Body-image distress is increased in women with polycystic ovary syndrome and mediates depression and anxiety

Women with polycystic ovary syndrome (PCOS) had higher body image distress (BID) versus controls; BID mediated association between PCOS and anxiety/depressive scores and correlated with lower quality of life.

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Volume 112, Issue 5, Pages 930–938.e1


Snigdha Alur-Gupta, M.D., Anat Chemerinski, M.D., Chang Liu, B.A., Jenna Lipson, M.D., Kelly Allison, Ph.D., Mary D. Sammel, Sc.D., Anuja Dokras, M.D., Ph.D.



To evaluate differences in body-image distress (BID) scores between women with polycystic ovary syndrome (PCOS) and controls and whether BID mediates anxiety and depression.


Cross-sectional study.


Academic institution.


Reproductive-aged women with PCOS (n = 189) and controls (n = 225).


Administering the Multidimensional Body-Self Relations-Appearance Subscale (MBSRQ-AS), Stunkard Figure Rating Scale (FRS), Hospital Anxiety and Depression Scale (HADS), and PCOS quality of life survey (MPCOS-Q).

Main Outcome Measure(s)

BID, depression, and anxiety scores and mediation of depression and anxiety scores by BID.


Women with PCOS had worse BID scores on all five MBSRQ-AS subscales adjusted for age, body mass index, race, pregnancy history, income, and employment, and larger differences on the FRS compared with the control women. In multivariable regression models, the prevalence of depressive (28% vs. 19.2%) and anxiety (76.5% vs. 56.5%) symptoms were also statistically significantly higher in women with PCOS compared with the controls. Most MBSRQ-AS subscale scores statistically significantly correlated with depression, anxiety, and quality of life scores. The association between PCOS/control status and higher anxiety and depression scores was completely mediated by the appearance evaluation and body areas satisfaction subscales and partially mediated by overweight preoccupation, appearance orientation, and self-classified weight.


Women with PCOS have increased BID and depressive and anxiety symptoms. In our study different aspects of BID either fully or partially mediated the association between PCOS/control status and depression and anxiety scores, suggesting that therapeutic interventions targeted at improving body image may decrease depressive and anxiety symptoms.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.