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.