Analysis of risk factors for postoperative depressive disorders in patients with intrauterine adhesions

doi:10.5498/wjp.v16.i3.112649

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World Journal of Psychiatry

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©Author(s) (or their employer(s)) 2026. No commercial re-use. See Permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Mar 19, 2026; 16(3): 112649
Published online Mar 19, 2026. doi: 10.5498/wjp.v16.i3.112649

Analysis of risk factors for postoperative depressive disorders in patients with intrauterine adhesions

Wen-Ling Du, Shuang Chen, Si-Si Zhan

Wen-Ling Du, Si-Si Zhan, Department of Gynecology, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang Province, China

Shuang Chen, Department of Psychology, The First People’s Hospital of Shenyang, Shenyang 110031, Liaoning Province, China

Author contributions: Du WL participated in write original draft preparation and visualization; Du WL and Zhan SS contributed to data collection, statistical analysis; Chen S and Zhan SS contributed to review and edit the manuscript and methodology; Chen S contributed to psychological assessment design and implementation; Zhan SS contributed to conceptualization, supervision, project administration, funding acquisition. All authors contributed to manuscript revision and approved the final version.

Institutional review board statement: Approved by the Institutional Review Board of Wenzhou Central Hospital (approval No. 20250417629000402964).

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

Corresponding author: Si-Si Zhan, Attending Physician, Department of Gynecology, Wenzhou Central Hospital, No. 252 Baili East Road, Wuma Street, Lucheng District, Wenzhou 325000, Zhejiang Province, China. zhansisi@wmu.edu.cn

Received: August 8, 2025
Revised: September 16, 2025
Accepted: December 8, 2025
Published online: March 19, 2026
Processing time: 204 Days and 0.8 Hours

Abstract

BACKGROUND

Intrauterine adhesions (IUA) are a common gynecological condition that can significantly impact patients’ reproductive health and psychological well-being. This study aimed to analyze the incidence and associated risk factors of postoperative depressive disorders in patients with IUA to provide evidence for clinical interventions.

AIM

To determine the incidence of postoperative depressive disorders in patients undergoing hysteroscopic adhesiolysis for IUA, identify independent risk and protective factors associated with depression development.

METHODS

A retrospective analysis was conducted on clinical data from 400 patients who underwent intrauterine adhesion lysis surgery at our hospital from January 2022 to December 2024. Demographic characteristics, medical history, surgical parameters, and follow-up outcomes were collected. The Self-Rating Depression Scale and Hamilton Depression Scale were used to assess depressive status before surgery and 3 months postoperatively. Univariate analysis and multivariate logistic regression were performed to determine independent risk factors for postoperative depressive disorders.

RESULTS

Among the 400 patients, 112 (28.0%) developed depressive disorders within 3 months after surgery. Multivariate analysis showed that age ≥ 35 years [odds ratio (OR) = 2.05, 95% confidence interval (CI): 1.27-3.32, P = 0.003], history of infertility (OR = 2.58, 95%CI: 1.66-4.01, P < 0.001), history of recurrent miscarriage (OR = 2.82, 95%CI: 1.73-4.59, P < 0.001), severe IUA (American Fertility Society classification grade III) (OR = 3.31, 95%CI: 1.94-5.65, P < 0.001), postoperative complications (OR = 2.47, 95%CI: 1.39-4.38, P = 0.002), and previous history of depression or anxiety (OR = 4.16, 95%CI: 2.24-7.74, P < 0.001) were independent risk factors for postoperative depressive disorders. Protective factors included higher education level (OR = 0.58, 95%CI: 0.37-0.92, P = 0.019), good social support (OR = 0.45, 95%CI: 0.28-0.74, P = 0.001), and normal menstruation within 3 months after surgery (OR = 0.40, 95%CI: 0.24-0.67, P < 0.001).

CONCLUSION

The incidence of postoperative depressive disorders in patients with intrauterine adhesions is relatively high and associated with multiple factors.

Keywords: Intrauterine adhesions; Depression; Risk factors; Intrauterine adhesiolysis; Psychological health; Fertility

Core Tip: Postoperative depression affects 28% of patients undergoing hysteroscopic adhesiolysis for intrauterine adhesions, representing a significantly higher rate than the general female population. Six independent risk factors were identified: Age ≥ 35 years, history of infertility, recurrent miscarriage, severe adhesions (grade III), postoperative complications, and previous depression or anxiety disorders. Three protective factors emerged: Higher education level, strong social support, and successful menstrual restoration within 3 months post-surgery.