A survey on depression among infertile women in Ghana

Global prevalence of major depressive disorder, generalized anxiety, stress, and depression among infertile women: a systematic review and meta-analysis

BACKGROUND

In recent years, the global prevalence of infertility has increased among women (Talmor and Dunphy, Best Pract Res Clin Obstet Gynaecol 29(4):498-506, 2015) and is considered as a public health concern. One of the impacts of infertility is mental health problems in the patients, which can lead to complications such as stress, anxiety, and depression. The aim of this study is to investigate the global prevalence of major depressive disorder, general anxiety, stress, and depression in infertile women through a systematic review and meta-analysis.

METHODS

To identify studies that have reported the prevalence of major depressive disorder, generalized anxiety, stress, and depression in infertile women, the PubMed, Scopus, Web of Science, Embase, ScienceDirect, and Google Scholar repositories were systematically searched. Articles published up until February 2023 were included, while no lower time limit was imposed in the search strategy. Heterogeneity of studies was examined using the I2 test and, thus, random-effects model was used to perform the analysis. Data analysis was conducted within the Comprehensive Meta-Analysis (v.2) software.

RESULTS

In the review of 44 studies with a sample size of 53,300 infertile female patients, the overall prevalence of major depressive disorder (clinical depression), generalized anxiety, stress, and depression was found to be 22.9%, 13.3%, 78.8%, and 31.6% respectively. It was also found that mental health complications are more prevalent among infertile women in Asia (continent).

CONCLUSION

Considering the prevalence of mental disorders among infertile women, health policymakers can use the results of the present meta-analysis to pay more attention to the mental health of infertile women and devise suitable interventions and programs to reduce and prevent the spread of psychological disorders among infertile women.

The social determinants of mental health disorders among women with infertility: a systematic review

INTRODUCTION

Infertility is associated with mental health disorders in women, even if a successful pregnancy resolves infertility. However, the link between social determinants of health (SDoH) and mental health in women with infertility is not well understood. We aimed to investigate the determinants thoroughly so that mental health screening and services can be tailored to suit women with infertility who are vulnerable to mental health disorders.

METHODOLOGY

All observational studies that included women participants of reproductive age with infertility and assessed social determinants associated with mental health disorders were searched using a combination of keywords from MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus, and Web of Science databases and published in English. Two reviewers conducted screening, data extraction, quality assessment and risk of bias. The protocol was registered on PROSPERO (number CRD42022343962).

RESULTS

The systematic review included 32 studies out of 3405 screened articles from January 1st 2010 to 16th October 2023. Compared to women without infertility, the prevalence of mental health disorders, including anxiety, depression, psychological distress, and stress, is high among women with infertility, with the severity being influenced by social determinants-those with higher education, employment, higher personal or family income, private health insurance, higher social support, stronger religious beliefs, and higher spiritual well-being reported better mental health outcomes.

CONCLUSION

The study highlights the need for early detection, tailored interventions, and integrated and comprehensive support systems to address the mental health needs of women with infertility and improve their well-being.

Systematic Review: Risk Factors of Anxiety, Depressiveness, and (Lack of) Social Support in Women and Men Prior to Assisted Reproduction

This review provides a systematic overview of the state of knowledge to date of psychosocial risk factors with a focus on anxiety, depressiveness, and (lack of) social support among involuntarily childless women and men prior to assisted reproduction. The databases PubMed, PubPsych, PsycINFO-Ebsco, and Web of Science were searched for relevant publications in English or German, and finally a total of 20 publications were included in the systematic review. Of these, 18 studies focused on depressiveness, 15 studies focused on anxiety, and 9 studies focused on social support. Half of the studies included both men and women, while the other half included only women. Due to the large heterogeneity of the study results as well as limitations, no clear conclusions can be drawn regarding a difference between the risk profiles of men and women with an unfulfilled desire to have children. However, it has been shown that infertile couples or women experience higher levels of stress in the form of depressiveness and anxiety compared to fertile participants. Furthermore, it was found that social support, regardless of gender difference, within the couple and from family and friends may be associated with a lower risk for depressiveness and anxiety.

"The biggest disappointment": women's expectations from sex are ignored, from the perspective of infertile women

OBJECTIVE

The aim of this study is to determine the attitudes, behaviours and experiences of infertile women towards sexuality.

METHODS

This study was carried out in the infertility outpatient clinic of a state hospital in Istanbul of Turkey. Fifteen infertile women who had been receiving primary infertility treatment for at least two years and were actively continuing infertility treatment were included in the study. Data were collected by means of an detailed information form and a semi-structured interview. Content analysis was applied to the data obtained from semi-structured interviews. Consistency percentage calculation was made between the codes and themes determined by 4 researchers who are experts in their fields.

RESULTS

Results based on the interviews with the participants, 2 main themes, 6 sub-themes and 27 codes related to sub-themes were determined as 'Factors Affecting Sexual Life' and 'Overview of Sexual Health and Sexuality'. 'Disappointment' was determined as the most commonly defined code in the determined main theme and sub-themes.

CONCLUSION

It was determined that the majority of infertile women base their sexual lives on reproductive functions, experience serious sexual health problems, feel worthless, and describe their sexual life as a great disappointment.

Factors affecting self-esteem and disease acceptance in patients from infertile couples

Introduction

Infertility has been diagnosed in millions of people around the world and is described as a complex medical, mental, and social problem that affects many aspects of life. The aim of the study was to extract the determining factors and the level of self-esteem and the degree of acceptance of the disease in infertile patients and to find differences between women and men in this aspect.

Methods

A total 456 patients (235 women and 221 men) from infertile couples participated in a cross-sectional study. To collect data a Personal Information Form (PIF), Rosenberg Self-Esteem Scale (SES), and Acceptance of Illness Scale (AIS) were used.

Results

The overall self-esteem score for the whole sample was 30.50 (15 ± 30) points and for acceptance of the disease 32.4 (8 ± 40) points. In the study group, men obtained a slightly higher level of self-esteem than women (31.00 vs. 30.04 points). Additionally, men had a higher level of acceptance of the disease (33.12 vs. 31.80) than women. Socio-demographic factors such as age and level of education had impact on scores SES and AIS. Clinical factors did not determine the results of SES and AIS, both in the overall sample and in the female and male groups.

Conclusion

Self-esteem in patients from infertile couples increases with age and level of education. There are also significant differences between women and men, i.e., positive correlations between the level of education and self-esteem in men and the degree of acceptance of the disease in women.

Paths towards parenthood after repeated treatment failures: a comparative study on predictors of psychological health outcomes in infertile couples persisting in treatments or opting for adoption

Introduction

Infertility literature suggests widespread recourse to long-term medical treatments despite evidence of high stress, costs, and adverse effects of repeated treatment failures. However, there is a lack of research comparing predictors of stress and psychological health outcomes between members of infertile couples who - after repeated failures - persist in pursuing medical treatments (PT) with those who opted for quitting treatments and adopting (QTA). Basing on a transactional and multidimensional approach to infertility-related stress and health, the present study aims at exploring individual (socio-demographics; coping strategies) and situational (infertility-related parameters; infertility-related stressors; couple's dyadic adjustment dimensions) predictors of state-anxiety and depression in male and female partners of PT-infertile couples and of QTA-infertile couples.

Methods

Participants were both members of 176 couples with duration of infertility and a history of medical treatments for at least 3 years (76 PT-infertile couples, 100 QTA-infertile couples). The study variables were compared by study group across genders. Structural equation models (SEM) were used to test main and moderating effects of study variables on state-anxiety and depression by study group and across genders.

