title: Risk of psychiatric disorders following polycystic ovary syndrome: a nationwide population-based cohort study.
abstract: BACKGROUND
  Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among women of reproductive age. A higher prevalence of psychiatric comorbidities, including depressive disorder, anxiety disorder, and bipolar disorder has been proved in patients with PCOS. However, a clear temporal causal relationship between PCOS and psychiatric disorders has not been well established.
  
  
  OBJECTIVE
  We explored the relationship between PCOS and the subsequent development of psychiatric disorders including schizophrenia, bipolar disorder, depressive disorder, anxiety disorder, and sleep disorder.
  
  
  METHODS
  We identified patients who were diagnosed with PCOS by an obstetrician-gynecologist in the Taiwan National Health Insurance Research Database. A comparison cohort was constructed of patients without PCOS who were matched according to age and sex. The occurrence of subsequent new-onset psychiatric disorders was evaluated in both cohorts based on diagnoses made by psychiatrists.
  
  
  RESULTS
  The PCOS cohort consisted of 5431 patients, and the comparison cohort consisted of 21,724 matched control patients without PCOS. The incidence of depressive disorder (hazard ratio [HR] 1.296, 95% confidence interval [CI] 1.084-.550), anxiety disorder (HR 1.392, 95% CI 1.121-1.729), and sleep disorder (HR 1.495, 95% CI 1.176-1.899) were higher among the PCOS patients than among the patients in the comparison cohort. In addition, a higher incidence of newly diagnosed depressive disorder, anxiety disorder, and sleep disorder remained significantly increased in all of the stratified follow-up durations (0-1, 1-5, ≥5 y).
  
  
  CONCLUSIONS
  PCOS might increase the risk of subsequent newly diagnosed depressive disorder, anxiety disorder, and sleep disorder. The risk of newly diagnosed bipolar disorder, which has often been reported in the literature to be comorbid with PCOS, was not significantly elevated.
authors.affiliation: Department of Obstetrics and Gynecology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
authors.forename: Jeng-Hsiu
authors.initials: JH
authors.lastname: Hung
authors.affiliation: Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Li-Yu
authors.initials: LY
authors.lastname: Hu
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Shih-Jen
authors.initials: SJ
authors.lastname: Tsai
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Center for Dynamical Biomarkers and Translational Medicine, National Central University, Chungli, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Albert C
authors.initials: AC
authors.lastname: Yang
authors.affiliation: Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan.
authors.forename: Min-Wei
authors.initials: MW
authors.lastname: Huang
authors.affiliation: Department of Psychiatry, Yuanshan Branch, Taipei Veterans General Hospital, Yilan, Taiwan.
authors.forename: Pan-Ming
authors.initials: PM
authors.lastname: Chen
authors.affiliation: Department of Dental Laboratory Technology, entral Taiwan University of Science and Technology, Taichung, Taiwan.
authors.forename: Shu-Li
authors.initials: SL
authors.lastname: Wang
authors.affiliation: Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Ti
authors.initials: T
authors.lastname: Lu
authors.affiliation: Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan; Department of information magagement, National Chung-Cheng University, Chiayi, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Cheng-Che
authors.initials: CC
authors.lastname: Shen
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D001523:Mental Disorders / Q000453:epidemiology* / Q000209:etiology; D011085:Polycystic Ovary Syndrome / Q000150:complications* / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D013624:Taiwan / Q000453:epidemiology