Table 4.
Predictors of Mental Health Outcomes in Women with CPP
| Author/Year | Setting, Methodology, Data Source | Participants, Size (n), Diagnoses, Age. | Results | Comments |
|---|---|---|---|---|
| Allaire et. al.45 | Women with CPP from an interdisciplinary pain clinic including counselling intervention in British Columbia. 1 year prospective cohort study design. EHP-30, service access reports, VAS pain ratings. | n=296 women with CPP. Age M=34.3 (SD=7.6). | Multi-disciplinary treatment in a team including psychology improved median pain severity and decreased emergency and physician visits after 1 year. Quality of life on the EHP-30 pain subscale improved. Higher chronic pain severity at 1 year associated with higher pain catastrophizing score at baseline. Counselling intervention included mindfulness skills (body scan, breathing, progressive muscle relaxation) and CBT to challenge thinking and beliefs. | 57% response rate at 1 year follow up. May not be generalizable to other cohorts. Did not consider potential moderators of catastrophizing at baseline. Participants were reported to have 2 visits to counselling. |
| Donatti et al.48 | Brazilian sample of women with Endometriosis. Prospective explorative within group design. COPE, BDI, LISS measures. | n=171 women with endometriosis. Age M= 39.5 (SD=5.6) years of age. | Higher depression scores predicted higher maladaptive strategies in solving daily life problems. Increased CPP severity predicted increased stress and increased depression scores. Participants who used positive coping strategies had lower depression scores and adapted better to stress. | Statistics appeared to be correlational than inferential and were not well described. Not reflective of population as a whole. No inferential statistics. Confounding not considered. Withdrawal participants not described. |
| Facchin et al.72 | Women with endometriosis from an Italian obstetrics and gynaecology department sample recruited 2012–2014. Cross-sectional study, between groups comparisons. Investigated whether endometriosis predicted personality factors on the TCI-R 240 item scale. | n=133 split into 3 groups: endometriosis with pain (n=58), endometriosis no pain (n=24) and controls no endometriosis or pain (n=51). | Women with pain and endometriosis had lower novelty seeking, lower exploratory excitability, higher harm avoidance, lower responsibility and higher fatigability in comparison to pain free endometriosis and control groups. Higher CPP severity predicted higher harm avoidance and lower self-directedness. | Small control sample, groups not matched. May not be generalizable to other cohorts. Included pain with sex and periods associated with endometriosis diagnoses. Model of personality related to Cloningers’ model (1998). |
| Facchin et al.46 | Italian women with endometriosis from a gynaecology department, recruited 2015–2017. Cross sectional study, within group design. Measures HADS, RRS for mental health outcomes. Rosenburg self-esteem scale, emotional self-efficacy scale. | n=210 endometriosis patients. Age M=36.7 (SD=7). | Being in a stable relationship was associated with decreased rumination on the RRS. Pelvic pain severity predicted anxiety, depression and rumination. Greater self-esteem, body esteem and emotional self-efficacy were associated with less anxiety, depression and rumination. | Potential confounding (eg Fertility, pregnancy, sexual concerns, beliefs about gender, cultural differences) was not considered. |
| Facchin et al.47 | Italian women with Endometriosis recruited from an endometriosis service 2014–2015. Grounded theory based interviews looking at how endometriosis affects mental health. Textual analysis of transcripts. Qualitative study. | n=74 women with Endometriosis. Age M= 36.44 (SD=6.9). | Women with high distress reported regular life disruption as a theme, where those without distress did not. Life disruption and continuity of care were affected by: pathway to diagnoses, quality of doctor-patient relationship, support (intimate and financial), female identity (body impact, fertility, sexuality), meaning of life with endometriosis. | One institution limits generalizability of results. Cultural and gender factors not considered. |
