The Association of Trait Emotional Intelligence with Perceived Stress,Body Image and Quality of Life in Indian Women with Polycystic Ovary Syndrome: A Cross-sectional Study

Abstract

Background

Polycystic ovary syndrome (PCOS) imposes a substantial psychological burden, with affected women experiencing an increased risk of depression and suicidal behaviour. Although the clinical features of PCOS are well documented, the influence of modifiable psychological factors such as emotional intelligence (EI) remains underexplored, particularly among Indian women.

Purpose

This study examined the associations between trait EI, perceived stress, body shape concern and quality of life in Indian women with PCOS.

Methods

A cross-sectional analytical study was conducted at a tertiary care centre in Puducherry, India. One hundred women aged 18–35 with confirmed PCOS were recruited. Participants completed validated questionnaires: the Trait Emotional Intelligence Questionnaire-Short Form, Perceived Stress Scale-10, Body Shape Questionnaire-16A and Polycystic Ovary Syndrome Questionnaire. Multiple linear regression models were used to identify independent correlates of psychological outcomes.

Results

A significant psychological burden was evident, with 91% of participants reporting moderate to high perceived stress. Higher trait EI was significantly associated with better psychological well-being, showing negative correlations with both perceived stress (ρ = −0.60) and body shape concern (ρ = −0.43). Multiple linear regression analysis, after controlling for covariates, confirmed that higher EI was the strongest independent correlate of lower perceived stress (β = −0.58, p < .001), reduced body shape concern (β = −0.34, p < .001) and higher overall quality of life (β = 0.51, p < .001). Additionally, moderate physical activity was independently associated with lower perceived stress (p < .001) and higher quality of life (p = .011).

Conclusion

Trait EI emerged as a key independent correlate of lower perceived stress, reduced body shape concern and improved quality of life. Moderate physical activity also contributed independently to lower stress and better quality of life. These findings support incorporating emotion-focused interventions into comprehensive PCOS management.

Keywords

Polycystic ovary syndrome emotional intelligence perceived stress body image quality of life

Introduction

The psychological burden of polycystic ovary syndrome (PCOS) is a critical public health issue. Women with this condition are up to eight times more likely to experience depressive symptoms and face a nearly 8.5-fold increased risk of suicide attempts compared to healthy controls.¹ As the most common endocrine disorder in reproductive-age women, PCOS is clinically defined by a combination of hyperandrogenism, chronic anovulation and polycystic ovarian morphology.^2–5 However, its impact extends far beyond physical health, creating profound psychosocial distress that urgently requires investigation.

The syndrome’s clinical manifestation encompasses a significant metabolic component, including insulin resistance and obesity.^{6, 7} The burden of PCOS is particularly acute in women of Indian ethnicity, who are reported to have a high prevalence of the condition and an early onset of symptoms.⁸ For these women, the reproductive and physical symptoms of PCOS—including irregular periods, infertility and hyperandrogenism (such as unwanted facial hair or hirsutism)—are heavily stigmatised, creating unique sociocultural barriers to care. In this context, symptoms directly impact a woman’s desirability and role within her family and society, often leading to a poor quality of life.⁸ Symptoms like hirsutism and related body image issues directly compromise health-related quality of life, particularly in the psychological domain,^{9, 10} highlighting the urgent need for interventions that target the core processes driving this distress.^{11, 12}

Despite the recognised high prevalence of psychological distress, the mechanisms that link the chronic physical stressors of PCOS (e.g., body image dissatisfaction, infertility stigma) to severe psychological outcomes are often overlooked in intervention research. One critical, modifiable mechanism is emotion regulation (ER). ER refers to the process by which individuals influence which emotions they have, when they have them and how they experience and express them.^{13, 14} In chronic disease populations, difficulties with ER are associated with increased difficulties in coping with illness-related stressors and contribute to poorer physical function and overall health outcomes.¹⁴

Emotional intelligence (EI), particularly trait EI (the self-perception of one’s emotional abilities), provides the dispositional framework for understanding a person’s typical pattern of ER.^{15, 16} Adaptive ER strategies allow an individual to reframe stressful events in a more positive or less threatening light, thus promoting better psychological adjustment to the demands of chronic illness.¹⁴

Despite the high prevalence of psychological distress in PCOS, a significant knowledge gap persists regarding the role of emotional coping mechanisms, particularly within the Indian context. Previous research has largely prioritised the condition’s clinical and biochemical aspects. Therefore, the present study was designed to address this gap by conducting a primary investigation into the associations between trait EI, perceived stress, body image and quality of life among Indian women with PCOS. Specifically, our objectives were to assess the levels of EI, perceived stress, body image perception and quality of life and to identify the associations between these variables in women with PCOS.

