**4. Discussion**

Illness, especially a chronic one such as diabetes, cardiovascular disease, or thyroid disease, is a major challenge for the person diagnosed with it. It has a considerable impact on the patient's life and functioning, which is associated with multiple and diverse factors, including concern about one's health and life, possible complications, impact of the disease on family or professional life, self-efficacy, optimism, and a number of other social, demographic, and economic considerations [2,10,17–19]. Polycystic ovary syndrome matches the above description of the impact illness has on the patient's life, as the literature emphasizes that a diagnosis of PCOS affects the whole of a woman's life. Symptoms of PCOS first manifest during puberty or in early adulthood, but its complications or sequelae have a negative impact on women's functioning and QoL at subsequent stages as well, including menopause or even old age [5,7,10,20–23]. Therefore, the authors of the present paper attempted to evaluate generalized self-efficacy, dispositional optimism, and illness acceptance in women with PCOS, as well as the determinants of these characteristics.

Self-efficacy is strongly associated with an ability to control one's actions so as to achieve the desired results, even in unfavorable circumstances. It reflects a person's beliefs about their capability to change their behavior when diagnosed with an illness or to prevent potential health problems [24–26]. The author of the Polish adaptation of GSES reported mean scores for Polish populations, including a population of women who had undergone a mastectomy—30.07 [14]. In Polish hysterectomy patients, a self-efficacy score of 32.46 was reported [1], in University of the Third Age students—a mean of 30.12 [25], and in patients with heart failure—32 [27]. These data indicate a strong sense of self-efficacy in the various groups [1,14,25,27]. As to the present study, it demonstrated a moderate level of self-efficacy in PCOS patients (28.74), similar to that found in diabetics (28.34) or in women with migraines (28.57) [14].

Kozica et al. (2013) studied self-efficacy and self-care in women with and without PCOS, demonstrating that significant predictors of self-efficacy in their respondents included health vigilance, overall health history, and diagnosed infertility. The authors state that women with PCOS should be aware that their illness is a chronic condition that requires them to carefully manage their health by introducing lifestyle modifications and undergoing regular screening [24]. Rogala et al. (2015) investigated the relationship between mental adaptation to cancer and self-efficacy in women who had undergone hysterectomies due to cancer. Their analysis included socio-demographic factors, such as education, residence, relationship status, and economic standing, which could affect the respondents' self-efficacy. The only statistically significant variable was the patients' relationship status, as women in a relationship had a higher level of self-efficacy than single ones [1]. In a study by Zieli ´nska-Wi ˛eczkowska (2017), concerning the relationships between satisfaction with life and selected personal resources in University of the Third Age students, self-efficacy was associated with education, financial standing, and perceived health. Lower levels of education were associated with poorer self-efficacy, while a better financial standing or better perceived health was related to higher GSES scores [25]. In the present study, lower levels of self-efficacy were found in PCOS patients who lived in cities other than province capitals, had had a primary/vocational education, had higher BMI

values, and had been living with PCOS for a longer time (1–10 years), while higher levels were found in women with a better socio-economic standing.

The present study also analyzed another important individual characteristic or tendency, namely optimism, defined as an overall expectation of positive rather than negative life experiences in the future. This trait is conducive to motivation, perseverance, and determination in pursuing and achieving goals [2,28–30]. The literature on the subject provides a highly inconsistent view on dispositional optimism and its predictors in various patient groups studied in the world, depending on their health status [2,25,28–31]. In their study on the relationship between dispositional optimism and acceptance of illness in a group of patients with Graves' disease, Basi ´nska et al. (2008) found comorbidity to be the only variable significantly affecting the patients' optimism levels. Those diagnosed with other diseases beside Graves' had lower levels of dispositional optimism than those with no comorbidities [2]. A study by Chung et al. (2016) showed that, in stroke patients, there was a negative correlation between optimism and depression symptoms—lower optimism levels were associated with more severe symptoms of depression [28]. Bleil et al. (2012), in turn, found that a more pessimistic attitude may contribute to the failure of fertility treatment [29]. Moyer et al. (2009) analyzed optimism/pessimism and health-related quality of life (HRQoL) in pregnan<sup>t</sup> women from China, Ghana, and the US. Optimism levels were found to be associated with the women's country of origin, professional activity, education, and treatment for emotional disorders [30]. Zieli ´nska-Wi ˛eczkowska (2017) demonstrated that financial standing had a significant impact on dispositional optimism in the University of the Third Age students she studied [25]. The present results corroborate those reported by this author. Satisfaction with one's socio-economic standing was associated with a higher level of dispositional optimism, which overall was moderate in the PCOS patients studied.

