Clinical Characteristics of Hyperandrogenism Include Hirsutism, Polycystic Ovary Syndrome, and Acne: Association with Psychiatric Disease in Women -A Nationwide Population-Based Cohort Study in Taiwan

doi:10.2147/IJWH.S376244

. 2022 Aug 27:14:1173-1189.

doi: 10.2147/IJWH.S376244. eCollection 2022.

Clinical Characteristics of Hyperandrogenism Include Hirsutism, Polycystic Ovary Syndrome, and Acne: Association with Psychiatric Disease in Women -A Nationwide Population-Based Cohort Study in Taiwan

Tsan-Min Wang^{1

2}, Cheng-Hao Chou^{1

2}, Yi-Liang Lee^{3

4}, Chi-Hsiang Chung^{1

5

6}, Yao-Ching Huang^{1

7}, Xiao-Cheng Lai⁸, Chien-An Sun^{9

10}, Chieh-Yi Kang¹¹, Gwo-Jang Wu^{1

3

12}, Wu-Chien Chien^{1

5

6

8}

Affiliations

¹ Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan.
² Taipei Municipal Jianguo High School, Taipei, Taiwan.
³ Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
⁴ Department of Obstetrics and Gynecology, Kang Ning Hospital, Taipei, Taiwan, Republic of China.
⁵ School of Public Health, National Defense Medical Center, Taipei, Taiwan.
⁶ Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, Taiwan.
⁷ Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei, Taiwan.
⁸ Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
⁹ Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, Republic of China.
¹⁰ Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, Republic of China.
¹¹ Chi Mei Medical Center Gynecologic Oncologist Division, Department of Obstetrics & Gynecology, Tainan City, Taiwan, Republic of China.
¹² Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.

PMID: 36059578
PMCID: PMC9432384
DOI: 10.2147/IJWH.S376244

Clinical Characteristics of Hyperandrogenism Include Hirsutism, Polycystic Ovary Syndrome, and Acne: Association with Psychiatric Disease in Women -A Nationwide Population-Based Cohort Study in Taiwan

Tsan-Min Wang et al. Int J Womens Health. 2022.

. 2022 Aug 27:14:1173-1189.

doi: 10.2147/IJWH.S376244. eCollection 2022.

Authors

Affiliations

¹ Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan.
² Taipei Municipal Jianguo High School, Taipei, Taiwan.
³ Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
⁴ Department of Obstetrics and Gynecology, Kang Ning Hospital, Taipei, Taiwan, Republic of China.
⁵ School of Public Health, National Defense Medical Center, Taipei, Taiwan.
⁶ Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, Taiwan.
⁷ Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei, Taiwan.
⁸ Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
⁹ Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, Republic of China.
¹⁰ Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, Republic of China.
¹¹ Chi Mei Medical Center Gynecologic Oncologist Division, Department of Obstetrics & Gynecology, Tainan City, Taiwan, Republic of China.
¹² Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.

PMID: 36059578
PMCID: PMC9432384
DOI: 10.2147/IJWH.S376244

Abstract

Objective: Previous studies have shown an increased in psychiatric disorders in women with disorders associated with hyperandrogenism, but few nationwide cohorts have studied this phenomenon. Therefore, this study is aimed to examine the association between the clinical manifestations of hyperandrogenism and subsequent psychiatric disorders.

Methods: Based on the National Health Insurance Research Database, 49,770 enrolled participants were matched for age and index date between January 1, 2000, and December 31, 2015. Hirsutism, polycystic ovary syndrome, and acne are characterized by hyperandrogenism. After adjusting for confounding factors, we used Cox proportional analysis to compare the risk of psychiatric disorders during the 16 years of follow-up.

Results: Of all the participants, 1319 (13.25%) had psychiatric disorders in the study group, whereas only 3900(9.80%) had psychiatric disorders in the control group. After adjusting for age, and monthly income, the Cox regression analysis showed that the study patients were more likely to develop psychiatric disorders (hazard ratio [HR]: 2.004, 95% confidence interval [CI] = 1.327-2.724, P < 0.001). The results demonstrated that women aged 20-29 years had a more significant risk.

Conclusion: Women with clinical characteristics of hyperandrogenism have a higher risk of developing psychiatric disorders, especially those aged 20-29 years.

Keywords: Taiwan; cohort study; hyperandrogenism; national health insurance research database; psychiatric disorders; women.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

**Figure 1**
The flowchart of the study.

**Figure 2**
Kaplan-Meier for survival of mental disorders among aged 15–49 women stratified by hyperandrogenism with Log rank test.