Methods

Study Design and Ethical Approval

This was a cross-sectional analytical study conducted in the Department of Physiology at the Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry. The data collection for the study took place between August 2025 and September 2025. The study protocol and all related documents received full approval from the Institutional Ethics Committee (IEC) for Human Studies at JIPMER (Approval No. JIP/IEC-OS/2025/031). Before any participant was enrolled, we obtained their written informed consent. This process was comprehensive: the study procedures were explained in detail to each participant in their mother tongue, and all of their queries were fully addressed. We conducted the research in strict adherence to all institutional ethical guidelines.

Participant Selection and Recruitment

We recruited participants for this study from the population of women attending the Obstetrics and Gynaecology outpatient department at our institution. Participants were required to meet the following inclusion criteria: (a) age between 18 and 35 years; and (b) a confirmed diagnosis of PCOS according to the Rotterdam criteria,^{2, 3} defined by the presence of at least two of the following: (i) oligomenorrhoea or dysmenorrhoea, (ii) clinical and/or biochemical signs of hyperandrogenism or (iii) polycystic ovarian morphology on ultrasound. Exclusion criteria were: (a) a history of other endocrine disorders; (b) any known psychiatric or other chronic illness; (c) current engagement in any form of psychological treatment or (d) pregnancy. We used a consecutive sampling technique to enrol all eligible women who consented to participate until our target sample size was met.

Sample Size Determination

The sample size was calculated a priori using G*Power software. The calculation was based on an anticipated correlation coefficient (r) of 0.30, a significance level (α) of 0.05 and a desired statistical power of 90%. While a previous study by Manjareeka and Yadav¹⁷ reported a correlation of r = 0.38, we opted for a more conservative estimate of r = 0.30 to ensure an adequate sample size. The analysis indicated that 112 participants were required for 90% power. While the final recruited sample comprised 100 participants, a post-hoc power analysis confirmed that this sample size provides 86% power to detect the anticipated effect size (r = 0.30) at a significance level of 0.05, exceeding the conventional 80% threshold.

Study Procedure and Measures

All data for each participant were collected during a single study visit, which lasted approximately 50 min. The procedure followed a standardised sequence:

Informed consent: First, the study’s objectives and procedures were explained, and written informed consent was obtained.

Demographic and personal data: Participants completed a structured proforma to collect demographic, clinical and personal information.

Anthropometric measurements: A series of physical measurements, including height, weight and waist/hip circumferences, were then taken.

Psychometric evaluation: Finally, participants were provided with a set of validated, self-administered questionnaires to assess the psychological and quality of life outcomes.

Anthropometric and Personal Data

We recorded personal details including age, education, occupation, menstrual history and the duration of their PCOS diagnosis. We also assessed the participant’s physical activity level over the preceding 7 days using the International Physical Activity Questionnaire-Short Form.¹⁸ For the anthropometric assessment, we measured height to the nearest 1 mm using a wall-mounted stadiometer and weight to the nearest 0.5 kg using a calibrated digital weighing scale. From these values, we calculated the body mass index (BMI) using the formula: weight (kg)/[height (m)]². We measured waist circumference (WC) at the narrowest point between the lower costal border and the top of the iliac crest. Hip circumference (HC) was measured at the level of the greatest posterior protuberance of the buttocks. The waist–hip ratio was then calculated as WC/HC.

Psychological Measures

Emotional intelligence: Assessed using the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF).^{19, 20} This 30-item self-report instrument uses a 7-point Likert scale (1: ‘completely disagree’ to 7: ‘completely agree’) and provides a global trait EI score, ranging from 30 to 210, with higher scores indicating greater EI.

Perceived stress: Measured using the Perceived Stress Scale-10 (PSS-10).²¹ This 10-item questionnaire uses a 5-point scale (0: ‘never’ to 4: ‘very often’). Total scores (0–40) are interpreted as low (0–13), moderate (14–26) or high (27–40) perceived stress.

