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Bagade T, Thapaliya K, Breuer E, Kamath R, Li Z, Sullivan E, Majeed T. Investigating the association between infertility and psychological distress using Australian Longitudinal Study on Women's Health (ALSWH). Sci Rep 2022; 12:10808. [PMID: 35752691 PMCID: PMC9233676 DOI: 10.1038/s41598-022-15064-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/17/2022] [Indexed: 11/09/2022] Open
Abstract
Infertility affects millions of people globally. Although an estimated 1 in 6 couples in Australia are unable to conceive without medical intervention, little is known about the mental health impacts of infertility. This study investigated how infertility impacts the mental health of women. The study used nationally representative Australian Longitudinal Study on Women's Health (ALSWH) data. We analysed data from survey periods 2-8 conducted every three years between 2000 and 2018 for 6582 women born in 1973-78. We used a Generalised Equation Modelling (GEE) method to investigate the association of primary, secondary and resolved fertility status and psychological distress over time. Multiple measures were used to measure psychological distress: the (1) the mental health index subscale of the 36-item short form survey (SF-36), (2) the Center for Epidemiological Studies Depression Scale (CESD-10), (3) the Goldberg Anxiety and Depression Scale (GADanx) anxiety subscale; and a (4) composite psychological distress variable. About a third (30%) of women reported infertility at any of the survey rounds; a steady increase over 18 years from 1.7% at round 2 to 19.3% at round 8. Half of the women reporting primary or secondary infertility reported psychological distress, with the odds of having psychological distress was higher in women reporting primary (odds ratio (OR) 1.24, 95% confidence interval (CI) 1.06-1.45), secondary (OR 1.27, 95% CI 1.10-1.46) or resolved infertility (OR 1.15, 95% CI 1.05-1.26) compared to women reporting normal fertility status. Women with partners, underweight or higher BMI, smoking, and high-risk alcohol use had higher odds of psychological distress, whereas women in paid work had significantly lower odds of psychological distress (p < 0.001). Diabetes, high blood pressure, asthma, and other chronic physical illness were independently associated with higher odds of psychological distress. Infertility has a significant impact on mental health even after it is resolved. Frequent mental health assessment and a holistic approach to address the lifestyle factors should be undertaken during the treatment of infertility.
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Affiliation(s)
- Tanmay Bagade
- College of Health, Medicine and Wellbeing, The University of Newcastle (UON), University Drive, Callaghan, NSW, 2308, Australia.
| | - Kailash Thapaliya
- College of Health, Medicine and Wellbeing, The University of Newcastle (UON), University Drive, Callaghan, NSW, 2308, Australia.,Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, SA, 5000, Australia
| | - Erica Breuer
- College of Health, Medicine and Wellbeing, The University of Newcastle (UON), University Drive, Callaghan, NSW, 2308, Australia
| | | | - Zhuoyang Li
- College of Health, Medicine and Wellbeing, The University of Newcastle (UON), University Drive, Callaghan, NSW, 2308, Australia
| | - Elizabeth Sullivan
- College of Health, Medicine and Wellbeing, The University of Newcastle (UON), University Drive, Callaghan, NSW, 2308, Australia
| | - Tazeen Majeed
- College of Health, Medicine and Wellbeing, The University of Newcastle (UON), University Drive, Callaghan, NSW, 2308, Australia
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Clarke M, Whitson N, Williams C, Robson SJ. A silent burden-prolapse, incontinence, and infertility in Australian Aboriginal and Torres Strait Islander women: A systematic search and narrative review. Int J Gynaecol Obstet 2021; 155:268-274. [PMID: 34543443 DOI: 10.1002/ijgo.13920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/18/2021] [Accepted: 09/07/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pelvic organ prolapse (POP), urinary incontinence, and infertility are all prevalent conditions associated with considerable reduction in quality of life. As a group, Aboriginal and Torres Strait Islander women may be at higher risk of these conditions, but studies are scarce. OBJECTIVE To review the literature pertaining to the epidemiology, diagnosis, and management of these conditions in Indigenous Australian women. SEARCH STRATEGY Medline, Embase, and Scopus were searched for articles published between 1980 and 2021 pertaining to these conditions in Indigenous Australian women. SELECTION CRITERIA Studies that did not directly address the epidemiology, diagnosis, and management of these conditions were excluded. MAIN RESULTS It was possible to identify only 11 papers dealing with these conditions in Indigenous Australian women. Only one dealt with POP and was a retrospective audit of a health outreach program in the Northern Territory concluding that there was significant underreporting of the condition. Five papers dealt with urinary incontinence and, again, described significant underreporting and poor referral pathways. Five papers reported small studies about infertility, one reporting poor engagement from clinical directors. CONCLUSION It was concluded that despite the importance of these conditions, there is almost no body of research and this is an urgent national problem.