Results

Members of infertile couples quitting treatments and adopting (QTA) reported significantly lower levels of state-anxiety and depression, higher stress related to need for parenthood and rejection of childfree-lifestyle and lower stress related to social and couple's relationship concerns than those who persist in pursuing medical treatments (PT). Members of infertile couples quitting treatments and adopting (QTA) recurred to a greater extent to active coping strategies (problem-solving/social-support) and to a lower extent to passive coping strategies (avoiding/turning-to-religion), and they reported higher levels of dyadic adjustment. Specificities in main and moderating factors related to state-anxiety and depression by study group and across genders were found.

Conclusion

Findings should be addressed to provide a comprehensive assessment of both members of infertile couples facing repeated treatment failures to identify risks and resources and develop tailored evidence-based interventions.

The impact of stigma on mental health and quality of life of infertile women: A systematic review

Introduction

The stigma of not giving birth to children affects approximately 53. 08~64% of female infertility patients worldwide. This stigma not only causes harm to the mental health of these infertility patients, but also affects their quality of life, making them bear the adverse social consequences such as domestic violence, marriage breakdown, or even delay in receiving the treatment. Therefore, it is crucial to have a deep understanding of the patients' stigma and effective intervention in alleviating it.

Aims/Question

This study aims to discuss and summarize the stigma in infertile women and its impact on patients, and to provide a theoretical basis for the clinical treatment and nursing intervention of disease stigma in infertile female patients.

Methods

The literature search used four English databases (Cochrane Library, EMBASE, Web of Science, and PubMed) and two Chinese databases (CNKI and Wanfang). The search time of the literature ranges from the establishment of the library to 2022, with no language restriction.

Results

The review included 28 studies, with 20 cross-sectional studies and 8 qualitative studies. This study found that social support, living environment, education level, occupation, and fertility awareness were the major influencing factors of infertility stigma.

Conclusions

Infertility stigma can bring heavy mental pressure and psychological burden to female infertility patients and affect their quality of life. Therefore, effective and targeted psychological interventions should be developed to reduce the patients' stigma and improve their quality of life.

Implications for practice

Healthcare workers must develop targeted nursing interventions, provide professional counseling services to reduce the level of stigma in female infertility patients, alleviate fertility stress, and improve their quality of life.

Development and psychometric properties of Female Infertility Stigma Instrument (ISI-F): A sequential mixed method study

BACKGROUND

Infertility stigma is a hidden burden that overshadows the dimensions of reproductive and sexual health in infertile women. The aim of this study was to develop and evaluate the psychometric properties of the Female Infertility Stigma Instrument (ISI-F).

METHODS

This mixed method study with sequential exploratory design was conducted in qualitative and quantitative phases. In the first phase, the initial item pool of the Female Infertility Stigma Instrument (ISI-F) was generated using in-depth interviews. In the quantitative phase, psychometric properties of the ISI-f including content, face and construct validity, as well as reliability (internal consistency and stability) were assessed. Exploratory factor analysis was performed on the collected data from 300 infertile women for evaluation of construct validity. Data was analyzed using SPSS version 20. This study has followed the Mixed Methods Article Reporting Standards checklist.

RESULTS

The final version of ISI-F had 20 items. Total CVI and CVR were 0.94 and 0.87, respectively. Explanatory factor analysis identified 3 main factors that explained 54.013% of the variance. These factors consisted of stigma profile (7 items), self-stigma (6 items) and escaping from stigma (7 items). Internal consistency and stability of the ISI-F has been approved by Cronbach's alpha, McDonald's Omega (0.909, 0.916) and Intraclass Correlation Coefficient (ICC = 0.878).

CONCLUSION

The Female Infertility Stigma Instrument (ISI-F) is a valid and reliable tool for evaluation of the perceived female infertility stigma, that was developed in this study.

Women's experiences of living with involuntary childlessness in Uganda: a qualitative phenomenological study

BACKGROUND

Involuntary childlessness is a global phenomenon that negatively impacts the couple, or the family involved. The experiences of women living with involuntary childlessness have not been well documented in the literature, specifically in the Ugandan context. The purpose of the study was to explore the experiences of women living with involuntary childlessness in Uganda.

METHODS

A qualitative phenomenological approach was used. Fifteen in-depth interviews were conducted among women experiencing involuntary childlessness attending a National Referral Hospital. Purposive sampling was, and data saturation determined the actual sample size. Thematic analysis was used for data analysis. The results are presented in the form of text and narrative quotes from participants.

RESULTS

Six themes emerged (i) Inadequate social support (ii) psychological torture (iii) continued grief (iv) marital instability (v) failure attributed to childlessness and (vi) financial constraints. Inadequate social support was in the form of having an unsupportive partner, altered social relation, and altered social status, while women experienced name-calling, emotional abuse, stigma, and blame under the psychological torture theme. Women experienced feelings of distress and grief, including anger, irritability, sadness, stress, and feelings of despair. Women with involuntary childlessness recounted experiencing unstable marriages characterized by infidelity, divorce, abandonment, and polygamous marriages. Some women coped positively, while others employed negative coping strategies such as social withdrawal and isolation. Women who their partners and families well supported coped positively. In contrast, those who did not receive as much support were stressed, sad, angry, and had lost hope of pregnancy.

CONCLUSIONS

In this study, women with involuntary childlessness lacked social support amidst experiences of marital turmoil, psychological torture, feelings of distress and grief, unfulfilled motherhood expectations, and financial constraints while seeking treatment, therefore, there is a need to screen the women for psychological / mental illness symptoms and provide empathetic care and counseling. The prevalence of involuntary childlessness is not well documented in Uganda and a study can be done to determine its extent.

The Role of Online Social Support in Patients Undergoing Infertility Treatment - A Comparison of Pregnant and Non-pregnant Members

The role of social support in the online setting is explored in this study. For this purpose, the posts of infertility treatment patients participating in an infertility treatment online support group between 2002 and 2016 were retrieved. Members who contributed at least 100 words were divided into two groups according to the treatment outcome they reported (pregnancy). The association between the length of group membership, type of support provided, intensity of interaction, active support seeking, overall sentiment and the amount of sadness, anxiety and anger words and the treatment outcome was examined. The findings suggest that online social, in particular emotional, support acts as a buffer between the stressor and the treatment outcome. The expression of anger and initiating of communication by new members diminish this relationship.

Self-reported history of comorbidities and markers of ovarian reserve among subfertile women

PURPOSE

To investigate whether history of comorbidities is associated with markers of ovarian reserve among subfertile women.

METHODS

This observational study includes 645 women seeking fertility care at the Massachusetts General Hospital who enrolled in the Environment and Reproductive Health (EARTH) study (2005-2019). Women completed a comprehensive questionnaire including medical diagnosis of comorbidities. Ovarian reserve markers including antral follicle count (AFC), assessed by transvaginal ultrasound, and circulating serum levels of day 3 FSH and AMH, are assessed by immunoassays. We fit linear regression models to evaluate the association between history of comorbidities and markers of ovarian reserve while adjusting for confounders.

RESULTS

Self-reported history of hypertension, cancer, and neurological disorders was negatively associated with AFC in unadjusted models and in adjusted models for age, smoking, physical activity, comorbidity count, and BMI. Adjusted mean AFC (95% CI) was lower among women with history of hypertension, compared to women with no self-reported history of hypertension (11.5 vs 15.6, p value 0.0001). In contrast, day 3 FSH levels were positively related to history of eating disorders in both unadjusted and adjusted models (10.8 vs. 7.43 IU/L, p value ≤ 0.0001). Self-reported history of other comorbidities was unrelated to AFC, day 3 FSH, and AMH levels.

CONCLUSIONS

History of hypertension, cancer, and neurological disorders was negatively associated with AFC, and eating disorders were positively related to day 3 FSH levels. The prevention of common comorbidities among women in reproductive age may help increase women's fertility given the declining birth rates and increasing use of assisted reproductive technologies in the past years.

