Understanding Polycystic Ovary Syndrome (PCOS) and Mental Health Disparities in Bangladeshi Women: A Mixed Method Approach

doi:10.21203/rs.3.rs-4918589/v1

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Understanding Polycystic Ovary Syndrome (PCOS) and Mental Health Disparities in Bangladeshi Women: A Mixed Method Approach

https://doi.org/10.21203/rs.3.rs-4918589/v1

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Background

PCOS is a common hormonal disorder affecting women's well-being. It is a chronic ailment without a cure, posing a significant threat to women's health, with many going untreated.

Aims

Many women in Bangladesh lack knowledge about PCOS, leading to delays in diagnosis and treatment. This gap hinders understanding of coping strategies, treatment options, and lifestyle improvements related to the condition.

Methods

In total, 426 participants were included in this mixed method study, and data were collected from them in a mixed-method way. A standard approach was used for the assessment of knowledge level among Bangladeshi people about PCOS signs & symptoms, causes, diagnosis & treatment options, and impacts on health. The prevalence of diagnostic tests among people and the extent to which women are underdiagnosed were also determined.

Results

Women with positive PCOS status had a significantly negative impact on mental health conditions. The knowledge level about PCOS among participants is low (63.7%), moderate (21.6%), and high (14.7%). We have found a significant association between knowledge level and age, education, occupation, living place, screening practice, and PCOS status (p-value < 0.05). It is remarkable that 63.4% of women in Bangladesh remain undiagnosed with a symptomatic appearance.

Conclusion

It is evident that a significant number of women have limited knowledge about PCOS. They also failed to assess their PCOS status, even though the prevalence of PCOS is over thirty percent. Hence, it is important to arrange a health education initiative aimed at educating and encouraging women to actively engage in the diagnostic process to prevent PCOS complications.

PCOS

Women

Reproductive

Mental Health

PCOS is a prevalent hormonal illness that affects women's physical and psychological health. It is a chronic condition that cannot be cured with medicine. Several symptoms associated with PCOS include irregular periods, hirsutism, high testosterone levels, metabolic disorders, ovarian cysts, excessive hair fall, insulin resistance, acne, and more. Irregular period is the major sign of PCOS and hormonal imbalance. Irregular periods or menstrual abnormality is the first and foremost symptom that is commonly seen in PCOS patients and PCOS symptomatic patients. According to Abu-Taha et al. (2020), 90.3% of women knew that irregular periods or no menstrual cycle were signs of PCOS (1). PCOS is a major cause of infertility in women. Significant psychological conditions, such as reactive depression, anxiety, hypertension, etc. can be brought on by PCOS.

PCOS has become an existential danger to women, with an estimated 8–13% of women worldwide of reproductive age having the disorder and 70% not receiving treatment. Studies from the United Arab Emirates, Thailand, and South India reported a prevalence of PCOS as high as 50.1% (2).The condition has spread like wildfire. This is the reason we concentrated on PCOS rather than other illnesses, as it is currently most significantly affecting the health of women. 5–15% of females under the age of 18–44 worldwide suffer from this prevalent endocrine circumstance (3). The black paw of PCOS typically strikes women with a family history of obesity, type 2 diabetes, or infertility. Depression, psychological disorders, and type 2 diabetes are more common in women with PCOS (4). These days, this disease is very common in women, triggering them to live abnormal lives and eventually develop endometrial cancer, cardiovascular diseases, or infertility. Approximately 40% of teenage girls with irregular periods have ultrasound-confirmed polycystic ovaries (5). A PCOS patient may have severe trauma and reactive depression. Her self-confidence is undermined by a masculine body image that typically consists of excess weight in the upper body and hirsutism or unsightly facial hair. According to Fauser et al. (2012), 70% of women with PCOS exhibit hirsutism (5).

