Date of Conferral

2-11-2026

Degree

Ph.D.

School

Health Sciences

Advisor

Howell Sasser

Abstract

Endometriosis is a chronic gynecologic condition associated with physical, psychological, and social burden. Guided by Engel’s biopsychosocial model, this study examined associations between depressive symptoms and general, physical, and mental health-related quality of life (HRQoL) among U.S. women aged 20–54 years with self-reported physician-diagnosed endometriosis. Data came from the 2005–2006 National Health and Nutrition Examination Survey. The analytic domain included 104 women; complete-case samples for the general and physical analyses included 102. Survey-weighted logistic regression accounted for the complex survey design and covariates. Elevated depressive symptoms were associated with higher adjusted odds of fair or poor general health (aOR = 3.63, p = .048). The association with frequent physical distress was not statistically significant (aOR = 4.91, p = .166), although it was significant when depressive symptoms were modeled continuously. Endorsement of at least one depressive symptom was strongly associated with frequent mental distress (aOR = 23.12, p < .001). The planned analysis of education as a moderator could not be interpreted reliably because sparse-data separation affected the interaction model; an exploratory collapsed-education model found no statistically significant evidence of moderation (interaction OR = 4.98, p = .235). These findings may contribute to positive social change by increasing recognition of the psychological and functional burden of endometriosis, supporting more integrated and patient-centered approaches to care, and informing larger population-based studies aimed at improving the health and well-being of U.S. women living with endometriosis.

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