Prevalence and predictors of depressive symptoms among married Egyptian women: a multicenter primary healthcare study

BACKGROUND

Depression affects about 3.8% of the world's population. Although marriage may contribute to subjective well-being, some marital variables could increase women's risk for depression. This study aimed to determine the prevalence of depressive symptoms and their correlates among married females attending primary healthcare facilities.

METHODS

A cross-sectional study was conducted on a purposive sample of 371 married women at the primary healthcare centers, Assiut Governorate, Upper Egypt. In this study, an interviewer-administered questionnaire was used for data collection. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) and marital satisfaction using the ENRICH Marital Satisfaction Scale (EMS). Standardized measurements of weight and height were performed.

RESULTS

According to the PHQ-9 diagnostic criteria, the prevalence of depressive symptoms among the studied married females was 30.2%. The significant predictors of depressive symptoms were advanced husbands' ages, living with an extended family, exposure to spousal verbal violence, high body weight, and low marital satisfaction levels.

CONCLUSIONS

Approximately one-third of married Egyptian women experienced depressive symptoms. In addition to high body weight, some social and marital factors contributed to the increase in women's vulnerability to depressive symptoms. Egyptian primary healthcare physicians should be trained to identify females with depressive symptoms and refer them to specialists if need be. To combat depression in women, it may be helpful to construct qualified marital counseling centers. This may improve marital satisfaction, decrease the negative consequences of spousal violence, and ensure the value of independence for new families.

Quality of Infertility Care Services and Emotional Health of South Asian Women

Background

Treatment tolerability and treatment environment are two major spheres of infertility care that may associate with women’s emotional health and coping mechanisms.

Aim

The present study aimed at assessing the relationship between infertility treatment quality and various aspects of emotion-focus coping, problem-focus coping, and avoidance coping mechanisms.

Method

The study was completed by using standardized tools and data from this descriptive, cross-sectional, correlational study were collected from 350 women undergoing infertility treatments in private reproductive healthcare centers in Quetta, Pakistan.

Findings

Treatment tolerability was found to be positively associated with positive reframing (p < 0.02) and negatively associated with the use of emotional support (p < 0.03); acceptance (p < 0.01); humor (p < 0.03); behavioral disengagement (p < 0.01) and venting (p < 0.01). The quality of the treatment environment demonstrated a negative correlation between religious coping (p < 0.02) and behavioral disengagement (p < 0.01), whereas it showed a positive correlation with active coping (p < 0.03) and planning (p < 0.02). The linear regression analysis demonstrated that treatment tolerability significantly increased with positive reframing (R2 = 0.118, F(304) = 2.22, p < 0.03). Behavioral disengagement significantly decreased with better treatment environment (R2 = 0.111, F(304) = 2.09, p < 0.02).

Discussion

We discussed the findings keeping in view the role of social, cultural, and economic factors related to infertility care in the context South-Asian culture, and recommendations are made to promote women’s mental health and coping by improving some specific aspects of infertility treatment quality.

Conclusions

High treatment tolerability may associate with some useful aspects of emotion-focus coping, such as positive reframing, whereas low treatment tolerability may associate with avoidance coping, such as behavioral disengagement and venting. Besides, the quality of the infertility treatment environment enables women to use problem-focus coping mechanisms, such as planning and active coping.

Worldwide prevalence, risk factors and psychological impact of infertility among women: a systematic review and meta-analysis

OBJECTIVES

To assess the prevalence, risk factors and psychological impact of infertility among females. This review summarises the available evidence, effect estimates and strength of statistical associations between infertility and its risk factors.

STUDY DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE, CINAHL and ScienceDirect were searched through 23 January 2022.

ELIGIBILITY CRITERIA

The inclusion criteria involved studies that reported the psychological impact of infertility among women. We included cross-sectional, case-control and cohort designs, published in the English language, conducted in the community, and performed at health institution levels on prevalence, risk factors and psychological impact of infertility in women.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently extracted and assess the quality of data using the Joanna Briggs Institute Meta-Analysis. The outcomes were assessed with random-effects model and reported as the OR with 95% CI using the Review Manager software.

RESULTS

Thirty-two studies with low risk of bias involving 124 556 women were included. The findings indicated the overall pooled prevalence to be 46.25% and 51.5% for infertility and primary infertility, respectively. Smoking was significantly related to infertility, with the OR of 1.85 (95% CI 1.08 to 3.14) times higher than females who do not smoke. There was a statistical significance between infertility and psychological distress among females, with the OR of 1.63 (95% CI 1.24 to 2.13). A statistical significance was noted between depression and infertility among females, with the OR of 1.40 (95% CI 1.11 to 1.75) compared with those fertile.

CONCLUSIONS

The study results highlight an essential and increasing mental disorder among females associated with infertility and may be overlooked. Acknowledging the problem and providing positive, supportive measures to females with infertility ensure more positive outcomes during the therapeutic process. This review is limited by the differences in definitions, diagnostic cut points, study designs and source populations.

PROSPERO REGISTRATION NUMBER

CRD42021226414.

Association between Family Functionality, Sociodemographic Factors, and Severity of Depression in Women with Infertility Attending a Gynecology Clinic in Northwest Nigeria

Background  Depression is a common psychological disorder in women with infertility, which causes significant morbidity and mortality. Little attention is currently given to depression by health care providers who manage infertility, and there is a scarcity of studies on depression among women with infertility in northern Nigeria.

Objective  This study aimed at assessing the association between family functionality, sociodemographic factors, and depression severity in women with infertility attending a gynecology clinic in northwest Nigeria.

Methods  This was a cross-sectional study involving 415 females systematically selected from women with infertility attending a gynecology clinic in a Nigerian hospital. They were interviewed using Beck's Depression Inventory and Family APGAR (Adaptability, Partnership, Growth, Affection, Resolve) questionnaires over 12 weeks. Data regarding participants' sociodemographic and infertility characteristics were also collected. The association between categorical variables was assessed using the chi-square or Fisher's exact test. The determinants of depression severity were assessed using logistic regression analysis. A p -value of < 0.05 was considered significant.

Results  The mean age of respondents was 30.9 ± 6.6 years; the prevalence of depression was 44.6% (32.5% were of mild severity). Most families (73.5%) were highly functional. Association between family functionality and depression severity was not statistically significant (chi-square =5.143, p  = 0.259). Respondents' religion (chi-square = 10.813, p  = 0.029), education (chi-square = 36.835, p  = 0.001), and monthly income (chi-square = 9.261, p  = 0.010) were associated with depression severity. Being a Muslim (odds ratio [OR] = 2.9, 95% confidence interval [CI] = 1.8–5.6, p  = 0.001) and having formal education (OR = 10.2, 95% CI = 4.7–16.5, p  = 0.001) were determinants of depression severity.

Conclusion  The prevalence of depression was high among the respondents. Although no association was found between family functionality and depression severity, respondents who are Muslims or had formal education were at increased risk of depression. Therefore, a high index of suspicion for depression and holistic care is required to manage women with infertility.

Physician Experiences and Perceived Barriers to Providing Quality Infertility Care in the Greater Accra Region of Ghana

High-quality, patient-centered care is essential to achieving equity and dignity for individuals with infertility, yet few studies have explored quality of infertility care in sub-Saharan Africa. We interviewed 13 non-specialist physicians and 2 medical school faculty to explore experiences in and perceptions of providing infertility care in Greater Accra, Ghana. We used a patient-centered infertility care model to inform our analysis and results. Individualized care and taking time to counsel and emotionally support patients were perceived as the most important things a physician can do to provide quality infertility care. Financial costs and lack of infertility services within a single facility were the most common barriers reported to providing quality infertility care. To the best of our knowledge, our study is the first to explore quality of infertility care provided by physicians in public sector facilities in Ghana, shedding light on existing barriers and identifying strategies for improvement.

