Psychological distress in women with primary and secondary infertility: a comparative analysis of depression, anxiety, and stress

Abstract

Background: Polycystic Ovary Syndrome (PCOS) and Recurrent Pregnancy Loss (RPL) are reproductive disorders frequently linked to psychological distress. This study compared the severity of depression, anxiety, and stress levels between women with PCOS and RPL and assessed their association with years of marriage. Materials and methods: A cross-sectional study conducted a random sampling method on 157 women (PCOS: 70; RPL: 87) attending the Obstetrics and Gynecology OPD at IMS BHU, Varanasi. Psychological status was assessed using the DASS-21 scale, a reliable tool widely used in reproductive health research. Chi-square test and independent sample t-tests were used for statistical analysis. Results: Mean scores were significantly higher in RPL than in PCOS: depression (10.7 ± 3.5 vs. 8.8 ± 4.3, p = 0.003), anxiety (13.3 ± 3.8 vs. 10.7 ± 5.5, p = 0.001), and stress (12.3 ± 4.4 vs. 10.3 ± 6.1, p = 0.007). Marriage duration was significantly longer among women with severe depression (RPL: 8.4 ± 5.2 yrs.; PCOS: 6.3 ± 3.1 yrs), anxiety (RPL: 8.6 ± 5.1 yrs.; PCOS: 7.1 ± 3.3 yrs), and stress (RPL: 9.0 ± 5.2 yrs.; PCOS: 6.3 ± 3.1 yrs), all p < 0.05. Age was higher in RPL patients (p = 0.024); LH was higher in PCOS (p = 0.000). No significant differences were observed in AMH or BMI. Psychological symptoms were more severe among women with RPL, and a longer duration of marriage was associated with greater symptom severity. Marriage duration was significantly higher in women classified with severe depression, anxiety, and stress based on DASS-21 scores, indicating a correlational rather than causal relationship. Conclusion: Routine psychological assessment is recommended for women with PCOS and RPL. Early identification of psychological distress may help improve overall reproductive and emotional health outcomes in these patients. © © 2025 Chaurasiya, Singh, Bahadur, Singh, Maurya and Rai.