Depressive symptoms, mental disorders, and treatment-seeking behavior in endometriosis: A cross-sectional study of prevalence and associations with quality of life

Endometriosis, the second most common gynecological disease, can result in reductions of quality of life and high rates of depressive and anxiety symptoms. Understanding treatment-use patterns and associations with psychological burden may help identify gaps in care. We aimed to describe depressive symptoms, mental disorders, and treatment use and explore associations with endometriosis-related quality of life in individuals with endometriosis interested in an online cognitive behavioral therapy program. Three hundred twenty‑nine participants completed an online survey assessing treatments used, quality of life (Endometriosis Health Profile-30+23), and psychological symptoms (Beck Depression Inventory-II, Web Screening Questionnaire). Of 322 participants, 26.4 percent (n = 85) had never used hormonal therapy. Moderate to severe depressive symptoms were reported by 46.2 percent (n = 152). Additionally, 265 participants completed the Structured Clinical Interview-I for DSM-IV, where 27.5 percent (n = 73) met criteria for a mental disorder, most commonly depressive disorders (14 percent, n = 37). An exploratory multivariate multiple regression showed that a greater treatment count was associated with greater pain-related impairment (B = 2.06, adjusted R2 = .05, Holm-adjusted p < .001) and control/powerlessness (B = 2.24, adjusted R2 = .05, Holm-adjusted p < .001). These findings support integrated, patient-centered biopsychosocial care that combines medical with psychological interventions.