Hostname: page-component-848d4c4894-ttngx Total loading time: 0 Render date: 2024-05-20T22:16:21.430Z Has data issue: false hasContentIssue false
  • English
  • Français

Anxiety and depression symptoms among sub-fertile women, women pregnant after infertility treatment, and naturally pregnant women

Published online by Cambridge University Press:  23 March 2020

L. Salih Joelsson ,
T. Tydén ,
K. Wanggren ,
M.K. Georgakis ,
J. Stern ,
A. Berglund  and
A. Skalkidou
L. Salih Joelsson
Affiliation:
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
T. Tydén
Affiliation:
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
K. Wanggren
Affiliation:
Department of Clinical Science, Intervention and Technology, Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
M.K. Georgakis
Affiliation:
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Sweden
J. Stern
Affiliation:
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden Department of Health Promotion, Sophiahemmet University, Stockholm, Sweden
A. Berglund
Affiliation:
The National Centre for Knowledge of Men's Violence against Women, Uppsala University, Uppsala, Sweden
A. Skalkidou*
Affiliation:
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
*
*Corresponding author. Women’s and Children’s Health, Uppsala University, 75185 Uppsala, Sweden. E-mail address:alkistis.skalkidou@kbh.uu.se (A. Skalkidou).
Get access

Abstract

Background:

Infertility has been associated with psychological distress, but whether these symptoms persist after achieving pregnancy via assisted reproductive technology (ART) remains unclear. We compared the prevalence of anxiety and depressive symptoms between women seeking for infertility treatment and women who conceived after ART or naturally.

Methods:

Four hundred and sixty-eight sub-fertile non-pregnant women, 2972 naturally pregnant women and 143 women pregnant after ART completed a questionnaire in this cross-sectional study. The Anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A≥8) and Edinburgh Postnatal Depression Scale (EPDS≥12) were used for assessing anxiety and depressive symptoms, respectively. Multivariate Poisson regression models with robust variance were applied to explore associations with anxiety and depressive symptoms.

Results:

The prevalence of anxiety and depressive symptoms among sub-fertile, non-pregnant women (57.6% and 15.7%, respectively) were significantly higher compared to women pregnant after ART (21.1% and 8.5%, respectively) and naturally pregnant women (18.8% and 10.3%, respectively). History of psychiatric diagnosis was identified as an independent risk factor for both anxiety and depressive symptoms. The presence of at least one unhealthy lifestyle behavior (daily tobacco smoking, weekly alcohol consumption, BMI≥25, and regular physical exercise < 2 h/week) was also associated with anxiety (Prevalence Ratio, PR: 1.24; 95%CI: 1.09–1.40) and depressive symptoms (PR: 1.25; 95%CI: 1.04–1.49).

Conclusions:

Women pregnant after ART showed no difference in anxiety and depressive symptoms compared to naturally pregnant women. However, early psychological counseling and management of unhealthy lifestyle behaviors for sub-fertile women may be advisable, particularly for women with a previous history of psychiatric diagnosis.

Keywords

AnxietyDepressionInfertilityPregnancyAssisted reproductive technology (ART)
Type
Original article
Information
European Psychiatry , Volume 45 , September 2017 , pp. 212 - 219
Copyright
Copyright © European Psychiatric Association 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Abbreviations: ,ART, Assisted reproductive technology ,HADS, Hospital Anxiety and Depression Scale ,EPDS, Edinburgh Postnatal Depression Scale ,IVF, in vitro fertilization ,SD, standard deviation, PR, prevalence ratio, CI, confidence intervals, BMI, Body mass index, ICSI, intracytoplasmic sperm injection

