Depressive symptoms among young women with polycystic ovary syndrome in Bangladesh

Abstract

Background

Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder among women of reproductive age. Evidence suggests a markedly elevated burden of depression among women with PCOS; however, context-specific data from South Asia, particularly Bangladesh, remain limited. This study assessed the prevalence, severity, and associated factors of depression among young Bangladeshi women diagnosed with PCOS.

Methods

A cross-sectional analytical study was conducted between December 2024 and July 2025 among 417 women aged 18–30 years with clinically diagnosed PCOS across Bangladesh. Participants were recruited from gynecology and endocrinology clinics, digital health, and online PCOS support platforms using a combined purposive and convenience-based voluntary sampling approach. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) and total scores were categorized into mild, moderate, and severe depressive symptom levels. The PHQ-9 was used exclusively to assess depressive symptoms. Psychosocial variables including body image dissatisfaction, perceived family and social support, fertility concerns, and stress related to PCOS symptoms were assessed separately using structured questionnaire items developed based on relevant literature. Bivariate analyses and multivariable logistic regression were performed, with associations reported using adjusted odds ratios (aORs), 95% confidence intervals (CIs), and p-values.

Results

Nearly two-thirds of participants (67.4%) experienced moderate to severe depressive symptoms. Moderate depression was most common (36.0%), followed by mild (32.6%) and severe symptoms (31.4%). After adjustment, longer PCOS duration (> 2 years; aOR = 1.47, 95% CI 1.08–2.01, p < 0.05), menstrual irregularity (aOR = 2.11, 95% CI 1.34–3.32, p < 0.01), and fertility concerns (aOR = 2.87, 95% CI 1.72–4.79, p < 0.001) were independently associated with depression. Body image dissatisfaction (aOR = 0.27, 95% CI 0.15–0.48, p < 0.001) and adequate perceived social support (aOR = 0.29, 95% CI 0.16–0.51, p < 0.001) showed significant protective associations against depression.

Conclusion

Depression is highly prevalent among young women with PCOS in Bangladesh and is strongly associated with both clinical and psychosocial factors. Integrating routine mental health screening and culturally sensitive psychosocial support into PCOS care is essential for improving overall health outcomes.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1007/s44192-026-00523-3.

Introduction

Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders affecting women of reproductive age. Estimated global prevalence ranges from 6 to 20% depending on diagnostic criteria and population characteristics [1]. Polycystic Ovarian Syndrome (PCOS) is increasingly recognized as a multisystem disorder with substantial metabolic and psychological consequences [2]. Alongside menstrual irregularities, infertility, obesity, acne, and hirsutism, women with PCOS experience disproportionately high rates of mental health problems, particularly depression, which substantially impairs quality of life and long-term health outcomes [3].

Women with PCOS are approximately three times more likely to experience depressive symptoms compared with women without PCOS [4]. Reported prevalence of moderate to severe depression among women with PCOS ranges from 40 to 60%, far exceeding estimates observed in the general female population [4, 5]. Hyperandrogenism, insulin resistance, chronic low-grade inflammation, and dysregulation of the hypothalamic–pituitary–adrenal axis are involved in mood regulation [6, 7]. These biological vulnerabilities interact with psychosocial stressors, creating a complex etiological pathway linking PCOS and depression.

In South Asian regions, including Bangladesh, the psychological burden of PCOS may be further amplified by sociocultural norms emphasizing marriage, fertility, and physical appearance [8]. In Bangladesh, where mental health literacy remains limited and stigma surrounding psychological disorders persists, depressive symptoms among women with PCOS are frequently under-recognized and under-treated [9]. Young women in particular face compounded vulnerability due to pressures related to education, career development, marriage prospects, and expectations of motherhood, all of which may intensify distress when reproductive health is compromised [10]. Despite the high prevalence of PCOS in South Asia, empirical data examining its mental health correlates within this cultural context remain sparse.

Most existing studies on PCOS-related depression originate from high-income Western countries, limiting their generalizability to low- and middle-income settings where healthcare access, gender norms, and psychosocial stressors differ substantially [4, 11, 12]. Furthermore, many studies aggregate wide age ranges, overlooking the distinct psychosocial challenges faced by young women during early adulthood. In Bangladesh, there is a notable lack of population-based or clinic-linked evidence quantifying the burden of depression among young women with PCOS and identifying its biological, psychological, and socio-demographic correlates.

