Objectification, ambiguity and spiritual transformation among women with polycystic ovary syndrome : a mixed-method study

Abstract

Women with Polycystic Ovary Syndrome (PCOS) experience great psychological distress. The imbalanced hormonal levels, changed appearance and uncertain fertility potential brought by PCOS can create anxiety and depression, leading to poor quality of life. Traditional Chinese culture attaches great importance to fertility, while modern China’s media and social environment promote the aesthetics of white skin and slim figures. Therefore, women with PCOS in China may feel highly objectified and stigmatized. However, very little research has focused on their psychological well-being in the Chinese context until today. The Objectification Theory, the Uncertainty in Illness Theory and the Self-Efficacy Theory provide essential perspectives to understand the living experience of those women. Based on the existing theories and empirical studies, this research aims to present the pattern and relationship of objectification, ambiguity and psychological well-being of women with PCOS in China and explore the mechanism of their spiritual transformation in the long-term adaptation process using a mixed-method study approach. A systematic review and meta-analysis were conducted to demonstrate the mental health status of women with PCOS. According to the inclusion criteria, forty-six studies, including 9,265 women with PCOS and 25,638 controls, were qualified for review. Compared to healthy women, women with PCOS reported significantly higher depression, anxiety, lower quality of life, and no significant sexual dysfunction. Besides, participants in China reported a more substantial effect size of depression and anxiety than patients from other countries. Another systematic review on psychosocial interventions for women with PCOS was conducted. Only 13 studies were qualified for the inclusion criteria, with limited effectiveness. Therefore, although patients with PCOS suffer from both physical and mental disorders, a holistic intervention is still lacking, especially in China. One hundred eleven women with PCOS in China joined a quantitative investigation by filling in a questionnaire containing the scales on body shame, body surveillance, illness ambiguity, illness acceptance, self-efficacy and psychological problems. The results revealed a high level of body surveillance, body shame, illness ambiguity, appearance anxiety, anxiety and depression, verified the negative influence of self-objectification and illness ambiguity on psychological health, and supported the mediation roles of self-efficacy and illness acceptance in this relationship. Fifteen women joined a face-to-face semi-structured in-depth interview. Questions about their illness ambiguity, objectified experience, behaviors to pursue beauty, and spiritual growth were asked. Findings presented the problems and obstacles in their body, mind, identity and social interaction. The positive roles of self-efficacy, illness acceptance and self-love in pursuing spiritual growth were found. Twenty-eight patients participated in a tailored-made Integrative Body-Mind-Spirit (IBMS) intervention. Both laboratory and psychological measurements were taken. Results indicated that the IBMS method could long-termly improve women’s physical, mental and spiritual health with PCOS in China. Longitudinal qualitative follow-ups clarified the practical roles of self-acceptance and self-love to attain holistic well-being. This research presented a ‘Body-Identity-Self-Mind’ framework to understand Chinese women’s living and adaptation experience with PCOS. The tailored IBMS intervention is a promising method for improving patients’ holistic health with PCOS in the long term.