Central sensitization and mental health outcomes of endometriosis patients during the COVID-19 pandemic

To determine whether central nervous system sensitization in patients with endometriosis was associated with worse mental health outcomes during the COVID-19 pandemic. Data were linked between two British Columbia databases: the prospective Endometriosis Pelvic Pain Interdisciplinary cohort (EPPIC) that phenotypes endometriosis patients; and the Rapid Evidence Study of a Provincial Population Based Cohort for Gender and Sex cohort (RESPPONSE) that follows mental health outcomes during the COVID-19 pandemic. The predictors were the Central Sensitization Inventory (CSI) score and central sensitivity syndrome (CSS) comorbidities at baseline from EPPIC. The primary outcomes were PHQ-9 (depression) and GAD-7 (anxiety) scores in Phase 1 of the pandemic from RESPPONSE. Bivariate and multivariable analyses were performed. There were N=329 subjects in the linked dataset. On bivariate analysis, more central sensitization at baseline (i.e. higher CSI scores and more CSS comorbidities) was strongly associated with worse mental health during the pandemic (i.e. higher PHQ-9 and GAD-7 scores). On multivariable regression, after controlling for baseline mental health measures, age, BMI, and parity, both the CSI score and the number of CSS comorbidities at baseline were associated with worse PHQ-9 (P <0.0001, P = 0.0075) and worse GAD-7 (P <0.0001, P = 0.0054) scores during the pandemic. Central nervous system sensitization was associated with worse mental health for endometriosis patients during the COVID-19 pandemic. Central sensitization may predict mental health outcomes in the face of a pandemic or other stressors.