Socio-psychological distress, violence, and food insecurity in women undergoing gynecological examinations: insights from a cross-sectional study of an Italian Tertiary Clinic

Background

The reality of gynecological patients represents a distinct subgroup of the population in which social and psychological distress can coexist alongside the burden of the disease. “Unmet social needs,” including social distress, which encompasses gender and family violence, abuse, unemployment, and food insecurity, are now widely recognized as critical determinants of health. Some studies have examined the social needs experienced by patients with gynecological disorders, but primarily in gynecologic oncology patients.

Objective

This study aims to assess the prevalence of socio-psychological distress, experiences of violence, and food insecurity in patients attending a tertiary outpatient gynecological clinic. Data were collected using a tailored open-ended questionnaire administered by trained volunteers.

Study design

This is a prospective cross-sectional study. An ad-hoc questionnaire, validated through the Delphi methodology, was administered to all women attending the Gynaecological Outpatient Clinic at Fondazione Policlinico A. Gemelli IRCCS in Rome, Italy, from March to November 2023. Their responses were analyzed focusing on self-reported socio-psychological distress, violence experienced and food insecurity. Inferential analysis was provided to evaluate the possible association with socioeconomic distress and clinical characteristics of patients. Multivariable logistic regression models for predicting outcomes were performed including those parameters that were statistically significant at univariable analysis (p value <.05).

Results

A total of 408 women were included in the study. One hundred and fifty-two (37.2%) reported socio-psychological distress, 136 (33.3%) violence, and 60 (14.7%) food insecurity. Independent risk factors for socio-psychological distress included oncological conditions (OR: 3.76, 95% CI: 1.55–9.11), chronic conditions (OR: 2.22, 95% CI: 1.38–3.57), economic difficulties (OR: 3.91, 95% CI: 2.20–6.93), and experiencing violence (OR: 4.65, 95% CI: 2.83–7.65). Independent risk factors for violence were benign gynecological conditions (OR: 1.95, 95% CI: 1.02–3.74), alcohol use (OR: 1.88, 95% CI: 1.16–3.04), economic difficulties (OR: 1.72, 95% CI: 1.02–2.90), and experiencing food insecurity (OR: 1.92, 95% CI: 1.03–3.59). The only independent risk factor for food insecurity was having economic difficulties (OR: 6.01, 95% CI: 3.06–11.81).

Conclusion

Socio-psychological distress and experiences of violence were found to be prevalent in over one-third of the population studied. Identified risk factors include the type of gynecological condition, economic hardship, and food insecurity. These findings underscore the urgent need for the development of comprehensive social support systems to assist women with gynecological conditions. While integrated clinical and social support programs remain underdeveloped in some countries, trained volunteers can serve as a valuable interim resource, complementing but not replacing the essential role of professional social and psychological services.