Indian Journal of Health Social Work
(UGC Care List Journal)
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PSYCHO-SOCIAL EXPERIENCES OF ADOLESCENT GIRLS WITH
POLYCYSTIC OVARY SYNDROME: A QUALITATIVE STUDY
Iqra Nazir1 & Aadil Bashir2
1Research Scholar, Department of Social Work, University of Kashmir, Srinagar, 2Associate
Professor, Department of Social Work, University of Kashmir, Srinagar
Correspondence: Iqra Nazir, e-mail: naziriqra128@gmail.com
ABSTRACT
Background: Polycystic Ovary Syndrome (PCOS) is prevalent among women of reproductive
age, featuring psychological and physical challenges. Its global impact on adolescents is
concerning, notably its link to depression. Our study delves into PCOS’s psycho-social effects to
uncover its lasting implications. Aim: To enquire about and comprehend the social and
psychological experiences of adolescent girls, as well as their family support and socioeconomic
aspects in Kashmir. Methods and Materials: This study used a qualitative research design,
focusing on participants from a local hospital. We used non-probability purposive sampling and
conducted semi-structured interviews for data collection. A qualitative thematic approach was
used to derive themes from the data to provide a broader, more comprehensive analysis of the
entire body of data. Results: The study uncovered high rates of anxiety, depression, obesity,
hirsutism, and sleep disorders, especially anxiety disorders. This points to a lack of awareness
among participants and their parents, which is a serious issue. The findings suggest that some
awareness programs need to be developed, and if possible, a separate section in the hospital
should be developed for these patients to provide them with full assistance promptly. Conclusion:
Psychosocial problems are increasing among adolescent girls with PCOS in Kashmir due to a lack
of awareness. The study suggests creating awareness programs and dedicated sections for
timely assistance to address these issues. It is therefore necessary to develop an effective solution
to lessen the long-term health issues linked to PCOS in adolescents.
Keywords: Adolescence, Kashmir, Polycystic ovary syndrome, Qualitative research.
INTRODUCTION
Polycystic ovary syndrome (PCOS) is a
common reproductive endocrine disorder that
affects 5-10% of reproductive-age women
(Knochenhauer ES, 1998). The classic
symptoms of polycystic ovary syndrome
include irregular menstruation, biochemical or
clinical hyperandrogenism, and ultrasound
evidence of polycystic ovaries (Wild RA,
2010). Any woman who displays at least two
of the following three symptoms can be
diagnosed with PCOS, according to the
Rotterdam criteria, which is the one that is
most frequently used. An ultrasound
examination may identify ovarian cysts, ovulation
failure,
biochemical
hyperandrogenism, or hyperandrogenaemia
(Dybciak P, 2022). PCOS increases the risk
of infertility, preeclampsia, early pregnancy
loss, and endometrial cancer in women.
Furthermore, since PCOS is linked to insulin
resistance, evidence suggests that women
with PCOS are more likely to develop type 2
diabetes, dyslipidemia, hypertension, and
heart disease (Bashir, 2020). The cysts are
not harmful, but they do cause hormonal
i mbalances (Watson, 2019). Obesity,
insufficient physical activity, and a family
history of the condition are risk factors. Many
observations may be temporary during this
pubertal transition since various traits may be
changing. Later, during adolescence, many
findings may stabilize (Bashir, 2020). Early
diagnosis and treatment can aid in symptom
control and prevent long-term consequences.
