Date of Conferral

2-11-2026

Degree

Ph.D.

School

Health Sciences

Advisor

Howell Sasser

Abstract

Endometriosis is a chronic gynecologic condition associated with substantial physical, psychological, and social burden, and depressive symptoms are consistently linked to poorer health-related quality of life (HRQoL) among affected women. However, limited population-based research has examined how depressive symptoms intersect with social factors. Guided by Engel’s biopsychosocial model, nationally representative data from the 2005–2006 National Health and Nutrition Examination Survey (NHANES)—the most recent cycle to include an item on endometriosis diagnosis—were analyzed among U.S. women with self-reported endometriosis (N = 4,137). Complex samples logistic regression models were used to examine associations between depressive symptoms and HRQoL across general, physical, and mental health domains after adjusting for age, income-to-poverty ratio, educational attainment, marital status, household size, and survey design. Women with depressive symptoms had significantly lower odds of reporting good or excellent general health (OR = 0.29, p < .001) and significantly higher odds of reporting frequent physically unhealthy days (OR = 4.55, p < .001) and frequent mentally unhealthy days (OR = 9.29, p < .001) compared with women without depressive symptoms. In moderation analyses, educational attainment did not moderate the association between depressive symptoms and mental HRQoL. These findings support routine depression screening and integrated mental health care in gynecologic and chronic pain settings to improve mental health identification and management among women with endometriosis.

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