Abstract
BACKGROUND: Infertility is a common problem for patients with polycystic ovary syndrome (PCOS), which is closely related to stress and raises the risk of depression, while psychological resilience has been revealed to be protective for mental health. However, the associations of fertility stress, psychological resilience, and depressive symptoms in individuals with PCOS are not thoroughly explored. Our study aims to examine the associations of fertility stress and psychological resilience with depressive symptoms among patients with PCOS, as well as the mediating role of psychological resilience. METHODS: A cross-sectional study was conducted in a reproductive clinic. The participants completed structured questionnaires on fertility stress (Fertility Problem Inventory (FPI)), psychological resilience (10-Item Connor-Davidson Resilience Scale (CD-RISC 10)), and depressive symptoms (Beck Depression Inventory-II (BDI-II)). Hierarchical regression was utilized to explore the relationship between fertility stress, psychological resilience, and depressive symptoms in PCOS patients after controlling for covariates. Psychological resilience was included in the final layer of the regression model to determine its potential mediating roles by comparing changes in the effect sizes between models. The percentage of mediating effect was then determined using structural equation modeling (SEM). RESULTS: A total of 192 women with PCOS were included. Of them, 50 (26%) presented depressive symptoms, 18% of which were severe. Hierarchical regression showed that after adjusting for sociodemographic and health-related characteristics, both fertility stress (β=0.361; p<0.001) and resilience (β=-0.453; p<0.001) were significantly correlated with depressive symptoms. SEM demonstrated that fertility stress was directly linked to depressive symptoms in women with PCOS (β=0.050; 95% CI (0.028, 0.084); p<0.001). Psychological resilience mediated 21.9% of the relationship between fertility stress and depressive symptoms (β=0.014; 95% CI (0.005, 0.034); p=0.001). CONCLUSION: This study demonstrated that among women with PCOS, fertility stress was, directly and indirectly through psychological resilience, associated with depressive symptoms. However, this study was cross-sectional, and the participants were recruited from a single clinical hospital. If replicated in longitudinal studies, the findings provide fertility stress and psychological resilience as potential intervention targets for better mental health in this population.