Changes in behavior and lifestyle are part of
PCOS treatment (Gupta, 2018). Many groups
have developed diagnostic standards for this
illness. The National Institutes of Health (NIH)
created the NIH criteria, the American Society
of Reproductive Medicine created the
Rotterdam criteria, and the Androgen Excess
and Polycystic Ovary Syndrome Society
created the AES criteria (AE-PCOS) (Naz MS,
2019). Women who have PCOS are more likely
to experience psychological issues. Studies
conducted in the past have revealed that
PCOS patients have a greater prevalence of
psychiatric diseases, notably mood disorders
(Rasgon NL, 2003). The increased risk of
depression among PCOS-affected women
supports earlier studies. (Rassi A, 2010)
revealed that 26.4% of PCOS patients had
significant depression, and (Hollinrake E,
2007) found that 21% of PCOS patients and
3% of controls had depression. whereas,
(Månsson M, 2008) and (Kerchner A, 2009)
revealed that, correspondingly, 45% and 40%
of PCOS patients had depression. This
variance in depression prevalence between
studies can be attributed to a variety of
screening and diagnosis techniques and
i nstruments, the impact of culture on
depression epidemiology, and ultimately, the
usage of medications like oestrogen (Hussain
A, 2015). (Sadeeqa S, 2018)Conducted
extensive research on PCOS-related mental
stress, indicating that the symptoms of PCOS
most commonly affecting patients include
i ncreased androgen levels, menstrual
disturbances, infertility, obesity, hirsutism, or
alopecia, but behavioral scientists are now
observing significant levels of mental stress
in PCOS patients, particularly among young
girls. This could be because young girls are
more concerned with their physiology and
physical health during adolescence. (Gupta,
2018) This syndrome is a growing concern
among adolescents worldwide, with varying
reports of its prevalence in different parts of
the world. Reports on the prevalence of PCOS
in adolescents are rare. (Joshi B, 2014) In an
Indian study, the prevalence of this syndrome
in 15-19-year-old adolescents was 22.6%
based on the Rotterdam criteria and 9.8%
based on the AE-PCOS criteria. Another study
on adolescents aged 17 to 19 in Thailand
found 5.29% had this syndrome (Kaewnin J,
2018). According to studies conducted in Iran,
the prevalence rate ranges from 8.3% to
11.4% (Asgharnia M, 2011). Studies show
that between 5% and 10% of the general
population worldwide has PCOS (Azziz R,
2004). Depressive symptoms are common in
PCOS patients, especially in young girls, and
are present in about 40% of reproductive-age
women (Kerchner A, 2009). It was found that
4% of people in the southwest of the United
States have PCOS. The incidence was 9.13%
among adolescent Indians (Nidhi R, 2011).
According to the National Institute of Health,
the prevalence of PCOS in adult reproductive
aged women worldwide has increased from
6.5% to 6.8% (Asunción M, 2000). Tabassum
K conducted a study in a hospital in Bangalore and discovered that 10% of women had PCOS.
She also reported a 4.8% prevalence of PCOS
in the 15-24, year age group (Hussain A,
2015). The prevalence of PCOS was reported
to be 22.5% in a study conducted by (Joshi B,
2014) among adolescents and young girls in
Mumbai, India. The prevalence of PCOS in
adolescents was found to be 9.13% in a
residential college in Andhra Pradesh, South
India (Hussain A, 2015). In North India, (Gill
H, 2012) found a prevalence of 3.7% in the
age group of 18-25 years. Adolescent females
with PCOS have more emotional stress and
depression due to obesity, which is the
condition’s primary defining characteristic
(Ibáñez L, 2009). The mechanisms underlying
the relationship between PCOS and anxiety
and depression disorders are unknown
(Dybciak P, 2022). They can be the result of
hormonal changes, PCOS symptoms, or a mix
of the two. New therapy modalities may result
from a better understanding of the risk of
mood problems in women with PCOS.
Therefore, in 2018, the Androgen Excess
Polycystic Ovary Syndrome Society published
a call to action declaring mental health as a
priority for PCOS research (Dokras, et al.,
2018). Natural maturation characteristics
overlap with PCOS signs and symptoms in
adolescent girls (Naz MS, 2019). The condition
is defined by three different sets of diagnostic
criteria in adult women, although their
applicability to adolescents is debatable
(Merino PM, 2018). To the best of our
knowledge, data on PCOS in Kashmir is limited
to a few studies. In 2017, a study found that
the age group 15-24 years had the highest
prevalence of PCOS, i.e., 5.0% (Bashir, 2020).