The relationship between stigma, perceived social support and depression in infertile Turkish women undergoing in vitro fertilization-embryo transfer

This study was conducted to determine the relationship between the perceived social support, stigmatization and depression in infertile women and the influencing factors. The study was conducted on 298 infertile women at a private hospital between March and September 2019 using a Personal Information Questionnaire, Infertility Stigma Scale (ISS), Beck Depression Inventory (BDI), and Multidimensional Scale of Perceived Social Support (MSPSS). BDI had a significantly positive correlation with ISS and negative correlation with MSPSS. And MSPSS had a significantly negative correlation with ISS. Infertility leads women to suffer various psychosocial problems. Nurses should be aware of these problems during diagnostic procedures for infertility treatment, which should also include psychiatric counseling.

Prevalence and Correlates of Perceived Infertility in Ghana

Perceived infertility is an understudied phenomenon in low‐ and middle‐income countries, where biomedical infertility can have severe consequences, particularly for women. We conducted a nationally representative survey of Ghanaian women, estimated the prevalence of and reasons for perceived infertility, and assessed factors associated with higher levels of perceived infertility using a partial proportional odds model. Among 4,070 women, 13 percent believed they were “very likely” to have difficulty getting pregnant when they wanted to, 21 percent believed this was “somewhat likely,” and 66 percent believed this was “not at all likely.” Reasons for perceived infertility varied by whether the respondent was currently seeking pregnancy. In multivariable analysis, several factors were associated with higher levels of perceived infertility, while unexpectedly, women who reported ever using contraception were less likely to report perceived infertility. Acknowledging the need to address infertility globally and understanding the role of perceived infertility are important components in supporting people's ability to decide whether and when to have children.

Comparison of self-esteem and depression among fertile and infertile women in a low resource setting

This study aimed to explore the effect of infertility on self-esteem and depression, and to identify the sociodemographic and infertility characteristics associated with self-esteem and depression among infertile women in Ekiti State, Nigeria. Self-esteem and depression were assessed in 100 infertile women and 100 women seeking family planning (controls) using the Rosenberg Self-Esteem Scale (RSES) and Patient Health Questionnaire (PHQ-9), respectively. Infertile women had significantly lower RSES score (19.4 ± 4.5 vs. 20.7 ± 4.4, p=.038) and higher PHQ-9 score (5.1 ± 4.1 vs. 3.8 ± 3.5, p=.023) compared to controls. Among infertile women, marital status, being remarried, duration of infertility, and RSES score were associated with PHQ-9 score on simple linear regression. On multiple linear regression analysis, the RSES score had a negative association with the PHQ-9 score (β= -0.32, p<.001). In conclusion, infertile women have lower self-esteem and higher depression scores. Mental health screening and management should be an integral part of care administered to infertile women.Impact StatementWhat is already known on this subject? Infertility is a global health problem with negative effects on the mental health and quality of life of couples, especially women.What the results of this study add? Infertile women have lower self-esteem and higher depression scores. The prevalence of major depressive disorder (MDD) is higher among infertile women. Longer duration of infertility, older age, ≤6 years of formal education, and low self-esteem are significant associations of MDD among infertile women.What the implications are of these findings for clinical practice and/or further research? Mental health screening and management should be included in the care given to women undergoing evaluation and treatment for infertility. Larger community-based studies evaluating other aspects of mental health among infertile couples are encouraged.

Self-reported fertility impairments and help-seeking strategies among young women in Malawi

This paper analyses wave 4 the Tsogolo la Thanzi survey of n = 1349 Malawian women aged 16–26 to explore the prevalence and predictors of self-reported fertility impairments (difficulties conceiving and/or difficulties carrying a pregnancy to term) and help-seeking strategies. Using descriptive statistics, logistic regression models, and graphic displays, the correlates of self-reporting an impairment and patterns of help-seeking strategies are examined. Nearly 13% (n = 117) of those who had ever tried to conceive reported experiencing a fertility impairment. Age was positively associated with reporting an impairment, while there was a negative association with education and with parity. Of women who reported an impairment, 85.5% sought help. Visiting a hospital or clinic was the most common response, followed closely by going to a traditional healer. Around one-quarter employed multiple help-seeking strategies, highlighting the need for various help-seeking behaviours to be viewed in tandem rather than in isolation.

Infertility Stigma: A Qualitative Study on Feelings and Experiences of Infertile Women

Background:

Infertility stigma is a phenomenon associated with various psychological and social tensions especially for women. The stigma is associated with a feeling of shame and secrecy. The present study was aimed to explore the concept of infertility stigma based on the experiences and perceptions of infertile women.

Materials and Methods:

This qualitative conventional content analysis study was conducted in Isfahan Fertility and Infertility Center, Iran. Data were collected through in-depth interviews with 17 women who had primary infertility. All the interviews were recorded, transcribed and analyzed according to the steps suggested by Graneheim and Lundman. The Standards for Reporting Qualitative Research (SRQR) checklist was followed for this research.

Results:

Eight hundred thirty-six initial codes were extracted from the interviews and divided into 25 sub-categories, 10 categories, and four themes. The themes included “stigma profile, self-stigma, defensive mechanism and balancing”. Stigma profile was perceived in the form of verbal, social and same sex stigma. Self-stigma was experienced as negative feelings and devaluation. Defensive mechanism was formed from three categories of escaping from the stigma, acceptance and infertility behind the mask. Two categories; empowered women and pressure levers, created a balancing theme against the infertility stigma.

Conclusion:

Infertile women face social and self-stigma which threatens their psychosocial wellbeing and self-esteem. They use defensive response mechanisms and social support to mitigate these effects. Education focused on coping strategies might be helpful against infertility stigma.

Infertility-Related Stress and Psychological Health Outcomes in Infertile Couples Undergoing Medical Treatments: Testing a Multi-dimensional Model

The study aims to propose and test a multi-dimensional infertility-related stress model including socio-demographic and fertility-related characteristics, infertility-related stress dimensions, coping strategies and couple's dyadic adjustment dimensions as predictors of anxiety and depression among partners of couples undergoing infertility treatments. Both members of 250 infertile couples filled out a questionnaire consisting of Socio-demographics (Age; Educational level; Employment status), Fertility-related characteristics (Type of diagnosis; Duration of infertility), Fertility Problem Inventory-Short Form, Coping Orientations to Problem Experienced-New Italian Version, Dyadic Adjustment Scale, State-Trait Anxiety Inventory-Y and Edinburgh Depression Scale. Hierarchical Multiple Linear Regressions indicated that the proposed predictive models for anxiety and depression were significant and had good levels of fit with the data. Gender differences emerged in predictor variables. Findings provide valid predictive models that could be adopted to assess psychological health in infertile patients and to develop evidence-based and tailored counselling interventions at centres for assisted reproduction.

EEG based Major Depressive disorder and Bipolar disorder detection using Neural Networks:A review

Mental disorders represent critical public health challenges as they are leading contributors to the global burden of disease and intensely influence social and financial welfare of individuals. The present comprehensive review concentrate on the two mental disorders: Major depressive Disorder (MDD) and Bipolar Disorder (BD) with noteworthy publications during the last ten years. There is a big need nowadays for phenotypic characterization of psychiatric disorders with biomarkers. Electroencephalography (EEG) signals could offer a rich signature for MDD and BD and then they could improve understanding of pathophysiological mechanisms underling these mental disorders. In this review, we focus on the literature works adopting neural networks fed by EEG signals. Among those studies using EEG and neural networks, we have discussed a variety of EEG based protocols, biomarkers and public datasets for depression and bipolar disorder detection. We conclude with a discussion and valuable recommendations that will help to improve the reliability of developed models and for more accurate and more deterministic computational intelligence based systems in psychiatry. This review will prove to be a structured and valuable initial point for the researchers working on depression and bipolar disorders recognition by using EEG signals.

