 2015), but its relationship with metacognition in hyperandrogenic PCOS subjects has not been investigated. ...
The aim of this study was to determine whether serum androgen levels have an effect on mindfulness and metacognition in adolescents with polycystic ovary syndrome (PCOS). Adolescents diagnosed with PCOS were asked to answer a questionnaire that included socio-demographic information and two scales: the Mindful Attention Awareness Scale (MAAS) and the Metacognition Scale Child and Adolescent form (MCQ-C). The patients were divided into two groups, the hyperandrogenism group and the non-hyperandrogenism group, according to serum androgen levels. The scores of MAAS and MCQ-C were compared between the groups. The study sample consisted of 70 adolescents. Of these, 44 had hyperandrogenism according to a blood test. No statistically significant difference was found in MAAS scores between the hyperandrogenism and the non-hyperandrogenism groups (p = 0.79). However, the level of mindfulness was found to be lower in participants with a higher modified Ferriman-Gallwey score (mFGS) (r = 0.26, p = 0.02). Mindfulness levels were also lower for obese patients with PCOS compared to non-obese patients with PCOS (p = 0.02). Cognitive monitoring (MCQ-C-CM), one of the MCQ-C sub-scales, was significantly higher in the non-hyperandrogenism group (p = 0.03), and similarly, a positive correlation was detected between higher androgen levels and the positive meta-worry (MCQ-C-PM) sub-scale of the MCQ-C (for total testosterone; r = 0.348, p = 0.03, and for androstenedione; r = 0.35, p = 0.03). High serum androgen levels in PCOS had no effect on mindfulness, but as the modified Ferriman Gallwey score increased, mindfulness levels decreased. For the sub-scales of MCQ-C,MCQ-C-CM, and MCQ-C-PM, the scores increased as androgen levels increased. In line with the results of the present study, evaluating mindfulness in PCOS patients with increased hair growth and metacognition in PCOS patients with serum hyperandrogenism may contribute well-being in adulthood by reducing the psychological burden caused by the disease.
... A study conducted at Athens University Medical School have been reported that application of mindfulness reduced depression, anxiety, stress as well as salivary cortisol concentration improving their satisfaction and Quality of Life (Stefanaki et al, 2014). Integral application of nutrition, medical adherence, physical activity and sleep among PCOS women practicing mindfulness were found to have decreased psychological and physiological distress with PCOS (Cara.C. Young et al., 2022). Also, another study proved that implementing mindful practice among PCOS women in Kerman, Iran reduced mental ...
The dynamic progress of choosing a desirable end state, acting to get there, and tracking one’s progress alongthe route is known as self-regulation. Polycystic ovarian syndrome (PCOS) is a widespread illness that hassubstantial psychological and physiological effects. The psychological impacts of PCOS in women aredepression, body dissatisfaction, eating disorders, sexual related problems, bipolar disorder, and otherpsychological symptoms like distress, anxiety, social fears, symptoms of obsessive-compulsive disorder, angerand aggression, and interpersonal adjustment issues. In physiological manner, it is linked to pregnancy issuessuch as gestational diabetes, preeclampsia, large gestational age newborns, and it affects women at all stagesof their reproductive lives.
... These modules may include education about understanding PCOS and treatment options available, behavioral interventions (diet, exercise, sleep), stress management (relaxation techniques, cognitive therapy), dealing with body changes, goal setting, tracking progress, positive reinforcement, etc. [167,168]. They can be designed as counselling/therapy sessions, group discussions, workshops, education materials, or mobile apps [169,170]. Table 3 summarizes the results of RCTs that have studied the effectiveness of these modules in PCOS patients. In an RCT involving 161 patients, a one-time structured education module significantly (p < 0.05) improved the understanding of PCOS and quality of life (emotions, fertility, weight and mental wellbeing), but could not improve anthropometric and biochemical parameters [182]. ...
Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine disorders among reproductive-aged women. It is characterized by hyperandrogenism, anovulation, and polycystic ovaries. Lifestyle changes are suggested as first-line interventions in managing PCOS. This systematic review aims to assess the scientific evidence regarding the role of lifestyle modifications (dietary changes, physical activity, and behavioral changes) in improving reproductive, anthropometric, metabolic, and psychological outcomes in women with PCOS. Dietary interventions such as foods with low glycemic index scores; caloric restrictions; high-fiber, omega three fatty acid-rich diets; ketogenic diets; Mediterranean diets; antioxidant-rich food; and anti-inflammatory diets improve insulin sensitivity and hormonal balance in women with PCOS. Physical activity, like aerobic and resistance exercise, enhances insulin sensitivity, helps weight loss, and improves metabolic and reproductive outcomes in women with PCOS. Further, behavioral and education modules can also be used to improve awareness, adherence, and the effectiveness of conventional treatment and to manage mental health issues related to PCOS. Collectively, lifestyle modifications not only improve the biochemical, hormonal, and anthropometric parameters in PCOS patients but also reduce the long-term risks of metabolic and cardiovascular diseases.
... These include improved self-efficacy relating to healthy lifestyle behaviours, wellbeing, symptoms of anxiety and depression, and body image concerns. 106,107 In such instances, the exercise professional should work closely with the wider medical team as adjunctive psychological interventions may lead to greater improvements in the aforementioned outcomes as well as potentially assisting with physical activity uptake and long-term adherence. 108 Importantly, it is not uncommon for individuals with disordered eating to undertake dysfunctional exercise, defined as a pathological relationship with exercise resulting in physical and/or psychological health impairment. ...
... Stress may be a barrier to lifestyle change [32]. Mindfulness-based stress reduction activities have been effective in reducing stress, depressive, and anxiety symptoms in PCOS [94] and in increasing self-efficacy for physical activity and nutrition behaviors [95]. Physical activity has well-recognized benefits for mood and perceived stress [96,97], including in women with PCOS [98,99]. ...
Background
Polycystic ovary syndrome (PCOS) represents a significant global health burden requiring urgent attention. This common chronic endocrine and cardiometabolic condition affects around 1 in 10 women and individuals assigned female at birth, with significant adverse effects on well-being, quality of life, and mental health, as well as serious and complex long-term health consequences. International guidelines for best health care practice recommend the provision of comprehensive cognitive behavioral interventions to support self-management and improve health outcomes for those living with PCOS. Web-based health interventions have the potential to meet this need in an accessible and scalable way.
Objective
We aim to identify barriers to self-management and psychological well-being in women with PCOS and adapt a web-based self-management program to provide a prototype digital support intervention for them.
Methods
We adapted an existing support program (HOPE) for PCOS using the antecedent target measure approach. We conducted qualitative interviews with 13 adult women living with PCOS, 3 trustees of a patients with PCOS advocacy charity, and 4 endocrinologists to identify “antecedents” (barriers) to self-management and psychological well-being. Framework analysis was used to identify potentially modifiable antecedents to be targeted by the novel intervention. At a national conference, 58 key stakeholders (patients and health professionals) voted for the antecedents they felt were most important to address. We used research evidence and relevant theory to design a prototype for the PCOS intervention.
Results
Voting identified 32 potentially modifiable antecedents, relating to knowledge, understanding, emotions, motivation, and behaviors, as priorities to be targeted in the new intervention. A modular, web-based prototype HOPE PCOS intervention was developed to address these, covering six broad topic areas (instilling HOPE for PCOS; managing the stress of PCOS; feeding your mind and body well; body image, intimacy, and close relationships; staying healthy with PCOS; and keeping PCOS in its place).
Conclusions
We identified barriers to self-management and psychological well-being in women with PCOS and used these to adapt a web-based self-management program, tailoring it for PCOS, which is a comprehensive group intervention combining education, empowerment, lifestyle management, peer support with cognitive behavioral tools, and goal-setting (to be delivered by peers or codelivered with health care professionals). The modular structure offers flexibility to adapt the program further as new clinical recommendations emerge. The intervention has the potential to be delivered, evaluated for feasibility, and, if effective, integrated into health care services. Self-management interventions are not designed to replace clinical care; rather, they serve as an additional source of support. The HOPE PCOS program conveys this message in its content and activities. Future research should evaluate the prototype intervention using primary outcomes such as measures of psychological well-being, self-management self-efficacy, depression, anxiety, and PCOS-related quality of life. They should also assess the intervention’s acceptability, scalability, and cost-effectiveness.
... Although the results of MBSR interventions in PCOS have been generally positive, there is at least one study with negative results. A 5week, mindfulness-based healthy lifestyle group intervention in young adults with PCOS did not significantly improve anxiety or depressive symptoms compared with a waitlist control condition (73). Thus, mindfulness interventions show promise in treating PCOS, but clinical trials that focus specifically on PCOS with comorbid affective disorders are needed as well as studies of group MBSR interventions that include a valid comparison group intervention to control for social support effects that are inherent to a group intervention. ...