Body image perception: Evaluated with the Body Shape Questionnaire-16A (BSQ-16A).²² This 16-item measure assesses concerns about body shape over the past 4 weeks. A higher score indicates more dissatisfaction and discomfort with one’s body.

Quality of life: Measured using the Polycystic Ovary Syndrome Questionnaire (PCOSQ).²³ This 26-item instrument is answered on a 7-point Likert scale across five domains: Emotional, body hair, weight, infertility and menstruation. Higher mean scores reflect a better quality of life.

Statistical Analysis

Statistical analyses were performed using Jamovi (Version 2.6.26). Continuous variables were presented as mean and standard deviation or median and interquartile range (IQR) based on their distribution, while categorical data were summarised as frequencies and percentages. Associations between variables were examined using Spearman’s rank-order correlation. Group comparisons based on physical activity levels were conducted using a one-way analysis of variance (ANOVA). Where a significant effect was found, pairwise comparisons were performed using the Games–Howell post-hoc test. To identify independent correlates of psychological outcomes, a series of multiple linear regression models was developed. Statistical significance was set at a p value of <.05. Data were collected using an electronic survey where all fields were mandatory, resulting in a complete dataset with no missing values.

Results

This section first describes the socio-demographic and psychological profile of the study participants and then presents the results of the bivariate correlation and multiple linear regression analyses, identifying the primary correlates of psychological outcomes.

Internal Consistency of Study Instruments

The internal consistency of all study instruments was evaluated using Cronbach’s alpha (α). The PSS-10 questionnaire demonstrated acceptable reliability (α = 0.727). The BSQ-16A questionnaire showed good internal consistency (α = 0.784). The TEIQue-SF questionnaire exhibited excellent reliability for the global scale (α = 0.922). At the factor level, Cronbach’s alpha values were 0.783 for well-being, 0.673 for sociability, 0.671 for self-control and 0.664 for emotionality, consistent with prior validation studies of TEIQue-SF, where factor-level alphas typically range from 0.50 to 0.80 due to the brevity of each subscale (six to eight items).

The PCOSQ-26 questionnaire demonstrated good overall reliability (α = 0.894). Domain-specific alphas were: Emotional (α = 0.837), infertility (α = 0.836), body hair (α = 0.832), menstruation (α = 0.813) and weight (α = 0.751). All values exceeded the conventional threshold of 0.70, indicating satisfactory internal consistency across domains.

Participant Characteristics (Table 1)

The final study sample comprised 100 women diagnosed with PCOS. Their socio-demographic, clinical and anthropometric characteristics are detailed in Table 1. Participants had a median age of 28.0 years (IQR = 5.5) and a median disease duration of 48.0 months (IQR = 48.0). The majority were homemakers (78.0%) and had graduate or postgraduate education (59.0%). Nearly all participants reported irregular menstrual cycles (94.0%). The median BMI was 28.3 kg/m² (IQR = 5.1), indicating a predominantly overweight to obese cohort, with a median waist–hip ratio of 0.88 (IQR = 0.13), suggesting central adiposity. Physical activity levels were moderate in 56.0%, low in 40.0% and high in 4.0% of participants.

Table 1.

Baseline Characteristics of Study Participants (N = 100).

Characteristic	Value [N (%) or Median (IQR)]
Socio-demographic Characteristics
Age (years)	28.0 (5.5)
Education
Primary	5 (5.0%)
Secondary	28 (28.0%)
Diploma	8 (8.0%)
Graduate	55 (55.0%)
Postgraduate	4 (4.0%)
Occupation
Homemaker	78 (78.0%)
Teacher	6 (6.0%)
Student	9 (9.0%)
Tailor	4 (4.0%)
Farmer	3 (3.0%)
Clinical Characteristics
Duration of disease (months)	48.0 (48.0)
Menstrual History
Regular	6 (6.0%)
Irregular	94 (94.0%)
Physical Activity Level
Low	40 (40.0%)
Moderate	56 (56.0%)
High	4 (4.0%)
Anthropometric Parameters
Height (cm)	154.5 (7.0)
Weight (kg)	66.8 (18.0)
BMI (kg/m²)	28.3 (5.1)
Waist circumference (cm)	92.0 (16)
Hip circumference (cm)	105.0 (8.0)
Waist–hip ratio	0.88 (0.13)

Psychological Profile of Participants

Descriptive statistics for the psychological and quality of life outcomes are presented in Table 2. The median perceived stress score was 24.0 (IQR = 11.0) on the PSS-10. Categorical analysis (Figure 1) showed that 91% of participants experienced moderate-to-high perceived stress: 40% (n = 40) were classified as high stress (PSS ≥ 27) and 51% (n = 51) as moderate stress (PSS 14–26). Only 9% (n = 9) reported low perceived stress.