To address these gaps, the present study aims to assess the prevalence and severity of depression among young Bangladeshi women diagnosed with PCOS and to examine associated clinical, psychological, and socio-demographic factors. The study hypothesizes that depression is highly prevalent among young women with PCOS in Bangladesh and that greater symptom severity is associated with adverse clinical features, body image dissatisfaction, limited social support, and unfavorable socio-demographic conditions. By generating context-specific evidence, this study seeks to inform integrated, gender-sensitive, and culturally appropriate approaches to PCOS management that incorporate mental health screening and psychosocial support within routine care.

Methodology

Study design

A cross-sectional analytical study design was employed to estimate the prevalence of depression and determine associated factors among young women diagnosed with PCOS.

Study setting

The study was conducted between December 2024 and July 2025 using both facility-based and online recruitment platforms across Bangladesh.

Study area and population

The study population comprised young women aged 18–30 years residing in Bangladesh who had been clinically diagnosed with PCOS from qualified healthcare providers. Participants were recruited from endocrinology and gynecology outpatient clinics as well as online PCOS support groups and digital health forums.

Sample size and sampling

Sample size was calculated using a standard single-population proportion formula for cross-sectional studies (n = z²pq/e²), assuming a 42% prevalence of depression (p) among women with PCOS, a 95% confidence level (z), and a 5% margin of error (e) [5]. After adjusting for a 10% non-response rate, the final required sample size was 417 participants.

A combined purposive and convenience-based voluntary response sampling strategy was applied. Facility-based participants were purposively recruited from endocrinology and gynecology outpatient clinics, while online participants were recruited voluntarily through PCOS support groups and digital health platforms. In case of online support group and digital health forum, we contacted the respondents over the phone and email, explained the study objectives to them, and asked for volunteer participation in the study. Participants who agreed to participate voluntarily were enrolled and provided with the research questionnaire.

Inclusion and exclusion criteria

Women aged 18–30 years with a confirmed diagnosis of PCOS who provided informed consent were included. Participants without a formal PCOS diagnosis, outside the specified age range, currently pregnant, or unwilling to participate were excluded.

Respondents and data collection tools

Data were collected using a structured, self-administered questionnaire (Supplementary File 1) comprising socio-demographic characteristics, clinical features of PCOS, treatment history, psychosocial factors, and depression screening. The Bangla-validated version of the PHQ-9 was used in this study. Previous studies have demonstrated satisfactory psychometric validity and reliability of the Bangla PHQ-9 among Bangladeshi populations [8, 11, 13]. In the current study sample, the PHQ-9 demonstrated good internal consistency reliability with a Cronbach’s alpha coefficient of 0.84. The PHQ-9 response options were based on a four-point Likert scale, and total scores were categorized into mild, moderate, and severe depressive symptom levels for analytical interpretation. Associations between depressive symptoms and psychosocial factors including body image satisfaction, perceived social support, and stress related to PCOS symptoms were subsequently examined during statistical analysis. Data collection procedures were standardized across all recruitment platforms. Questionnaires were pre-tested, and data completeness and consistency were routinely monitored. Confidentiality was ensured by anonymizing all participant records.

Study variables

Consistent with the study objectives, the primary outcome variable was depressive symptom severity measured using PHQ-9 scores, while socio-demographic, clinical, and psychosocial characteristics were treated as explanatory variables to examine their associations with depressive symptoms among women with PCOS. Operationally, PCOS is defined in this study according to established clinical diagnostic criteria requiring the presence of at least two of the following: oligo- or anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasonography [1]. Depression is operationalized as the presence and severity of depressive symptoms measured using the Patient Health Questionnaire-9 (PHQ-9), a validated screening tool widely used in epidemiological and clinical research [11, 13]. Depression severity was categorized into mild, moderate, and severe depressive symptom levels based on PHQ-9 score distributions and analytical grouping.

Data analysis

Data were analyzed using descriptive and inferential statistics with IBM SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA). Frequencies, percentages, means, and standard deviations summarized participant characteristics. Chi-square tests assessed bivariate associations, and logistic regression models identified independent predictors of depression. For logistic regression analysis, depression was dichotomized using a PHQ-9 cut-off score of ≥ 10 to indicate moderate-to-severe depressive symptoms, consistent with established clinical and epidemiological recommendations. Statistical significance was set at p < 0.05, with results presented as odds ratios and 95% confidence intervals [14].