... Management of weight and lifestyle factors such as diet, physical activity, and psychological well-being are first-line therapies in evidence-based guidelines for PCOS [42]. Mindfulness-based stress management programs have been proposed and successfully used in women with PCOS to reduce their levels of stress, anxiety, and depression [43,44] and to improve their self-efficacy related to diet and physical activity [45]. To our knowledge, no study to date has attempted to examine the effects of mindfulness on epigenetic changes in PCOS. ...
Polycystic ovary syndrome (PCOS) is an endocrine and metabolic disorder affecting women of reproductive age. Research has shown that epigenetic alterations such as DNA methylation may play a role in the development and progression of abnormal ovarian function and metabolic disorders in PCOS. Studies have identified specific genes (related with insulin signaling and steroid hormone metabolism) that are methylated in women with PCOS. DNA methylation appears to respond to various interventions aimed at altering health and lifestyle factors. We tested the efficacy of a mindfulness-based stress reduction program (MBSR) in PCOS patients. We examined its effects on anthropometric measurements, mental health and wellbeing, and alterations in DNA methylation in peripheral blood. MBSR was associated with a reduction in body mass index, waist circumference and blood glucose level, an improvement in subjectively perceived general health, emotional role limitation, and levels of pain, as well as mindfulness-like traits. MBSR reduced the expression of anxious symptomatology and subjectively perceived stress. Methylation changes were observed in four genes: COMT, FST, FKBP51, and MAOA. We conclude that MBSR may be a useful supplementary therapy to mitigate the deleterious effects of PCOS on mental health.
... Similarly, another RCT investigating the impact of mindfulness meditation for eight weeks in PCOS showed reduced stress, depression and anxiety symptoms, and increased life satisfaction and QoL in the intervention group compared to no treatment [156]. In adolescents with PCOS (n=37), a pilot RCT reported higher levels of nutrition and physical activity self-efficacy following a mindfulness and self-management program [161]. Mindfulness-based cognitive therapy (MBCT) combines both elements of MBSR and CBT, but as yet there are no trials investigating this intervention in PCOS. ...
Polycystic ovary syndrome (PCOS) is a common condition affecting reproductive-aged women with reproductive, metabolic and psychological consequences. Weight and lifestyle (diet, physical activity and behavioural) management are first-line therapy in international evidence-based guidelines for PCOS. While these recommend following population-level diet and physical activity guidelines, there is ongoing interest and research in the potential benefit of including psychological and sleep interventions, as well as a range of traditional, complimentary and integrative medicine (TCIM) approaches, for optimal management of PCOS. There is limited evidence to recommend a specific diet composition for PCOS with approaches including modifying protein, carbohydrate or fat quality or quantity generally having similar effects on the presentations of PCOS. With regards to physical activity, promising evidence supports the provision of vigorous aerobic exercise, which has been shown to improve body composition, cardiorespiratory fitness and insulin resistance. Psychological and sleep interventions are also important considerations, with women displaying poor emotional wellbeing and higher rates of clinical and subclinical sleep disturbance, potentially limiting their ability to make positive lifestyle change. While optimising sleep and emotional wellbeing may aid symptom management in PCOS, research exploring the efficacy of clinical interventions is lacking. Uptake of TCIM approaches, in particular supplement and herbal medicine use, by women with PCOS is growing. However, there is currently insufficient evidence to support integration into routine clinical practice. Research investigating inositol supplementation have produced the most promising findings, showing improved metabolic profiles and reduced hyperandrogenism. Findings for other supplements, herbal medicines, acupuncture and yoga is so far inconsistent, and to reduce heterogeneity more research in specific PCOS populations, (e.g. defined age and BMI ranges) and consistent approaches to intervention delivery, duration and comparators are needed. While there are a range of lifestyle components in addition to population-recommendations for diet and physical activity of potential benefit in PCOS, robust clinical trials are warranted to expand the relatively limited evidence-base regarding holistic lifestyle management. With consumer interest in holistic healthcare rising, healthcare providers will be required to broaden their knowledge pertaining to how these therapies can be safely and appropriately utilised as adjuncts to conventional medical management.
Evidence suggests that targeting physical activity, sedentary behavior, and sleep in combination can benefit health and academic outcomes in young people. This scoping review aimed to describe the extent, range, and nature of combined movement behavior interventions and examine recruitment and effectiveness patterns in equity‐denied populations. The following electronic databases were searched: Web of Science, CINAHL, MEDLINE, and PsycINFO. Gray literature was identified through ProQuest Dissertations and Theses Global, Google Scholar, and the British Library EThOS. Included studies were randomized or quasi‐experimental interventions that modified two or more movement behaviors with the goal of affecting health‐, behavioral‐, or academic‐related outcomes in children or adolescents. Peer‐reviewed publications from scientific databases, master's level dissertations, and doctoral theses from gray literature searches in the English language were included. The behavior change technique taxonomy and PROGRESS‐Plus framework were used to map intervention characteristics. Thirty studies met the inclusion criteria. Most studies were individual‐level randomized controlled trials (40%), conducted in Europe (43%), and delivered in a school setting (77%). Physical activity and sedentary behavior were the predominant behaviors that were modified (83%). The most commonly used behavior change techniques included information about health consequences (67%) and social support [unspecified] (70%). All included studies focused on health‐related outcome measures. Ten studies (33%) examined differential effects by PROGRESS‐Plus subgroups. Future research should explore the value of movement behavior interventions across the breadth of non‐health‐related outcomes and include a stronger focus on differential effectiveness across population subgroups.
Polycystic ovary syndrome (PCOS) is a prevalent and complex health issue that affects approximately 2.2–26.0% of women of reproductive age worldwide. This condition not only impairs fertility but also poses long-term health risks, including metabolic disorders, cardiovascular disease, and type 2 diabetes. The intricate connection between PCOS and nutritional factors presents a unique challenge, as dietary habits significantly influence the severity and progression of PCOS. Despite the known impact of nutrition, there remains a gap in comprehensive dietary management tailored to PCOS, highlighting the need for specialized approaches. This chapter provides a comprehensive overview of PCOS, elucidating its etiology and symptoms and the intricate relationship between PCOS and nutrition. Emphasis is placed on the role of dietary management as a key component of the therapeutic approach for PCOS. This chapter explores various dietary strategies and their potential to mitigate symptoms, improve fertility outcomes, and address common comorbidities, such as insulin resistance and obesity. The narrative synthesizes current research findings, offering practical guidelines for nutritional interventions tailored to the unique needs of women with PCOS. Future research on PCOS should focus on understanding the interplay of genetic, environmental, and lifestyle factors with nutrition. The use of AI and machine learning to develop personalized dietary plans is promising. Longitudinal studies are needed to evaluate the long-term impact of dietary interventions. Investigating the role of the gut microbiome in PCOS and dietary modulation offers potential for new treatments. Integrating nutrition, medical treatment, and technology is essential for improving health outcomes for women with PCOS.
A síndrome dos ovários policísticos (SOP) afeta entre 5% e 10% das mulheres em idade fértil e é diagnosticada com base na presença de dois dos seguintes critérios: anovulação crônica, hiperandrogenismo e ovários com aspecto policístico. Essa condição compromete a qualidade de vida, impactando dimensões fisiológicas, sociais e psicológicas. O tratamento de primeira linha recomenda uma abordagem integrada que inclui uma dieta balanceada, exercício físico regular e acompanhamento ginecológico.
Background: Although self-management does great importance to women with PCOS, there’s no standardized instrument to measure self-management ability in women with PCOS. The study aims to develop and evaluate psychometric properties of a PCOS self-management scale(PCOS-SMS).
Method: This is a mixed-method study with a qualitative and a quantitative phase. The study will start from literature review, in which way we could combined the traditional chronic disease management evaluation method with the physiological and psychological characteristics of PCOS patients. Then qualitative study will be carried out to understand the experience and feelings of self-management in PCOS women and construct item pool of PCOS self-management scale. Delphi survey will give grading and guidance to the scientific of scale construction. The quantitative phase will evaluate the psychometric properties in each items including face, content, and construct validity as well as reliability.
Discussion: The successful construction of the scale can provide an useful tool to evaluate the effectiveness of self-management projects for patients with PCOS as well as a certain reference for the development of relevant scales in the future.