Table 2.

Psychological and Quality of Life Scores of the Study Population (N = 100).

Instrument/Domain	Median (IQR)
Perceived stress (PSS-10)	24.0 (11.0)
Body shape concern (BSQ-16A)	59.5 (16.0)
Trait Emotional Intelligence (TEIQue-SF)
Global trait EI	3.99 (0.90)
Well-being	4.33 (1.50)
Self-control	4.17 (1.33)
Sociability	4.00 (1.00)
Emotionality	3.92 (1.66)
Quality of Life (PCOSQ)
QoL: Emotional	3.86 (1.75)
QoL: Body hair	5.20 (2.20)
QoL: Weight	3.60 (2.45)
QoL: Infertility	3.25 (2.75)
QoL: Menstruation	3.00 (1.60)
Overall QoL score	3.66 (1.35)

Note: BSQ-16A: Body Shape Questionnaire; PCOSQ: Polycystic Ovary Syndrome Questionnaire; PSS-10: Perceived Stress Scale; TEIQue-SF: Trait Emotional Intelligence Questionnaire-Short Form; QoL: Quality of life.

Figure 1.

Notes: The pie chart illustrates the categorisation of participants based on their scores from the Perceived Stress Scale-10 (PSS-10). Scores were classified as low (0–13), moderate (14–26) or high (27–40).

Body shape concerns showed a similar pattern. The median BSQ-16A score was 59.5 (IQR = 16.0). As illustrated in Figure 2, 69% reported moderate-to-high body shape concern, with 43% (n = 43) moderate concern and 26% (n = 26) high concern. Additionally, 28% (n = 28) reported mild concern, while only 3% (n = 3) reported no concern.

Figure 2.

Notes: The pie chart illustrates the categorisation of participants based on their scores from the Body Shape Questionnaire-16A (BSQ-16A). Scores were classified as no concern (<38), mild concern (38–51), moderate concern (52–66) or high concern (>66).

The median global TEIQue-SF score was 3.99 (IQR = 0.90), with subscale medians ranging from 3.92 (emotionality) to 4.33 (well-being). Overall quality of life, measured by PCOSQ-26, had a median score of 3.66 (IQR = 1.35). Among domains, body hair had the highest median score (5.20, IQR = 2.20), while menstruation had the lowest (3.00, IQR = 1.60), indicating menstrual irregularity imposed the greatest detriment to quality of life.

Bivariate Correlation Analyses

Spearman’s rank-order correlations are presented in Figure 3. Global trait EI was significantly and negatively correlated with perceived stress (ρ = −0.60, p < .001) and body shape concern (ρ = −0.43, p < .001), indicating that higher EI was associated with lower psychological distress. Conversely, global trait EI showed a significant positive correlation with overall quality of life (ρ = 0.49, p < .001).

Among the PCOSQ-26 domains, trait EI showed the strongest positive associations with the emotional (ρ = 0.52, p < .001), weight (ρ = 0.45, p < .001) and body hair (ρ = 0.41, p < .001) domains. The association with infertility was modest but significant (ρ = 0.22, p = .032), while the correlation with menstruation did not reach statistical significance (ρ = 0.17, p = .086).

Perceived stress was significantly and inversely correlated with all five PCOSQ domains and the overall quality of life score (ρ = −0.55, p < .001). Body shape concern was most strongly associated with the Weight domain (ρ = −0.68, p < .001) and emotional domain (ρ = −0.59, p < .001). A strong positive correlation was observed between perceived stress and body shape concern (ρ = 0.58, p < .001), suggesting a shared psychological burden.

Figure 3.

Note: Cell colors reflect correlation strength: Blue = positive, red = negative, white = near-zero. EI = Trait Emotional Intelligence (TEIQue-SF Global Score); PSS = Perceived Stress Scale; BSQ = Body Shape Questionnaire; QoL = Quality of Life (PCOSQ domains and overall score).