The researcher team believes that this study
i s necessary because the causes and
consequences of PCOS have previously been
discussed in many studies, but the impact of
the problem on the psycho-social health of
women, particularly adolescent girls, their
experiences, and outcomes has yet to be
investigated, so this study was conducted to
fill that gap.
METHODS AND MATERIALS
Universe and Sampling
The research was carried out at Srinagar’s
territory hospital, central to the Kashmir
division. It’s a sub-district facility in Hazratbal,
Srinagar. The sample comprised ten
participants from the Srinagar district, chosen
via Non-Probability Purposive sampling.
Identification and contact with respondents
The researcher obtained permission from the
hospital’s higher authority to collect data and
interact with participants during check-ups and
t reatments. With the hospital’s open
participant flow, interviews were conducted
with the doctors’ consent.
Research setting and participants
The researcher focused on adolescent girls’
social and psychological experiences, family
support, and socioeconomic aspects. A
qualitative thematic approach (Braun, 2006)
was used to derive themes for detailed
analysis and comparative data assessment,
aiming for rich descriptions.
Tool preparation and data collection
While preparing the tool, the Research team
visited the hospital to understand the setting
and participant availability. Developed semi
structured interview guides based on
l iterature and expertise. Utilized prior
experience from visits to other hospitals.
Designed a background questionnaire.
Conducted interviews with 10 adolescents,
ages 12-19, in Kashmiri and Urdu. Sessions
lasted 40-60 minutes with verbal consent.
Recorded interviews and maintained a memo
book for notes. Communication of the
recording process was prior to the interviews.
Data management and the Process of analysis
The conducted interviews (in Kashmiri and
Urdu) were transcribed and translated by the
first author, fluent in Kashmiri, Urdu, and
English. Verbatim representation with emotional indicators was prioritized, including
i nterruptions, pauses, intonation, and
simultaneous talk.
Analysis of data
We used thematic analysis to identify,
organize, and draw patterns in the data
(Braun, 2006). The analysis of the transcripts
began as an iterative process carried out by
the AUR. The authors closely read and reread
the transcripts to become acquainted with the
data, and preliminary notes of the important
points were taken from the process. After the
first few interviews, data coding began, and
a codebook was created. The first author
coded all of the interviews to generate as
many patterns as possible. Themes were
derived from the data, and emerging themes
were identified and organized with descriptive
categories and subthemes (JM, 2008). Using
an inductive approach, the data were further
analyzed for theme mapping and comparative
analysis within document groups. Since the
themes did not exactly correspond to the
words, the analysis was not only dependent
on an inductive framework (Banister P, 2011)
or “emerge,” rather, they were deliberately
created by the researchers and informed by
the literature as well as their own experience
and knowledge (Braun, 2006) (Williams,
2018).
Ethical Clearance
Ethical clearance was obtained from the Block
Medical Officer, SDH Habbak of Hazratbal
Srinagar. The research was conducted from
September 2022 to November 2022.
RESULTS
Socio-economic Profile
Table 1 displayed that all participants were
females aged 15 to 20, predominantly from
the BPL category (below the poverty line). The
BPL category refers to marginalized people
for whom the Government of India has
imposed an income limit. Most participants,
around 98%, fell into this category, with only
2% classified as APL (above the poverty line).
The table shows the participants’ family
income, which starts at 2000 and does not
exceed 10000. The participants’ educational
levels were found to be secondary and higher
secondary. Secondary education in India
serves as a bridge between elementary and
secondary education, preparing young people
aged 14 to 18 for entry into higher education.
Higher secondary schools typically have
classes from 11th to 12th grade, with
students ranging in age from 16 to 18 years.
Students can select their preferred stream
and subjects at this level of education. They
can major in the arts, business, or science
(medical & non-medical).
Key themes from interviews
I) Obesity and depression-related factors
As demonstrated by various investigators,
obesity, excessive body hair, infertility, and
changes in physical appearance all contribute
to psychosocial problems in PCOS patients
(Sadeeqa S, 2018). Adolescents with PCOS
experience extreme mental stress and
depression when embarrassing symptoms
such as hirsutism, obesity, and acne appear
during adolescence (McCook JG, 2005).