Acceptance of illness is a very important stage in the life of a person diagnosed with a disease, especially a chronic one. It allows the patient to adapt to their new situation, and higher levels of illness acceptance contribute to better coping with the illness, and ultimately, to a better QoL [2,32,33]. In the study on Graves' patients by Basi ´nska et al. (2008), the reported acceptance of illness score was 28.48 [2]. In turn, Bie ´n et al. (2016) reported a score of 30.66 in a group of patients with gestational diabetes mellitus (GDM) [32]. A comparison between the cited scores and the mean score of 27.90 found in the present study demonstrates that PCOS patients have a lower level of illness acceptance than other populations. This finding may be explained by the complexity and variety of PCOS symptoms, which significantly affect the life of patients, as well as their self-perception in relation to the expectations of the contemporary world [6,8,9,24,34].

The multiple factors affecting acceptance of illness also have an impact on a person's adaptation to the illness, which occurs to various degrees, as shown in the literature on the subject, as well as in another part of the present study [2,32,33,35]. In a study by Jankowska-Pola ´nska et al. (2016), determinants of illness acceptance in patients with chronic obstructive pulmonary disease (COPD) included age, education, and duration of illness. Better illness acceptance was found in younger COPD patients, in those with college/university education, and with a shorter duration of illness [35]. Bie ´n et al. (2016) demonstrated that acceptance of illness in women with GDM improved with very good financial standing, dietary treatment of diabetes, and very good overall perceived health [32]. In turn, Kostyła et al. (2013), in a study on patients with psoriasis, found acceptance of illness to increase as psycho-pathological symptom intensity decreased [33]. In the present study, PCOS patients who lived in cities other than province capitals and had been diagnosed with PCOS between 1 and 5 years before were found to have lower levels of illness acceptance. Better socio-economic standing was associated with greater acceptance of PCOS in the group studied.

The findings of the present study demonstrate a single common determinant of all the aspects analyzed, including self-efficacy, dispositional optimism, and acceptance of illness: The PCOS patients' socio-economic standing. The literature on the subject emphasizes the importance of financial situation for health, as it affects access to health care in general and to specific methods of treatment, the ability to maintain a healthy lifestyle, as well as how the patients manage on a daily basis and their family life [19,25,32,36].

The final stage of the present study involved an analysis of correlations between self-efficacy, dispositional optimism, and acceptance of illness in women with PCOS. Popa-Velea & Purcarea (2014), investigating the psychological factors affecting HRQoL in COPD patients, demonstrated that self-efficacy and optimism were positively correlated with the patients' HRQoL. Moreover, patients with low levels of self-efficacy and optimism may experience more problems and discomfort than those with higher levels of these traits in the case of a comparable decrease in lung function [37]. Zieli ´nska-Wi ˛eczkowska (2017) found satisfaction with life to be positively correlated both with generalized self-efficacy and with dispositional optimism [25]. Basi ´nska et al. (2008) demonstrated an association between dispositional optimism and acceptance of illness in their group of patients with Graves' disease [2]. As to the present study, a stronger sense of self-efficacy was associated with both greater optimism and more acceptance of PCOS, and similarly, higher levels of optimism were associated with greater illness acceptance. This warrants the conclusion that acceptance of illness is the product of an individual's personal resources that allow them to come to terms with their illness and to adapt to it, so as to live and function better with the illness, as evidenced both by literature reports and by the present study [2,25,37].

So far, the authors have found no studies on the level and determinants of generalized self-efficacy, dispositional optimism, and illness acceptance among women with PCOS in the available literature. Therefore, the study is an original one. The present study has certain limitations. The study concept did not include an analysis of the impact of PCOS symptoms (including hirsutism or menstrual disorders) or psychological condition on the patient's life, though these analyses were included in a number of studies worldwide, providing information and direction to the authors of the present paper. Further studies are still warranted on PCOS, its clinical circumstances, etiology, impact on patients' lives, and long-term consequences.