| Kaya et al.54 | Women with PP from Inonu University Medical Facility in Turkey, collected January – April 2000. Cross-sectional survey, quasi-experimental case control design. Measures BDI, BAI, STAI, GRIS. | n=19 women with CPP. Age M= 34.1 (SD=9.3), n=25 healthy controls, age M=30.6 (SD=7.3). | Avoidance, dissatisfaction and non-sensuality subscales of the GRIS positive correlation with depression and anxiety scores. Linked anxiety, depression and sexual dysfunction in women with CPP. | Underpowered. Non-parametric statistics. Statistical investigation stopped at correlations for some associations. |
| Low et al.52 | Women with CPP who presented to a UK gynaecology clinic with concerns related to CPP, infertility or both. Between groups comparison. EPQ, BDI, GHQ-30, STAI, GRIMS, MPQ-SF short form measures. | 3 groups of women separated by referral reason. n=61 CPP referral group, n=12 infertility referral group, n=15 CPP and infertility referral group. Measures completed 2 weeks pre-treatment and 13 months post-treatment. | Concluded anxiety associated with pain not fertility. Less psychopathy associated with less pain. | Small group sizes and no power calculation noted. Confounding not considered. n=58 had prior treatment, n=50 had prior surgical treatment. Pre and post assessments in different settings. CPP higher anxiety pre and post treatment in comparison to infertility group. |
| Norman et al.37 | US obstetrics and gynaecology sample of women with CPP. Prospective RCT. Demographics, medical history taken at assessment. Measures essays, MPQ, SIP, PANAS negative affect, AEQ, CSQ at assessment and two month follow up. | n=48 (n=28 disclosure, n=20 control groups). 18–64 (M=38.2, SD= 11.5) years old. n=12 drop out. For written emotional exposure, CPP group wrote about their negative experiences with CPP, controls wrote about positive life experiences unrelated to CPP | Baseline catastrophizing, negative affect and ambivalence were found to predict daily disability. However, baseline catastrophizing was no longer a significant moderator of daily disability over and above negative affect and baseline ambivalence. | No power calculation and high drop-out rate. Participants predominantly Caucasian. 75% of women reported previous depression diagnoses which may have influenced negative affect and ambivalence. |
| Oniszczenko et al.58 | Sample of women hospitalized for gynaecological reasons in Polish hospital. Cross-sectional study. PTSD-FVIT, FCB-TI, MSI, GHQ-28. | n=136 women with CPP, 18–60 (M=34.60, SD=9.92) years old. n=10 drop outs. | Emotional reactivity, anxiety and lovability explained 8%, 34% and 6% of the variance in PTSD FVIT scores respectively, 48% of total variance. Suggested esteem has a protective role in trauma for women with CPP. | No power calculation. Participants were not blinded. 75% of participants had a history of diagnosed depression. 8/12 women gave reasons for drop out, feedback was it was too upsetting or too hard to think positively of their CPP. Multiple diagnoses included. Follow up measures were completed at home. |
| Petreluzzi et al.51 | Women with CPP recruited from Brazilian Women’s Health Centre for endometriosis group, Between groups comparison. PSQ, HRQOL- SF-36, HPA axis activity from salivary cortisol, VAS for pain scores measures. | n=93 women with endometriosis and CPP non responsive to surgical or pharmacological treatment, n=82 controls made up of university staff and student volunteers. Endometriosis diagnosed by laparoscopy or laparotomy. Age endometriosis group M=33.85 (SD=1.04) controls M=30.9 (SD=0.92). | PSQ stress score higher for women with constant versus intermittent pain, pain intensity did not differ between groups. | Mental health conditions such as anxiety and depression can influence salivary cortisol. Antidepressants can be used to manage CPP in women and may influence cortisol concentrations. Participants had different levels of endometriosis. Did not consider many confounding variables. |