Obesity has been identified as the leading cause of depression and emotional stress in
PCOS adolescents (Moran LJ, 2009). Obesity
is the most common feature in PCOS patients,
increasing psychological strain and depression
in adolescent girls (Ibáñez L, 2009). Obesity
was identified as a major cause of depression
and anxiety in this study’s participants. And,
as the researchers interacted with the
participants, they shared their experiences
dealing with issues such as (anger, mood
swings, vulgar thoughts, High Blood Pressure,
low interest in work or studies, etc.). The data
revealed that obesity has a major effect on
these participants’ psychological health as well
as their social life, as these participants avoid
social gatherings and interacting with others
due to their physical changes. As a result, it
is possible to conclude that depression occurs
as a result of the obesity factor, which affects
both their psychological and social well-being.
One of the Participants added, “I started
noticing changes in my body as my
weight was increasing, and also my face
was full of pimples and hair. That was the
time I started worrying and consulted a
doctor.”
II) Social withdrawal
This high degree of sadness and anxiety in
PCOS patients may be brought on by several
variables, including a high BMI (body mass
index) and social demoralization, which, if
severe, can result in social disengagement
(Veldhuis JD, 2001). In this study, social
withdrawal has been found in these
participants as they describe their personal
experiences of isolating themselves due to the
severity of the sickness by staying away from
social settings, including schools, public
places, and other gatherings. Even some of
the participants admitted to having cut
themselves off from their relatives. One of the
only motives is embarrassment over bodily
changes, such as weight gain, acne, facial hair,
etc.
One of the Participants added, “Whenever
I see my face in the mirror, I find myself ugly
and fat, so I keep myself away from my
siblings, and most of the time I sit alone in
my room.”
Similarly, another Participant “I started
avoiding my friends and my family members
as I was scared of going out because of my
facial hair growth and lots of pimples.”
III) Uncertainty about infertility
Furthermore, patients with PCOS who have a high BMI factor, depression in the family, infertility in the family, sleep issues (Dantzer, 2001), and elements of depression include tiredness, followed by a loss of interest in routine tasks and changes in appetite (Sadeeqa S, 2018). Several studies have linked specific PCOS symptoms, such as infertility, hirsutism, and acne to decreased mental well-being (Hussain A, 2015). 50% of PCOS patients will actively seek infertility treatment at some point in their lives (Azziz R M. C., 2005). The current study found that PCOS patients face a variety of challenges, with the majority of them dealing with infertility issues, such as being unable to have children. Individuals with a history of PCOS frequently require extensive treatment to become pregnant. Girls reach sexual maturity during puberty, as is well known. As a result, when people discover they have PCOS, it becomes a frustrating time in their lives as they begin to consider the consequences of their illness. The researcher discovered that the fear of being unable to bear a child in the future has a large impact on the minds of these participants, causing chaos in their psychological and social lives.
Furthermore, patients with PCOS who have a high BMI factor, depression in the family, infertility in the family, sleep issues (Dantzer, 2001), and elements of depression include tiredness, followed by a loss of interest in routine tasks and changes in appetite (Sadeeqa S, 2018). Several studies have linked specific PCOS symptoms, such as infertility, hirsutism, and acne to decreased mental well-being (Hussain A, 2015). 50% of PCOS patients will actively seek infertility treatment at some point in their lives (Azziz R M. C., 2005). The current study found that PCOS patients face a variety of challenges, with the majority of them dealing with infertility issues, such as being unable to have children. Individuals with a history of PCOS frequently require extensive treatment to become pregnant. Girls reach sexual maturity during puberty, as is well known. As a result, when people discover they have PCOS, it becomes a frustrating time in their lives as they begin to consider the consequences of their illness. The researcher discovered that the fear of being unable to bear a child in the future has a large impact on the minds of these participants, causing chaos in their psychological and social lives.
One of the Participants added, “The
moment my doctor told me about my
disease (PCOS), I got stressed as I had no
awareness about the same before. By the time
I reached my home, I started crying, thinking that I won’t be able to conceive in the future.”
