title: Depression, Anxiety, and Anger in Patients with Polycystic Ovary Syndrome.
abstract: BACKGROUND
  Polycystic Ovary Syndrome (PCOS) is a syndrome of heterogeneous nature, affecting multiple systems, particularly the endocrine system. We propose to investigate the possible relationships among hormonal changes, levels of anxiety, depression, and anger in patients with PCOS.
  
  
  METHODS
  Forty-four female patients with PCOS and 44 body mass index (BMI )-matched healthy women participated in this study. We measured the sociodemographic features, some serum hormonal levels (insulin, gonadotropins, prolactin, dehydroepiandrosterone sulfate (DHEAS), thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), 17 OH-progesterone, and total and free testosterone), and some other biochemical parameters of the participants. Also, all participants completed the Trait Anger-Anger Expression Scale (STAS), Beck Depression, and Beck Anxiety Inventories. We evaluated the psychiatric scale scores obtained from PCOS patients and control subjects. We used the independent-samples t-test for parametric data to evaluate normal distribution, and Mann-Whitney U-test was used for both abnormally distributed and nonparametric data. We used Pearson correlation analysis to evaluate the potential connection between the two groups' data.
  
  
  RESULTS
  The mean ages of the patients with PCOS and control subjects who participated in this study were 27.3±5.6 and 27.4±6.1 years, respectively. The measures of BMI, insulin, luteinizing hormone (LH), DHEAS, and total testosterone serum levels in the patient group were significantly higher than in the control group (p<.05). There was a statistically significant positive correlation between Beck anxiety scores and serum DHEAS levels (Pearson r=.4366, P=.0001). We found significant differences between the two groups in terms of trait anger, anger control, outward and inward anger, anxiety level, and depression scores (P<.05).
  
  
  CONCLUSIONS
  Anxiety symptoms indicate a stronger relationship compared to depression with DHEAS serum levels via the autonomic nervous system, considering the gamma-aminobutyric acid (GABA)-antagonistic effect of DHEAS. Obesity, hirsutism, and infertility may reduce self-confidence and create depressive symptoms in patients with PCOS. In addition, changes in hormonal levels may lead to anxiety directly. Possibly, depressive symptoms are a secondary reflection of these changes.
authors.affiliation: Gülhane Military Medical Academy, Department of Psychiatry, Ankara, Turkey.
authors.forename: Adem
authors.initials: A
authors.lastname: Balikci
authors.affiliation: Gülhane Military Medical Academy, Department of Psychiatry, Ankara, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Erdem
authors.affiliation: Gülhane Military Medical Academy, Department of Obstetrics and Gynaecology, Ankara, Turkey.
authors.forename: Uğur
authors.initials: U
authors.lastname: Keskin
authors.affiliation: Erenköy Mental Health and Neurological Diseases Education and Research Hospital, Department of Psychiatry, İstanbul, Turkey.
authors.forename: Selma
authors.initials: S
authors.lastname: Bozkurt Zincir
authors.affiliation: Gülhane Military Medical Academy, Department of Psychiatry, Ankara, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Gülsün
authors.affiliation: Gümüşsuyu Military Hospital, Department of Biochemistry, İstanbul, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Özçelik
authors.affiliation: Gülhane Military Faculty of Medicine, Department of Biochemistry, Ankara, Turkey.
authors.forename: Emin Özgür
authors.initials: EÖ
authors.lastname: Akgül
authors.affiliation: Gülhane Military Medical Academy, Department of Psychiatry, Ankara, Turkey.
authors.forename: Süleyman
authors.initials: S
authors.lastname: Akarsu
authors.affiliation: Turkish Armed Forces Medical Command, Department of Biochemistry, Ankara, Turkey.
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Öztosun
authors.affiliation: Gülhane Military Medical Academy, Department of Obstetrics and Gynaecology, Ankara, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Ergün
keywords: DHEAS; Polycystic ovary syndrome; anger; anxiety; depression; testosterone