Integrated Mental Health Support Models in Pediatric and Adolescent Gynecology: A Multicenter Clinical Implementation Study

Abstract

ABSTRACT Pediatric and adolescent gynecology (PAG) encompasses complex clinical scenarios, including congenital adrenal hyperplasia, polycystic ovary syndrome (PCOS), endometriosis, disorders of sex development (DSD), and severe menstrual disorders. Beyond physical manifestations, these condition-specific vulnerabilities elicit profound psychological distress, anxiety, body dysmorphia, and depression among young female patients. Despite increasing clinical recognition, mental health screening and psychiatric interventions remain poorly integrated into standard PAG clinical workflows across South Asian tertiary healthcare centers. This study evaluates the efficacy of an Integrated Psychological Care (IPC) protocol within PAG clinics through a two-year prospective, multi-center, parallel-group cohort study (N = 450). Patients aged 10–19 years diagnosed with organic PAG conditions were assigned to either Standard Gynecological Care (SGC, n=225) or Integrated Psychological Care (IPC, n=225), which embedded routine psychological screening, rapid cognitive-behavioral counseling, and trauma-informed supportive care. Baseline and 12-month post-intervention assessments were performed using the Hospital Anxiety and Depression Scale (HADS), Pediatric Quality of Life Inventory (PedsQL), and the Illness Perception Questionnaire-Revised (IPQ-R). Quantitative evaluation revealed a significant 41.2% reduction in clinical anxiety scores (p < 0.001) and a 38.5% reduction in depression scores (p < 0.001) in the IPC group compared to marginal improvements (6.1% and 4.2%) in the SGC cohort. Treatment adherence to hormonal and surgical therapies improved from 58.4% to 89.2% in the IPC cohort (p < 0.001). We establish that embedding dedicated mental health specialists within PAG clinical frameworks significantly enhances emotional resilience, therapeutic compliance, and overall health-related quality of life.

KEYWORDS: Pediatric and Adolescent Gynecology, Mental Health Integration, Polycystic Ovary Syndrome, Endometriosis, Anxiety and Depression, Treatment Adherence, Multidisciplinary Care Model.