Iron deficiency anemia is associated with depressive symptoms in adolescents with heavy menstrual bleeding

Heavy menstrual bleeding (HMB) and associated iron deficiency (ID) with anemia (IDA) or without anemia lead to adverse health outcomes for adolescents.

This descriptive study aimed to assess the association between ID/IDA and depressive symptoms, as measured by Patient Health Questionnaire (PHQ)-9 scores, among adolescents with HMB.

This is a single-center retrospective records review of adolescents with physician-documented HMB and at least 1 PHQ-9 score, evaluated in a specialty clinic. With ID defined as ferritin of <25 ng/dL and IDA as hemoglobin (Hgb) of <12 g/dL, univariate and multivariate statistical models were used to compare ID/IDA with PHQ-9 scores cross-sectionally and longitudinally. We hypothesized that the incidence of PHQ-9 scores of ≥10 would be higher among patients with ID/IDA than that in those without.

Among 123 adolescents with HMB, 90 had ID and 61 had IDA; 37% of those with ID (33/90) and 51% of those with IDA (31/61) had a PHQ-9 score of ≥10 at baseline (P = .653 and P = .006, respectively). Further, 74 of the 123 had 2 or more PHQ-9 scores across multiple visits during the study period. Among these, PHQ-9 scores improved significantly when Hgb levels improved (P = .04) but did not change when ferritin levels improved (P = .23). PHQ-9 scores also improved with improvement of HMB, regardless of Hgb or ferritin levels (P = .003).

This study highlights the importance of addressing and optimally managing depressive symptoms in adolescents with HMB and related IDA.