Another participant added, “My mother is
worried because she thinks I will be having
issues in my future, maybe I will never
conceive.”
IV) Cost of Medical Treatment
In this research study, it was revealed that
the patient’s cost of therapy can occasionally
be high because it often takes months or even
years for the disease to be cured. These
participants revealed during the interview
session that the cost of medicines sometimes
causes them to consider discontinuing their
treatment because the cost of medicines is
so high. They feel very sad because they
believe they are becoming a burden on their
parents. According to a reasonable estimate,
the annual financial cost of PCOS among
people aged 14 to 44 is over $4.37 billion. In
the treatment of the associated menstrual
dysfunction/AUB, 31% of the burden stems
from the treatment of hirsutism, 14% from
the treatment of hirsutism, and 12% is
attributable to the provision of infertility
treatments. Only around 2% of the estimated
economic burden associated with healthcare
was attributable to the costs of a single
diagnostic examination for each patient (Azziz
R M. C., 2005).
One of the participants added, “My father
is a laborer, and our family income is modest.
Since being diagnosed with PCOS, I have been
on medication that costs me between 1500
and 2000 per month, and I sometimes feel
sorry for my father because my medication
has become a significant burden on his
income.”
V) Sleeping disorder
The researchers found that girls with PCOS
struggle with sleep problems due to illness
related distress and despair. These issues
lead to stress and sleep disorders, including
lower sleep quality, increased snoring, and a
higher risk of obstructive sleep apnea. Women
with PCOS have lower subjective sleep quality,
snoring is more common, and they have a
greater chance of having obstructive sleep
apnea (Hachul H, 2019).
One of the Participants added, “My
menstrual cycle was delayed, and I got
worried why this was happening, so I
consulted a doctor, and she suggested
going for a USG, where I was diagnosed with
PCOS. I started feeling sleepless as the fear
was increasing with each passing day.”
VI) Immediate Reaction
Because it is fundamental to human nature
for every person to react to the same event
differently, the researchers found that
participants’ reactions to learning about their
illness varied. Many were unfamiliar with
PCOS before and had initial thoughts like,
“What is PCOS?”
One of the Participants added, “My mother
was present when my doctor informed me of
my PCOS condition, and the doctor helped us
comprehend what PCOS is, as well as its
causes and effects. Many unfavorable
thoughts began to emerge in my brain, and
by the time I knew about my disease, “I
started crying hopelessly.”
VII) Support systems
Participants mostly had strong family support,
especially from parents who took care of their
health and went with them to doctors. Some
also found support in extended family and
friends.Top of Form
One of the Participants added, “My family
is very loving and caring by nature, and after
learning that I had PCOS, my parents have
become even more loving and concerned. My
mother constantly reminds me that I must get
regular check-ups on certain days.”
VIII) Coping mechanism
Religious belief
Some participants disclosed that they
turned to religion and spirituality for comfort,
going so far as to start seeing God-men (Peer
Sahib) to treat their illnesses because religion
holds such a high place in our culture. They
felt a certain amount of relief since they
believe that there is nothing these God-men
cannot heal.
Resilience
After numerous visits, the researchers
discovered a case history of a woman who
had been 14 when she was first diagnosed
with PCOS; today, she is 28 years old, but
she has a long history of this particular illness.
She is married right now, but she is having a
lot of trouble becoming pregnant, and she is
really upset. In this situation, we may
conclude how crucial it is to raise the disease’s
awareness among every person in society,
especially adolescent girls.
IX) Quality of life
Barriers to treatment
Treatment for PCOS is accessible but often
costly due to its long duration. The study
suggests that hospitals should have dedicated
PCOS sections for easier access.
Stigma
PCOS causes concern due to its link to
infertility, leading to worry and sadness. In
some cases, doctors sometimes suggest early
marriage for future childbearing.
DISCUSSION
Our study’s main findings were high rates of
depression, anxiety, obesity, hirsutism, and
sleeping disorders. We discovered a high
prevalence of anxiety disorders, in particular.