In addition to experiencing fast weight gain, dietary limitations and difficulties in losing weight might contribute to a woman's depression. Over half of people with PCOS are often obese, which is a significant side effect of the disease (6). Approximately 44% of women with PCOS are obese overall (7). Psychological and behavioral problems, such as eating and sexual disorders, dysfunctional relationships, and a lower quality of life, are more prevalent among PCOS patients (5). Numerous studies demonstrate that reactive depression and mild psychological disorders are common in hirsute PCOS patients (8). Patients with PCOS frequently endure infertility. Cardiovascular issues, neurological and psychological consequences on quality of life (such as depression and anxiety), and endometrial and breast cancers are all linked to PCOS.

Polycystic ovarian syndrome, or PCOS, is frequently referred to as the most prevalent cause of anovulatory infertility in women (9). Generally, PCOS patients are very sensitive to dietary imbalances and irregular lifestyles. PCOS risk factors include an improper diet, lifestyle, and any infectious medicine (3). They have to strictly maintain healthy food and a routine lifestyle They are strictly restricted to having junk and packaged foods, sea foods, and allergenic foods. In addition, the course of therapy is very expensive. Thus, the majority of women never receive a diagnosis. Additionally, there is no specific drug that may be used to cure PCOS. PCOS can be managed with a change in lifestyle, including consuming nutritious foods, exercising, more physical activity, maintaining a positive atmosphere, etc. Though lifestyle changes has been an established reason for various non-communicable diseases (10).

However, in the least developed nations, like Bangladesh, this maintenance is extremely difficult. Poverty can exacerbate health inequalities, impacting women's ability to afford essential healthcare services and medications. It can also make it difficult to navigate the healthcare system or advocate for themselves. All of this hurts the mental health of PCOS sufferers as well as those who only experience symptoms, yet don't receive a diagnosis. According to a study, PCOS is becoming more common, yet despite the fact that many students had the disease's symptoms, few of them were aware of it (11). Eighty-four percent of women had no prior knowledge of PCOS, according to Wasata et al. (12). The lack of knowledge among Bangladeshi women regarding PCOS, its signs, and its impact on mental health may cause a delay in diagnosis and treatment. Only 38% of women are aware that mental health diseases, that include depression and anxiety, exist, according to research on the assessment of awareness of mental health conditions (13). In overall aspects, this problem has now become a triggering one in the context of Bangladesh nowadays for women’s reproductive health and well-being. General women must be aware and knowledgeable about the causes, consequences, and long-term health impacts of PCOS.

Study Design

This study was carried out from April 2024 to August 2024.

Study Participants

A study conducted in Bangladesh involved a questionnaire survey of 413 women aged 15 to 45 years and older, including undiagnosed PCOS patients and general women. The research employed focus group discussions (FGDs) for qualitative aspects and offline questionnaire methods for quantitative aspects. The study involved ten respondents each representing two distinct groups: those with PCOS and those who were symptomatic. The participants were selected from the University of Chittagong and the renowned "Strong Muscle Gym Center" fitness facility, Chattogram. The study found that 72 women had PCOS, 79 were healthy, and 262 were undiagnosed.

Measures

Personal Information Form

A predesigned and pretested Personal Information Form (PIF) was used to collect sociodemographic data from the participants. The form included questions on age, height, weight, marital status, living place, educational background, occupation, and household income.

Depression, Anxiety, and Stress Scale (DASS-21)

The DASS-21 is a valid and reliable measure of psychological well-being. It is a condensed version of the 42-item DASS, which includes scales for depression, anxiety, and stress (14, 15). Each of the three DASS-21 subscales has seven items. This well-known and widely used DASS-21 scale has been translated and validated into Bengali (16). On a four-point Likert scale ranging from 0 (never) to 3 (almost always), respondents were asked about their level of mental distress over the previous four weeks. Individual scores for depression, anxiety, and stress were calculated by summing the scores of the seven corresponding items. The final scores for the three dimensions were then multiplied by two to obtain a score ranging from 0 to 42 (14, 17). The individual scores of these three subscales were then classified into five severity categories: normal, mild, moderate, severe, and extremely severe (18).

