2. Depression in Adolescent and Adult Women with Endometriosis

Background Endometriosis is associated with pelvic pain, which increases the risk of depression. While endometriosis-related symptoms often develop in adolescence, little is known about psychiatric comorbidities in this age group. This study compared the prevalence of depression in adolescents and adults with endometriosis, and examined factors that may be associated with depression in affected women, including pain interference, history of mood disorders, and duration of disease relative to age. Methods Adolescents (n = 17, age ≤21 y) and adults (n = 33) with surgically confirmed endometriosis and chronic pelvic pain (self-reported pain ≥3/0-10 scale, ≥14 days/month) despite hormonal medication use were recruited for an interventional trial. At baseline, participants completed questionnaires on health history and medication use. Fraction of life with endometriosis was calculated as duration of disease relative to age. The Beck Depression Inventory-II (BDI) was used to assess depression symptoms. Interference of pain with daily life was measured with the Brief Pain Inventory Interference scale (BPI), and physical activity limitations measured by the Functional Disability Inventory (FDI). Both univariate and multivariate models were used for analyses. The study was approved by our local IRB. Results Table 1 summarizes participant demographic and clinical characteristics. Median BDI score was higher, but not statistically different, in adolescents (median = 10 [Interquartile Range (IQR) = 14.8]) compared to adults (median = 6 [IQR = 9.0], p = 0.17). When the two groups were analyzed separately, adolescents who lived with endometriosis for a longer time (median = 13.3% of their life) had a statistically higher BDI score (β = 0.18, confidence interval (CI): [1.05, 9.61], p = 0.02), whereas this association was non-significant in adults (median = 9.4% of their life; p = 0.72). In the entire cohort, pre-existing mood disorder diagnosis was correlated with higher BDI scores (β = 5.33, (CI): [1.39 10.0], p = 0.02). Pain interference was also positively correlated with BDI scores (β = 2.04, CI: [1.22, 2.86], p < 0.01), as was FDI (β = 0.36, CI: [0.19, 0.53], p < 0.01). Conclusions In this cohort, we did not observe higher BDI scores in adolescents compared to adults. However, we observed a positive association between the duration of time that adolescents lived with endometriosis diagnosis and BDI scores. Those with a longer percent time lived with endometriosis had worse depression scores. This latter finding may be of interest to clinicians given that this association was not observed among adults. Further research is warranted to also explore the impact of pain on our findings.