Abstract
BACKGROUND: Endometriosis affects approximately 10% of reproductive-age women and is frequently associated with chronic pelvic pain. Patients with endometriosis often experience comorbid depression and anxiety, but the underlying mechanisms connecting these conditions are unclear. AIM: To assess the prevalence of depression and anxiety in endometriosis patients and explore neuroimmune mechanisms mediated via inflammatory biomarkers. METHODS: A retrospective cohort study was conducted with 200 patients with endometriosis-associated chronic pain from June 2020 to December 2024. Depression and anxiety were assessed using validated psychological instruments. Inflammation biomarkers interleukin (ILs) (IL-6, IL-1β), tumor necrosis factor-alpha, C-reactive protein, and brain-derived neurotrophic factor were measured in serum. Pain severity was assessed using visual analog scales. Correlation and regression analyses were performed to examine relationships between inflammatory markers, pain severity, and psychological outcomes. RESULTS: Among the 200 patients, 42.5% exhibited clinically significant depression and 51.0% showed anxiety symptoms. Serum levels of IL-6, IL-1β, tumor necrosis factor-alpha, and C-reactive protein were significantly higher in patients with comorbid depression and anxiety compared with those without psychological symptoms (P < 0.001). Brain-derived neurotrophic factor levels were lower in the depression group. Pain severity positively correlated with inflammatory marker levels and with depression and anxiety scores. CONCLUSION: Overall, the findings suggest that inflammatory factors mediate a neuroimmune mechanism linking endometriosis-associated chronic pain with depression and anxiety. Therapeutic targets for managing psychological comorbidities in patients with endometriosis through anti-inflammatory interventions should be explored, and an integrated treatment approach addressing both physical and psychological symptoms is emphasized.