The social stigma of infertile women in Zhejiang Province, China: a questionnaire-based study

BACKGROUND

Infertile women often face stigmatization worldwide. This study aimed to investigate the stigma against infertile women in China and to analyze its influencing factors.

METHODS

Of 270 women who were randomly selected from patients receiving adjuvant fertility treatment in Zhejiang Province, China, 254 successfully completed the general information questionnaire, disease information questionnaire, and Chinese version of the infertility stigma scale (ISS). The ISS contained 27 positively worded items, each of which was graded on a 5-point Likert-type scale.

RESULTS

The total stigma score of female infertility patients was 66.39 ± 21.96. By dividing the number of items, the average score for each ISS item was 2.13 ± 0.81, indicating the presence of stigma. Among the four ISS factors, the social withdrawal score was the highest (2.64 ± 1.05), whereas the family stigma score was the lowest (1.88 ± 0.88). Multiple stepwise regression analysis further revealed that the duration of infertility and monthly income were important predictors of the stigma of infertile women.

CONCLUSIONS

Infertile women experience moderate to high levels of stigma in Zhejiang, China. Thus, supportive psychological interventions and public education are required to change patients' cognition and assist patients in coping with negative experiences.

The prevalence of depression symptoms among infertile women: a systematic review and meta-analysis

BACKGROUND

Infertile women's mental health problems, including depression, are key fertility health issues that affect infertile women more severely than infertile men. Depression may threaten the health of individuals and reduce the quality of their lives. Considering the role and impact of depression on responses to infertility treatments, a systematic review and meta-analysis were conducted to investigate the prevalence of depression symptoms among infertile women.

METHODS

International databases (PubMed, Cochrane Library, Web of Sciences, Scopus, Embase, and PsycINFO), national databases (SID and Magiran), and Google Scholar were searched by two independent reviewers for articles published from 2000 to April 5, 2020. The search procedure was performed in both Persian and English using keywords such as "depression," "disorders," "infertility," "prevalence," and "epidemiology." The articles were evaluated in terms of their titles, abstracts, and full texts. The reviewers evaluated the quality of the articles using the Newcastle-Ottawa Scale, after which they analyzed the findings using STATA version 14. The I² and Egger's tests were performed to examine heterogeneity and publication bias, respectively.

RESULTS

Thirty-two articles were subjected to the meta-analysis, and a random effects model was used in the examination given the heterogeneity of the articles. The samples in the reviewed studies encompassed a total of 9679 infertile women. The lowest and highest pooled prevalence rates were 21.01% (95% confidence interval [CI]: 15.61-34.42), as determined using the Hospital Anxiety and Depression Scale, and 52.21% (95% CI: 43.51-60.91), as ascertained using the Beck Depression Inventory, respectively. The pooled prevalence values of depression among infertile women were 44.32% (95% CI: 35.65-52.99) in low- and middle-income countries and 28.03% (95% CI: 19.61-36.44) in high-income countries.

CONCLUSION

The prevalence of depression among infertile women was higher than that among the general population of a given country. Especially in low- and middle-income countries, appropriate measures, planning, and policy that target the negative effects of depression on infertile women's lives should be established to reduce related problems.

Depression among Infertile Women in Gaza Strip: Symptom Severity and Predictors

BACKGROUND

Mental disorders are expected for women suffering from infertility. Depression is a predictable consequence but requires more investigations and considerations. This study is aimed at determining the severity of depression symptoms and its predictors among infertile women in the Gaza Strip, Palestine.

MATERIALS AND METHODS

A cross-sectional study was conducted. Three hundred eighty-five infertile women participated and were selected by convenience sampling. The participated women were selected from three large and major in vitro fertilization treatment centers (Al Helo, Al Basma, and Hindawi). A validated Arabic version of the Beck Depression Inventory-II was used. Univariate and multivariate logistic regression was applied to determine potential predictors for depression symptoms, and p ≤ .05 was statistically significant.

RESULTS

The mean age of participated women was 29 ± 6.58 years, and the mean duration of marriage and infertility was 7.76 ± 5.31 and 5.43 ± 3.50 years, respectively. Half of the women had some form of depression symptoms (22.3%, 8.6%, and 10.6% showed to have mild depression, moderate, and severe depression symptoms, respectively). Predictors of depression symptoms were as follows: duration of marriage (Wald test: 10.493; CI95%: 0.248-0.774), at least one abortion (Wald test: 21.233; CI95%: 1.863-4.528), primary infertility (Wald test: 6.666; CI95%: 1.148-2.742), and husband cause of infertility (Wald test: 10.878; CI95%: 0.800-0.982).

CONCLUSION

Infertility affects the various aspect of women's life. Psychological intervention including counselling, support, and therapy would be necessary to limit the consequences of infertility. Such interventions could be implemented in infertility treatment clinics.

Comparison of depression between primary and secondary infertile couples

OBJECTIVE

We aimed to compare the depression levels between primary and secondary infertile couples and to investigate the related factors that may affect depression.

STUDY DESIGN

Two hundred and fifty primary and secondary infertile couples, who admitted to Gynecology and Infertility Clinics of Pendik Teaching and Research Hospital affiliated with Marmara University were enrolled in this study. Sixty-four BMI-matched fertile female patients who applied to the General Gynecology Clinic and their husbands were taken as the control group. Beck Depression Inventory (BDI) form was filled by the infertile couples to evaluate the depression status before they started their cycles.

RESULTS

The mean total BDI scores were alike between groups among women. Mild depression was found to be higher in the primary infertile women and moderate depression was higher in women of the control group. Women had statistically higher depression scores than male partners. Primary infertile, secondary infertile, and fertile women had higher depression scores than their male partners in the corresponding groups. There was no significant difference in mean total BDI scores among males between the groups. The percentage of distribution of male partners in each level of depression was similar between the groups.

CONCLUSIONS

Only a weak positive correlation between the mean total BDI score and the number of previous treatment cycles was found. Psychiatric support before and during the upcoming fertility treatment might reduce the perception of the probable treatment failure.

The relationship between stigmatisation and quality of life in Ghanaian women and men with fertility problems: mediating role of coping strategies

INTRODUCTION

Fertility problems may have a devastating impact on the people involved. Specifically, in highly pronatalist settings like Ghana, the personal and social consequences are high. This study focused on the relationship between stigmatisation because of fertility problems and quality of life among Ghanaian women and men, and the possible mediating role of coping strategies.

METHODS

Participants (38 women, 11 men) were recruited with the help of a patient organisation and a hospital in Accra. Standardised instruments were used to measure the stigmatisation of having fertility problems, fertility quality of life and coping with fertility problems. Partial Pearson r correlations were conducted, followed by bootstrapped mediation analyses (PROCESS macro).

RESULTS

Stigmatisation was negatively correlated with fertility quality of life, and fertility quality of life was negatively correlated with active-avoidance coping. Active avoidance coping partially mediated the relationship between being stigmatised because of fertility problems and fertility quality of life.

CONCLUSIONS

Professionals working with people with fertility problems should pay more attention to how people are coping with experiences of stigmatisation.

Association of depression and resilience with fertility quality of life among patients presenting to the infertility centre for treatment in Karachi, Pakistan

Background

In Pakistan there is a dire need to explore the quality of life in infertile males and females and its undesirable psychological outcomes. This, study aimed to compare the quality of life (QoL) of males and females visiting an infertility centre for treatment and to assess its association with resilience, depression, and other socio-demographic factors.

Methods

An Analytical Cross-Sectional study was conducted amongst infertile males and females at the Australian Concept Infertility Medical Centre (ACIMC), Karachi, Pakistan. The non-probability (purposive) sampling strategy was used to recruit the participants. The sample size was 668. Data was analysed using STATA version 12. FertiQoL tool, Beck II Depression Inventory Tool and Resilience Scale 14 (RS-14) were used for assessing the quality of life, depression and resilience respectively of infertile patients.