See this image and copyright information in PMC

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References

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1. Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol. 2013;6:1–13. doi:10.2147/clep.S37559 - DOI - PMC - PubMed
1. Rodriguez-Paris D, Remlinger-Molenda A, Kurzawa R, et al. Psychiatric disorders in women with polycystic ovary syndrome [Występowanie zaburzeń psychicznych u kobiet z zespołem policystycznych jajników]. Psychiatr Pol. 2019;53(4):955–966. doi:10.12740/PP/OnlineFirst/93105 - DOI - PubMed
1. Azziz R. Controversy in clinical endocrinology: diagnosis of polycystic ovarian syndrome: the Rotterdam criteria are premature. J Clin Endocrinol Metab. 2006;91(3):781–785. doi:10.1210/jc.2005-2153 - DOI - PubMed
1. Brutocao C, Zaiem F, Alsawas M, Morrow AS, Murad MH, Javed A. Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis. Endocrine. 2018;62(2):318–325. doi:10.1007/s12020-018-1692-3 - DOI - PubMed

Grants and funding

The study was supported by the Medical Affairs Bureau, the Ministry of Defense of Taiwan (MND-MAB-D–111134), the Tri-Service General Hospital Research Foundation (TSGH-B-111018; TSGH-A-111012), and research grants from the Chi Mei Medical Center (CMNDMC10208; CMNDMC10304), which has no role in the study design, data collection and analysis, preparation of the manuscript, and decision to publish.

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[1] Heidelbaugh JJ. Endocrinology update: Hirsutism. FP Essent. 2016;451:17–24. - PubMed

[2] Heidelbaugh JJ. Endocrinology update: Hirsutism. FP Essent. 2016;451:17–24. - PubMed

[3] Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol. 2013;6:1–13. doi:10.2147/clep.S37559 - DOI - PMC - PubMed

[4] Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol. 2013;6:1–13. doi:10.2147/clep.S37559 - DOI - PMC - PubMed

[5] Rodriguez-Paris D, Remlinger-Molenda A, Kurzawa R, et al. Psychiatric disorders in women with polycystic ovary syndrome [Występowanie zaburzeń psychicznych u kobiet z zespołem policystycznych jajników]. Psychiatr Pol. 2019;53(4):955–966. doi:10.12740/PP/OnlineFirst/93105 - DOI - PubMed

[6] Rodriguez-Paris D, Remlinger-Molenda A, Kurzawa R, et al. Psychiatric disorders in women with polycystic ovary syndrome [Występowanie zaburzeń psychicznych u kobiet z zespołem policystycznych jajników]. Psychiatr Pol. 2019;53(4):955–966. doi:10.12740/PP/OnlineFirst/93105 - DOI - PubMed

[7] Azziz R. Controversy in clinical endocrinology: diagnosis of polycystic ovarian syndrome: the Rotterdam criteria are premature. J Clin Endocrinol Metab. 2006;91(3):781–785. doi:10.1210/jc.2005-2153 - DOI - PubMed

[8] Azziz R. Controversy in clinical endocrinology: diagnosis of polycystic ovarian syndrome: the Rotterdam criteria are premature. J Clin Endocrinol Metab. 2006;91(3):781–785. doi:10.1210/jc.2005-2153 - DOI - PubMed

[9] Brutocao C, Zaiem F, Alsawas M, Morrow AS, Murad MH, Javed A. Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis. Endocrine. 2018;62(2):318–325. doi:10.1007/s12020-018-1692-3 - DOI - PubMed

[10] Brutocao C, Zaiem F, Alsawas M, Morrow AS, Murad MH, Javed A. Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis. Endocrine. 2018;62(2):318–325. doi:10.1007/s12020-018-1692-3 - DOI - PubMed

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Clinical Characteristics of Hyperandrogenism Include Hirsutism, Polycystic Ovary Syndrome, and Acne: Association with Psychiatric Disease in Women -A Nationwide Population-Based Cohort Study in Taiwan

Affiliations

Clinical Characteristics of Hyperandrogenism Include Hirsutism, Polycystic Ovary Syndrome, and Acne: Association with Psychiatric Disease in Women -A Nationwide Population-Based Cohort Study in Taiwan

Authors

Affiliations

Abstract

Conflict of interest statement

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Abstract

Conflict of interest statement

Figures

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