Ethics and dissemination: Ethical approval was provided by Ethics Committee of Affiliated Hospital of Zunyi Medical University(KLLY-2021-186). Findings from this study will be disseminated to professionals and the public via peer-reviewed journal publications, popular social media and conference presentations.
IntroductionTo explore if a brief mindfulness-based intervention (MBI) leads to sustained, improved clinical outcomes in adolescents at-risk for type 2 diabetes (T2D).Methods
Participants were 12–17y girls with overweight/obesity, elevated depression symptoms, and T2D family history participating in a randomized, controlled pilot trial of a six-session MBI vs. cognitive-behavioral therapy (CBT) group. At baseline and 1-year, mindfulness, depression, insulin resistance (IR), and body composition were assessed with validated instruments.ResultsOne-year retention was 71% (n = 12) in MBI; 81% (n = 13) in CBT. At 1-year, depression decreased (Cohen’s d = 0.68) and IR decreased (d = 0.73) in adolescents randomized to MBI compared to those in CBT. There were no significant between-condition differences in mindfulness, adiposity, or BMI.DiscussionOne-year outcomes from this randomized, controlled pilot trial suggest that brief MBI may reduce depression and IR in at-risk adolescents. Replication and exploration of mechanisms within the context of a larger clinical trial are necessary.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NCT02218138.
Despite continued public health campaigns to promote physical activity, a majority of the population is inactive. In recent years, mindfulness‐based approaches have been used in health and lifestyle interventions for physical activity promotion. We conducted a systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines to investigate the evidence for the potential of mindfulness‐based approaches for physical activity. We searched electronic databases for papers that met eligibility criteria and identified 40 studies for inclusion. Evidence from cross‐sectional studies (n = 20) indicated a positive relationship between dispositional mindfulness and physical activity, particularly with psychological factors related to physical activity. Five studies found that the mindfulness–physical activity relationship was mediated by stress, psychological flexibility, negative affect and shame, satisfaction and state mindfulness. Evidence from mindfulness‐based interventions (n = 20) suggested positive between‐subjects effects on physical activity, but interventions varied in duration, session length, group size, delivery, content and follow‐up. Mindfulness‐based interventions were more likely to be successful if they were physical activity‐specific and targeted psychological factors related to physical activity. The body of research shows a need for more methodologically rigorous studies to establish the effect of mindfulness on physical activity and to identify potential mechanisms involved in the mindfulness–physical activity relationship reliably.
Polycystic Ovarian Syndrome (PCOS), with common symptoms of irregular menstrual cycles, ovarian cysts, and hirsutism, is thought to be the most common endocrine disorder found in women, and use of multidisciplinary teams has been shown to be effective. The purpose of this review is to determine the future need for specialized, comprehensive, multidisciplinary treatment for PCOS and the current description and efficacy of existing multidisciplinary clinics. The literature was searched using PubMed, CINAHL, PsycINFO, Medline, and the Cochrane Library. Keywords included treatment efficacy, polycystic ovary syndrome, treatment and collaboration. Results showed that while an increasing number of studies continue to come out expressing the need for multidisciplinary approaches to and clinics for the treatment of PCOS, there is still a large gap in the literature documenting actual multidisciplinary PCOS treatment facilities. The limited literature documenting the efficacy of multidisciplinary PCOS clinic have demonstrated increased weight loss, high patient satisfaction, and high retention compared to single-care providers. Data showed that these teams are most commonly made up of a combination of endocrinologists, psychologists, dietitians, gynecologists, and endocrine-specialized nurses. Data showed that there is a high degree of variability and rates of diagnosis between types of single-care providers, such as: endocrinology, dermatology, gynecology, and fertility. Individuals with PCOS are in need for specialized, individualized, and focused care from a diverse team of healthcare providers to treat PCOS comprehensively.
Context
Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism and subfertility but the effects on mental health and child neurodevelopment are unclear.
Objectives
To determine if (i) there is an association between PCOS and psychiatric outcomes, and (ii) whether rates of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are higher in children of mothers with PCOS.
Design
Data were extracted from the Clinical Practice Research Datalink. Patients with PCOS were matched to two control sets (1:1) by age, BMI and primary care practice. Control set 2 was additionally matched on prior mental health status. Primary outcomes were the incidence of depression, anxiety and bipolar disorder. Secondary outcomes were the prevalence of ADHD or ASD in the children.
Results
16,986 eligible patients were identified; 16,938 and 16,355 were matched to control sets 1 and 2 respectively. Compared to control set 1, baseline prevalence was 23.1% versus 19.3% for depression, 11.5% versus 9.3% for anxiety and 3.2% versus 1.5% for bipolar disorder (p<0.001). The hazard ratio for time to each endpoint was 1.26 (95% CI 1.19-1.32), 1.20 (1.11-1.29) and 1.21 (1.03-1.42) for set 1, and 1.38 (1.30-1.45), 1.39 (1.29-1.51) and 1.44 (1.21-1.71) for set 2. The odds ratios for ASD and ADHD in children were 1.54 (1.12-2.11) and 1.64 (1.16-2.33) for set 1, and 1.76 (1.27-2.46) and 1.34 (0.96-1.89) for set 2.
Conclusions
PCOS is associated with psychiatric morbidity and increased risk of ADHD and ASD in their children. Screening for mental health disorders should be considered during assessment.
Purpose of review:
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive age women and is associated with an increased prevalence of depression and anxiety symptoms. This review presents potential mechanisms for this increased risk and outlines treatment options.
Recent findings:
Women with PCOS have increased odds of depressive symptoms (OR 3.78; 95% CI 3.03-4.72) and anxiety symptoms (OR 5.62; 95% CI 3.22-9.80). Obesity, insulin resistance, and elevated androgens may partly contribute to this association. Therefore, in addition to established treatment options, treatment of PCOS-related symptoms with lifestyle modification and/or oral contraceptive pills may be of benefit. Screening for anxiety and depression is recommended in women with PCOS at the time of diagnosis. The exact etiology for the increased risk in PCOS is still unclear. Moreover, there is a paucity of published data on the most effective behavioral, pharmacological, or physiological treatment options specifically in women with PCOS.
Objective:
To test the feasibility of a randomized-controlled trial measuring the impact of an adapted mindfulness-based intervention (MBI) in female adolescents with chronic pain.
Methods:
This was a single center, single-blind, prospective, experimental, longitudinal trial conducted in a pediatric tertiary care center. Participants had a history of chronic pain during at least three months. They were randomized into an intervention group or a wait-list control group. Both groups successively followed an adapted eight-week MBI designed specifically for adolescents with chronic pain. Pre-determined criteria were established to assess the feasibility, validity and acceptability of the study model. Data evaluating changes in quality of life, depression, anxiety, pain perception, psychological distress and salivary cortisol were collected throughout the 4-month study period.
Results:
Nineteen female participants completed the study and had a mean age of 15.8 years (range 13.9 -17.8). Attrition rate was low (17%). Attendance to mindfulness sessions (84%) and compliance to study protocol (100%) were high. All participants reported a positive change in the way they coped with pain. No changes in quality of life, depression, anxiety, pain perception, and psychological distress were detected. Significant reductions in pre-and post-mindfulness session salivary cortisol levels were observed (p<0.001).
Conclusions:
Mindfulness is a promising therapeutic approach for which limited data exist in adolescents with chronic pain. Our study indicates the feasibility of conducting such interventions in teenage girls. A large trial is needed to demonstrate the efficacy and bio-physiological impacts of MBIs in teenagers with chronic pain.
To determine the effectiveness of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) on psychological and physical outcomes for people with vascular disease.
Systematic review and meta-analysis of randomised controlled trials.
AMED, CINAHL, EMBASE, British Nursing Index, Medline, Web of Science, PsycINFO, Cochrane Database of Systematic Reviews, Central, Social Sciences Citation Index, Social Policy and Practice, and HMIC from inception to January 2013.
Articles were screened for inclusion independently by two reviewers. Data extraction and quality appraisal were performed by one reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary. Random-effects meta-analyses were performed.
Nine articles (from eight original randomised controlled trials) met eligibility criteria and were included in the final review. In total, 578 participants were enrolled across the trials, with participants presenting with prehypertension/hypertension (n=3 trials), type 1 or 2 diabetes (n=2), heart disease (n=2) and stroke (n=1). Meta-analyses, using standardised mean differences, showed evidence of reductions in stress (-0.36; 95% CI -0.67 to -0.09; p=0.01), depression (-0.35; 95% CI -0.53 to -0.16; p=0.003) and anxiety (-0.50; 95% CI -0.70 to -0.29; p<0.001). Effects on physical outcomes (blood pressure, albuminuria, stress hormones) were mixed.