One of the primary causes of social withdrawal
is obesity and hirsutism. The study revealed
how the cost of the medication makes the
treatment burdensome for these patients.
There is a stigma associated with infertility
of not being able to bear a child in the future,
which causes great distress in the minds of
these patients. Moreover, even though most
patients have strong family support, the
psychological burden prevents them from
remaining positive. It was also concluded that
many patients seek spiritual assistance to
overcome this disease. This study discovered
a high prevalence of anxiety disorders, in
particular. (Månsson M, 2008) Also, an
increased incidence of anxiety disorder was
discovered in women with PCOS. Similarly,
(Kerchner A, 2009) discovered that PCOS
patients had high levels of anxiety disorders.
Anxiety levels are understandable by
continuous worries about fertility loss, the loss
of one’s sexuality, and concern over the
possibility of never having children in future
can be used to explain why there is such a
high level of anxiety (Hussain A, 2015). As
revealed in the current study, these
participants are affected by thoughts of the
consequences of their condition, which
frustrates them at times and affects their
psychological and social well-being.
Adolescent girls with PCOS are prevalent in
Kashmir. As it was not possible for the
research team to include every case in the
study, the team discovered that adolescent
girls with PCOS are numerous, and further
research could be done in future studies.
Also, the study’s limitation was that this study
was conducted on a small number of
participants, so it can’t be generalized to the
whole population. The research team found
that more studies should be conducted to get
more relevant data. And not every girl in this
age group (12-19 years) has a proper
understanding of PCOS, so it was concluded
that special attention and care should be
provided to women with PCOS, particularly
adolescent girls, because they are young and
do not have a proper understanding of the
disease’s consequences.
Possible measures
The study highlights the importance of early
detection and counseling for PCOS in
adolescent girls and their families. Awareness
programs in schools and community health
centers are crucial for addressing the lack of
knowledge about PCOS.
CONCLUSION
The study discovered high rates of melancholy,
anxiety, obesity, hirsutism, and sleeping
difficulties among patients, with anxiety
disorders being most common. Obesity and
hirsutism contribute to social withdrawal, and
drug costs increase the burden of therapy.
Even individuals with great family support are
deeply distressed by the stigma of infertility.
Many sufferers seek spiritual assistance to
cope. The study’s shortcomings include a
limited sample size and a lack of thorough
understanding of PCOS among adolescent
females, emphasising the importance of
additional research and targeted education for
this group.
REFERENCES
Asgharnia, M., Mirblook, F., & Soltani, M. A.
(2011). The prevalence of polycystic
ovary syndrome (PCOS) in high school
students in Rasht in 2009 according
to NIH criteria. International journal of
fertility & sterility, 4(4), 156.
Asuncioìn, M., Calvo, R. M., San Millaìn, J. L.,
Sancho, J., Avila, S., & Escobar
Morreale, H. F. (2000). A prospective
study of the prevalence of the
polycystic ovary syndrome in
unselected Caucasian women from
Spain. The Journal of Clinical
Endocrinology & Metabolism, 85(7),
2434-2438.
Azziz, R., Marin, C., Hoq, L., Badamgarav, E.,
& Song, P. (2005). Health care-related
economic burden of the polycystic
ovary syndrome during the
reproductive life span. The Journal of
Clinical
Endocrinology
&
Metabolism, 90(8), 4650-4658.
Azziz, R., Woods, K. S., Reyna, R., Key, T. J.,
Knochenhauer, E. S., & Yildiz, B. O.
(2004). The prevalence and features
of the polycystic ovary syndrome in an
unselected population. The Journal of
Clinical
Endocrinology
&
Metabolism, 89(6), 2745-2749.
Banister, P., Bunn, G., Burman, E., Daniels, J.,
Duckett, P., Goodley, D., … & Whelan,
P. (2011). EBOOK: Qualitative Methods
In Psychology: A Research Guide.
McGraw-Hill Education (UK).
Bashir, R., Bashir, R., Kausar Sideeq, D. S.,
Khan, S., & Masoodi, M. (2020).