| Spinhoven et al.57 | Women with CPP recruited from gynaecology departments of two academic hospitals in the Netherlands. Cohort study, correlational design. CPP sample was one of four samples in this study. SDQ-20 and self-report measures. | n=52 women who had CPP for over six months. Age M= 37.8 (SD=9.7) years. | Positive association between self-reported physical abuse and SDQ-20 scores for somatoform dissociation remained after general psychopathy removed as a mediating factor. Suggested considering dissociation in physical abuse history. | Physical abuse was self-reported. |
| Toomey et al.55 | Women with CPP from a hospital based CPP clinic in North Carolina. Between groups design. Abuse history questionnaire, MPQ, MPI, FIS, SLC-90 measures. | n=36 women with CPP, n=19 reported abuse history, n=17 reported no abuse history. VAS pain M=4.91 (SD=5.95), age M=30.31 (SD=9.56) years. | 19/36 participants reported prior abuse. Abuse group reported less perceived control, greater punishing responses to pain, high somatization, higher global distress in comparison to non-abuse group. | t-test only for statistical analyses and no consideration of potential confounding. |
| Vannuccini et al.49 | Italian sample of women with endometriosis. Observational cross-sectional design. PHQ measure. | Women with endometriosis n=134. Age M= 34.8 (SD=6.3) years, BMI M=22.0 (SD=3.7). | Having a mental health condition was highly correlated with pain symptoms. Pain positively correlated with incidence of multiple psychiatric disorders, pain and somatoform disorders were positively correlated. | Chronic pain often diagnosed as somatoform disorder hence high association pain and somatoform disorder diagnoses. Response rate 89.3%. |
| Weijenborg et al.50 | Women with CPP who attended gynaecology outpatient clinic at Leiden University in the Netherlands, between July 2001-January 2006. Retrospective cohort study. Intervention was hospital team treatment. Rand-36, HADS. PCCL, McGill VAS on MPQ Dutch version. | n=84 women with CPP completed pre and post measures. Age M= 40.2 (SD=11.3) years. | Reduction in pain intensity and catastrophizing, as well as improvements to depressive symptoms and SF-36 physical scores at follow up in comparison to baseline. Baseline PCCL internal pain control subscale score was associated in changes in depression scores and baseline pain intensity. PCCL catastrophizing and internal pain control subscales were negatively correlated. | 64% response rate that completed baseline and follow up measures. Correlation analyses. |
Abbreviations: BAI, Beck Anxiety Inventory; BDI, Beck Depression Inventory; CPP, chronic pelvic pain; COPE, Brief Coping Orientation to Problems Experienced; EHP-30, Endometriosis Health Profile 30- item; GRIS, Golombok-Rust Inventory of Sexual Satisfaction; HADS, Hospital Anxiety and Depression Scale; n, sample size; LISS, Lipps Stress Symptom Inventory for Adults; M Mean; SD, standard deviation, RCT, randomized control trial; RRS, Ruminative Response Scale; STAI, Speilberger State Trait Anxiety Index; VAS, Visual Analogue Scale; EPQ, Eysenck Personality Questionnaire; GHQ-30, General Health Questionnaire 30-item; GRIMS, Golombok-Rust Inventory of Marital State; MPQ-SF, Mcgill Pain Questionnaire- short form; MPQ, Mcgill Pain Questionnaire; PTSD, Post-Traumatic Stress Disorder; PTSD-FVIT, Post-Traumatic Stress Disorder Factorial Version Inventory; FCB-TI, Formal Characteristics of Behaviour Temperament Inventory; MSI, Multi-dimensional Self-esteem Inventory; PSQ, Perceived Stress Index; HRQOL, Health Related Quality of Life; SF-36, Short Form Survey 36-item; SDQ-20, Somatoform Dissociation Questionnaire; PHQ, Patient Health Questionnaire; PCCL, Pain Appraisal and Pain Coping Scale; GHQ-28, General Health Questionnaire 28-item; FIS; Functional Interference Scale; SCL-90, Symptom Checklist 90 item; HPA, Hypothalamic-Pituitary-Adrenal; TCI-R, Temperament and Character Inventory –Revised; SIP, Sickness Impact Profile; PANAS, Positive and Negative Affect Schedule; AEQ, Achievement Emotions Questionnaire; CSQ, Client Satisfaction Questionnaire; PCOS, Polycystic Ovary Syndrome.