Results

Total 668 infertile patients, 334 males and 334 females participated in the study. The mean age was 35.53 ± 6.72, among males, and 30.87 ± 6.12 among females. The mean resilience scores were significantly higher among males, (77.64 ± 8.56), as compared to females (76.19 ± 8.69) (95% CI; − 2.757, − 0.1347). However, a significantly higher proportion of females were depressed (13.8%) as compared to males (6%). The mean QoL scores for the general health domain, emotional domain, mind and body domain, and relational domain, and the total QoL were significantly higher in males as compared to females (p value< 0.001); however, QoL for the social domain was not significantly different in both the groups. On multivariable linear regression resilience and depression among males had a significant association with QoL, after adjusting for the covariates educational status, monthly income, and number of friends. Similar association was observed among females after adjusting for the covariate monthly income only.

Conclusion

Fertility related QoL of men and women has a significant association with no formal education, number of friends, income, depression and resilience. Therefore, health care professionals in the field of infertility must be adequately trained to respond to the needs of individuals going through these psychological problems.

Pharmacotherapy of infertility in Ghana: retrospective study at the cape coast teaching hospital

Background

Infertility is a major challenge for couples globally. Due to low income levels and the high cost of other assisted reproductive techniques, pharmacotherapy remain the major first line treatment option for infertility in Sub-Saharan Africa.

Objective

The aim of this study was to assess the prevalence of infertility as well as the effectiveness and success achieved following infertility pharmacotherapy at the Cape Coast Teaching Hospital in Ghana.

Methods

This study was a retrospective observational study of 825 couples attending infertility clinic at the hospital.

Results

Prevalence of infertility at the study center was estimated to be 12.3%. Treatment mainly involved the use of clomiphene citrate, antioxidants, herbo-mineral drugs (Ayurveda), multivitamin and antibiotics. Pharmacotherapy resulted in successful conception in one out of every five couples (19.4%; n = 160). Secondary infertility, although more prevalent in the study population (44.8%; n = 370), had lower conception rates during pharmacotherapy than primary infertility (15% vs 26.2%). Age, kind of infertility, employment status but not educational level were significantly associated with pharmacotherapy success. In ovulation induction, clomiphene citrate plus folic acid and vitamin E adjuncts improved ovulation rates during cycle treatments compared to clomiphene citrate alone. Pharmacotherapy of idiopathic infertility (39%, n = 323) was a major challenge with very limited success rates. Interestingly, it was noted that treating couples or female partners only for idiopathic infertility resulted in higher success rates than treating the male partner only. Again, 90-day treatment regimen doubled conception rates when compared with corresponding 30-day treatment regimen. However, zinc sulfate even in short term treatment regimens (30 days) enhanced conception rates in idiopathic infertility.

Conclusions

Prevalence of infertility was estimated to be about 12.3%. One out of every five infertile couples achieved success with pharmacotherapy. Factors such as age, type of infertility, employment status, but not education were significantly associated with treatment success.

Gender differences in factors associated with depression in infertility patients

AIMS

To clarify gender differences in the demographic variables and infertility problems associated with depression among men and women undergoing infertility treatment.

DESIGN

A cross-sectional study.

METHODS

We surveyed 380 women and 360 men undergoing infertility treatment at the reproductive medicine center of a hospital in China's Ningxia Province from March - September 2016.

RESULTS

For women, ethnicity, the number of clinic visits, social concern, and sexual concern were factors linked with depression symptoms. For men, treatment cost pressure and social concern were significantly associated with depression symptoms.

CONCLUSION

Psychological counseling and intervention programs should be integrated into in-vitro fertilization treatments and interventions should be targeted based on gender differences.

IMPACT

The provision of treatment-related sexual knowledge by nurses is indispensable for infertile participants. Mental health policies should be developed to facilitate the implementation of psychological services. Psychological counseling and intervention programs should be integrated into in vitro fertilization treatment to help men and women with infertility cope with psychological distress.

The effect of stigma on depression levels of Turkish women with infertility

PURPOSE

This study was conducted to determine the effect of stigma on depression levels of women with infertility in Turkey.

DESIGN AND METHODS

It was completed in the Infertility Polyclinic of the Health Research and Application Center in Eastern Turkey between 1 November 2017 and 31 January 2018. The population of the study consisted of all women who applied to the relevant unit between these dates and received infertility treatment. This study was completed with 121 infertile women. To gather data, the researchers used personal information questionnaires, Infertility Stigma Scale, and the Beck Depression Inventory.

FINDINGS

The mean score for the stigma level was 60.79 ± 2.03 and for depression, it was 28 ± 1.08. A positive significant relationship was found among the scales (P < 0.05). The levels of depression and stigma were moderate, and the stigma had a negative impact on depression.

PRACTICE IMPLICATIONS

Based on these results, nurses with counseling and trainer roles should be aware of the psychological issues faced by infertile individuals and psychiatric counseling should become a part of the diagnostic process for infertility treatment.

Effectiveness of two guided self-administered interventions for psychological distress among women with infertility: a three-armed, randomized controlled trial

STUDY QUESTION

What is the effect of two guided self-administered interventions on psychological distress in women undergoing IVF or ICSI?

SUMMARY ANSWER

A brief mindfulness intervention significantly reduced depression and improved sleep quality, while the gratitude journal intervention showed no significant effect on any outcome variables.

WHAT IS KNOWN ALREADY

Mindfulness and gratitude journal interventions have been found to be beneficial in reducing negative affect and improving well-being. However, there are very few mental health professionals who implement such interventions in low- and middle-income countries. Therefore, two guided self-administered interventions for women with infertility were designed to help them cope with their psychological distress.

STUDY DESIGN, SIZE, DURATION

A three-armed, randomized controlled trial was designed to evaluate the mindfulness and gratitude journal interventions for women undergoing IVF/ICSI. Between May 2016 and November 2017, at the reproductive center in a public hospital, 234 women were randomly assigned to the brief mindfulness group (BMG, n = 78), gratitude journal group (GJG, n = 78) or control group (CG, n = 78). The inclusion criteria were being a woman undergoing her first cycle of IVF, having at least junior middle school education and having no biological or adopted children.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Female infertility patients (n = 346) were approached, and 112 did not meet the inclusion criteria. All three randomized groups completed questionnaires on the day of down-regulation (T1), the day before embryo(s) transfer (T2), and 3 days before the pregnancy test (T3). The BMG completed four sessions and listened to a 20-minute audio daily, including guided mindfulness breathing and body scan. The GJG completed four sessions and wrote three gratitude journals daily. The CG received routine care. A generalized estimating equation was used in an intention-to-treat analysis. The primary outcome was depression. Secondary outcomes were anxiety, sleep quality, infertility-related stress, mindfulness and gratitude.

MAIN RESULTS AND THE ROLE OF CHANCE

Participants of the BMG showed decreased depression (mean difference (MD) = −1.69, [−3.01, −0.37], d = 0.44) and improved sleep quality (MD = −1.24, [−1.95, −0.39], d = 0.43) compared to the CG, but the effect was not significant for anxiety, Fertility Problem Inventory totals, mindfulness, gratitude scores or pregnancy rates. The BMG showed a significant reduction in depression and improvement in sleep quality between T1 and T2, a continuous significant reduction between T1 and T3 and no reduction between T2 and T3. There were no significant effects on any of the variables for the GJG.

LIMITATIONS, REASONS FOR CAUTION

The inclusion criteria may result in bias because some participants with low education were excluded and only women with infertility were included. A low compliance rate occurred in the gratitude journals group. Moreover, men were not included in this study. Further research should consider including spouses of the target population.