Results

Among the 417 participants, the majority were aged 23–26 years (65.2%), unmarried (84.2%), and undergraduate students (79.1%) (Table 1). Most participants were students (58%) or employed (38.4%). Clinically, 61.6% of participants had been diagnosed with PCOS for two years or less, whereas 38.4% reported a duration of more than two years since diagnosis. Almost all participants (99.5%) were currently receiving some form of treatment for PCOS.

Table 1.

Socio-demographic and clinical characteristics of study participants (n = 417)

Characteristic	Category	n (%)
Age group (years)	18–22	40 (9.6)
	23–26	272 (65.2)
	27–30	105 (25.2)
Marital status	Unmarried	351 (84.2)
	Married	60 (14.4)
	Divorced	6 (1.4)
Education level	Secondary or below	8 (1.9)
	Higher secondary	330 (79.1)
	Graduate or above	79 (18.9)
Occupation	Student	242 (58.0)
	Employed	160 (38.4)
	Unemployed/Homemaker	15 (3.6)
Duration since PCOS diagnosis	≤ 2 years	257 (61.6)
	> 2 years	160 (38.4)
Currently receiving PCOS treatment	Yes	415 (99.5)
	No	2 (0.5)

In Table 2, Menstrual irregularity was reported by 76.7% of women, while 23.3% reported regular menstrual cycles. About one-quarter had a family history of PCOS, diabetes, or thyroid disorders (28.8%). Mood swings or depressive feelings related to PCOS were reported by 75.0% of respondents. Similarly, 74.8% reported body image dissatisfaction, highlighting the substantial psychosocial burden of PCOS. Despite this, 76.7% perceived their social support from family or friends as adequate, whereas 23.3% reported inadequate support.

Table 2.

Distribution of respondents according to PCOS-related clinical and psychosocial features (n = 417)

Variable	Category	n (%)
Menstrual irregularity	Present	320 (76.7)
	Absent	97 (23.3)
Family history of PCOS/Diabetes/Thyroid disorder	Yes	120 (28.8)
	No	297 (71.2)
Mood swings or depressive feelings during PCOS	Yes	313 (75.0)
	No/Not sure	104 (25.0)
Body image dissatisfaction	Yes	312 (74.8)
	No/Neutral	105 (25.2)
Perceived social support (family/friends)	Adequate	320 (76.7)
	Inadequate	97 (23.3)

Assessment of depressive symptoms using a PHQ-9 based proxy revealed moderate depressive symptoms were the most common (36.0%), followed by mild symptoms (32.6%) and severe symptoms (31.4%) (Table 3). Notably, nearly two-thirds of participants (67.4%) experienced moderate to severe depressive symptoms. This dichotomized classification was subsequently used as the dependent outcome variable in logistic regression analyses.

Table 3.

Distribution of women with PCOS according to severity of depressive symptoms Based on PHQ-9 scores

Depression severity category	n (%)
Mild symptoms	136 (32.6)
Moderate symptoms	150 (36.0)
Severe symptoms	131 (31.4)

Depression was significantly associated with age, marital status, and education level (p < 0.05), as well as clinical factors like menstrual irregularity and fertility concerns (p < 0.01) (Table 4). Strong associations were found with body image dissatisfaction and perceived social support (p < 0.001).

Table 4.

Bivariate associations between participant characteristics and depression

Variable*	Category	p-value
Age group	18–30	< 0.05
Marital status	Married versus Unmarried	< 0.05
Education level	≤ Undergraduate versus Graduate	< 0.05
Menstrual irregularity	Yes versus No	< 0.01
Fertility concern	Yes versus No	< 0.01
Body image dissatisfaction	Yes versus No	< 0.001
Social support	Adequate versus Inadequate	< 0.001

^*Only variables meeting inclusion criteria were advanced to multivariable analysis

After adjusting for socio-demographic and psychosocial covariates, several factors remained independently associated with depression. In Table 5, longer duration of PCOS (> 2 years) was significantly associated with higher odds of depression (aOR = 1.47, 95% CI 1.08–2.01, p < 0.05). Menstrual irregularity was associated with more than twofold increased odds of depression (aOR = 2.11, 95% CI 1.34–3.32, p < 0.01), while fertility concern demonstrated a strong positive association with depressive symptoms (aOR = 2.87, 95% CI 1.72–4.79, p < 0.001).