The heatmap visualises the Spearman’s rank-order correlation coefficients (rho) between key study variables (N = 100). The colour intensity and shade correspond to the magnitude of the correlation, with blue indicating positive correlations (e.g., trait EI and quality of life) and red indicating negative correlations (e.g., trait EI and perceived stress). The figure was generated using the Rj Editor+ module within jamovi (Version 2.6) using the ‘ggplot2’ and ‘reshape2’ packages. Full variable names are as follows: Emotional intelligence (TEIQue-SF Global Score), perceived stress (PSS-10 Score), body shape concern (BSQ-16A Score) and quality of life (PCOSQ domain and overall scores).

Association of Physical Activity with Psychological Outcomes

Welch’s ANOVA examined differences in psychological outcomes across physical activity levels (Table 3). A significant difference was observed for perceived stress (F = 6.74, p = .012). Post-hoc Games–Howell comparisons indicated that participants with moderate physical activity (n = 56) reported significantly lower perceived stress scores (21.21 ± 7.53) than the low-activity group (25.27 ± 4.55, p = .004) and the high-activity group (26.50 ± 2.52, p = .027).

Table 3.

Comparison of Psychological Outcomes by Physical Activity Level (N = 100).

Variable	Low Activity (n = 40)	Moderate Activity (n = 56)	High Activity (n = 4)	F (Welch’s)	p Value
Emotional intelligence	3.94 ± 0.91	4.00 ± 1.21	4.36 ± 0.42	1.32	.305
Perceived stress	25.27 ± 4.55	21.21 ± 7.53	26.50 ± 2.52	6.74	.012
Body shape concern	59.05 ± 9.28	57.46 ± 10.42	57.00 ± 6.88	0.34	.721
Quality of life	3.56 ± 0.67	4.04 ± 1.06	3.61 ± 0.58	3.43	.078

Notes: Values are presented as mean ± standard deviation. The F-statistic is from Welch’s ANOVA. Significant p values (p < .05).

Quality of life scores were numerically higher in the moderate-activity group (4.04 ± 1.06) than the low-activity group (3.56 ± 0.67), although this difference did not reach statistical significance (p = .078). No significant differences were found for EI (p = .305) or body shape concern (p = .721) across activity levels.

Independent Correlates of Psychological Outcomes: Multiple Linear Regression

To identify independent correlates of each psychological outcome, three multiple linear regression models were constructed (Tables 4 –6). All models were evaluated for multicollinearity; variance inflation factor values were below 2.0 for all predictors in each model, confirming the absence of problematic multicollinearity.

Table 4.

Multiple Linear Regression Analysis Predicting Perceived Stress Score in Women with Polycystic Ovary Syndrome (PCOS) (N = 100).

Predictor	B (SE)	95% CI for B	β	t	p
Intercept	31.46 (6.93)	[17.68, 45.24]		4.54	<.001
Global trait EI	−3.59 (0.50)	[−4.58, −2.60]	−0.58	−7.14	<.001
BMI	0.26 (0.15)	[−0.04, 0.56]	0.14	1.74	.086
Age	0.03 (0.15)	[−0.26, 0.32]	0.02	0.21	.836
Duration of disease (months)	−0.004 (0.013)	[−0.03, 0.02]	−0.02	−0.27	.786
Physical Activity^*
High–low	2.35 (2.53)	[−2.68, 7.38]	0.35	0.93	.355
Moderate–low	−3.58 (1.05)	[−5.67, −1.49]	−0.54	−3.42	<.001

Notes: Dependent variable: Perceived Stress Scale (PSS) score. R² = 0.528, adjusted R² = 0.497, F(6, 93) = 17.33, p < .001. ^*Reference category: ‘Low’ physical activity level. B: Unstandardised coefficient; CI: confidence interval; B: Standardised coefficient.

Table 5.

Multiple Linear Regression Analysis Predicting Body Shape Concerns (BSQ) in Women with Polycystic Ovary Syndrome (PCOS) (N = 100).