WIDER IMPLICATIONS OF THE FINDINGS

The brief mindfulness intervention was beneficial in decreasing depression and improving sleep quality. Implementation of guided self-administered mindfulness could make the psychological counseling service more accessible for patients with infertility in resource-poor settings. The efficiency and feasibility of the gratitude journal intervention needs to be investigated further.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the National Social Science Foundation (17BSH054). The authors have no conflicts of interest.

TRIAL REGISTRATION NUMBER

ChiCTR-IOR-16008452.

TRIAL REGISTRATION DATE

9 May 2016

DATE OF FIRST PATIENT’S ENROLMENT

15 May 2016.

Effectiveness of a psychological intervention focused on stress management for women prior to IVF

Objective: To evaluate the effectiveness of a psychological intervention focused on stress management in women who are candidates for in vitro fertilisation (IVF).Method: Pre-post study with two groups (n = 26). The psychological intervention group (IG) received a 90-minute session that included psychoeducation, relaxation training and coping skills. The control group (CG) did not receive any psychological intervention. All participants later underwent IVF. In the initial and final evaluations, state anxiety, emotional imbalance, adaptive resources and quality of life were measured. In the initial evaluation, demographic and clinical variables were also measured.Results: In the IG, the final evaluation reflected: (1) decreased levels of anxiety and emotional imbalance; (2) the perception of enhanced quality of life. Moreover, among the participants who received the psychological intervention and later achieved a successful IVF, the level of anxiety appeared to have decreased more strongly.Conclusions: A brief intervention focused on stress management can benefit the psychological adjustment of women who are candidates for IVF, reducing the anxiety they may experience in this regard. However, our conclusions are based on a small sample, and so should be considered with caution. Nevertheless, these results are promising and highlight the advisability of further research.

Infertility and self-rated health among Malawian women

Infertility is prevalent and stigmatized in sub-Saharan Africa. Self-rated health, a subjective indicator that has been consistently related to objectively measured health, may be useful in evaluating the relationship between women's infertility and health. Data were from surveys conducted from July 2014 to January 2015 with women aged 15-39 years (n = 915) as part of the initial assessment in a cohort study in Lilongwe district, Malawi. We first assessed correlates of self-reported infertility among women in rural Malawi. We then used multiple logistic regression to examine associations between infertility and self-rated health. Of women surveyed, 20 percent had a history of infertility. Compared to women who had not experienced infertility, women with a history of infertility were older (p = 0.05), less educated (p = 0.01), and more likely to report depressive symptoms (p = 0.02) and forced first intercourse (p = 0.02) and to have been previously diagnosed with a sexually transmitted infection (p = 0.05). However, women with a history of infertility were not significantly more likely to report poor self-rated health (adjusted odds ratio: 1.69; 95 percent confidence interval: 0.70-4.07). Infertility was prevalent in our sample of Malawian women but was not significantly related to self-rated health, an instrument widely used in public-health research.

FREQUENCY AND DETERMINANTS OF DEPRESSIVE ILLNESS AMONG INFERTILE WOMEN

Background: Depression is much more common among infertile women as compared to the general population. The objectives of our study were to determine the frequency of depression among infertile women and association of depression among infertile women with age groups, level of education, and duration of infertility. Materials & Methods: This cross-sectional study was conducted at Department of Psychiatry, Gomal Medical College, D.I.Khan, Pakistan from 1st January 2018 to 31st December 2018. Sample size was 145 women with primary infertility selected through consecutive sampling technique. The demographic variables were; age groups, level education, duration of primary infertility and research variables was presence of depression. Observed and expected frequency for depression was analyzed by chi-square goodness-of-fit test. Association of depression with age groups, level of education and infertility duration were analyzed by chi-square test of independence. Results: Out of 145 infertile women. 122(84.1%;78.15-90.05%) had depression whereas 23(15.9%;9.95-21.85%) had no depression. Thirty seven out of 145(25.52%) women in the age group

The contribution of social-environmental factors to the emotional adjustment of Israeli religious Jewish women coping with infertility

The community is often considered a resource for coping with health-related stress but has potential for negative effects when coping with fertility problems. In this study, we examined the associations between the social-environmental variables (seeking the support of the community, perception of pressure from the community, and perception of spouse support as a possible moderator of this pressure) and emotional adjustment to fertility problems among religious Jewish women in Israel, a highly pronatalist society. Data were collected from January to August 2011. Structural equation modeling using data from 186 women indicated that perception of pressure from the community was associated with poorer emotional adjustment. This association was not moderated by perceived spouse support, but spouse support was associated with better adjustment. Seeking the support of the community was found to be composed of two dimensions: Seeking Ties and Belonging to the Community, which was associated with poorer adjustment, and Seeking Approval and Recognition from the Community, which was associated with better adjustment. These results point to the complexity of dealing with health-related stress when it comes to important community values. Understanding this complexity can help professionals conduct culturally sensitive evaluation and treatment that will contribute to women's emotional adjustment to fertility problems.

Predictors of Infertility Stress among Couples Diagnosed in a Public Center for Assisted Reproductive Technology

Background:

All around the world, infertility, in many ways, is recognized as a stressful and a critical experience that can have impact on social and marital life of a couple. Infertility stress may affect the treatment and its outcome for such couples. The objective of the present study is to assess the predictors of high stress of infertility among married couples.

Materials and Methods:

This cross-sectional study was conducted on 120 couples (240 patients) who were diagnosed with primary and secondary infertility from June 2017 to June 2018. A psychological self-assessment questionnaire (Perceived Stress Scale-10) was used as a tool to evaluate the presence of high infertility stress among couples after obtaining their consent. Furthermore, other socioepidemiological data of patients were collected.

Statistical Analysis:

Data were analyzed using SPSS software (version 20). Univariate statistical analysis was used followed by multiple logistic regressions between high infertility stress and the predictor variables.

Results and Discussion:

The prevalence of high infertility stress was 53.3% among women and 40.8% among men. For women, multivariate analysis showed leading associations of high infertility stress with level of education, infertility type, infertility duration, and etiologies of infertility. However, for men, multivariate analysis showed leading associations between high infertility stress and alcohol status and inadequate sleep and infertility type.

Psychological health and religious coping of Ghanaian women with infertility

Background

Infertility has been shown to have considerable psychological effects on the well-being of couples, especially women. Religion has been found as a resource used by infertile women to cope with their distress. Little research has examined the influence of religious coping on psychological distress among infertile women in Ghana. This study examines the relationship between positive and negative religious coping and psychological health for women with infertility problems in Ghana.

Methods

One hundred and fifty married women who were receiving assisted reproduction care in two specialized clinics were recruited for this study. Participants were administered with the Brief Symptom Inventory and Brief Religious Coping Scale to assess psychological health associated with infertility and religious coping respectively. A hierarchical regression was performed to examine the relative contribution of the domains of psychological health (i.e. somatization, anxiety and depression) in predicting negative religious coping and positive religious.

Results

The results showed that negative religious coping was significant and positively correlated with somatization, depression and anxiety. Furthermore, a positive relationship also existed between positive religious coping and somatization and anxiety but not depression. After controlling for age and duration of infertility, somatization and anxiety predicted positive religious coping whilst all the domains of psychological health (somatization, anxiety and depression) precited negative religious coping.

Conclusions

This study expanded on the existing literature by examining positive and negative religious coping with psychological distress associated with infertility for women. These results underscore the need for health professionals providing therapies for women with infertility to acknowledge and consider their religious beliefs as this influences their mental health.

"I am anxious and desperate": psychological experiences of women with infertility in The Greater Accra Region, Ghana

Background

Research has shown that infertility affects millions of couples worldwide. Infertility is considered one of the most difficult life experiences and can result in psychological consequences for couples, especially for women. The purpose of this study was to explore the psychological experiences of women with infertility.

