Suicide risk in persons with polycystic ovarian syndrome: a systematic review

Background: Polycystic ovarian syndrome (PCOS) is a common and increasingly prevalent reproductive and metabolic endocrine disorder that is characterized by metabolic alterations, hyperandrogenism, menstrual irregularities as well as an increased risk of depression. Available evidence suggests PCOS may also be associated with disparate aspects of suicidality. Herein, we sought to determine the prevalence of suicidal ideation, suicidal behaviours and completed suicide in the PCOS population. Methods: We systematically searched PubMed, Ovid and Scopus databases from inception to January 7, 2024. A manual search was conducted on Google Scholar. Two reviewers independently screened the retrieved studies against the eligibility criteria (S.W. and G.H.L.). Human studies investigating suicide outcomes in women of reproductive age with a confirmed diagnosis of PCOS were included. Results: Eleven studies meeting our eligibility criteria were included. Although results were mixed, available evidence suggests that persons with PCOS are at an increased risk of suicidal ideation, self-harm and suicide attempts and are also differentially affected by psychiatric comorbidities (e.g., depressive disorders). Notwithstanding, suicide risk was not fully accounted for by the presence of mental illness, which suggests that PCOS may also be contributory. Conclusion: PCOS is associated with an increased risk of suicidal ideation and behaviour and associated psychiatric comorbidities. Persons with PCOS should be routinely evaluated for the presence of clinically significant suicidality. Whether increased suicidality in PCOS populations is a direct effect of the disease state and/or is largely moderated by psychiatric comorbidity is a future research vista.