Predictor	B (SE)	95% CI for B	β	t	p
Intercept	46.85 (11.64)	[23.73, 69.96]		4.02	<.001
Global trait EI	−3.11 (0.84)	[−4.79, −1.44]	−0.34	−3.69	<.001
Age	−0.20 (0.25)	[−0.69, 0.29]	−0.07	−0.80	.425
BMI	1.00 (0.25)	[0.51, 1.49]	0.38	4.02	<.001
Duration of disease (months)	0.02 (0.02)	[−0.02, 0.07]	0.10	1.08	.283
Physical Activity^*
High–low	−1.77 (4.25)	[−10.20, 6.66]	−0.18	−0.42	.678
Moderate–low	0.08 (1.76)	[−3.41, 3.58]	0.01	0.05	.962

Notes: Dependent variable: Body Shape Questionnaire (BSQ) score. Higher BSQ scores indicate greater body shape concerns/dissatisfaction. R² = 0.389, adjusted R² = 0.350, F(6, 93) = 9.87, p < .001. ^*Reference category: ‘Low’ physical activity level. B: Unstandardised coefficient; CI: Confidence interval; B: Standardised coefficient.

Table 6.

Multiple Linear Regression Analysis Predicting Quality of Life (PCOSQ Total) in Women with PCOS (N=100).

Predictor	B (SE)	95% CI for B	β	t	p
Intercept	2.03 (1.07)	[−0.09, 4.16]		1.90	.060
Global Trait EI	0.44 (0.08)	[0.28, 0.59]	0.51	5.61	<.001
Age	0.03 (0.02)	[−0.01, 0.08]	0.13	1.44	.153
BMI	−0.04 (0.02)	[−0.08, 0.01]	−0.15	−1.57	.120
Duration of disease (Months)	−0.002 (0.002)	[−0.006, 0.002]	−0.07	−0.81	.420
Physical activity⁺
High – low	−0.06 (0.39)	[−0.84, 0.71]	−0.02	−0.16	.874
Moderate – low	0.42 (0.16)	[0.10, 0.74]	0.24	2.61	.011

Note: Dependent variable: PCOSQ Total Score (Quality of Life). Higher scores indicate better quality of life. R² = 0.423, Adjusted R² = 0.386, F(6, 93) = 11.36, p < .001. *Reference category: “low” physical activity level.

Perceived stress: The regression model for perceived stress was statistically significant, F(6, 93) = 17.33, p < .001, accounting for 52.8% of the variance (R² = .528; adjusted R² = .497). Global trait EI emerged as the strongest independent correlate, demonstrating a significant inverse association with perceived stress (β = −0.58, B = −3.59, 95% CI [−4.58, −2.60], p < .001). Among lifestyle factors, moderate physical activity was associated with significantly lower stress levels compared to the low-activity reference group (β = −0.54, B = −3.58, 95% CI [−5.67, −1.49], p < .001). BMI showed a positive but non-significant trend (β = 0.14, p = .086). Neither age (p = .836) nor disease duration (p = .786) contributed significantly to the model.

Body shape concern: The model for body shape concern was statistically significant, F(6, 93) = 9.87, p < .001, explaining 38.9% of the variance (R² = .389; adjusted R² = .350). Two variables emerged as significant independent correlates. BMI demonstrated a significant positive association with body shape concern (β = 0.38, B = 1.00, 95% CI [0.51, 1.49], p < .001), indicating that higher BMI was associated with greater body dissatisfaction. Global trait EI showed a significant inverse association (β = −0.34, B = −3.11, 95% CI [−4.79, −1.44], p < .001), suggesting a protective role of EI against body image disturbance. Age (p = .425), disease duration (p = .283) and physical activity level (p > .05) did not reach statistical significance.

Quality of life: The model for overall quality of life was statistically significant, F(6, 93) = 11.36, p < .001, accounting for 42.3% of the variance (R² = .423; adjusted R² = .386). Global trait EI was the most robust positive correlate (β = 0.51, B = 0.44, 95% CI [0.28, 0.59], p < .001), underscoring its central role in quality of life among women with PCOS. Moderate physical activity was associated with significantly higher quality of life compared to the low-activity reference group (β = 0.24, B = 0.42, 95% CI [0.10, 0.74], p = .011). BMI exhibited a negative trend that did not attain statistical significance (β = −0.15, p = .120). Neither age (p = .153) nor disease duration (p = .420) contributed independently to quality of life.

Discussion

The findings of this study highlight a potentially modifiable psychological mechanism—trait EI—that is significantly associated with the well-being of women with PCOS. Higher self-perceived EI was a robust independent correlate of lower stress levels and fewer body shape concerns. This finding suggests potential therapeutic avenues beyond standard clinical management, indicating that interventions aimed at strengthening emotional competencies may support psychological well-being.