PCOS Knowledge Scale

The PCOS Knowledge Scale is a 20-item questionnaire developed specifically for this study to assess the knowledge and awareness levels of university students regarding Polycystic Ovary Syndrome (19). The scale was designed to cover various aspects related to PCOS, including perceptions about the condition, signs and symptoms, treatment options, risk factors, diagnostic processes, attitudes toward doctor consultations, and views on lifestyle modifications, such as exercise and dietary habits. Additionally, the questionnaire collected demographic information, allowing for the correlation between demographic characteristics and participants' perceptions and attitudes toward PCOS.

Data Collection

This study was approved by the institutional review board (IRB) at the Bangladesh institute of innovative health research (IRB protocol no.: BIIHR-2024-005) and conducted following the ethical principles outlined in the Declaration of Helsinki (20). All participants received comprehensive information about the nature, purpose, and procedures of the study, and informed consent was obtained from each participant before their participation. Participants were assured of their right to withdraw from the study at any time without any consequences. Privacy and confidentiality were strictly maintained, with data anonymized to protect participants’ identities.

The study utilized Focused Group Discussions (FGDs) and offline questionnaire surveys for the quantitative portion, with research assistants obtaining consent from respondents. The FGDs took 45–60 minutes, while the surveys were 12–15 minutes and non-biased. The survey questionnaire format was used for the quantitative portion.

Statistical Analysis

The mean, frequency, and percentage of the responses were evaluated using descriptive statistics. To evaluate the relationship between the explanatory and dependent variables, chi-square tests were used. A p-value of less than 0.05 was taken into consideration for a statistically significant difference. Version 27.0 of the SPSS (Statistical Package for the Social Sciences) was used to perform the statistical analyses.

Descriptive statistics were used in the study's quantitative analysis to determine the mean, frequency, and percentage of responses. Chi-square tests were also used to evaluate the relationships between the dependent and explanatory variables; a p-value of less than 0.05 was considered statistically significant. In addition, two Focused Group Discussions (FGDs) narrative assessments were incorporated into the qualitative analysis to offer deeper insights into the real-life experiences of PCOS patients.

Quantitative Findings:

Table 1

Demographic characteristics of participants
Variables	Category	Number	Percentage
Age	15 - <30	350	84.4%
	30 - <45	42	10.2%
	45 or above	21	5.1%
BMI	Underweight	235	56.9%
	Normal	164	39.7%
	Overweight	11	2.7%
	Obese	3	0.7%
Marital status	Single	310	75.1%
Marital status	In a relationship	103	24.9%
Living place	Urban	348	84.2%
	Sub-urban	29	7%
	Rural	36	8.8%
Education	No education	14	3.4%
	Primary	8	1.9%
	Secondary	118	28.6%
	Higher study	273	66.2%
Occupation	Employed	59	14.2%
	Unemployed	56	13.4%
	Student	298	72.2%
Household income	< 20,000	109	26.4%
	20,000–30,000	70	16.9%
	> 30,000–50,000	127	30.8%
	> 50,000	107	25.9%

In this research, 84.4% of 413 women were aged between 15 and under 30, with only 5.1% being 45 years old or above. 56.6% of the participants in the study were classified as underweight, while 2.7% were considered overweight and 0.7% were categorized as obese. Most of the individuals in the research resided in urban areas (84.2%), had attained higher education (66.2%), and were enrolled as students (72.2%); only a small percentage held employment (14.2%). Respondents' family income was roughly equal across low, higher-middle, and higher-income brackets (Table 1).

Figure 1: PCOS Status among Bangladesh Women

In our research, 262 women, making up 63.4% of the sample, did not receive a PCOS diagnosis, indicating they are unaware of their PCOS status, whereas only 151 (36.5%) were tested for PCOS. Therefore, it is clear that the prevalence of screening or diagnosis tests is very low in Bangladesh. The majority of females in this nation have not been tested. In this study, 17.4% of the women had a positive PCOS status while 19.1% had a negative status (Fig. 1).

Figure 2: Knowledge Level regarding PCOS among Bangladeshi Women

In this research, most of the 413 women involved had varying levels of knowledge about PCOS: 63.8% had low knowledge, 21.5% had moderate knowledge, and 14.7% had high knowledge. It can be observed that only a small number of women possessed a higher level of understanding regarding PCOS, which could impact their choice to undergo a screening test for the condition (Fig. 2).

