Data collection
Demographic variables included age, marital status, educational level, BMI, hirsutism, and acne. Body Mass Index (BMI) was calculated as the weight ratio in kilograms to the square height in meters (kg/m2). According to the Chinese Body Mass Index (BMI) standard consensus statement, patients were divided into normal weight (BMI< 25) and overweight/obesity (BMI≥ 25). Clinical assessment of hirsutism was determined by physicians using the Ferriman-Gallwey scoring (FGs) system to grade nine body parts from 0 (no hirsutism) to 4 (severe hirsutism). The total score ranges from 0 to 36, with five or more considered positive for hirsutism in China.
Generalized Anxiety Disorder-7 (GAD-7) is an instrument for screening and assessing the severity of generalized anxiety developed by Spitzer et al. in 2006(Spitzer et al., 2006). The GAD-7 scale consists of 7 entries and can assess the severity of anxiety in the last two weeks. The scale is scored 0-3 depending on the frequency of anxiety symptoms, with a total score of 0-21, where 0-4 is no anxiety, 5-9 is mild anxiety, 10-14 is moderate anxiety, and 15 or more is severe anxiety. Patients with a total score of greater than or equal to 5 on the GAD-7 are usually considered to have a generalized anxiety disorder(Löwe et al., 2008). The Cronbach’s alpha coefficient for the GAD-7 in this study was 0.92.
The Patient Health Questionnaire 9 (PHQ-9) was developed by Kroenke et al. (Kroenke et al., 2001)to assess depressive symptoms based on the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The scale consists of 9 items, each of which takes a Likert-4 scale to assess participants’ depressive symptoms in the past two weeks, with the total score representing the severity of depression, classified as minimal (0-4), mild (5-9), moderate (10-14), and moderate-severe/severe depressive symptoms (≥15). This study used a score greater than or equal to 5 as the cut-off for positive depressive symptoms. In this study, Cronbach’s coefficient of the scale was 0.84.
The Body Image States Scale (BISS) was developed by Cash et al. in 2002 (Cash et al., 2002) and was used to measure satisfaction with body image. There are six items in the questionnaire, using Likert’s 9-point scoring method, of which 1, 3, and 5 adopt positive scoring; items 2,4 and 6 were scored in reverse. The higher the BISS score, the more positive the body image. A lower total score means more severe body image distress. The internal consistency was considered good(Cronbach alpha=0.77) (Cash et al., 2002). In this study, Cronbach’s coefficient of the scale was 0.84.
Subjective well-being was measured by the Index of Well-Being scale (IWB) was used in this study to measure the level of subjective well-being in women with PCOS. The scale was developed by Campbell(Campbell et al., 1976). It contained two subscales, the overall effective index and the life satisfaction scale, with eight entries for the overall well-being index and one for the life satisfaction scale. The scale is scored on a Likert7 scale, and the total score is the sum of the mean score of the overall affective index scale and the score of the life satisfaction scale (weighted at 1.1). The total score ranges from 2.1 to 14.7, and higher scores indicate an increased sense of well-being. The scale has good internal consistency, and Cronbach’s alpha coefficient for this scale in this study was 0.95.
The Emotion Regulation Questionnaire (ERQ) was developed by Professor Cross(Gross, 2013) of Stanford University based on the Process Model of Emotion Regulation. The scale contains ten items, divided into two dimensions: cognitive reappraisal and expressive inhibition, with six items for cognitive reappraisal and four for expressive inhibition. Each item was rated on a Likert scale of 1-7, with one representing ”completely disagree” and seven representing ”completely agree”. The frequency of use of the emotion regulation strategy was positively correlated with the score. The internal consistency coefficient of the cognitive reappraisal dimension in this study was 0.78, and the internal consistency coefficient of the expressive suppression dimension was 0.80.
The Multidimensional Scale of Perceived Social Support (MSPSS) scale(Zimet et al., 1990), which contains 12 entries divided into three dimensions: family support, friend support, and other support, was used in this study to assess the degree of support perceived by women with PCOS for various social supports. The scale assesses each item using a 7-point Likert scale from 1 (strongly disagree) to 7 (strongly agree), with a total score ranging from 12 to 84. The total score indicates the full degree of social support felt by the individual, with higher scores indicating better perceived social support. In this study, Cronbach’s alpha for this scale was good at 0.94.