Table 5.

Multivariable logistic regression analysis of factors associated with depression

Predictor variable	Adjusted odds ratio (aOR)	95% CI	p-value
Age group	0.84	0.61–1.16	0.306
Duration of PCOS	1.47	1.08–2.01	< 0.05
Menstrual irregularity	2.11	1.34–3.32	< 0.01
Fertility concern	2.87	1.72–4.79	< 0.001
Family history of PCOS/DM/Thyroid	0.02	0.003–0.18	0.003
Body image dissatisfaction	0.27	0.15–0.48	< 0.001
Perceived social support	0.29	0.16–0.51	< 0.001
PHQ-9 score	0.77	0.64–0.92	0.005

Model adjusted for socio-demographic and psychosocial covariates

Conversely, participants with a family history of PCOS, diabetes, or thyroid disorders had significantly lower odds of depression (aOR = 0.02, 95% CI 0.003–0.18, p = 0.003). Similarly, absence of body image dissatisfaction was associated with reduced odds of depression (aOR = 0.27, 95% CI 0.15–0.48, p < 0.001), while adequate perceived social support also showed a significant protective association against depression (aOR = 0.29, 95% CI 0.16–0.51, p < 0.001). Higher PHQ-9 scores remained significantly associated with depression severity (aOR = 0.77, 95% CI 0.64–0.92, p = 0.005). However, age group did not retain statistical significance in the adjusted multivariable model (aOR = 0.84, 95% CI 0.61–1.16, p = 0.306).

Discussion

This study contributes to the growing global evidence that Polycystic Ovary Syndrome is a significant mental health concern for women, particularly during early adulthood. The findings align with international literature demonstrating that women diagnosed with PCOS experience a substantially higher psychological burden compared with the general female population and the depressive symptomatology is linked with biological and psychosocial pathways [15]. This study extends existing knowledge to a sociocultural context in PCOS-related mental health research among young Bangladeshi women that has been largely underrepresented.

Prior studies from Europe, North America, and East Asia consistently report elevated depressive symptoms among women with PCOS, that contributes to neuroendocrine dysregulation, insulin resistance, and chronic inflammatory processes [16, 17]. The present findings conceptually support these mechanisms that neurotransmitter systems and stress-response pathways concerned in depression. However, psychological distress in PCOS often persists even when metabolic parameters are controlled, underscoring the relevance of psychosocial determinants [18].

Psychological models emphasize body image dissatisfaction, perceived loss of femininity, and uncertainty regarding fertility as central mediators between PCOS and depression. Comparative studies have demonstrated that hirsutism, acne, and weight changes negatively affect self-esteem and social functioning among young women with PCOS [19]. The present study conceptually corroborates these frameworks, reinforcing the hypothesis that depressive experiences in PCOS are not merely incidental but embedded within broader processes of self-perception, stigma, and chronic stress.

Within the Bangladeshi context, sociocultural norms surrounding marriage, motherhood, and physical appearance appear to intensify the psychological impact of PCOS [20]. Research from South Asia suggests that reproductive potential is closely tied to social value and familial expectations, placing women with menstrual irregularities or fertility concerns at heightened risk of emotional distress [20]. Mental health stigma further compounds this burden by discouraging help-seeking and normalizing psychological suffering [21]. These contextual factors may contribute to the elevated psychological burden observed among women with PCOS in Bangladesh.

Studies from India and Pakistan have documented strong associations between PCOS, depressive symptoms, and perceived social pressure, suggesting that cultural context shapes not only symptom expression but also coping mechanisms and access to care [22]. In contrast, Western literature often emphasizes weight stigma and individual self-concept, highlighting how cultural ideals mediate the pathways between PCOS symptoms and mental health outcomes [23]. These cross-cultural contrasts underscore the importance of context-sensitive research and caution against uncritical generalization of findings across settings.

This study addresses its stated objectives by integrating biological, psychological, and socio-demographic perspectives within a single analytical framework. The findings support the biopsychosocial model as a robust explanatory paradigm for understanding depression among women with PCOS, consistent with international recommendations advocating for holistic approaches to women’s health [24]. The observed relevance of psychosocial factors further reinforces arguments that routine PCOS management strategies focusing exclusively on hormonal regulation and metabolic control are insufficient to address the full spectrum of patient needs.

