Predictors of psychological distress

Greater self-esteem and self-efficacy is associated with less psychological distress in women with endometriosis.

Key Points

Highlights

• Individual differences among women with endometriosis play a role in psychological health. In particular, greater self-esteem and self-efficacy is associated with less distress.

Importance

• Although evidence has established that endometriosis affects women’s mental health, there is less of an understanding of the specific factors, especially of individual differences (self-esteem, body esteem, emotional self-efficacy) which may lead to positive or negative psychology.

What’s Done Here

• This study explores the psychological impact of three categories of factors in predicting mental health: demographic variables, endometriosis-related variables, and individual differences.
• 210 Caucasian women participated in the study.
• Structured interviews were conducted to collect information on demographic variables and endometriosis-related variables, whereas the ‘Body Esteem Scale’, Appearance and Attribution scales, ‘Emotional Self-Efficacy in Regulating Negative Emotions’ scale, and ‘Emotional Self-Efficacy in Expressing Positive Emotions’ scale were used to assess individual differences.
• Mental health was assessed using the ‘Hospital Anxiety and Depression Scale’.

Key Results

• Individual differences played a significant role in predicting mental health: participants with greater self-esteem and self-efficacy were less distressed.
• Being in a stable intimate relationship was associated with decreased rumination.
• A shorter time from diagnosis was associated with more severe anxiety.
• ‘Higher pelvic pain severity’ was associated with poorer mental health overall.

Limitations of the Study

• Pelvic pain was assessed regardless of women’s menstrual cycle phase, which may affect pain severity. Future studies should control for the effects of this variable.
• The study is cross-sectional and does not allow an understanding of the evolution of women’s endometriosis experience over time.
• The role of infertility may have been underestimated as participants who had and who did not have current infertility were compared, without controlling for the effects of possible past infertility.

Lay Summary

Studies have now established that endometriosis can negatively impact mental health and quality of life, however, some studies show that not all women with endometriosis are necessarily more distressed than healthy women. This suggests that individual differences may explain women’s’ subjective experience of endometriosis, which could include an individual women’s self-esteem and self-efficacy.

This study by Faccin et al. from Italy, published in the journal "Human Reproduction" entitled "Mental health in women with endometriosis: searching for predictors of psychological distress" explored the psychological impact of three categories of factors in predicting mental health: Demographic variables (age and intimate relationship status); endometriosis-related variables (hormonal treatment, surgical interventions, current infertility, time from diagnosis, pain severity); and individual differences (self-esteem, body esteem, emotional self-efficacy). 

Studies have already shown that age, intimate relationship status, treatment variables, current infertility, and pelvic pain may affect anxiety and depression. This study confirmed that pelvic pain severity negatively affects mental health. The finding that being in an intimate relationship was associated with decreased rumination is also supported by the literature and shows that partners may be a protective factor against negative psychological outcomes. The authors suggest further study on the impact of endometriosis on intimate relationships should be conducted.  

Differently from previous studies, this study adds to the literature by finding that a shorter time from diagnosis was associated with increased anxiety. The authors argue that this not only reaffirms the need to deliver a sensitive, respectful, and well-explained diagnosis to patients but that it also suggests early psychological intervention may benefit women with endometriosis as it may reduce the risk of developing mental disorders by helping them find more effective strategies to cope with the disease and its implications. The authors suggest that future studies need to focus on exploring the relationship between diagnostic delays as well as the temporal relationship between endometriosis and mental health. 

The most important finding is the discovery that participants with greater self-esteem and self-efficacy were less distressed, showing the association between individual differences and mental health in endometriosis. This relationship has been observed in patients with other chronic conditions but has for the first time been discovered in endometriosis through this study.

The authors advise that these findings highlight the importance of offering interventions to improve self-efficacy and self-esteem within psychological treatment and suggest conducting further studies on this topic.

Research Source: https://academic.oup.com/humrep/article-abstract/32/9/1855/4055583