Insulin Resistance Linked to Higher Depression Scores in Women with PCOS

Women with polycystic ovary syndrome (PCOS) who also have insulin resistance report substantially more depressive symptoms than women with PCOS whose insulin sensitivity is intact, according to a cross-sectional comparative study conducted in Ahvaz, Iran. The finding, published in BioPsychoSocial Medicine, suggests that the metabolic component of PCOS may be a key factor in the mental health burden carried by women with the condition.

PCOS is a common endocrine disorder in reproductive-aged women, frequently accompanied by metabolic disturbances such as insulin resistance. Although emerging evidence has pointed to a link between PCOS and mental health disorders, the specific role of insulin resistance in depression and anxiety among affected women has remained insufficiently understood. The research team set out to investigate the association between depression, anxiety, and insulin resistance in women with PCOS.

The study enrolled 274 women aged 18 to 45 years between June and December 2025 at a tertiary gynecology clinic and an infertility center. Participants were divided into three groups: 87 women with PCOS and insulin resistance, 87 women with PCOS without insulin resistance, and 100 healthy controls. PCOS was diagnosed using the Rotterdam criteria, and insulin resistance was defined as a HOMA-IR value above 2.5. Depression and anxiety symptoms were measured with the Beck Depression Inventory-II and the Beck Anxiety Inventory, respectively.

The three groups were comparable in education level, employment status, spouse’s occupation, and parity. However, significant differences emerged in age, body mass index, waist and hip circumference, blood pressure, and socioeconomic status, all with p-values below .001. Because these metabolic and demographic variables could confound any apparent link between insulin resistance and mood, the researchers adjusted their analyses accordingly.

After adjustment for age, BMI, waist circumference, blood pressure, and socioeconomic status — with hip circumference excluded due to multicollinearity — depressive symptom scores differed significantly across the three groups. The overall test yielded F(2, 265) = 10.59, p < .001, with a partial eta-squared of .074, indicating a medium effect size. Bonferroni post-hoc comparisons then pinpointed where the difference lay.

The PCOS group with insulin resistance scored significantly higher on depression than both comparison groups. Compared with women who had PCOS without insulin resistance, the adjusted mean difference was 5.81 points (standard error 1.29, p < .001, 95% confidence interval 2.71 to 8.92). Compared with healthy controls, the adjusted mean difference was 4.19 points (standard error 1.64, p = .034, 95% confidence interval 0.23 to 8.15). Notably, women with PCOS but without insulin resistance did not differ significantly from healthy controls in depression scores (p = .993), suggesting that insulin resistance, rather than PCOS diagnosis alone, drove the elevation in depressive symptoms.

Anxiety told a different story. After the same adjustments, anxiety scores did not differ significantly among the three groups: F(2, 265) = 1.62, p = .199, with a partial eta-squared of .012, a negligible effect size. This dissociation between depression and anxiety is one of the study’s more striking results, indicating that the association with insulin resistance is specific to depressive symptoms rather than a general marker of psychological distress.

The authors conclude that insulin resistance in women with PCOS is independently associated with elevated depressive symptoms, but not anxiety, after accounting for key demographic and metabolic confounders. They suggest the findings support integrating routine depression screening into the clinical management of women with PCOS, particularly those with metabolic abnormalities. Because the study is cross-sectional, it cannot establish causal direction, and the authors call for future prospective studies to elucidate causal pathways and to evaluate whether targeted metabolic interventions can ameliorate depressive burden in this population.

Subject of Research: The association between insulin resistance and depression and anxiety symptoms in women with polycystic ovary syndrome

Article Title: Association between insulin resistance and depression in women with polycystic ovary syndrome: a three-group comparative study

Article References: Ashtiani, N. M., Haghighizadeh, M. H., Amirzadeh, S., & Mohammadi, S. (2026). Association between insulin resistance and depression in women with polycystic ovary syndrome: a three-group comparative study. BioPsychoSocial Medicine. https://doi.org/10.1186/s13030-026-00375-x

Image Credits: AI Generated

DOI: 10.1186/s13030-026-00375-x

Keywords: polycystic ovary syndrome, insulin resistance, depression, anxiety, HOMA-IR, Beck Depression Inventory, cross-sectional study, metabolic health, women's health, Iran, reproductive endocrinology, mental health screening