Prevalence of polycystic ovarian
syndrome in women of different age
groups in Hazratbal area of Srinagar
by ultrasonographic evaluation
hospital data based study. IJAR, 6(6),
292-295.
Braun, V., & Clarke, V. (2006). Using thematic
analysis in psychology. Qualitative
research in psychology, 3(2), 77-101.
Dantzer, R. (2001). Cytokine-induced sickness
behavior: where do we stand?. Brain,
behavior, and immunity, 15(1), 7-24.
Dokras, A., Stener-Victorin, E., Yildiz, B. O.,
Li, R., Ottey, S., Shah, D., … & Teede,
H. (2018). Androgen Excess-Polycystic
Ovary Syndrome Society: position
statement on depression, anxiety,
quality of life, and eating disorders in
polycystic ovary syndrome. Fertility
and sterility, 109(5), 888-899.
Dybciak, P., Humeniuk, E., Raczkiewicz, D.,
Krakowiak, J., Wdowiak, A., & Bojar,
I. (2022). Anxiety and Depression in
Women with Polycystic Ovary
Syndrome. Medicina, 58(7), 942.
Gill, H., Tiwari, P., & Dabadghao, P. (2012).
Prevalence of polycystic ovary
syndrome in young women from North India:
A
Community-based
study. Indian journal of endocrinology
and metabolism, 16(Suppl 2), S389.
Gupta, M., Singh, D., Toppo, M., Priya, A.,
Sethia, S., & Gupta, P. (2018). A cross
sectional study of polycystic ovarian
syndrome among young women in
Bhopal, Central India. Int J Community
Med Public Health, 5(1), 95-100.
Hachul, H., Polesel, D. N., Tock, L., Carneiro,
G., Pereira, A. Z., Zanella, M. T., … &
Togeiro, S. M. (2019). Sleep disorders
i n polycystic ovary syndrome:
i nfluence
of
obesity
and
hyperandrogenism. Revista da
Associação Médica Brasileira, 65,
375-383.
Hollinrake, E., Abreu, A., Maifeld, M., Van
Voorhis, B. J., & Dokras, A. (2007).
Increased risk of depressive disorders
i n women with polycystic ovary
syndrome. Fertility and sterility, 87(6),
1369-1376.
Hussain, A., Chandel, R. K., Ganie, M. A., Dar,
M. A., Rather, Y. H., Wani, Z. A., … &
Shah, M. S. (2015). Prevalence of
psychiatric disorders in patients with
a diagnosis of polycystic ovary
syndrome in Kashmir. Indian journal of
psychological medicine, 37(1), 66-70.
Ibáñez, L., Díaz, R., López-Bermejo, A., &
Marcos, M. V. (2009). Clinical
spectrum of premature pubarche:
links to metabolic syndrome and
ovarian hyperandrogenism. Reviews
i n
Endocrine and Metabolic
Disorders, 10, 63-76.
Joshi, B., Mukherjee, S., Patil, A., Purandare,
A., Chauhan, S., & Vaidya, R. (2014).
A cross-sectional study of polycystic
ovarian syndrome among adolescent
and young girls in Mumbai,
India. Indian journal of endocrinology
and metabolism, 18(3), 317.
Kaewnin, J., Vallibhakara, O., Arj-Ong
Vallibhakara, S., Wattanakrai, P.,
Butsripoom, B., Somsook, E., … &
Sophonsritsuk, A. (2018). Prevalence
of polycystic ovary syndrome in Thai
University adolescents. Gynecological
Endocrinology, 34(6), 476-480.
Kerchner, A., Lester, W., Stuart, S. P., &
Dokras, A. (2009). Risk of depression
and other mental health disorders in
women with polycystic ovary
syndrome:
a
l ongitudinal
study. Fertility and sterility, 91(1),
207-212.
Knochenhauer, E. S., Key, T. J., Kahsar-Miller,
M., Waggoner, W., Boots, L. R., &
Azziz, R. (1998). Prevalence of the
polycystic ovary syndrome in
unselected black and white women of
the southeastern United States: a
prospective study. The Journal of
Clinical
Endocrinology
&
Metabolism, 83(9), 3078-3082.
