REVIEW  MULTIDISCIPLINARY MANAGEMENT OF ENDOMETRIOSIS 

Minerva Medica 2020 February;111(1):90-102

DOI: 10.23736/S0026-4806.19.06350-X

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Psychological stress levels in women with endometriosis: systematic review and meta-analysis of observational studies

Diogo L. BRASIL ¹, Erik MONTAGNA ¹ ✉, Camila M. TREVISAN ¹, Valentina Lucia LA ROSA ², Antonio Simone LAGANÀ ³, Caio P. BARBOSA ^{1, 4}, Bianca BIANCO ^{1, 4}, Victor ZAIA ^{1, 4}

¹ Facultade de Medicine do ABC/Centro Universitário Saúde ABC, Santo André, Brazil; ² Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Catania, Italy; ³ Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy; ⁴ Discipline of Sexual and Reproductive Health and Populational Genetics, Department of Collective Health, Faculdade de Medicina do ABC/Centro Universitário Saúde ABC, Santo André, Brazil

INTRODUCTION: Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, associated with chronic and inflammatory reaction. Symptoms range from dysmenorrhea, dyspareunia, chronic pelvic pain, unexplained infertility to asymptomatic. The patients’ quality of life is affected by anxiety, depression and stress. We aimed to verify the prevalence and levels of psychological stress among women with endometriosis.
EVIDENCE ACQUISITION: The systematic review followed the PRISMA statement and the MOOSE guideline. Databases searched were MEDLINE, EMBASE, PsychNET and SciELO. The risk of bias was assessed with a modified Newcastle-Ottawa Scale. The meta-analysis of proportions used inverse variance method for pooling and random-effects model. For the stress levels we used the restricted maximum likelihood estimator for summary effects. Heterogeneity was assessed through I2 and Q statistics. Publication bias was assessed through funnel plots. Meta-regression adopted a mixed-effects model, considering patient age, endometriosis staging, stress assessment tool and data collection as categorical moderators.
EVIDENCE SYNTHESIS: We included 15 studies encompassing 4,619 women with endometriosis. The overall prevalence of mild/high stress was 68% (95%CI:57%-79%), I2=98% and τ2=0.0228. The mean level of stress was 41.78% (95%CI =34.05%-49.51%), I2=99.9% and τ2=83.35. Meta-regression showed relationship with endometriosis staging.
CONCLUSIONS: This is the first meta-analysis exploring the association between endometriosis and psychological stress. The interdisciplinary management of the disease should expand the mental health support in this patient care, beyond pain management. Finally, the attitude of the medical team acknowledging the patients’ psychological stress may positively affect their treatment.

KEY WORDS: Endometriosis; Psychological stress; Mental health; Quality of life