Impact of depression on changes in pain symptoms after laparoscopic excision of moderate/severe endometriosis

OBJECTIVE: To assess the efficacy of surgical excision of endometriosis in treating pain symptoms caused by moderate/severe endometriosis (ASRM stage III/IV) in depressed patients (group D) and in non-depressed controls (group N). DESIGN: Comparative assessor-blinded prospective study. MATERIALS AND METHODS: The study included women of reproduc- tive age undergoing laparoscopy because of endometriosis-related pain symptoms who did not wish to conceive after surgery. Patients completed the Beck Depression Inventory (BDI) before surgery and, on the basis of the BDI score, they were assigned to group N (BDI score < 17) or to group D (BDI score R 17). Surgical procedures were performed by laparoscopy in all the patients. The investigators assessing changes in symptoms were blinded to the depression status. A visual analogue scale was used to assess the severity of pain symptoms. Patient satisfaction was investigated by using a Likert Scale. Quality of life (QoL) was evaluated by the Endometriosis Health Profile-30 (EHP-30) questionnaire. RESULTS: Eighty-four women with stage III/IV endometriosis were enrolled in the study. At 12-month follow-up, the rate of satisfied patients was higher in group N than in group D (p1⁄40.023). The intensity of dysmen- orrhea, deep dyspareunia, non-menstrual pelvic pain and dyschezia was similar in the two study groups at baseline. At 1-year follow-up, the intensity of dysmenorrhea and non-menstrual pelvic pain was higher in group D than in group N (p1⁄40.002 and p < 0.001). The EHP-30 scores were similar at baseline between the two study groups; at 12-month, follow-up they were significantly lower in group N than in group D (p1⁄40.003). CONCLUSION: Depressed women with stage III/IV endometriosis who undergo surgery are less satisfied than controls and have increased risk of persistence of symptoms.