Whilst populations with vascular disease appear to derive a range of psychological benefits from MBSR/MBCT intervention, the effects on physical parameters of disease are not yet established. More robust studies, with longer term follow-up, are required to ascertain full effectiveness of such intervention.
Background
Mindfulness interventions with adolescents are in the early stages of development. This study sought to establish efficacy of a mindfulness-based group intervention for adolescents with mixed mental health disorders. Method
One hundred and eight adolescents (ages 13–18) were recruited from community mental health clinics and randomised into two groups (control vs. treatment). All participants received treatment-as-usual (TAU) from clinic-based therapists independent of the study. Adolescents in the treatment condition received TAU plus a 5-week mindfulness-training programme (TAU+Mi); adolescents in the control group received only TAU. Assessments including parent/carer reports were conducted at baseline, postintervention and 3-month follow-up. ResultsAt postintervention, adolescents in the mindfulness condition experienced significant decrease in mental distress (measured with the DASS-21) compared to the control group (Cohen's d = 0.43), and these gains were enhanced at 3-month follow-up (Cohen's d = 0.78). Overall outcomes at 3 months showed significant improvement for adolescents in the mindfulness condition; in self-esteem, mindfulness, psychological inflexibility and mental health, but not resilience. Parents/carers also reported significant improvement in their adolescent's psychological functioning (using the CBCL). Mediation analyses concluded mindfulness mediated mental health outcomes. Conclusions
Increase in mindful awareness after training leads to improvement in mental health and this is consistent with mindfulness theory. The mindfulness group programme appears to be a promising adjunctive therapeutic approach for clinic-based adolescents with mental health problems.
Polycystic ovary syndrome (PCOS) is a common heterogeneous endocrine disorder characterized by irregular menses, hyperandrogenism, and polycystic ovaries. The prevalence of PCOS varies depending on which criteria are used to make the diagnosis, but is as high as 15%–20% when the European Society for Human Reproduction and Embryology/American Society for Reproductive Medicine criteria are used. Clinical manifestations include oligomenorrhea or amenorrhea, hirsutism, and frequently infertility. Risk factors for PCOS in adults includes type 1 diabetes, type 2 diabetes, and gestational diabetes. Insulin resistance affects 50%–70% of women with PCOS leading to a number of comorbidities including metabolic syndrome, hypertension, dyslipidemia, glucose intolerance, and diabetes. Studies show that women with PCOS are more likely to have increased coronary artery calcium scores and increased carotid intima-media thickness. Mental health disorders including depression, anxiety, bipolar disorder and binge eating disorder also occur more frequently in women with PCOS. Weight loss improves menstrual irregularities, symptoms of androgen excess, and infertility. Management of clinical manifestations of PCOS includes oral contraceptives for menstrual irregularities and hirsutism. Spironolactone and finasteride are used to treat symptoms of androgen excess. Treatment options for infertility include clomiphene, laparoscopic ovarian drilling, gonadotropins, and assisted reproductive technology. Recent data suggest that letrozole and metformin may play an important role in ovulation induction. Proper diagnosis and management of PCOS is essential to address patient concerns but also to prevent future metabolic, endocrine, psychiatric, and cardiovascular complications.
Type 2 diabetes mellitus (T2DM) is recognized as a worldwide epidemic and the health concern is particularly problematic among indigenous populations. Canada’s Aboriginal population experiences rates of T2DM that are 2.5–5.3 times higher than the non-Aboriginal population. Stress is understood to play a role in both the development and maintenance of diabetes, which makes stress reduction an avenue for health improvement in these patients. Stress is known to be an integral part of life for commonly disadvantaged Aboriginal people and we hypothesized that, due to its known stress reduction effects, a mindfulness intervention could lead to health improvements for those with T2DM. We also thought that the mind/body approach of a mindfulness intervention would be appropriate for, and acceptable to, Aboriginal people whose healing traditions incorporate aspects of mind, body, and spirit. To test the feasibility of such an approach, we recruited Aboriginal participants from urban and rural centres in Manitoba, Canada who took part in an 8-week, modified mindfulness intervention. Following the program, participants (N = 11) experienced significant and clinically important reductions in blood sugar (HbA1c reduced by .43 %, p = .02; d = .37) and blood pressure (mean arterial pressure reduced by 7.91 mm Hg, p = .05; d = .85). They also reported significant improvements in emotional health. Our small sample limits the generalizability of our findings but our results provide preliminary evidence of feasibility, which supports further exploration of the efficacy and effectiveness of mindfulness-based interventions for indigenous people with T2DM.
. Polycystic ovary syndrome (PCOS) is a heterogeneous disease and many symptoms are seen with varying degrees. The aim of the present study was to determine which symptoms increased such problems as depression, anxiety, low self-esteem, and social worry by classifying PCOS according to symptoms.
Methods
. The study was carried out with two groups. The first group consisted of 86 patients who were diagnosed with PCOS and the second group consisted of 47 healthy volunteers. Liebowitz’ Social Anxiety Scale, Rosenberg’ Self-Esteem Scale, Short-Form 36, Quality of Life Scale, Beck Anxiety Inventory, and Beck Depression Inventory were administered to each volunteer.
Results
. Depression scores of infertile group were higher while anxiety scores of the obese group were bigger than other groups. It was the obesity group that received the smallest score in self-esteem and trust in people and the highest score in sensitiveness to criticism. The most affected group was oligomenorrhea-hirsutism group in terms of physical functioning, physical role function, pain, social functioning, emotional role function, and emotional well-being.
Conclusion
. We suggest that not only gynecologist but also a multidisciplinary team may examine these patients.
This manual is suitable for practitioners who work with adolescents. It outlines step by step guide to lead a 5 week group intervention mindfulness-based training for adolescents. Learn how to let your attention ROAM more effectively.
Background:
Mindfulness-based interventions such as Mindfulness-based Stress Reduction (MBSR) and Mindfulness Cognitive Behavior Therapy (MCBT) have been used to treat adults with psychiatric disorders. This article describes initial modification and development of a mindfulness-based intervention group program for adolescents with psychiatric disorders. It was hypothesized that the intervention would improve mindfulness, mental health outcomes and decrease psychological distress and symptoms.
Method:
Adolescents from a mental health clinic attended a 5-week group pilot mindfulness-based intervention. Adolescents and parents completed questionnaires at pre- and post-intervention and at 3-month follow-up. Baseline measures indicated moderate to severe range of mental health symptoms.
Results:
After the intervention, adolescents reported significant decreases in psychological distress and increases in mindfulness and self-esteem. Qualitative data revealed the intervention to be engaging and beneficial. Parents also reported significant overall improvements of adolescents' functioning.
Conclusions:
These promising preliminary results suggest that the intervention was feasible, acceptable and offered positive impact on mental health problems, and the intervention warrants further research in a randomized controlled study.
The factor structure, reliability, and validity of the Depression Anxiety Stress Scales (DASS; S. H. Lovibond & P. F. Lovibond, 1995) and the 21-item short form of these measures (DASS–21 ) were examined in nonclinical volunteers (
n = 49) and patients with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) diagnoses of panic disorder (
n = 67), obsessive-compulsive disorder (
n = 54), social phobia (
n = 74), specific phobia (
n = 17), and major depressive disorder (
n = 46). This study replicates previous findings indicating that the DASS distinguishes well between features of depression, physical arousal, and psychological tension and agitation and extends these observations to the DASS–21. In addition, the internal consistency and concurrent validity of the DASS and DASS–21 were in the acceptable to excellent ranges. Mean scores for the various groups were similar to those in previous research, and in the expected direction. The implications of these findings are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Interventions based on training in mindfulness skills are becoming increasingly popular. Mindfulness involves intentionally bringing one's attention to the internal and external experiences occurring in the present moment, and is often taught through a variety of meditation exercises. This review summarizes conceptual approaches to mind-fulness and empirical research on the utility of mindfulness-based interventions. Meta-analytic techniques were incorporated to facilitate quantification of findings and comparison across studies. Although the current empirical literature includes many methodological flaws, findings suggest that mindfulness-based interventions may be helpful in the treatment of several disorders. Methodologically sound investigations are recommended in order to clarify the utility of these interventions.
There has been substantial interest in mindfulness as an approach to reduce cognitive vulnerability to stress and emotional distress in recent years. However, thus far mindfulness has not been defined operationally. This paper describes the results of recent meetings held to establish a consensus on mindfulness and to develop conjointly a testable operational definition. We propose a two-component model of mindfulness and specify each component in terms of specific behaviors, experiential manifestations, and implicated psychological processes. We then address issues regarding temporal stability and situational specificity and speculate on the conceptual and operational distinctiveness of mindfulness. We conclude this paper by discussing implications for instrument development and briefly describing our own approach to measurement.