Figure 3: Total distress mean score in respect to PCOS status

Figure 4: Depression mean score according to PCOS status

Figure 5: Anxiety mean score according to PCOS status

Figure 6: Stress mean score according to PCOS status

The study uses the DASS-21 questionnaire to assess mental health issues among women with PCOS. The average distress score for women with PCOS is 32.43, while those without PCOS have a lower score of 18.63. Women who are not diagnosed or unaware of their condition experience moderate distress (Fig. 3). Women with PCOS, without PCOS, and with unknown PCOS status have average depression scores of 11.09, 6.25, and 7.59, respectively (Fig. 4). Women with PCOS experience severe depression, while those without or with unknown status show mild and moderate depression levels. Women with PCOS experience high levels of anxiety, while those with unknown or negative PCOS status report moderate anxiety levels (Fig. 5). Women with PCOS have a mean stress score of 11.40, while those without PCOS score 6.78 and those with unknown PCOS score 7.96 (Fig. 6).

Table 2

Cross tabulation of mental health condition and PCOS status
Mental Health Condition		PCOS status
Types	Category	Positive (n = 72)	Negative (n = 79)	Not Known (n = 262)	Chi-squared value (p-value)
Depression	Normal	15 (20.8%)	38 (48.1%)	90 (34.4%)	1082.025 (0.000)
	Mild	1 (1.4%)	4 (5.1%)	36 (13.7%)
	Moderate	16 (22.2%)	18 (22.8%)	52 (19.8%)
	Severe	11 (15.3%)	9 (11.4%)	37 (14.1%)
	Extremely severe	29 (40.3%)	10 (12.7%)	47 (17.9%)
Anxiety	Normal	15 (20.8%)	37 (46.8%)	101 (38.5%)	1053.243 (0.000)
	Mild	1 (1.4%)	3 (3.8%)	13 (5.0%)
	Moderate	9 (12.5%)	14 (17.7%)	29 (11.1%)
	Severe	9 (12.5%)	4 (5.1%)	37 (14.1%)
	Extremely severe	38 (52.8%)	21 (26.6%)	82 (31.3%)
Stress	Normal	16 (22.2%)	49 (62.0%)	131 (50.0%)	1086.824 (0.000)
	Mild	12 (16.7%)	7 (8.9%)	29 (11.1%)
	Moderate	8 (11.1%)	7 8.9%)	45 (17.2%)
	Severe	20 (27.8%)	11 (17.5%)	32 (12.2%)
	Extremely severe	16 (22.2%)	5 (6.3%)	25 (9.5%)
Total Distress	Normal	13 (18.1%)	39 (49.4%)	108 (41.2%)	1051.798 (0.000)
	Mild	4 (5.6%)	8 (10.1%)	19 (7.3%)
	Moderate	8 (11.1%)	8 (10.1%)	28 (10.7%)
	Severe	5 (6.9%)	2 (2.5%)	15 (5.7%)
	Extremely Severe	42 (58.3%)	22 (27.8%)	92 (35.1%)

Table 2 reveals that women with polycystic ovary syndrome (PCOS) often experience extremely severe depression, with 40.3% exhibiting this. Similarly, women without PCOS and those unaware of their condition have a higher percentage of normal depression, with 48.1% and 34.4% respectively. A chi-squared test found a significant relationship between depression and PCOS status. Anxiety levels were also found to be significantly correlated with PCOS status, with 52.8% of individuals experiencing very intense anxiety. Interestingly, stress levels were found to be significantly correlated with PCOS status, with 27.8% and 22.2% of participants experiencing severe stress levels. The overall distress level was found to be significantly higher in women with PCOS, with 58.3% experiencing severe distress (Table 2).