Descriptive Profile: Situating the Cohort in the Broader Literature

Women in our study exhibited moderate-to-high perceived stress, consistent with evidence demonstrating elevated psychological distress among women with PCOS. Benjamin et al. reported significantly higher serum cortisol and DHEA levels in Indian women with PCOS compared with healthy controls.²⁴ Similarly, Khafagy et al. found higher PSS scores among adolescents with PCOS than among controls.²⁵ These findings support a bidirectional relationship in which PCOS symptoms may increase stress, while chronic stress may exacerbate hormonal imbalance and metabolic dysfunction, potentially influencing PCOS pathogenesis. Women with PCOS consistently report higher stress levels than the general female population, as shown by PSS-10 assessments across diverse cohorts.²⁶

Participants also reported moderate-to-marked body shape concerns on the BSQ-16A, consistent with evidence that body dissatisfaction is a major psychosocial challenge in PCOS. A meta-analysis by Davitadze et al. reported significantly greater dissatisfaction across multiple body-image domains in women with PCOS compared with controls.²⁷ Similarly, Alkheyr et al. found lower body image satisfaction, reduced self-confidence and greater social avoidance among women with PCOS in a Middle Eastern cohort.²⁸ These concerns are often driven by manifestations of hyperandrogenism—such as hirsutism, acne and central obesity—which conflict with societal beauty norms and contribute to negative self-perception. Sun et al. demonstrated that body image distress negatively affects quality of life both directly and indirectly through anxiety.²⁹

In the Indian context, several studies have documented the heightened vulnerability of young women with PCOS to body dissatisfaction and low self-esteem.^30–32 Psychological distress in our cohort may also reflect sociocultural influences. Research among ethnic Indian women indicates that symptoms such as hirsutism, irregular cycles and weight gain are closely linked to perceptions of femininity and ‘marriageability’. Rao et al. reported that these manifestations often lead to social stigma and familial pressure related to reproductive health.⁸ Although marital status was not analysed in this study, the high prevalence of stress (91%) aligns with findings by Joshi et al., suggesting that sociocultural beauty standards act as persistent background stressors for Indian women with PCOS.³² Within this context, trait EI may function as an important psychological resource that helps women navigate these societal and familial expectations.

The Association of EI with Psychological Distress

The central finding of this study was the strong inverse correlation between trait EI and both perceived stress and body shape concerns. Women with higher self-perceived EI reported lower stress and fewer body shape concerns, consistent with evidence linking higher EI with reduced psychological distress. Fteiha et al. demonstrated that individuals with higher EI employ more effective emotional and problem-focused coping strategies.³³ Similarly, Singh and Sharma reported that higher EI was associated with lower levels of acute and chronic perceived stress, independent of general intelligence.³⁴

Trait EI encompasses self-perceptions related to ER, stress management and impulse control, which are essential for adaptive coping. Ramesar et al. identified stress management as a core component of EI.³⁵ Mohamed et al. reported that higher EI was associated with greater resilience and lower stress among health sciences students.³⁶ Bilimale et al. further observed that EI may not directly predict academic performance but plays a key role in managing emotional challenges, highlighting its relevance for psychological resilience rather than cognitive achievement.³⁷ Together, these findings emphasise EI as an important psychological resource that may buffer the emotional consequences of chronic conditions, such as PCOS.

BMI was independently associated with greater body shape concern, consistent with the established relationship between adiposity and body dissatisfaction in PCOS. However, BMI was not a significant independent correlate of perceived stress or overall quality of life after adjusting for EI and physical activity, suggesting that the psychological effects of body weight may be domain-specific rather than global.

Association of EI and Quality of Life

Higher trait EI was also the strongest independent correlate of better overall quality of life (β = 0.51, p < .001) measured by the PCOSQ-26. This finding is clinically important given the cohort’s median quality of life score of 3.66, with emotions and menstrual problems being the most affected domains. Women with greater emotional awareness and regulation may be better able to appraise and manage PCOS-related stressors, thereby maintaining well-being across life domains. This aligns with evidence that psychological flexibility and emotional self-efficacy are key determinants of health-related quality of life in chronic illness populations. Importantly, quality of life in PCOS appears to be influenced not only by symptom severity or BMI—neither of which independently predicted quality of life in our model—but also by emotional self-perceptions, suggesting that psychological interventions may improve quality of life even without changes in clinical parameters.