This article presents 4 studies (N = 1,413) describing the development and validation of the Child and Adolescent Mindfulness Measure (CAMM). In Study 1 (n = 428), the authors determined procedures for item development and examined comprehensibility of the initial 25 items. In Study 2 (n = 334), they reduced the initial item pool from 25 to 10 items through exploratory factor analysis. Study 3 (n = 332) evaluated the final 10-item measure in a cross-validation sample, and Study 4 (n = 319) determined validity coefficients for the CAMM using bivariate and partial correlations with relevant variables. Results suggest that the CAMM is a developmentally appropriate measure with adequate internal consistency. As expected, CAMM scores were positively correlated with quality of life, academic competence, and social skills and negatively correlated with somatic complaints, internalizing symptoms, and externalizing behavior problems. Correlations were reduced but generally still significant after controlling for the effects of 2 overlapping processes (thought suppression and psychological inflexibility). Overall, results suggest that the CAMM may be a useful measure of mindfulness skills for school-aged children and adolescents.
Despite the heavy burden and impact of the polycystic ovary syndrome (PCOS) in reproduction and public health, estimates regarding its prevalence at community levels are limited. We aimed to ascertain prevalence of PCOS in a community based sample using the National Institute of Health (NIH), the Rotterdam consensus (Rott.) and the Androgen Excess Society (AES) criteria.
Using the stratified, multistage probability cluster sampling method, 1126 women were randomly selected from among reproductive aged women of different geographic regions of Iran. PCOS were diagnosed using universal assessment of ultrasonographic parameters, hormonal profiles and clinical histories.
The mean +/- SD of age of study population was 34.4 +/- 7.6 years. Estimated prevalence of idiopathic hirsutism was 10.9% (95% CI: 8.9-12.9%); 8.3% of women had only oligo/anovulation and 8.0% had only polycystic ovaries. The prevalence of PCOS was 7.1% (95% CI: 5.4-8.8%) using the NIH definition, 11.7% (95% CI: 9.5-13.7%) by AES criteria and 14.6% (95% CI: 12.3-16.9%) using the Rott definition.
At community level, widespread screening of Rotterdam criteria will increase the estimated prevalence of PCOS over twofold. Establishing an explicit and contemporaneous method for definition and screening of each PCOS criteria has important investigational implications and increase the comparability of published research.
In Brief
Diabetes poses a major life stress that requires considerable physical, emotional, and psychological accommodation and coping. Mind-body therapies have drawn significant interest for their potential to assist in managing stress and adaptation to chronic illness. This review highlights the literature and research on Mindfulness-Based Stress Reduction to improve the health and well-being of individuals with diabetes.
Polycystic ovary syndrome (PCOS) is of clinical and public health importance as it is very common, affecting up to one in five women of reproductive age. It has significant and diverse clinical implications including reproductive (infertility, hyperandrogenism, hirsutism), metabolic (insulin resistance, impaired glucose tolerance, type 2 diabetes mellitus, adverse cardiovascular risk profiles) and psychological features (increased anxiety, depression and worsened quality of life). Polycystic ovary syndrome is a heterogeneous condition and, as such, clinical and research agendas are broad and involve many disciplines. The phenotype varies widely depending on life stage, genotype, ethnicity and environmental factors including lifestyle and bodyweight. Importantly, PCOS has unique interactions with the ever increasing obesity prevalence worldwide as obesity-induced insulin resistance significantly exacerbates all the features of PCOS. Furthermore, it has clinical implications across the lifespan and is relevant to related family members with an increased risk for metabolic conditions reported in first-degree relatives. Therapy should focus on both the short and long-term reproductive, metabolic and psychological features. Given the aetiological role of insulin resistance and the impact of obesity on both hyperinsulinaemia and hyperandrogenism, multidisciplinary lifestyle improvement aimed at normalising insulin resistance, improving androgen status and aiding weight management is recognised as a crucial initial treatment strategy. Modest weight loss of 5% to 10% of initial body weight has been demonstrated to improve many of the features of PCOS. Management should focus on support, education, addressing psychological factors and strongly emphasising healthy lifestyle with targeted medical therapy as required. Monitoring and management of long-term metabolic complications is also an important part of routine clinical care. Comprehensive evidence-based guidelines are needed to aid early diagnosis, appropriate investigation, regular screening and treatment of this common condition. Whilst reproductive features of PCOS are well recognised and are covered here, this review focuses primarily on the less appreciated cardiometabolic and psychological features of PCOS.
Women with polycystic ovary syndrome (PCOS) often have cardiovascular disease (CVD) risk factors. The Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society created a panel to provide evidence-based reviews of studies assessing PCOS-CVD risk relationships and to develop guidelines for preventing CVD.
An expert panel in PCOS and CVD reviewed literature and presented recommendations.
Only studies comparing PCOS with control patients were included. All electronic databases were searched; reviews included individual studies/databases, systematic reviews, abstracts, and expert data. Articles were excluded if other hyperandrogenic disorders were not excluded, PCOS diagnosis was unclear, controls were not described, or methodology precluded evaluation. Inclusion/exclusion criteria were confirmed by at least two reviewers and arbitrated by a third.
Systematic reviews of CVD risk factors were compiled and submitted for approval to the AE-PCOS Society Board.
Women with PCOS with obesity, cigarette smoking, dyslipidemia, hypertension, impaired glucose tolerance, and subclinical vascular disease are at risk, whereas those with metabolic syndrome and/or type 2 diabetes mellitus are at high risk for CVD. Body mass index, waist circumference, serum lipid/glucose, and blood pressure determinations are recommended for all women with PCOS, as is oral glucose tolerance testing in those with obesity, advanced age, personal history of gestational diabetes, or family history of type 2 diabetes mellitus. Mood disorder assessment is suggested in all PCOS patients. Lifestyle management is recommended for primary CVD prevention, targeting low-density and non-high-density lipoprotein cholesterol and adding insulin-sensitizing and other drugs if dyslipidemia or other risk factors persist.
Polycystic ovary syndrome (PCOS) is considered to be the most common endocrine disorder in women of reproductive age, yet debate over appropriate diagnostic criteria and design limitations with sampling methodology have left some doubt as to the actual prevalence in the community. The objective of this study was to create a representative prevalence estimate of PCOS in the community under the National Institutes of Health (NIH) criteria and the more recent Rotterdam consensus criteria and Androgen Excess Society (AES) criteria.
A retrospective birth cohort study was carried out in which 728 women born during 1973-1975 in a single maternity hospital were traced and interviewed in adulthood (age = 27-34 year; n = 728). Symptoms of PCOS (hyperandrogenism, menstrual dysfunction and polycystic ovaries) were identified by examination and the presence of polycystic ovaries in those that did not consent to the ultrasound were imputed.
The estimated prevalence of PCOS in this birth cohort using the NIH criteria was 8.7 +/- 2.0% (with no need for imputation). Under the Rotterdam criteria, the prevalence was 11.9 +/- 2.4% which increased to 17.8 +/- 2.8% when imputed data were included. Under the AES recommendations, PCOS prevalence was 10.2 +/- 2.2%, and 12.0 +/- 2.4% with the imputed data. Of the women with PCOS, 68-69% did not have a pre-existing diagnosis.
The Rotterdam and AES prevalence estimates were up to twice that obtained with the NIH criteria in this, as well other prevalence studies. In addition, this study also draws attention to the issue of many women with PCOS in the community remaining undiagnosed.
The article discusses a scenario-based dieting self-efficacy scale, the DIET-SE, developed from dieter's inventory of eating temptations (DIET). The DIET-SE consists of items that describe scenarios of eating temptations for a range of dieting situations, including high-caloric food temptations. Four studies assessed the psychometric properties of the 11-item DIET-SE. Exploratory factor analysis (N = 392) and confirmatory factors analysis (N = 124) revealed three internally consistent and reliable factors representing challenges to adhere to a diet (high-caloric food temptations [HCF], social and internal factors [SIF], negative emotional events [NEE]). Convergent validity is established with other measures of dieting self-efficacy, as well as measures of eating disinhibition, susceptibility to hunger, and weight loss competency. Criterion-related validity is provided through the assessment of goal adherence, and predictive validity is established for dieters' actual food intake (N = 68). The DIET-SE represents a short, reliable, and valid scenario-based measure of dieting self-efficacy.
To develop a reliable and valid physical activity screening measure for use with adolescents in primary care settings.