Global clinical guidelines increasingly recommend mental health screening as part of PCOS management; however, implementation remains limited, particularly in low- and middle-income countries [25]. In Bangladesh, integrating brief depression screening tools into gynecology and endocrinology services may represent a feasible and cost-effective strategy to improve early identification and referral. Additionally, culturally sensitive counseling addressing body image, fertility-related anxiety, and family dynamics may enhance psychological resilience and treatment adherence.

The findings of this study have several important implications for clinical practice and public health policy in Bangladesh. First, routine depression screening using brief validated tools such as the PHQ-9 should be integrated into gynecology and endocrinology outpatient services managing women with PCOS, particularly among younger women presenting with menstrual irregularities, fertility concerns, or body image dissatisfaction. Second, multidisciplinary care pathways involving gynecologists, endocrinologists, psychologists, and mental health counselors may improve holistic patient management and treatment adherence. Third, awareness programs targeting families and communities may help reduce stigma surrounding both PCOS and mental health problems, thereby improving social support and care-seeking behaviors. At the policy level, incorporation of mental health assessment within national reproductive health programs and women’s health services may facilitate early identification and referral of psychologically vulnerable women with PCOS. Future longitudinal and intervention-based studies are warranted to examine causal relationships and evaluate the effectiveness of culturally tailored psychosocial interventions among women with PCOS in low- and middle-income settings.

Limitations

This study has several limitations that should be considered when interpreting the findings. First, the cross-sectional design precludes causal inference between PCOS-related factors and depressive symptoms. Second, reliance on self-reported questionnaire data may introduce recall bias and social desirability bias, particularly for psychosocial variables and mental health symptoms. Third, the use of clinic-based and online voluntary recruitment may introduce selection bias and limit representativeness, particularly among women without internet access, lower health literacy, or limited healthcare utilization. Consequently, the findings may not be fully generalizable to all women with PCOS in Bangladesh. Despite these limitations, the study provides important context-specific evidence regarding the psychological burden associated with PCOS among young Bangladeshi women.

Conclusion

This study demonstrates that Polycystic Ovary Syndrome is closely associated with depressive symptoms among young Bangladeshi women, and PCOS represents a significant mental health risk beyond its reproductive and metabolic manifestations. By addressing biological, psychological, and socio-demographic dimensions simultaneously, the findings align with global evidence and underscore the relevance of the biopsychosocial model in understanding PCOS-related depression. The study highlights the role of body image, social support, and cultural expectations in shaping mental health outcomes within the Bangladeshi context. These insights emphasize that PCOS management must extend beyond biomedical treatment to include routine mental health screening, culturally sensitive counseling, and integrated referral systems. Implementing multidisciplinary and culturally responsive care models that combine reproductive and mental healthcare services may substantially improve long-term psychological and reproductive outcomes among women with PCOS. Future research should focus on longitudinal and intervention-based studies to inform sustainable, context-specific care models that address both the physical and psychological dimensions of PCOS.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary Material 1 ^{(16.4KB, docx)}

Author contributions

Sumaiya Binte Khalid: Conceptualization, data curation, formal analysis, investigation, methodology, visualization, and writing – original draft. Md. Monir Hossain Shimul: Methodology, formal analysis, validation, visualization, writing – original draft, and writing – review & editing. Salim Khan: Methodology, supervision, and writing – review and editing. Salamat Khandker: Methodology, supervision, validation, and writing – review & editing.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Data availability

The data supporting the conclusions of this article are included within the article.

Declarations

Ethics approval and consent to participate

Ethical approval for this study was obtained from the Institutional Review Board (IRB) of the Faculty of Health and Life Sciences, Daffodil International University, Dhaka, Bangladesh (Ref: REC-FHLS/DIU/2024/0142). Written institutional approvals were collected before data collection. Prior to data collection, participants were informed about the purpose, procedures, potential risks, and benefits of the study in local language. Written informed consent was obtained from all participants. Confidentiality was strictly maintained and data were used solely for academic purposes. The study adhered to the ethical principles of the Declaration of Helsinki. No experiments on humans and/or the use of human tissue samples were done in this study.

Consent for publication

Not applicable.

Competing interests

The authors report there are no competing interests to declare.