Examining the relationship between endometriosis and psychological distress: roles of cultural background, body image and self-criticism in women's health.

Objective: Endometriosis, a chronic condition affecting 10-15% of women of reproductive age, often leads to psychological distress (PD), including depression and anxiety. This study examined how body image and self-criticism mediate the relationship between endometriosis and PD, comparing Israeli women to those from English-speaking countries, and explored the moderating role of cultural background. Methods: A cross-sectional survey was conducted with 437 women from Israel and English-speaking countries. Participants completed questionnaires to evaluate depression symptoms, anxiety, self-criticism, and body appreciation. Data were analyzed using multivariate MANOVA and moderated mediation models. Results: Women with endometriosis showed higher PD, with significant differences by cultural background. Israeli participants reported higher depression and anxiety. The mediation model showed that body image and self-criticism were significant mediators in the endometriosis-PD link, a process consistent across cultural groups. However, the direct effect of endometriosis on PD was stronger among Israeli women. Conclusion: Our findings highlight the impact of cultural context on PD on women with endometriosis, emphasizing body image and self-criticism as intervention targets. This study underscores the importance of culturally sensitive support for mental health in endometriosis, with implications for clinical practice and public health strategies.