INTRODUCTION
Polycystic ovarian syndrome (PCOS
) is a common reproductive endocrine, metabolic disease in women of
childbearing age, which is characterized by increased androgen,
polycystic ovarian changes, irregular menstruation, obesity, hirsutism
and acne(Sidra et al., 2019; Teede et al., 2010). Increasing evidence
indicates that PCOS is associated with mood and psychiatric disorders. A
systematic review by Cooney et al.
(Cooney et al., 2017) that
included 18 studies reported a 36.6% prevalence of depressive symptoms
and a 41.9% prevalence of anxiety symptoms in PCOS women. Women with
PCOS tend to view body image negatively and have lower body
satisfaction(Kogure et al., 2019). Symptoms such as hirsutism, acne and
hair loss can cause negative perceptions of body image in women with
PCOS, mainly including dissatisfaction with their appearance, sexuality,
and sense of self, thus reducing their body image satisfaction and
negatively impacting their mental health(Becker et al., 2019; Neubronner
et al., 2021; Xing et al., 2022; Yin et al., 2022). Overall,
psychopathological disorders such as anxiety, depression and body image
distress are common in PCOS women and negatively impact their mental
health. Due to the importance of mental health, the guide recommends
evaluating and managing mental health among this group of women(H. J.
Teede et al., 2018).
Generally, psychological symptoms, such as anxiety and depressive
symptoms, are used to assess whether an individual is in optimal mental
health. However, several studies have shown that low scores on anxiety
and depression scales do not necessarily mean that individuals have
higher levels of well-being. Positive psychology believes that “mental
health is not simply the elimination of negative factors such as mental
illness but also the stimulation of well-being experience and positive
skills”(Seligman, 2008). The Dual-Factor Model of Mental Health (DFM)
suggests that mental health is not just the absence of mental illness or
a high level of well-being but that it should include both the lack of
mental illness and a high level of well-being (Clark & Malecki, 2022;
King et al., 2022). Therefore, according to the Dual-Factor model of
mental health, the population is divided into four categories : (1)
complete mental health ( low mental illness symptoms and high subjective
well-being ) ; (2) vulnerable ( people with low psychological symptoms
and low subjective well-being are prone to psychological problems in the
future) ; (3) symptomatic but content ( people with high mental illness
and high subjective well-being have strong psychological self-healing
ability, and psychological problems often heal themselves ; (4) Troubled
( people with high mental illness and low subjective well-being will
show not only psychopathological symptoms but also have a poor
psychosocial function )(Doll, 2008; Suldo & Shaffer, 2008). From the
perspective of the DFM for mental health, well-being and psychopathology
may be considered separate indicators of complete mental health. Someone
may exhibit severe symptoms of psychopathology yet also demonstrate high
subjective well-being. As far as research is known, psychopathological
symptoms such as anxiety, depression, and body image distress are
prevalent in women with PCOS and have become significant barriers to
affecting the complete mental health of women with PCOS(Cooney et al.,
2017; Kogure et al., 2019). Understanding how anxiety, depression,
body-image distress, and well-being are related has important
conceptual, theoretical, and practical implications for women with PCOS.
Although several researchers have studied the perceived mental health of
women with PCOS(Çetinkaya Altuntaş et al., 2022; Joshi et al., 2022),
most studies are variable-centred analysis, which means that they assume
that individuals usually experience the same pattern of anxiety,
depression, body image distress and subjective well-being. However,
there may be differences in patients’ mental health not only at the
individual level but also at the group level, which means that patients’
mental health is heterogeneous. In the present study, we adopted a
powerful method to classify subgroups based on latent mixture modelling
to evaluate latent mental health profiles in a sample of women with PCOS
through a latent profile analysis (LPA). We begin by defining the
critical indicators used in the present study, including
psychopathological symptoms (anxiety, depression, body image distress)
and subjective well-being.
Specifically, it is crucial to identify the factors for women with PCOS
in different subgroups and develop interventions to promote coping
skills for those with high psychopathological symptoms (anxiety,
depression, and body image distress) or low subjective well-being. An
essential concept in understanding psychopathological disorders, emotion
regulation is a goal-oriented process of monitoring, evaluating and
regulating the generation and expression of emotions by perceiving
internal and external environmental changes(Eisenberg & Spinrad, 2004;
Song et al., 2022). The ability to effectively regulate negative
emotions plays a crucial role in mental health, social functioning, and
overall well-being(van Middendorp et al., 2005). Conversely, failure in
emotion regulation is thought to increase the risk of later
internalizing psychopathology, including depression and anxiety
disorders. (Yan et al., 2018). Cognitive reappraisal and expression
suppression are the most widely used emotion regulation strategies in
regulating negative emotions (Gross & Jazaieri, 2014). Cognitive
reappraisal is the most adaptive adjustment strategy, which positively
changes the emotional experience. However, expression inhibition is
usually considered a maladaptive adjustment strategy after the emotion
is generated, related to the reduction of positive emotion, the decrease
of life satisfaction and the more serious negative emotion(Aldao et al.,
2010). However, the relationship between two types of emotion regulation
styles (cognitive reappraisal and expressive suppression) and mental
health is unknown in PCOS women. A further key aim of this study is to
elucidate the association between mental health and emotion regulation
strategies within established mental health latent profiles based on the
Dual-Factor Model.
Social support is defined as the physical, cognitive and emotional
support that individuals in society use social network relationships to
get(Gottlieb & Bergen, 2010). Social support considerably impacts
physical and mental health and has been identified as an important
protective factor against negative emotional states(Guo et al., 2022; Yu
et al., 2020). Studies have consistently shown that social support can
help individuals reduce the impact of stressors on themselves and play
an essential role in regulating individual mental health(Al-Dwaikat et
al., 2022; Ning et al., 2022; Sufredini et al., 2022; Yu et al., 2020).
Additionally, studies reported that when a woman receives positive
social support from her family, her body image perception improves (Liu
et al., 2021). Studies also reported that social support was associated
with greater subjective well-being and life satisfaction(Brajša-Žganec
et al., 2018; C. Liu et al., 2022). However, it remains unclear whether
social support has protective effects on PCOS women. Therefore, another
purpose of the current study is to evaluate the relationship between
social support and different mental health latent profiles in women with
PCOS.
This study had the following aims. First, we sought to identify latent
subgroups of PCOS females based on their psychopathological symptoms
(anxiety, depression, and body image distress) and subjective well-being
through a dual-factor approach using LPA. Second, we aimed to analyze
and understand the characteristics of different mental health subgroups
and examined differences in emotion regulation strategy and social
support among the extracted profiles. Finally, we tried to identify
predictors of mental health profiles in PCOS women through multinomial
logistic regression. We hope this study will contribute to the
understanding of the complete mental health of PCOS women and provide
the rationale to design appropriate measures to reduce anxiety,
depression, and body image distress in PCOS women with the ultimate aim
of improving their subjective well-being.