title: The influence of depression and anxiety on risk of adult onset vulvodynia.
abstract: BACKGROUND
  Studies have shown that women with vulvodynia are more psychologically distressed than women without vulvodynia. These studies, however, have not effectively established temporal associations between diagnosed psychiatric disorders and vulvodynia.
  
  
  METHODS
  The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) was administered to 240 case-control pairs of women with and without vulvodynia. Interviews established age at first onset of diagnosed mood and anxiety disorder. Age information was used to determine whether the first episode of mood and/or anxiety was antecedent or subsequent to the first onset of vulvodynia symptoms. Conditional logistic regressions tested whether antecedent depression or anxiety was more likely among women with or without vulvodynia. Cox proportional hazards modeling was then used to estimate risk of subsequent new or recurrent onset of mood or anxiety disorder.
  
  
  RESULTS
  After adjusting for education, race, age at menarche, age at first tampon use, and age at first sexual intercourse, odds of vulvodynia were four-times more likely among women with antecedent mood or anxiety compared to women without (95% confidence interval [CI] 2.1-7.5). Vulvodynia was associated with new or recurrent onset of mood or anxiety disorder after adjustment (hazard ratio [HR] 1.7, 95% CI 1.1-2.6) and did not significantly change after including history of mood or anxiety disorder before the onset of vulvodynia or reference age of controls in the models.
  
  
  CONCLUSIONS
  This is the first community-based epidemiologic study demonstrating that DSM-IV-diagnosed antecedent depression and anxiety disorders influence the risk of vulvodynia and that vulvodynia increases the risk of both new and recurrent onset of psychopathology.
authors.affiliation: Division of Epidemiology & Community Health, School of Public Health, Minneapolis, Minnesota 55454, USA.
authors.forename: Maheruh
authors.initials: M
authors.lastname: Khandker
authors.forename: Sonya S
authors.initials: SS
authors.lastname: Brady
authors.forename: Allison F
authors.initials: AF
authors.lastname: Vitonis
authors.forename: Richard F
authors.initials: RF
authors.lastname: Maclehose
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Stewart
authors.forename: Bernard L
authors.initials: BL
authors.lastname: Harlow
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001007:Anxiety / Q000150:complications*; D016001:Confidence Intervals; D003863:Depression / Q000150:complications*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008404:Massachusetts; D008875:Middle Aged; D016016:Proportional Hazards Models; D018570:Risk Assessment; D056650:Vulvodynia / Q000453:epidemiology* / Q000209:etiology*; D055815:Young Adult