Impact of mild and severe pain intensity on mental health outcomes in women with endometriosis

Objectives To evaluate the impact of moderate and severe pain symptoms on self-reported mental health in patients with endometriosis using an online survey.

Materials and methods Mental health was assessed by the PHQ-4 questionnaire, which combines a depression (PHQ-2) and an anxiety (GAD-2) scale. PHQ-2 and GAD-2 scores of ≥3 were cut-off points between the normal range and probable cases of major depression or generalized anxiety, and PHQ-4 ≥6 score served as a general marker of psychological distress. Pain intensity was assessed by the visual analogue pain scale (VAS; VAS=0-44: no or low pain; VAS=45-74: moderate pain; VAS=75-100: severe pain).

Results Severe dysmenorrhea significantly increased the odds for depression (OR=3.446; 95% CI 1.845-6.437; p<0.001), anxiety (OR=3.446; 95% CI 1.845-6.437; p<0.001) and psychological distress (OR=3.651; 95% CI 1.938-6.876; p<0.001) compared to those with no or low pain intensity by using univariate logistic regression. Severe lower back pain significantly increased the odds for depression (OR=2.954; 95% CI 1.668-5.233; p<0.001), anxiety (OR=1.812; 95% CI 1.037-3.165; P=0.037) and psychological distress (OR=2.115; 95% CI 1.204-3.718; p=0.009) compared to those women with no or low pain intensity. Women with moderate and severe non-cyclic pain and dyschezia showed significantly increased odds (all OR>1.8; all p<0.05) for anxiety, depression and psychological distress, respectively.

Conclusion Women with endometriosis who experience at least moderate non-cyclic pain or dyschezia, and those who experience severe dysmenorrhoea and lower back pain should be screened for adverse psychological outcomes. Treatment should be provided by a multidisciplinary team that addresses both physical and psychological complaints.

Publication History

Article published online:
11 October 2022