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Affiliation(s)
- Marilyn Clarke
- Department of Obstetrics and Gynaecology, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Nicole Whitson
- Department of Obstetrics and Gynaecology, John-Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Corey Williams
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Stephen J Robson
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
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Gilbert E, Walker R, Simon D, Derkenne R, Rumbold A, Campbell S, Boyle JA. "We are only looking at the tip of the iceberg in infertility": perspectives of health providers about fertility issues and management among Aboriginal and Torres Strait Islander people. BMC Health Serv Res 2021; 21:704. [PMID: 34271914 PMCID: PMC8285865 DOI: 10.1186/s12913-021-06714-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/01/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Aboriginal and Torres Strait Islander women and men are disproportionately affected by a range of risk factors for infertility. However, remarkably little is known about the prevalence of infertility in this group, or how Aboriginal and Torres Strait Islander people access fertility treatments including assisted reproductive technology (ART). This qualitative study aims to explore health care provider (HCP) perspectives on the health burden of infertility among Aboriginal and Torres Strait Islander people, as well as factors that may affect access to infertility treatment for this group. METHOD Semi-structured interviews were conducted with HCPs (8 doctors; 3 nurses and 1 Aboriginal Health Practitioner) working in fertility care in the Northern Territory, Australia. Transcribed interviews were analysed using an iterative thematic approach using the NVivo-9 software package. RESULTS Providers perceive infertility as an underestimated health issue in this patient population, reporting a high prevalence of infertility-related risk factors but fewer clinical encounters of diagnosis and treatment. Perceived barriers to accessing fertility care included cultural differences such as the shame and stigma associated with reproductive health and the separation of men's business and women's business; service-related barriers such as limited timely and affordable access to specialist health services and; a lack of culturally responsive and appropriate fertility services. Providers had mixed opinions on their role in ameliorating inequities of access, and hence a range of strategies to address barriers were suggested. These included a greater patient education, ongoing patient support and providing a culturally safe environment. CONCLUSION The current study adds to the understanding of how Aboriginal and Torres Strait Islander people access fertility treatments. There is a need for further research to quantify infertility in Aboriginal and Torres Strait Islander people, investigate community perceptions towards infertility and identify community-driven priorities to improve access to fertility care for this population.
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Affiliation(s)
- Emily Gilbert
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, VIC, Melbourne, Australia
| | - Ruth Walker
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, VIC, Melbourne, Australia
| | - David Simon
- Top End Health Service, NT, Casuarina, Australia
| | | | - Alice Rumbold
- South Australian Health and Medical Research Institute, SA, Adelaide, Australia
| | - Sandra Campbell
- Molly Wardaguga Research Centre, School of Nursing and Midwifery, Charles Darwin University, QLD, Brisbane City, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, VIC, Melbourne, Australia.
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Gilbert EW, Boyle JA, Campbell SK, Rumbold AR. Provision of assisted reproductive technologies (ART) to Aboriginal and Torres Strait Islander peoples: Limited engagement in an online survey of Medical Directors of ART services. Aust N Z J Obstet Gynaecol 2020; 60:980-982. [PMID: 32909257 DOI: 10.1111/ajo.13246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 08/09/2020] [Indexed: 12/18/2022]
Abstract
Current knowledge about infertility and access to infertility treatment among Aboriginal and Torres Strait Islander peoples is extremely limited. We conducted an online survey of Medical Directors of registered ART providers in Australia (n = 59) to obtain preliminary information on this topic. Six (10%) Directors responded; only two reported routinely collecting the Aboriginal and Torres Strait Islander status of clients. While the low response rate prevents generalising the findings, the poor engagement may indicate gaps in awareness of fertility issues for this group. This warrants further investigation, to understand whether Aboriginal and Torres Strait Islander people are appropriately accessing infertility care.
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Affiliation(s)
- Emily W Gilbert
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sandra K Campbell
- Molly Wardaguga Research Centre, Charles Darwin University, Cairns, Queensland, Australia
| | - Alice R Rumbold
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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