The Interplay of Physical Activity, EI and Well-being

Physical activity emerged as a significant independent correlate of perceived stress. Women engaging in moderate levels of physical activity reported significantly lower stress compared with those with low or high activity levels, suggesting that moderate exercise may provide optimal psychological benefits for Indian women with PCOS. High-intensity regimens may increase perceived physical or time-related burdens. Physical activity did not independently predict body shape concern after adjusting for EI and BMI.

However, moderate physical activity was independently associated with higher overall quality of life, indicating benefits beyond stress reduction. The absence of an association with body shape concern suggests that exercise alone may not address deeper psychological issues such as body image distress without concurrent psychological support. Mahindru et al. reported that physical activity improves self-concept, body image and quality of life.³⁸ Conte et al.³⁹ and Banting et al.⁴⁰ similarly reported lower depression severity among physically active women with PCOS. Our findings suggest that these benefits may be partly mediated by factors such as EI. It is possible that physical activity contributes to the development of EI, or that women with higher EI are more likely to engage in regular exercise.^{41, 42}

Although regular exercise (150–300 min of moderate-intensity aerobic activity weekly with strength training) remains a cornerstone of PCOS management guidelines,⁴³ poor body image and psychological distress may act as barriers to sustained engagement, potentially creating a negative feedback loop that limits the independent impact of exercise on long-term quality of life.⁴⁴

Limitations and Future Directions

The findings should be interpreted considering several limitations. First, the cross-sectional design establishes associations but does not allow causal inference. Second, the exclusive use of self-report questionnaires may introduce common method variance and response biases, such as social desirability. This is particularly relevant because the ‘stress management’ component of trait EI conceptually overlaps with the subjective evaluation of perceived stress, which may inflate observed associations. Third, recruitment from a single tertiary care centre may limit the generalisability of the findings to the broader population of Indian women with PCOS.

Future studies should employ longitudinal designs to clarify causal relationships between EI, physical activity and psychological well-being. Incorporating objective physiological markers such as cortisol levels or heart rate variability alongside psychometric measures may reduce self-report bias. Intervention studies are also needed to evaluate programs aimed at enhancing EI as a therapeutic strategy. Finally, mixed-methods approaches incorporating qualitative techniques, such as semi-structured interviews, could provide deeper insights into the lived experiences of Indian women and help contextualise these findings within relevant cultural stressors and societal expectations.

Conclusion

The present study identifies trait EI as a significant independent correlate of psychological well-being among Indian women with PCOS. Higher EI was strongly associated with lower perceived stress, fewer body shape concerns and better quality of life. Moderate physical activity was also independently linked to reduced stress and improved quality of life. These findings indicate that psychological well-being in PCOS is influenced by emotional self-perceptions beyond clinical and anthropometric factors. Enhancing emotional competencies through targeted psychological interventions may, therefore, be an important component of holistic PCOS care to promote resilience and improve quality of life.

Footnotes

Acknowledgements

The authors gratefully acknowledge the infrastructural support provided by JIPMER. They thank the volunteers who participated in this study for their time and commitment.

Authors’ Contributions

Concept and design: Saranya Kuppusamy, Pranav Venkatachaliah Kanamanapalli.

Acquisition, analysis or interpretation of data: Pranav Venkatachaliah Kanamanapalli, Chitra Thyagaraju, Saranya Kuppusamy, Senthil Kumar Subramanian.

Drafting of the manuscript: Saranya Kuppusamy, Pranav Venkatachaliah Kanamanapalli, Senthil Kumar Subramanian.

Critical review of the manuscript for important intellectual content: Saranya Kuppusamy, Pranav Venkatachaliah Kanamanapalli, Chitra Thyagaraju, Senthil Kumar Subramanian.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ICMJE Statement

All authors have read and approved the final manuscript and agree to be accountable for all aspects of the work. The manuscript has not been published previously and is not under consideration for publication elsewhere.

Informed Consent

Written informed consent was obtained from the patients for participating in the study.

Statement of Ethics

The study protocol and all related documents received full approval from the Institutional Ethics Committee (IEC) for Human Studies at JIPMER (Approval No. JIP/IEC-OS/2025/031).

ORCID iDs

Saranya Kuppusamy

Senthil Kumar Subramanian

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