title: Putative role for insulin resistance in depression risk in polycystic ovary syndrome.
abstract: OBJECTIVE
  To evaluate whether insulin resistance is associated with depression risk in women with polycystic ovary syndrome (PCOS), independent of other factors, including body mass index (BMI).
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Tertiary university center.
  
  
  METHODS
  A total of 301 women, aged 14-52 years, with PCOS by Rotterdam criteria, consecutively examined between 2006 and 2013.
  
  
  METHODS
  Complete history and physical examinations, including endovaginal ultrasounds, dermatologic assessments, completion of Beck Depression Inventory Fast Screen (BDI-FS), and serum testing.
  
  
  METHODS
  Scores >4 on BDI-FS indicated a positive screen for depression. Scores were further subdivided into mild (5-8), moderate (9-12), and severe (>12) depression risk. Insulin resistance was assessed using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR).
  
  
  RESULTS
  A total of 131 women (44%) were at risk for depression, determined by positive BDI-FS screening. These patients had higher BMI (32.3 vs. 28.5), and elevated insulin resistance, assessed by HOMA-IR (5.2 vs. 2.6), compared with patients with negative depression screening. In a stratified analysis by BMI category, obese women with positive depression screens had elevated HOMA-IR, compared with obese women with normal BDI-FS scores (7.4 vs. 4.1). In a multivariate logistic regression analysis, HOMA-IR was independently related to the odds of depression risk after controlling for age, ethnicity, BMI, and exercise (odds ratio: 1.07).
  
  
  CONCLUSIONS
  Depression is common in PCOS. After controlling for confounders in multivariate regression analyses, we found HOMA-IR to be significantly associated with depression risk. Our data suggest a complex interplay among insulin resistance, obesity, and depression in PCOS, warranting additional investigation. Mental health assessment is indicated in comprehensive care of patients with PCOS.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California. Electronic address: greenwoode@obgyn.ucsf.edu.
authors.forename: Eleni A
authors.initials: EA
authors.lastname: Greenwood
authors.affiliation: Department of Psychiatry, University of California San Francisco, San Francisco, California.
authors.forename: Lauri A
authors.initials: LA
authors.lastname: Pasch
authors.affiliation: Department of Dermatology, University of California San Francisco, San Francisco, California.
authors.forename: Kanade
authors.initials: K
authors.lastname: Shinkai
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California.
authors.forename: Marcelle I
authors.initials: MI
authors.lastname: Cedars
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California.
authors.forename: Heather G
authors.initials: HG
authors.lastname: Huddleston
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D016014:Linear Models; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011085:Polycystic Ovary Syndrome / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Polycystic ovary syndrome; depression; insulin resistance