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.