Månsson, M., Holte, J., Landin-Wilhelmsen, K.,
Dahlgren, E., Johansson, A., & Landén,
M. (2008). Women with polycystic
ovary syndrome are often depressed
or anxious—a case control
study. Psychoneuroendocrinology, 33(8),
1132-1138.
McCook, J. G., Reame, N. E., & Thatcher, S.
S. (2005). Health related quality of life
issues in women with polycystic ovary
syndrome. Journal of Obstetric,
Gynecologic,
&
Neonatal
Nursing, 34(1), 12-20.
Merino, P. M., Codner, E., & Cassorla, F.
(2011). A rational approach to the
diagnosis of polycystic ovarian
syndrome
during
adolescence. Arquivos Brasileiros de
Endocrinologia & Metabologia, 55,
590-598.
Moran, L. J., Pasquali, R., Teede, H. J., Hoeger,
K. M., & Norman, R. J. (2009).
Treatment of obesity in polycystic ovary syndrome: a position statement
of the Androgen Excess and Polycystic
Ovary Syndrome Society. Fertility and
sterility, 92(6), 1966-1982.
Morse, J. M. (2008). Confusing categories and
t hemes. Qualitative
health
research, 18(6), 727-728.
Naz, M. S. G., Tehrani, F. R., Majd, H. A.,
Ahmadi, F., Ozgoli, G., Fakari, F. R., &
Ghasemi, V. (2019). The prevalence
of polycystic ovary syndrome in
adolescents: A systematic review and
meta-analysis. International Journal of
Reproductive BioMedicine, 17(8), 533.
Nidhi, R., Padmalatha, V., Nagarathna, R., &
Amritanshu, R. (2011). Prevalence of
polycystic ovarian syndrome in Indian
adolescents. Journal of pediatric and
adolescent gynecology, 24(4), 223
227.
Rasgon, N. L., Rao, R. C., Hwang, S., Altshuler,
L. L., Elman, S., Zuckerbrow-Miller, J.,
& Korenman, S. G. (2003). Depression
i n women with polycystic ovary
syndrome: clinical and biochemical
correlates. Journal of affective
disorders, 74(3), 299-304.
Rassi, A., Veras, A. B., dos Reis, M., Pastore,
D. L., Bruno, L. M., Bruno, R. V., … &
Nardi, A. E. (2010). Prevalence of
psychiatric disorders in patients with
polycystic
ovary
s y n drome. Comprehensive
psychiatry, 51(6), 599-602.
Sadeeqa, S., Mustafa, T., & Latif, S. (2018).
Polycystic ovarian syndrome–related
depression in adolescent girls: a
review. Journal of pharmacy &
bioallied sciences, 10(2), 55.
Veldhuis, J. D., Pincus, S. M., Garcia-Rudaz,
M. C., Ropelato, M. G., Escobar, M. E.,
& Barontini, M. (2001). Disruption of
the joint synchrony of luteinizing
hormone, testosterone, and
androstenedione secretion in
adolescents with polycystic ovarian
syndrome. The Journal of Clinical
Endocrinology & Metabolism, 86(1),
72-79.
Watson, S. (2019). Polycystic Ovary Syndrome
(PCOS): Symptoms, Causes, and
Treatment.
Wild, R. A., Carmina, E., Diamanti-Kandarakis,
E., Dokras, A., Escobar-Morreale, H.
F., Futterweit, W., … & Dumesic, D.
A.
(2010).
Assessment of
cardiovascular risk and prevention of
cardiovascular disease in women with
the polycystic ovary syndrome: a
consensus statement by the Androgen
Excess and Polycystic Ovary Syndrome
(AE-PCOS) Society. The Journal of
Clinical
Endocrinology
&
Metabolism, 95(5), 2038-2049.
Williams, S. (2018). A Critical Realist
informed Thematic Analysis: Families’
experience of the process of
adjustment when a family member is
i n a forensic mental health
hospital (Doctoral dissertation,
University of East London).
Conflict of interest: None
Role of funding source: None
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