Table 3

Association between knowledge level and characteristics of respondents
Characteristics	Sub Categories	Knowledge level
Characteristics	Sub Categories	Low n = 263	Moderate n = 89	High n = 61	Chi-squared value (p-value)
Age	15 - <30	217 (62.0%)	80 (22.9%)	53 (15.1%)	1014.053 (0.000)
	30 - <45	27 (64.3%)	7 (16.7%)	8 (19.0%)
	45 or above	19 (90.5%)	2 (9.5%)	0 (0.0%)
Education	No education	11 (78.6%)	2 (14.3%)	1 (7.1%)	1016.124 (0.000)
	Primary	7 (87.5%)	0 (0.0%)	1 (12.5%)
	Secondary	79 (66.9%)	18 (15.3%)	21 (17.8%)
	Higher study	166 (60.8%)	69 (25.3%)	38 (13.9%)
Occupation	Employed	27 (45.8%)	21 (35.6%)	11 (18.6%)	1027.419 (0.000)
	Unemployed	43 (76.8%)	6 (10.7%)	7 (12.5%)
	Student	193 (64.8%)	62 (20.8%)	43 (14.4%)
Living place	Urban	212 (60.9%)	81 (23.3%)	55 (15.5%)	1014.214 (0.000)
	Sub-urban	21 (72.4%)	4 (13.8%)	4 (13.8%)
	Rural	30 (83.3%)	4 (11.1%)	2 (5.6%)
Did the PCOS test	Yes	59 (39.1%)	48 (31.8%)	44 (29.1%)	1156.425 (0.000)
Did the PCOS test	No	204 (77.9%)	41 (15.6%)	17 (6.5%)	1156.425 (0.000)
PCOS status	Positive	21 (29.2%)	20 (27.8%)	31 (43.1%)	1207.431 (0.000)
	Negative	38 (48.1%)	28 (35.4%)	13 (16.5%)
	Not Known	204 (77.9%)	41 (15.6%)	17 (6.5%)

Table 3 shows that knowledge levels about PCOS vary across age groups, with 62.0% of 15 to under 30 respondents having limited knowledge and 15.1% having advanced knowledge. Education levels also show a significant correlation with knowledge levels. Working individuals had varying degrees of understanding, with 45.8% having minimal knowledge and 35.6% having average knowledge. Unemployed individuals had lower knowledge levels, while students had 64.8%. Occupation also has a significant relationship with knowledge levels, with rural residents having the highest proportion at 83.3%. Urban residents had moderate to high levels of awareness, while rural residents had lower levels. Screening test results showed that 31.85% of individuals had moderate knowledge and 29.1% had higher-level knowledge. Those who did not undergo testing had limited knowledge, while only 6.5% had a thorough understanding. The knowledge level also correlated with willingness to undergo the screening test for PCOS. Those diagnosed with PCOS had a high level of knowledge, while those without PCOS had a moderate level. The link between having PCOS and knowledge about PCOS shows statistical significance (Table 3).

Qualitative Findings

In the qualitative segment of this study, narratives from ten individuals with Polycystic Ovary Syndrome (PCOS) and those exhibiting symptoms without a formal diagnosis were analyzed. Two separate Focused Group Discussions (FGDs) were conducted to explore symptoms, treatments, challenges, psychological disorders, and coping mechanisms. The first group consisted of university students from the University of Chittagong, primarily females in their 20s and 25s with substantial awareness of PCOS. Among them, four were undiagnosed despite displaying nearly all symptoms, and three had confirmed PCOS. The second group comprised gym members from Strong Muscle Gym Center, Chittagong, including both married and unmarried individuals aged 20 to 35.

Both groups revealed that the majority of PCOS patients first sought medical advice for irregular periods at a young age and received similar treatment protocols. Initial diagnosis involved hormone testing and ultrasonography, followed by medications for weight loss and contraceptive pills for three months. Patients noted that no specific medication could completely cure PCOS. Doctors advised reducing dairy, packaged foods, and junk food intake. Many patients experienced insulin resistance and metabolic disorders, leading to weight gain from minimal dietary indulgence. Refined sugar, particularly in sugary foods, was noted to exacerbate weight gain. Patients reported that maintaining a balanced lifestyle and regular exercise were essential for managing their condition.