We conducted 2 studies to evaluate the test-retest reliability and concurrent validity of 6 single-item and 3 composite measures of physical activity. Modifications were based on the findings of the 2 studies, and a best measure was evaluated in study 3. Accelerometer data served as the criterion standard for tests of validity.
In study 1 (N = 250; mean age, 15 years; 56% female; 36% white), reports on the composite measures were most reliable. In study 2 (N = 57; mean age, 14 years; 65% female; 37% white), 6 of the 9 screening measures correlated significantly with accelerometer data. Subjects, however, had great difficulty reporting bouts of activity and distinguishing between intensity levels. Instead, we developed a single measure assessing accumulation of 60 minutes of moderate to vigorous physical activity. Evaluated in study 3 (N = 148; mean age, 12 years; 65% female; 27% white), the measure was reliable (intraclass correlation, 0.77) and correlated significantly (r = 0.40, P<.001) with accelerometer data. Correct classification (63%), sensitivity (71%), and false-positive rates (40%) were reasonable.
The "moderate to vigorous physical activity" screening measure is recommended for clinical practice with adolescents.
Polycystic ovary syndrome (PCOS) is highly prevalent and increasingly diagnosed during adolescence. This study explored the context and processes of self-management among adolescents, and parents of adolescents, who have PCOS. Adolescents with PCOS (n = 7) and their parents (n = 8) participated in a series of focus groups. Deductive thematic analysis was guided by the Individual and Family Self-Management Theory (IFSMT), and the patterns that were identified aligned with the contexts and processes described therein. A secondary inductive approach was employed as a novel contextual pattern emerged: psychological health and well-being. Study findings suggest that adolescents and their families have a desire to engage in optimal self-management, and particularly effective strategies may consider a holistic, family intervention approach that addresses psychological health and well-being in addition to behavior change. Study findings are the first to reflect the unique needs of adolescents with PCOS and their families.
Purpose:
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among females. The foundation of PCOS self-management is engaging in healthy lifestyle habits, however, there is limited literature regarding adolescents' transition to PCOS self-management. The purpose of this study, therefore, is to explore parental and adolescent views of the transition to PCOS self-management.
Design and methods:
A qualitative descriptive approach was used through focus groups (N = 4) with adolescents diagnosed with PCOS and their parents.
Results:
A total of seven adolescents and eight parents participated in two focus groups each. The primary theme from the parent groups was Concerns for Transition to Self-Care with the subthemes of facilitation versus direction and recognition of personal habits. The primary theme identified from the adolescent groups was Taking Control with subthemes of managing symptoms, cognitive dissonance, support, and balance.
Conclusions:
Study findings provide insight into the experiences of adolescents with PCOS and their parents as they navigate both a family-level transition in health habits and anticipate the adolescent transition to self-management as an emerging adult.
Practice implications:
Nurses and other health care providers can help facilitate transition to self-management among adolescents with PCOS by encouraging increased independence in health behavior decisions while they are still living at home. Middle and older adolescents who begin to take ownership of their physical activity, nutritional choices, and sleep hygiene will have a firm foundation on which to build as they transition into life beyond high school.
Background:
Polycystic ovary syndrome (PCOS) prevalence estimates vary when different diagnostic criteria are applied. Lack of standardization of individual elements within these criteria may contribute to prevalence differences.
Objective and rationale:
A systematic review of studies reporting prevalence of PCOS, using at least one of the National Institutes of Health (NIH), Rotterdam or Androgen Excess Society (AE-PCOS) criteria, was conducted. The aim was to investigate the impact on prevalence reporting of different definitions of the clinical elements for PCOS diagnosis.
Search methods:
A systematic search of Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Emcare and BIOSIS was conducted. The search was limited to English language and studies published between January 1990 and January 2018. Included articles needed to define PCOS by at least one of the NIH, Rotterdam or AE-PCOS criteria, be of an unselected population and be published as a full text article. Risk-of-bias was assessed.
Outcomes:
A total of 21 studies met the inclusion criteria. The random-effects pooled prevalence of PCOS in studies that used the NIH criteria (7% [95% CI: 6-7%]), was significantly different from that identified in studies that used the Rotterdam criteria (12% [95% CI: 10-15%], P < 0.0001) but not studies that used the AE-PCOS criteria (10% [95% CI: 6-13%], P = 0.075). The pooled estimates for Rotterdam and AE-PCOS were not significantly different from each other (P = 0.201). Pooled prevalence estimates were compared between studies separated on the basis of: oligo-amenorrhoea vs oligo-amenorrhoea plus short cycles, clinical androgen excess requiring hirsutism vs any clinical androgen excess, use of different versions and cut-offs for the Ferriman-Gallwey (F-G) score, and inclusion vs non-inclusion of oral contraceptive users. There were no statistically significant differences for any of these comparisons. There was insufficient information to allow subgroup analyses of definitions of polycystic ovaries.
Wider implications:
Inclusion of ovarian morphology results in statistically significantly higher pooled prevalence estimates for PCOS. Heterogeneity in prevalence estimates for PCOS reflect the broad clinical spectrum of the condition, lack of standardization of the elements within each set of diagnostic criteria and the use of a range of diagnostic cut-offs, as well as potential differences between study populations. The use of different definitions for anovulation and clinical androgen excess did not appear to contribute to differences in the estimated prevalence of PCOS in this study. However, as the number of studies in most of the comparison groups was small, real differences may have been missed. Uncertainty surrounding the diagnosis of PCOS urgently needs to be addressed in order to provide clinicians and their patients with greater diagnostic certainty, and hence reduce inappropriate labelling and the potential psychological harm that may accompany misdiagnosis.
Introduction:
We aimed to determine the benefits/efficacy of mindfulness-based interventions (MBIs) implemented among adolescents with chronic diseases in clinical settings.
Methods:
An electronic search of PubMed, CINAHL, and PsycINFO databases was conducted in November 2017 to identify studies in which mindfulness was the primary intervention delivered for adolescents with chronic diseases to improve psychological and physical health.
Results:
Nineteen eligible studies were included in this review. Fifteen studies included adolescents with psychiatric or pain disorders, and four included adolescents with a chronic physical disorders. Psychological outcomes and pain were examined in most studies with effect sizes for MBIs ranging from small to large.
Discussion:
MBI studies conducted in clinical settings mainly engaged adolescents with psychiatric or pain disorders. The effectiveness of MBIs on improving psychological outcomes were inconsistent. Large randomized trials are needed to examine the effectiveness of MBIs and should expand to include adolescents with chronic physical diseases.
Objective:
(1) Evaluate feasibility and acceptability of a mindfulness-based group in adolescent girls at-risk for type 2 diabetes (T2D) with depressive symptoms, and (2) compare efficacy of a mindfulness-based versus cognitive-behavioral group for decreasing depressive symptoms and improving insulin resistance.
Design and setting:
Parallel-group, randomized controlled pilot trial conducted at a university.
Participants:
Thirty-three girls 12-17y with overweight/obesity, family history of diabetes, and elevated depressive symptoms were randomized to a six-week mindfulness-based (n=17) or cognitive-behavioral program (n=16).
Interventions:
Both interventions included six, one-hour weekly group sessions. The mindfulness-based program included guided mindfulness awareness practices. The cognitive-behavioral program involved cognitive restructuring and behavioral activation.
Main outcome measures:
Adolescents were evaluated at baseline, post-intervention, and six-months. Feasibility/acceptability were measured by attendance and program ratings. Depressive symptoms were assessed by validated survey. Insulin resistance was determined from fasting insulin and glucose, and dual energy x-ray absorptiometry was used to assess body composition.
Results:
Most adolescents attended ≥80% sessions (mindfulness: 92% versus cognitive-behavioral: 87%, p=1.00). Acceptability ratings were strong. At post-treatment and six-months, adolescents in the mindfulness condition had greater decreases in depressive symptoms than adolescents in the cognitive-behavioral condition (ps<.05). Compared to the cognitive-behavioral condition, adolescents in the mindfulness-based intervention also had greater decreases in insulin resistance and fasting insulin at post-treatment, adjusting for fat mass and other covariates (ps<.05).
Conclusions:
A mindfulness-based intervention shows feasibility and acceptability in girls at-risk for T2D with depressive symptoms. Compared to a cognitive-behavioral program, after the intervention, adolescents who received mindfulness showed greater reductions in depressive symptoms and better insulin resistance. ClinicalTrials.gov identifier: NCT02218138 clinicaltrials.gov.
Background:
Mindfulness-based interventions (MBIs) have emerged as a promising strategy for individuals with a chronic illness, given their versatility in targeting both physical and mental health outcomes. However, research to date has focused on adult or community-based populations.
