Comparison of Depression Frequency in Women with Polycystic Ovary Syndrome and Healthy Controls: A Case-Control Study in Isfahan, Iran (2025)

• Women with PCOS had significantly higher depression scores than age- and BMI-matched healthy controls. • Depression severity was positively associated with BMI, hirsutism, and menstrual irregularities. • Lower education and financial status were linked to higher depression scores. • Findings support routine psychological screening and culturally sensitive interventions for women with PCOS. Polycystic ovary syndrome (PCOS) is a common endocrine disorder in reproductive-aged women, often associated with depression, which can exacerbate physical symptoms and reduce quality of life. Cultural emphasis on fertility in Iran may further impact psychological well-being. This case-control study included 164 women aged 18–45 years (82 with PCOS, 82 age- and BMI-matched controls) attending Shahid Beheshti Hospital, Isfahan, in 2025. PCOS was diagnosed using the Rotterdam criteria. Demographics (age, marital status, education, financial status), clinical features (hirsutism, acne, menstrual irregularities, BMI), and depression were assessed using the Persian Beck Depression Inventory-II (BDI-II, score ≥20 as depression). Mean BDI-II scores were higher in PCOS women (26.3 ± 8.9) than controls (21.5 ± 7.4; p < 0.001, Cohen’s d = 0.59). Depression prevalence was 80.5% in PCOS vs. 53.7% in controls (OR = 3.56, 95% CI: 1.77–7.16; RR = 1.50, 95% CI: 1.19–1.88). In univariate analyses, higher BMI, hirsutism, menstrual irregularities, lower education, and lower financial status were associated with greater depressive symptoms. Multivariable logistic regression showed that PCOS, higher BMI, and lower educational level were independently associated with depression. Women with PCOS in Isfahan exhibit higher depression frequency and severity than matched controls. Routine psychological screening and culturally sensitive interventions are recommended, particularly for women with socioeconomic vulnerabilities.