Interestingly, undiagnosed individuals did not typically struggle with weight issues, with only one reporting weight concerns. Among the second group, two married respondents faced infertility issues related to PCOS, seeking medical help post-marriage due to difficulties in conceiving. One severe case required in-vitro fertilization (IVF) for conception. Additionally, severe hair loss, alopecia, acne, and hirsutism were common, necessitating medication for hair growth.

Respondents highlighted significant psychological impacts, with many experiencing severe depression and anxiety. Both diagnosed and undiagnosed individuals reported reactive depression and extreme mood swings, often feeling irate and emotionally sensitive. Poor self-esteem and feelings of unattractiveness were prevalent, especially among those with hirsutism. Undiagnosed individuals exhibited higher levels of anxiety and depression, primarily due to financial barriers preventing diagnosis and treatment. Some undiagnosed individuals were warned by doctors of potential future ovarian cysts, contributing to their distress.

Following the analysis, the study determined a substantial correlation between the respondents' characteristics and their degree of PCOS knowledge. There was also an association discovered between the respondents' mental health and PCOS status.

Of the responders, the majority were undiagnosed but symptomatic PCOS patients, a sizable portion were PCOS patients with a diagnosis, and the remainder were healthy. Similar findings were made in the Haq et al. (2017) research, where the majority of participants had indications and symptoms of PCOS but did not have a diagnosis (11). Siddique et al. (2024) report that the majority of students exhibited PCOS symptoms but were not identified (21).

This study indicates the greatest mean value for stress level compared to the Manchanda and Bhatt, (2024) study's mean depression, anxiety, and stress levels among PCOS-positive patients, where anxiety has the highest mean value (22). The majority of respondents had very little understanding of PCOS. This indicates that Bangladeshi women are not sufficiently informed about PCOS. According to research by Abu-Taha et al. (2020) and Rao et al. (2020), the participants' understanding of PCOS was lacking. Most participants assessed their level of PCOS knowledge as "Know some" or less (1, 24).

Based on the correlation between the respondents' characteristics as an independent variable and their degree of awareness of PCOS, we have determined that those in the 15–30 age range have the highest level of information about the condition, while those in the 45 + age range have the lowest level of knowledge. It is noteworthy that there is a severe dearth of awareness regarding PCOS among women with secondary and higher education. According to another study by Haq et al. (2017), majority of the respondents were not aware of PCOS when they were educated, but after receiving education, almost every one of them was aware of the condition (11). According to Abu Taha et al.'s (2020) research, participants' awareness of PCOS was substantially correlated with their marital status and educational attainment (1). This research shows similarities to Abu Taha as having a correlation with education and knowledge level but we have found no association between the presence of PCOS and marital status. In this study, compared to other professional women, students possess the highest degree of knowledge. According to an Udaipur, India research, there are also more students who experience anxiety due to PCOS (23).

In this investigation, it is discovered a strong relationship between the psychological states of PCOS patients, undiagnosed PCOS patients with symptoms, and healthy responders. A higher risk of psychological load is linked to the existence of PCOS, according to a 2017 study by Sulaiman et al. found that those with PCOS felt distressed and suffered from severe anxiety and panic attacks (24). As of He et al. (2020), Comparatively to those without PCOS, our study indicates that patients with PCOS experience extreme to severe levels of stress, anxiety, desperation, and general discomfort (25). Depression, anxiety, low self-esteem, and mood swings are more prevalent among PCOS patients in Bangladesh, according to another study (12). A study on the mental health of Bangladeshi women with PCOS was carried out by Hasan et al. in 2022 (26). According to the study, PCOS patients had extremely high rates of depressive illness, generalized anxiety disorder, and loneliness (26). Similar findings to our investigation were found in another study conducted by Siddique et al. (2024), in which the subjects suffered from severe stress, extremely high levels of anxiety, and considerable depression (21). Although the majority of students may be well-informed on PCOS, many are unsure about whether or not to take action. Additionally, research shows that most women never visit a gynecologist unless they experience serious or fatal symptoms or illnesses (23). Despite the fact that it is a widespread condition, women frequently put off receiving a verified diagnosis and treatment because of ignorance (9). Patients get dissatisfied when they are diagnosed with PCOS later than they should because of challenges in diagnosing the condition in adolescence and disagreements over diagnostic criteria (27).

