DISCUSSION
This study aimed to identify latent mental health profiles among women with PCOS. Based on the DFM of mental health and positive psychology perspective, this study conceptualized psychopathology indices (anxiety, depression, and body image distress) and subjective well-being as mental health totality in women with PCOS. A latent profile analysis identified three distinct mental health profiles within women with PCOS: Symptomatic but Content Profile, Complete Mental Health Profile and Troubled Profile, with group proportions of 52.3%, 35.7%, and 11.1 %, respectively. In addition, the mental health latent profiles were further examined in their relationships with the emotion regulation strategies, social support, and demographic and anthropometric data. Compared to the Complete Mental Health profile, the Symptomatic but Content Profile and Troubled profile were associated with social support, cognitive reappraisal, expressive suppression, and acne.
As far as we know, the present study describes for the first time a comprehensive mental health latent profile (anxiety, depression, body image distress, and subjective well-being) of PCOS women based on the DFM of mental health and positive psychology perspective. In this study, according to DFM, three (Complete Mental Health, Symptomatic but Content, and Troubled) of the four assumed mental health profiles appeared in PCOS women. A vulnerable profile (people with low psychological symptoms and low subjective well-being are prone to psychological problems in the future) was not found. The possible reasons for this are described below. Specifically, the need for fertility may be a watershed in women’s mental health with PCOS. First, without the need to have children, most women with PCOS showed good mental health, with only a portion of PCOS women showing symptoms of anxiety and depression due to menstrual disorders, obesity, and acne, and general well-being was not compromised(Bazarganipour et al., 2013; Joshi et al., 2022). Second, when women with PCOS want children, parental urgency, stigma, work stress, and repeated hospital visits may lead to high anxiety and depression symptoms and significantly lower subjective well-being(Dybciak et al., 2022; Ee et al., 2020).
The current study labelled three nonparallel mental health latent profiles: Symptomatic but Content Profile, Complete Mental Health Profile, and Troubled Profile. The proportions of the three profiles were 52.3%, 35.7%, and 11.1 %, respectively. Our results indicated that mental health problems (anxiety and depressive symptoms, body image distress, and decreased subjective well-being) were widespread and prevalent in PCOS women, supporting previous results of a high prevalence of psychopathology and poor quality of life in PCOS women (Bahadori et al., 2022; Xing et al., 2022; Yin et al., 2022). On the one hand, 52.3% of women with PCOS were classified as Symptomatic but Content profile, in that they exhibited significant mental illness symptoms (anxiety and depression) yet still reported relatively high subjective well-being. On the other hand, the Troubled profile of women with PCOS included 11.1% of the sample. These PCOS women may have the worst mental health status, characterized by clinically significant symptoms of anxiety and depression, body image distress, and poorly perceived well-being. The existence of three unique mental health profiles indicates that subjective well-being is not simply an illness without psychopathology and that psychopathology and subjective well-being coexist in women with PCOS. The LPA method used in this study offers an important new strategy for the early identification of mental health problems of PCOS women in general and the identification and classification of psychopathology (anxiety, depression, and body image distress) and subjective well-being. And these results may help to develop tailored intervention strategies for reducing mental health distress in different profiles of PCOS women. Specifically, transdiagnostic interventions should be designed to address the coexisting psychopathology of anxiety and depressive symptoms and body image distress and improve subjective well-being in women with PCOS.
Another noticeable finding in this study was that having acne was a significant antecedent predictor of membership classification between the Complete Mental Health profile and Symptomatic but Content profile. Previous studies revealed that acne was significantly associated with an increased risk for anxiety and depressive symptoms(Kocak & Ugurlu, 2022). As shown by Ekramzadeh et al.(Ekramzadeh et al., 2020), most PCOS women (90%) considered acne as one of the leading causes of fear, sadness, reduced self-confidence, and loss their physical attractiveness. In this sense, early diagnosis and timely assessment of the severity of acne are essential in women with PCOS. However, inconsistent with previous studies(Wang et al., 2021; Yin et al., 2022; Zachurzok et al., 2021), we did not find direct relationships between overweight or obesity and mental health in women with PCOS. The different findings may be due to the insufficient number leading to the bias. Because in this study, lean PCOS women (BMI<25) account for the vast majority of this study sample (75.10%), with less than one-third (24.90%) was obese/overweight PCOS women(BMI≥25). Therefore, more large-sample, high-quality prospective studies are needed to further confirm these preliminary findings.
The current study also explored the differences between three mental health profiles regarding cognitive reappraisal, expression suppression, and social support. Importantly, we assessed and revealed cognitive reappraisal and social support as indicators of positive adjustment and expression suppression as an indicator of negative barriers in women with PCOS. Specifically, women with PCOS belonging to the Complete Mental Health profile showed lower expressive suppression and higher social support than PCOS women in the Symptomatic but Content profile and Troubled profile. Indeed, compared to the Complete Mental Health profile, women with PCOS in the Symptomatic but Content profile and Troubled profile both experienced significant mental illness symptoms, including anxiety symptoms, depressive symptoms and body image distress. Expression inhibition is at the stage of emotional response adjustment, that is, after the physiological mechanisms of emotion have been activated; therefore, expression inhibition refers to the behaviour of individuals who consciously inhibit their emotional expression when emotions are aroused(Bebko et al., 2011; Lambert, 2007). Generally, expression suppression as a maladaptive strategy typically hurts an individual’s physical and mental health and leads to unhealthy psychological states such as anxiety and depression (Eftekhari et al., 2009; Tyra et al., 2021). Therefore, we believe that increasing the utilization of expressive suppression may be a significant predictor of poorer psychopathological symptoms (anxiety, depression, and body image disturbance) and subjective well-being. This further emphasizes the importance of reducing expression suppression as an emotion regulation strategy for coping with mental health problems such as anxiety and depression induced by PCOS. Social support refers to the moral and material support and assistance provided to individuals at all levels of society and family and is an essential part of social psychology(Finfgeld-Connett, 2005). Social support could promote self-protection, alleviate individual mental health problems (e.g., anxiety and depression), and increase an individual’s subjective well-being (Al-Dwaikat et al., 2022; Ozbay et al., 2007; Shumaker & Brownell, 1984). Although social support has been shown in other populations to help reduce anxiety, and depressive symptoms, manage emotions, promote positive body image cognition, and improve well-being (Al-Dwaikat et al., 2022; Bi & Wang, 2022; Faraci & Bottaro, 2022; Y. Liu et al., 2022), there are few studies in women with PCOS. This study revealed that women with PCOS in the Complete Mental Health profile received more social support and had significantly more significant mental health status than the other two. From this perspective, how strengthening emotional and social support may be an essential direction to help women with PCOS improve their mental health in the future.
Finally, we found that when the Complete Mental Health profile was served as the reference group, PCOS women in the Troubled profile had a low level of cognitive reappraisal. PCOS women in the Complete Mental Health profile applied more cognitive reappraisal to regulate their emotions. As a regulation strategy focusing on antecedents, cognitive reappraisal is often an effort to regulate emotional experiences before they arise and change one’s perception of things (Koval et al., 2015; Lazarus & Alfert, 1964). As an adaptive emotion regulation strategy, cognitive reappraisal has been shown to offer protection against the development of psychopathologies(Brown et al., 2022; Liang et al., 2022; Su et al., 2022). Thus, when faced with stressors from PCOS, cognitive reappraisal may enable women with PCOS to reconstruct these situations in a way that successfully alters the emotional experience, increasing self-efficacy in stress reduction and stress relief as well as further reducing anxiety and depressive symptoms, body image distress, and further improving subjective well-being by reinterpreting emotional events.