Iron Deficiency Anemia Is Associated With Depressive Symptoms in Adolescents With Heavy Menstrual Bleeding

Authors

• Ramya Ramakrishnan
• Hansa Boddu
• Kaleigh Riggs-Harpur
• Lakshmi V Srivaths
• Asha Davidson
• Rebecca M Beyda
• Neethu M Menon

Language

English

Publication Date

10-1-2025

Journal

Research and Practice in Thrombosis and Haemostasis

DOI

10.1016/j.rpth.2025.103184

PMID

41127533

PMCID

PMC12539287

PubMedCentral® Posted Date

9-17-2025

PubMedCentral® Full Text Version

Post-print

Abstract

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

Objectives: 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.

Methods: 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.

Results: 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).

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

Keywords

iron deficiency, Patient Health Questionnaire (PHQ-9), pictorial blood assessment chart, ferritin, hemoglobin, ethnicity, obesity, bleeding disorder, hormonal therapy, antifibrinolytic therapy, oral iron, intravenous iron

Published Open-Access

yes

Recommended Citation

Ramakrishnan, Ramya; Boddu, Hansa; Riggs-Harpur, Kaleigh; et al., "Iron Deficiency Anemia Is Associated With Depressive Symptoms in Adolescents With Heavy Menstrual Bleeding" (2025). Faculty, Staff and Student Publications. 4148.
https://digitalcommons.library.tmc.edu/uthmed_docs/4148