Abstract: Background/Significance: PCOS and hirsutism, disorders characterized by elevated androgen hormone, have been associated with a wide range of psychiatric disorders (Kerchner, 2009; Teede, 2018). Only one prior study has noted an association of increased suicide attempts with PCOS (Cesta, 2016), but rates of suicidal thoughts and behaviors were not studied. Additionally, the association of hirsutism with suicidality has not been studied. This study’s objective is to characterize the relationship between hyperandrogenic conditions and risk for suicidal thoughts, behaviors, and attempts when controlling for medical/psychiatric comorbidities.
Methods: Cross-sectional analysis of a cohort study of females at Veterans Health Administration primary care. PCOS, hirsutism, and psychiatric diagnoses were obtained from encounter records. Regression analyses performed to examine the association of PCOS/hirsutism with suicidality. IRB approval obtained from Yale University and Veterans Affairs Connecticut Healthcare System.
Results: Cohort of women with PCOS (n=2,748) or hirsutism (n=1,553) compared to women without these disorders (n=102,054). Results are pending at this time; relationship of hyperandrogenic conditions with suicidality is currently in data analysis phase. Data will be reported as risk of suicidal thoughts, behaviors, and attempts for PCOS group and hirsutism group compared to control group. Data will be presented from regression analyses controlling for medical and psychiatric comorbidities.
Discussion: If this study demonstrates an increased risk of suicidality among PCOS and hirsutism after controlling for medical/psychiatric comorbidities, then this study suggests that androgen hormones play a direct role in the comorbidity of PCOS/hirsutism with psychiatric disorders. Further prospective studies using androgen serum measures are needed to confirm the role of androgen as a direct mediator. If confirmed, these results suggest correction of hyperandrogenism as a potential treatment for women with comorbid hyperandrogenism and suicidal thoughts, behaviors, and attempts.
Conclusion/Implications: If this study demonstrates an increased risk for suicidal thoughts, behaviors, and attempts among women with PCOS and hirsutism, then these results suggest correction of hyperandrogenism with anti-androgen medications as a potential treatment for suicidality among women. It remains to be determined whether correction of hyperandrogenism could facilitate recovery from suicidality.
References:
Cesta CE, Månsson M, Palm C, Lichtenstein P, Iliadou AN, Landén M. Polycystic ovary syndrome and psychiatric disorders: Co-morbidity and heritability in a nationwide Swedish cohort. Psychoneuroendocrinology. 2016 Nov;73:196-203.
Kerchner A, Lester W, Stuart SP, Dokras A Risk of depression and other mental health disorders in women with polycystic ovary syndrome: a longitudinal study. Fertility and Sterility. 2009;91:207-212.
Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, Piltonen T, Norman RJ, International PN. Recommendations from the international evidence-based guideline for the assessment and management of PCOS. Hum Reprod. 2018;33:1602-1618.
Presentation Eligibility: Not previously published or presented.
Diversity, Equity, and Inclusion: This study very intentionally addresses race, gender, and factors that could significantly affect the study outcomes. Focused analysis is performed on prevalence across self-identified racial/ethnic groups to account for varying clinical phenotypes of PCOS/hirsutism across ethnic groups, optimizing treatment outcomes for all women. This study elevates research in women’s mental health specifically to optimize patient care for women and veterans; all subjects in this study are veterans and identify as women. Highlighting research for female-identifying veterans is important to optimize care for this often marginalized population. Additionally, the speaker is a first-generation American, first-generation college graduate, and identifies as LGBTQ+.
