Letters to the editor |
Incorporating qualitative approaches is the path to adequate understanding of the psychosocial impact of polycystic ovary syndrome
Department of Morphology and Health Sciences Graduating Program, Federal University of Rio Grande do Norte, Campus Universitário, BR 101, CEP 59078–970, Natal-RN, Brazil
1 To whom correspondence should be addressed. E-mail: georgedantas{at}uol.com.br
Sir,
We reviewed the manuscript by Elsenbruch et al. (2006)
with great interest. Using self-reported measures to characterize polycystic ovary syndrome (PCOS) patients at risk of psychiatric disease and to assess the impact of emotional distress on quality of life, the authors analysed the incidence of mental distress in women with PCOS. This topic is extremely relevant in the current clinical management of PCOS patients. By using the German version (Schmitz et al., 2000) of the Symptom Check List 90 (SCL-90-R) (Derogatis, 1983), the authors verified that only 22 of the 143 women studied had scores 
63, indicating marked psychological distress and probable psychological/psychiatric illness.
This study, as most of the previous research on PCOS, has been overwhelmingly conducted within a medical or psychiatric framework and has failed to explore women’s own experience regarding the syndrome. Thus, we would like to discuss the methodological procedures, especially related to the limitation of purely quantitative instruments, to assess essentially subjective aspects.
PCOS is a heterogeneous condition, and its main symptoms such as infertility, menstrual dysfunctions, hirsutism and obesity can, by themselves, cause increased psychosocial stress. Thus, we believe that a non-specific assessment instrument is unable to correctly evaluate the psychological impact of the disease. It therefore becomes increasingly more important to incorporate the contemporary qualitative approaches aimed at understanding the significant processes and the meanings experienced by women faced with PCOS (Kitzinger and Willmott, 2002; Keegan et al., 2003). The complexity involved in the illness process and the aspects related to the symptoms of this syndrome point to the importance of psychosocial studies that incorporate individuals’ perspective into their social context. Moreover, it becomes necessary to develop assessment instruments specific for use in patients with PCOS, as exemplified by Guyatt et al. (2004).
Using mixed methodology, we have performed a pilot study via a cross-sectional survey to provide information on health-related quality of life followed by in-depth semi-structured interviews to collect qualitative information. This latter approach aimed at identifying and understanding the feelings produced by women with PCOS regarding their disease. Preliminary results indicate that obesity and infertility have been mainly responsible for the feelings of social avoidance and sadness observed in PCOS patients. We have also found that effects on physical appearance cause a significant negative impact on psychosocial well-being by influencing feminine identity, corroborating the results previously related by Kitzinger and Willmott (2002). Thus, we believe that incorporating qualitative approaches into PCOS studies could contribute significantly to understanding the psychological impact of the disease and could act as an important complementary strategy to traditionally used methodologies.
References
Derogatis L. (1983) SCL-90-R Administration, Scoring and Procedures Manual(Clinical Psychometric Research, Towson, MD).
Elsenbruch S, Benson S, Hahn S, Tan S, Mann K, Pleger K, Kimmig R, Janssen OE. (2006) Determinants of emotional distress in women with polycystic ovary syndrome. Hum Reprod 21:1092–1099.
Guyatt G, Weaver B, Cronin L, Dooley JA, Azziz R. (2004) Health-related quality of life in women with polycystic ovary syndrome, a self-administered questionnaire, was validated. J Clin Epidemiol 57:1279–1287.[CrossRef][Web of Science][Medline]
Keegan A, Liao LM, Boyle M. (2003) ‘Hirsutism’: a psychological analysis. J Health Psychol 8:327–345.
Kitzinger C and Willmott J. (2002) ‘The thief of womanhood’: women’s experience of polycystic ovarian syndrome. Soc Sci Med 54:349–361.[CrossRef][Web of Science][Medline]
Schmitz N, Hartkamp N, Kiuse J, Franke GH, Reister G, Tress W. (2000) The Symptom Check-List-90-R (SCL-90-R): a German validation study. Qual Life Res 9:185–193.[CrossRef][Web of Science][Medline]
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