In contrast to the majority of studies conducted in Bangladesh and around the world, which exclusively use quantitative methods, this study used both qualitative and quantitative methods to examine not only the frequency, percentage, or significant association but also the lifetime experiences of PCOS patients and patients with PCOS symptoms.

The study aimed to identify PCOS patients and symptomatic patients among general women of reproductive age in Bangladesh. However, it was not as successful as anticipated due to the majority of respondents being of the same age group. The study only conducted two FGDs and needed more patients who underwent diagnostic testing and followed the entire treatment regimen to determine the true prevalence of PCOS in Bangladesh. Qualitative research is needed to gain more insights into the understanding and experiences of PCOS. Despite extensive research on PCOS prevalence, awareness, symptoms, and distribution worldwide, there is a lack of studies in South Asian nations like Bangladesh. The study aims to determine the level of knowledge and awareness among Bangladeshi women about this long-term and widely spread disease, benefiting reproductive women, Bangladesh's women, and the public healthcare sector.

Women who tested positive for PCOS experienced adverse effects on their mental health. PCOS patients experience a greater level of extreme distress compared to the negative and undiagnosed groups. In addition, the majority of women possess a limited understanding of PCOS, which is linked to screening behaviors. We have discovered a significant correlation between level of knowledge and age, education, occupation, location of residence, and PCOS status. It is concerning that a larger number of women in Bangladesh go undiagnosed despite showing symptoms. In order to determine the true frequency of PCOS in Bangladesh, it is necessary to carry out thorough screening tests on women throughout the entire country.

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Ethical Considerations

The study was conducted in compliance with ethical standards and received approval from the Institutional Review Board (IRB) at the Bangladesh Institute of Innovative Health Research (IRB Protocol Number: BIIHR-2024-005). Adherence to the Declaration of Helsinki was ensured throughout the research process. Permissions were obtained from the participating schools, and informed consent was secured from both the students and their guardians. Participants were assured of the confidentiality and anonymity of their responses, and they were informed of their right to withdraw from the study at any time without facing any adverse consequences.

Consent for publication

Not Applicable (N/A).

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Competing interests

Authors declared there is no conflict of interest.

Funding Statements

This study received no external funding from any organization(s).

Authors’ Contributions

Sl. No.	Contributing author	Area of contribution
1	Maharaj Khan	Data Curation, Writing - Original Draft Preparation, Investigation
2	Abdullah Jaman	Formal Analysis, Writing - Original Draft Preparation, Investigation
3	MD. Faisal Ahmed	Conceptualization, Investigation, Visualization, Writing - Review & Editing
4	Namrata Das	Conceptualization, Investigation, Writing - Review & Editing

Acknowledgements

We would like to express our deepest gratitude to all those who contributed to the successful completion of our research. Special thanks are extended to Khairul Islam Rayhan, Faria Islam Shila, Kazi Jannatul Nayem, Sabiha Bushra, and Mariam Mardia for their remarkable help in data collection. Their dedication and hard work were instrumental in gathering the necessary data that enabled us to explore the complex relationship between PCOS and mental health disparities among Bangladeshi women.

We also wish to acknowledge the unwavering support of our colleagues and peers who provided invaluable insights throughout the research process. Finally, we are grateful to the participants of the study, whose willingness to share their experiences made this research possible.

No competing interests reported.

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Understanding Polycystic Ovary Syndrome (PCOS) and Mental Health Disparities in Bangladeshi Women: A Mixed Method Approach

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Abstract

Background

Aims

Methods

Results

Conclusion

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Introduction

Materials & Methods

Study Design

Study Participants

Measures

Personal Information Form

Depression, Anxiety, and Stress Scale (DASS-21)

PCOS Knowledge Scale

Data Collection

Statistical Analysis

Results

Quantitative Findings:

Qualitative Findings

Discussion

Conclusion

References

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Additional Declarations

Supplementary Files

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