Objectives:
To systematically review and critically appraise MBIs in clinical pediatric samples living with chronic physical illness.
Data sources:
Electronic searches were conducted by a Library Information Specialist familiar with the field by using EMBASE, PsycINFO, MEDLINE, CINAHL, Web of Science, and EBM Reviews databases. Study Eligibility, Participants, and Interventions: Published English peer-reviewed articles of MBIs in clinical samples of children and adolescents (3-18 years) with chronic physical illness.
Study appraisal and synthesis methods:
Two reviewers independently selected articles for review and extracted data. Results are narratively described, and the reporting quality of each study was assessed via the STROBE Checklist.
Results:
Of a total 4710 articles, 8 articles met inclusion criteria. All studies were small (n?<?20, except 1 study of n?=?59), included only outpatient adolescent samples, and focused on feasibility and acceptability of MBI; only 1 study included a comparison group (n?=?1). No studies included online components or remote attendance. All studies found that MBI was acceptable to adolescents, whereas feasibility and implementation outcomes were mixed. Many studies were underpowered to detect significant differences post-MBI, but MBI did demonstrate improvements in emotional distress in several studies. Conclusions and Implications of Key Findings: The literature on MBIs is preliminary in nature, focusing on adapting and developing MBI for adolescents. Although MBIs appear to be a promising approach to coping with symptoms related to chronic illness in adolescents, future research with adequate sample sizes and rigorous research designs is warranted.
This systematic review aimed to examine the effectiveness of Mindfulness-based interventions in reducing diabetes-related physiological and psychological symptoms in adults with types 1 and 2 diabetes. Five databases were systematically searched. A total of 11 studies satisfied the inclusion criteria. Mindfulness-based intervention effectiveness for physiological outcomes (glycaemic control and blood pressure) was mixed. Mindfulness-based interventions appear to have psychological benefits reducing depression, anxiety and distress symptoms across several studies. Studies' short-term follow-up periods may not allow sufficient time to observe physiological changes or illustrate Mindfulness-based interventions' potential long-term efficacy. More long-term studies that include a consistent, standardised set of outcome measures are required.
Publisher Summary
It is believed that behavior is goal directed and feedback controlled, and that the goals underlying behavior form a hierarchy of abstractness. In thinking about the structure of self-regulation, one draws on ideas from disparate sources. The focus on goals that translate into behavior is very much in line with a growing reemergence of goal constructs. A variety of labels are used in this chapter: for example, current concern, personal strivings, life task, and personal project. In all these theories, there is room for individualization; that is, a life task can be achieved in many ways. People choose paths that are compatible with other aspects of their life situations and other aspects of their personalities. Two goal constructs that differ somewhat from those named thus far are the possible self and the self-guide. These constructs are intended to bring a dynamic quality to conceptualization of the self-concept. In contrast to traditional views, but consistent with other goal frameworks, possible selves are future oriented. They concern how people think of their unrealized potential, the kind of person they might become. Self-guides similarly reflect dynamic aspects of the self-concept.
Polycystic ovary syndrome (PCOS) is a common endocrine disorder with a significant psychological burden throughout the life course of affected women. Thus, use of mindful awareness may be beneficial as an adjunct to conventional medical management of women with PCOS. A randomized, controlled trial was conducted at the Evgenideion Hospital of the Athens University Medical School to explore the impact of an 8-week mindfulness stress management program on measures of depression, anxiety and stress as well as on the quality of life in reproductive age women with PCOS. Twenty-three and fifteen women with PCOS were randomly allocated to the intervention or control group, respectively. All participants were administered DASS21, PSS-14, PCOSQ, Daily Life and General Life Satisfaction Questionnaires and provided three-timed daily samples of salivary cortisol, before and after the intervention. Intervention group participants were provided with the Credibility/Expectancy Questionnaire at the day of enrolment, to check for possible placebo effect on the outcome. Post-intervention, between-group results revealed statistically significant reductions in stress, depressive and anxiety symptoms, as well as in salivary cortisol concentrations, along with an increase in Life Satisfaction and Quality of Life scores in the intervention group only. There was no significant ‘placebo’ effect on the outcome measures. Mindfulness techniques seem promising in ameliorating stress, anxiety, depression and the quality of life in women with PCOS and could be used as an adjunct method to the conventional management of these women.
Read More: http://informahealthcare.com/doi/abs/10.3109/10253890.2014.974030
Mindfulness-based interventions (MBIs) targeting eating behaviours have gained popularity in recent years. A literature review was conducted to determine the effectiveness of MBIs for treating obesity-related eating behaviours, such as binge eating, emotional eating and external eating. A search protocol was conducted using the online databases Google Scholar, PubMed, PsycINFO and Ovid Healthstar. Papers were required to meet the following criteria to be included in this review: (i) describe a MBI or the use of mindfulness exercises as part of an intervention; (ii) include at least one obesity-related eating behaviour as an outcome; (iii) include quantitative outcomes; and (iv) be published in English in a peer-reviewed journal. A total of N = 21 papers were included in this review. Interventions used a variety of approaches to implement mindfulness training, including combined mindfulness and cognitive behavioural therapies, mindfulness-based stress reduction, acceptance-based therapies, mindful eating programmes, and combinations of mindfulness exercises. Targeted eating behaviour outcomes included binge eating, emotional eating, external eating and dietary intake. Eighteen (86%) of the reviewed studies reported improvements in the targeted eating behaviours. Overall, the results of this first review on the topic support the efficacy of MBIs for changing obesity-related eating behaviours, specifically binge eating, emotional eating and external eating.
Polycystic Ovarian Syndrome (PCOS) has been associated with numerous reproductive and metabolic abnormalities. Despite tremendous advances in the management of reproductive dysfunction, insight into the metabolic implications of PCOS is limited by the lack of uniform diagnostic criteria, the heterogeneity of the condition and the presence of confounders including obesity. Obesity clearly has a role in long term health and may best predict both reproductive and metabolic dysfunction as well as negatively affect the response to treatment in women with PCOS. Diabetes, cardiovascular disease and cancer are also at the forefront of any risk assessment or comprehensive treatment strategy for these women. Lifestyle modifications including dietary changes, increased exercise and weight loss are appropriate first line interventions for many women with PCOS. Pharmaceuticals including metformin, lipid lowering agents and oral contraceptives should be tailored to the individual's risk profile and treatment goals.
IntroductionSelf-Regulation as an Orienting FrameworkSelf-Regulation Models and Stress-and-Coping ModelsDysfunctional Responses to Threat and LossCoping with Chronic IllnessCoronary DiseaseConcluding CommentReferences
To perform a systematic review and meta-analysis of studies that compared the prevalence of anxiety symptoms in women with polycystic ovary syndrome (PCOS) and control women.
Meta-analysis and systematic review.
University practice.
Cross-sectional studies comparing PCOS subjects and geographically matched clearly defined non-PCOS control subjects with data on age and body mass index (BMI).
Anxiety screening tool.
The primary analysis contrasted prevalence of anxiety. Cochrane Review Manager 5.0.24 software was used to construct forest plots comparing frequency of anxiety symptoms in case and control subjects.
Of 613 screened articles, nine met our selection criteria for a systematic review and four were included in the meta-analysis. The prevalence of generalized anxiety symptoms was available in four studies and was significantly greater in PCOS subjects (42/206, 20.4%) compared to controls (8/204, 3.9%). The odds for anxiety symptoms were significantly greater in women with PCOS compared with control subjects (odds ratio 6.88, 95% confidence interval 2.5-18.9). The mean anxiety score was significantly increased in three of the remaining five studies. Other anxiety disorders, such as social phobia, panic attacks, and obsessive compulsive disorders, were assessed infrequently.
Our systematic review suggests an increased odds of anxiety symptoms in women with PCOS, underscoring the importance of screening all women with PCOS for anxiety symptoms. Follow-up evaluation and treatment are essential, because generalized anxiety disorder is a chronic condition. Potential contributors for anxiety symptoms, such as hirsutism, obesity, and/or infertility may be specific to women with PCOS but need further investigation.
Polycystic ovary syndrome (PCOS) is associated with several metabolic complications. A few small studies have also suggested an increased risk of depression in women with PCOS. The goals of this study were to estimate the prevalence of depressive disorders in women with PCOS compared with controls and to evaluate the correlation between depression, hyperandrogenism, and other metabolic markers.
Cohort study.
University Hospital.
Women with PCOS (Rotterdam criteria; n = 103). Women without PCOS seen during the same time period for an annual exam were used as control subjects (n = 103).
Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD PHQ) and the Beck Depression Inventory.
