Long-term psychosocial outcomes after HIFU for uterine fibroids: Interplay between symptom severity and psychological distress

OBJECTIVE: To evaluate the long-term effects of HIFU ablation on quality of life, symptom severity, and psychological states (depression, anxiety, and stress) in women with uterine fibroids at least two years post-treatment. MATERIALS AND METHODS: This retrospective cohort study investigated 38 patients who underwent HIFU ablation for uterine fibroids at Chung Shan Medical University Hospital from 2015 to December 2018. Participants completed validated questionnaires including the Depression, Anxiety, and Stress Scale-21 Items (DASS-21) and the Uterine Fibroid Symptom and Health-related Quality of Life (UFS-QOL) questionnaire. Statistical analyses included descriptive statistics, correlation analysis, ANOVA, and logistic regression. RESULTS: The mean patient-rated symptom severity score (SSS) was 28.87, and the mean total health-related quality of life (HRQOL) score was 61.39. Over 60% of patients demonstrated normal scores in depression, anxiety, and stress domains. Significant negative correlations were found between HRQOL items and symptom severity scale (all p < 0.05). Positive correlations were observed between symptom severity and depression/anxiety/stress scores. For each one-point increase in disease severity, the likelihood of experiencing depression, anxiety, and stress increased by 1.041, 1.043, and 1.027 times, respectively. CONCLUSION: HIFU ablation demonstrates favorable and sustained long-term efficacy in managing symptoms. Crucially, psychological well-being plays a central role in determining long-term quality of life, with psychological factors explaining a significant proportion of HRQOL variance. This interplay underscores the necessity of integrating routine psychological screening (such as DASS-21) and adopting a holistic, multidisciplinary approach to long-term follow-up care for uterine fibroid patients.