Methods

A qualitative exploratory descriptive approach was used to conduct in-depth interviews. The psychological component of the bio-psychosocial model was used as a guiding framework to understand the experiences of women with infertility. Fourteen women were selected based on the purpose of the study and provided their informed consent, and were interviewed between November 2015 and January 2016. All the women were recruited from the Greater Accra Region of Ghana. Each interview lasted for 30 to 40 min. All interviews were audio taped, transcribed verbatim and analyzed using thematic content analysis.

Results

The findings from the study showed that women with fertility problems experienced many emotional difficulties such as loneliness, anxiety, depression, lack of concentration, worrying, and reduced sexual satisfaction.

Conclusions

Women in this study encountered psychological challenges and experienced emotional distress. Such women would benefit from psychological support such as counseling to help alleviate their psychological problems. These findings have implications for the care of women with infertility in Ghana.

Difficulties Conceiving and Relationship Stability in Sub-Saharan Africa: The Case of Ghana

Little is known about the relationship between self-identified difficulties conceiving, biomedical infertility, and union instability in Sub-Saharan Africa. Previous research suggests that infertility increases the risk of psychological distress and marital conflict, encourages risky sexual behaviour, and deprives infertile individuals and couples of an important source of economic and social capital. Qualitative research has suggested that there may be a link between infertility and divorce; less is known about the implications of infertility for unmarried couples. In this paper, discrete-time hazard models are applied to 8 waves of secondary panel data from Ghana collected by the Population Council of New York and the University of Cape Coast (pooled n = 10,418) between 1998 and 2004. Results show a positive relationship between perceived difficulties conceiving and relationship instability for both married women and those in non-marital sexual unions; this relationship, however, does not hold for biomedical infertility. Future research should examine this relationship using nationally representative data in a cross-national comparison to determine whether results hold across the subcontinent.

Depression, anxiety and stress among female patients of infertility; A case control study

OBJECTIVES

Infertility, in many ways, is a very distressing condition that can have its impact on social and marital life of a couple. Depression, anxiety and stress associated with infertility may affect treatment and outcomes for such couples. The purpose of this study was to find out prevalence of depression, anxiety and stress among females suffering from infertility.

METHODS

One hundred females suffering from infertility as study subjects and 100 females accompanying them as controls were randomly selected from infertility clinic at Arif Memorial Teaching Hospital, Lahore, Pakistan. Females with diagnosed mental health issues and those from couples having male factor infertility were not included. Validated Urdu version of Depression, anxiety, stress scale (DASS) was used for assessment of depression, anxiety and stress scores. Results from both groups were compared and independent sample t-test was used to analyze the results.

RESULTS

There was high prevalence of depression, anxiety and stress among females suffering from infertility compared to females in control group (p < 0.05). Level of education did not appear to have any positive effect on these scores. Similarly, results did not appear to change when occupations of infertile females were used for stratified analysis.

CONCLUSION

Depression, anxiety and stress are very common among females suffering from infertility. Healthcare professionals should consider psychological counseling, and psychiatric help if required, when they offer fertility treatment for such females.

Depression and anxiety among parents of phenylketonuria children

Objective:

To investigate the existence of depression and/or anxiety with underlying risk factors among parents of children with classical phenylketonuria (PKU).

Methods:

This cross-sectional study was conducted in the Division of Pediatric Metabolism, Ankara Children’s Hospital, Dokuz Eylul University, Kırıkkale University, and Erzurum Local Research Hospital, Turkey, between January and July 2014. Parents of 61 patients and 36 healthy controls completed the self-report questionnaires. We used Beck Depression Inventory (BDI) to assess the parental depression and State-Trait Anxiety Inventory S-T (STAI S-T) to assess parental anxiety.

Results:

Depression and anxiety scores were significantly higher in the case group (BDI 12.3±9.1; STAI-S: 38.2±9.6; STAI-T: 43.2±6.9) than controls (BDI: 5.4±4.1 p=0.000; STAI-S: 31.8±7.6 p=0.001; STAI-T: 37.0±7.2 p=0.000). Mothers of the patients had higher scores than the other parental groups (BDI: p=0.000, STAI-S: p=0.001 and STAI-T: p=0.000). Logistic regression analysis showed that low educational level of the parent was the only independent factor for depression (OR 9.96, 95% CI: 1.89-52.35, p=0.007) and state anxiety (OR: 6.99, 95% CI: 1.22-40.48, p=0.030) in the case group.

Conclusion:

A subset of parents with PKU patients have an anxiety or depressive disorder. Supportive services dealing with the parents of chronically ill children such as PKU are needed in order to reduce the level of anxiety.

Psychiatric Morbidity in Infertility Patients in a Tertiary Care Setup

CONTEXT

Infertility is regarded as a trigger for psychological morbidity. Infertile couples often suffer from anxiety, depression and lack of self confidence.

AIMS

To study the demographic factors associated with infertility in a tertiary care setup and to determine the level of anxiety and depression associated with it by using standardized scales. The study protocol also included studying the various coping strategies employed by these patient groups.

SETTINGS AND DESIGN

Case control study.

MATERIALS AND METHODS

A prestructured questionnaire based study conducted for a span of 6 months. The study population included the patients attending the infertility and the family planning outpatient department. We applied the Hospital Anxiety and Depression scale (HADS) and the Becks Depression Inventory (BDI). Brief COPE Inventory was applied to look for the various coping measures that are employed by the anxious and depressed patients.

STATISTICAL ANALYSIS

Data analysis was done using SPSS ver20.

RESULTS

A total of 280 study subjects were included in the study; which included 140 women from the infertility clinic and 140 from the family planning OPD. A total of 56.4% (79/140) of the females were found to be suffering from depression and 68.9% (96/140) of the females were found to be suffering from anxiety and depression both. Seven risk factors were found to be significant for depression based on the Beck Depression Inventory (BDI) scale and 6 risk factors were found to be significant based on the Hospital Anxiety and Depression Scale (HADS). The most common coping method employed by depressed women was venting 72.2% (57/79) followed by behavioural disengagement 70.9% (56/79); whereas the most important coping method employed by the anxious and depressed women was behavioural disengagement 71.9% (69/96).

CONCLUSION

Anxiety and depression is common among patients suffering from infertility and measures should be taken to alleviate it.

Thyroid hormones and prolactin levels in infertile women in southern Nigeria

INTRODUCTION

Human infertility is a complex global health problem. It has multiple social consequences which are especially profound for thyroid hormones in infertility with the aim of determining the degree of association of thyroid hormones with hyperprolactinemia in our population.

MATERIALS AND METHODS

The serum levels of prolactin, T3, T4 and TSH were determined in 90 hyperprolactinemic infertile women, 90 normoprolactinemic infertile women and 50 fertile women. The hormones were assayed using Enzyme Linked Immunosorbent Assay kits.

STATISTICAL ANALYSIS

Analysis of variance and Pearson's correlation were used to analyze the data, with the significant p-level set at 0.05.

RESULTS

A significantly higher mean serum prolactin and TSH were observed among the infertile groups compared to the fertile controls (p<0.05). The mean serum T3 and T4 were significantly lower in the hyperprolactinemic infertile women compared to the fertile controls (p<0.05). The mean TSH and T3 of normoprolactinemic infertile women and controls were comparable (p>0.05). However, the mean T4 was significantly lower in normoprolactinemic infertile women compared to the fertile controls (p<0.05). In all the groups, TSH correlated inversely with T3 and T4, while T3 correlated positively with T4. It was only in the control group that prolactin correlated positively and significantly with TSH.

CONCLUSION

It is therefore concluded that hyperprolactinemia with thyroid dysfunction may be a major contributory hormonal factor in infertility among infertile women and as such, estimation of prolactin, T3, T4 and TSH should be included in the workup for infertile women especially those with hyperprolactinaemia.