Depressive disorders.
Women with PCOS were at an increased risk for depressive disorders (new cases) compared with controls (21% vs. 3%; odds ratio 5.11 [95% confidence interval (CI) 1.26-20.69]; P<.03). The overall risk of depressive disorders in women with PCOS was 4.23 (95% CI 1.49-11.98; P<.01) independent of obesity and infertility. Compared with the nondepressed PCOS subjects, the depressed PCOS subjects had a higher body mass index (BMI) and evidence of insulin resistance (P<.02).
We report a significantly increased risk of depressive disorders (as defined by the Diagnostic and Statistical Manual IV) in women with PCOS and recommend routine screening in this population.
To study the age at diagnosis of polycystic ovarian syndrome (PCOS) in a pediatric population. To compare risk factors involved in causing PCOS in preadolescent and adolescent girls. To review the current literature on the reported age of PCOS in girls.
A retrospective chart review and systematic review of the literature.
Patients included 58 girls (age ≤ 18 yrs) with a diagnosis of PCOS based on the Rotterdam criteria. Girls were grouped as preadolescents (<13 yrs) or adolescents (13-18 yrs). Clinical and biochemical data were reviewed from the time of diagnosis.
Age at diagnosis. Differences in risk factors for PCOS (Ethnicity, obesity, family history of PCOS, birth weight, age at pubarche, thelarche and menarche, evidence of hyperandrogenism and/or insulin resistance) were compared between the two groups.
There were 26% (15/58) preadolescent girls (9-12 yrs) vs 74% (43/58) adolescents (13-18 yrs). There was no significant difference between the two groups in ethnicity, BMI z-score, family history of maternal PCOS, birth weight, hyperandrogenism, or insulin resistance. Preadolescents with PCOS had significantly earlier onset of pubarche and thelarche than adolescents with PCOS, by 1.9 and 1.5 yrs, respectively (P = 0.018, 0.030). In addition to earlier puberty, PCOS developed 2.1 years sooner after thelarche in preadolescents than in adolescents. (P = 0.008) Preadolescents were significantly taller for age than adolescents (72nd % vs 43rd %) (P = 0.005). A review of the 28 studies published in the last 3 years that included PCOS patients with age <=18 yrs described only 6.4% (27/425) of pediatric subjects with age <13 yrs. Four were primarily pediatric studies that included patients under the age of 13 yrs, with 9.4% (12/127) of the patients <13 yrs.
Increased awareness of PCOS in young females is needed. PCOS may occur at a younger age in girls who develop early pubarche and thelarche. Therefore, the diagnosis and workup should be considered in young girls with risk factors suggestive of PCOS.
To summarize physiological and psychological characteristics that are common among women diagnosed with polycystic ovary syndrome (PCOS) and provide evidence suggesting that addressing psychological disturbances can reduce or alleviate physical symptoms of PCOS through behavioral pathways and physiological pathways.
Empirical studies and expert consensuses pertaining to physiological, psychological, and medical management aspects of PCOS were identified and presented in this review. Articles were identified by searching Pubmed, PsycInfo, Medline ISI, CINAHL, or a Web browser (i.e., Google) using numerous combinations of terms pertaining to physiological, psychological, and medical management aspects of PCOS. An article was chosen to be included in this review if it reported findings and/or provided information that related to and helped support the main purpose(s) of this review article.
Available literature on the physiological (i.e., hyperandrogenism, central obesity, inflammation, insulin resistance) and psychological (i.e., depression, anxiety, eating disorders) factors among women with PCOS provides evidence that these various aspects of PCOS are strongly interrelated.
The existence of these relationships among physiological and psychological factors strongly suggests that medical management of PCOS would greatly benefit from inclusion of psychological and behavioral approaches.
Polycystic ovary syndrome (PCOS) is associated with high levels of depression, which impact quality of life and limit self-efficacy, yet less is known about prevalence of anxiety. This cross-sectional, observational study of community-based women with PCOS comprehensively examined mood and found that anxiety existed at higher levels than depression, anxiety was underdiagnosed, and more women with PCOS who reported infertility were depressed. (Fertil Steril (R) 2010;93:2421-3. (C) 2010 by American Society for Reproductive Medicine.)
The objective of this study was to perform a systematic review of the literature to determine whether there is an association between polycystic ovary syndrome (PCOS) and gynaecological malignancy. Medline and Embase databases (1968-2008) were searched to identify publications on the association between PCOS and gynaecological cancers including breast cancer. Studies were selected that examined the association between PCOS and all types of gynaecological malignancies. A total of 19 studies exploring the association between PCOS and breast, endometrial and ovarian cancer were identified. Of these, only eight could be included after review. The data showed variability in the definition of PCOS. A meta-analysis of the data suggests that women with PCOS are more likely to develop cancer of the endometrium (OR 2.70, 95% CI 1.00-7.29) and ovarian cancer (OR 2.52, 95% CI 1.08-5.89) but not breast cancer (OR 0.88, 95% CI 0.44-1.77). Women with PCOS appear to be three times more likely to develop endometrial cancer but are not at increased risk of breast cancer. There is insufficient evidence to implicate PCOS in the development of vaginal, vulval, cervical or ovarian cancers. The paucity of studies investigating the association between PCOS and gynaecological cancers is likely to affect the reliability of the conclusions.
NIDDM occurs commonly among women with polycystic ovary syndrome (PCOS). The prevalence and natural history of its precursor, impaired glucose tolerance (IGT), is less well known. The objective of this study was to characterize the prevalence and incidence of glucose intolerance in a large cohort of women with well-characterized PCOS.
A total of 122 women with clinical and hormonal evidence of PCOS were recruited from the Medicine, Endocrinology, Gynecology, and Pediatrics Clinics at the University of Chicago. All women had a standard oral glucose tolerance test (OGTT) with measurement of glucose and insulin levels. A subset of 25 women were subsequently restudied with the aim of characterizing the natural history of glucose tolerance in PCOS.
Glucose tolerance was abnormal in 55 (45%) of the 122 women: 43 (35%) had IGT and 12 (10%) had NIDDM at the time of initial study. The women with NIDDM differed from those with normal glucose tolerance in that they had a 2.6-fold higher prevalence of first-degree relatives with NIDDM (83 vs. 31%, P < 0.01 by chi 2) and were significantly more obese (BMI 41.0 +/- 2.4 vs. 33.4 +/- 1.1 kg/m2, P < 0.01). For the entire cohort of 122 women, there was a significant correlation between fasting and 2-h glucose concentrations (r = 0.76, P < 0.0001); among the subset with IGT, the fasting glucose concentration was poorly predictive of the 2-h level (r = 0.25, NS). After a mean follow-up of 2.4 +/- 0.3 years (range 0.5-6.3), 25 women had a second OGTT. The glucose concentration at 2 h during the second glucose tolerance test was significantly higher than the 2-h concentration during the first study (161 +/- 9 vs. 139 +/- 6 mg/dl, P < 0.02).
The prevalence of IGT and NIDDM in women with PCOS is substantially higher than expected when compared with age- and weight-matched populations of women without PCOS. The conversion from IGT to NIDDM is accelerated in PCOS. The fasting glucose concentration does not reliably predict the glucose concentration at 2 h after an oral glucose challenge, particularly among those with IGT, the subgroup at highest risk for subsequent development of NIDDM. We conclude that women with PCOS should periodically have an OGTT and must be closely monitored for deterioration in glucose tolerance.
To examine health-related quality of life (HRQL) in adolescents with polycystic ovary syndrome (PCOS), compared with healthy adolescents, and to determine whether clinically observed or self-perceived severity of illness affects their HRQL.
Cross-sectional study of female adolescents conducted at an urban, hospital-based adolescent medicine clinical practice.
Ninety-seven adolescent patients with PCOS and 186 healthy patients who were seen for care between October 15, 1999, and March 2, 2001.
Health-related quality-of-life scores as determined by the Child Health Questionnaire-Child Self-Report Form.
Adolescents with PCOS scored lower on subscales measuring general health perceptions, physical functioning, general behavior, and limitations in family activities because of illness. Patients scored higher on the change in health in the last year subscale, and most had been diagnosed and initiated treatment for PCOS in the last year. Patients who had higher self-perceived severity of illness also scored lower on the general health perceptions subscale, but clinical severity was not associated with differences in HRQL.
Adolescents with PCOS experience lower HRQL compared with healthy adolescents. Polycystic ovary syndrome and perceived severity of illness negatively affect HRQL in adolescents. This study suggests a need to develop interventions to reduce the distress that patients with PCOS may face as adolescents and young adults.