References

Kupka, MSD’Hooghe, TFerraretti, APDe Mouzon, JErb, KCastilla, JA, et al.Assisted reproductive technology in Europe, 2012: results generated from European registers by ESHRE. Hum Reprod 2015; 31: 233–248. http://dx.doi.org/10.1093/humrep/dev319.Google Scholar
Homan, GFDavies, MNorman, RThe impact of lifestyle factors on reproductive performance in the general population and those undergoing infertility treatment: a review. Hum Reprod Update 2007; 13: 209–223. http://dx.doi.org/10.1093/humupd/dml056.CrossRefGoogle ScholarPubMed
Skakkebaek, NEJørgensen, NMain, KMRajpert-De Meyts, ELeffers, HAndersson, A.-M., et al.Is human fecundity declining?. Int J Androl 2006; 29: 2–11. http://dx.doi.org/10.1111/j.1365-2605.2005.00573.x.CrossRefGoogle Scholar
Cooke, PSHolsberger, DRWitorsch, RJSylvester, PWMeredith, JMTreinen, KA, et al.Thyroid hormone, glucocorticoids, and prolactin at the nexus of physiology, reproduction, and toxicology. Toxicol Appl Pharmacol 2004; 194: 309–335. http://dx.doi.org/10.1016/j.taap.2003.09.016.CrossRefGoogle Scholar
Lynch, CDSundaram, RMaisog, JMSweeney, AMBuck Louis, GMPreconception stress increases the risk of infertility: results from a couple-based prospective cohort study – the LIFE study. Hum Reprod 2014; 29: 1067–1075. http://dx.doi.org/10.1093/humrep/deu032.CrossRefGoogle ScholarPubMed
Csemiczky, GLandgren, BMCollins, AThe influence of stress and state anxiety on the outcome of IVF-treatment: psychological and endocrinological assessment of Swedish women entering IVF-treatment. Acta Obstet Gynecol Scand 2000; 79: 113–118. http://dx.doi.org/10.1034/j.1600-0412.2000.079002113.x.CrossRefGoogle ScholarPubMed
Smeenk, J.M.J.Verhaak, CMVingerhoets a, J.J.M.Sweep, C.G.J.Merkus, J.M.W.M.Willemsen, SJ, et al.Stress and outcome success in IVF: the role of self-reports and endocrine variables. Hum Reprod 2005; 20: 991–996. http://dx.doi.org/10.1093/humrep/deh739.CrossRefGoogle ScholarPubMed
Schmidt, LSocial and psychological consequences of infertility and assisted reproduction – what are the research priorities?. Hum Fertil 2009; 12: 14–20. http://dx.doi.org/10.1080/14647270802331487.CrossRefGoogle ScholarPubMed
Galhardo, APinto-Gouveia, JCunha, MMatos, MThe impact of shame and self-judgment on psychopathology in infertile patients. Hum Reprod 2011; 26: 2408–2414. http://dx.doi.org/10.1093/humrep/der209.CrossRefGoogle ScholarPubMed
Wischmann, TScherg, HStrowitzki, TVerres, RPsychosocial characteristics of women and men attending infertility counselling. Hum Reprod 2009; 24: 378–385. http://dx.doi.org/10.1093/humrep/den401.CrossRefGoogle ScholarPubMed
Volgsten, HEkselius, LPoromaa, ISSvanberg, ASPersonality traits associated with depressive and anxiety disorders in infertile women and men undergoing in vitro fertilization treatment. Acta Obstet Gynecol Scand 2010; 89: 27–34. http://dx.doi.org/10.3109/00016340903447396.CrossRefGoogle ScholarPubMed
Klonoff-Cohen, HChu, ENatarajan, LSieber, WA prospective study of stress among women undergoing in vitro fertilization or gamete intrafallopian transfer. Fertil Steril 2001; 76: 675–687. http://dx.doi.org/10.1016/S0015-0282(01)02008-8.CrossRefGoogle ScholarPubMed
Boivin, JSchmidt, LInfertility-related stress in men and women predicts treatment outcome 1 year later. Fertil Steril 2005; 83: 1745–1752. http://dx.doi.org/10.1016/j.fertnstert.2004.12.039.CrossRefGoogle ScholarPubMed
Matthiesen, S.M.S.Frederiksen, YIngerslev, HJZachariae, RStress, distress and outcome of assisted reproductive technology (ART): a meta-analysis. Hum Reprod 2011; 26: 2763–2776. http://dx.doi.org/10.1093/humrep/der246.CrossRefGoogle ScholarPubMed
Gameiro, SBoivin, JDancet, EKlerk, De C.Emery, MLewis-Jones, C, et al. VC. ESHERE. Routine psychosocial care in infertility and medically assisted reproduction – A guide for fertility staff; 2015; 1–162.CrossRefGoogle Scholar
Verhaak, CMSmeenk, J.M.J.Evers, A.W.M.Kremer, J.A.M.Kraaimaat, FWBraat, D.D.M.Women's emotional adjustment to IVF: a systematic review of 25 years of research. Hum Reprod Update 2007; 13: 27–36. http://dx.doi.org/10.1093/humupd/dml040.CrossRefGoogle Scholar
Hjelmstedt, AWidström, A.-M.Wramsby, HCollins, AEmotional adaptation following successful in vitro fertilization. Fertil Steril 2004; 81: 1254–1264. http://dx.doi.org/10.1016/j.fertnstert.2003.09.061.CrossRefGoogle ScholarPubMed
Younger, MHollins-martin, CChoucri, LCrescent, TLancashire, MIndividualised care for women with assisted conception pregnancies and midwifery practice implications: an analysis of the existing research and current practice (Director of Midwifery, Counselling and Psychotherapy, Lead midwife for Education). Midwifery 2015; 31: 265–270. http://dx.doi.org/10.1016/j.midw.2014.06.008.CrossRefGoogle Scholar
Poikkeus, PSaisto, TUnkila-Kallio, LPunamaki, R.-L.Repokari, LVilska, S, et al.Fear of childbirth and pregnancy-related anxiety in women conceiving with assisted reproduction. Obstet Gynecol 2006; 108: 70–76. http://dx.doi.org/10.1097/01.aoa.0000288288.53081.1c.CrossRefGoogle ScholarPubMed
Allan, HFinnerty, GThe practice gap in the care of women following successful infertility treatments: unasked research questions in midwifery and nursing. Hum Fertil 2007; 10: 99–104. http://dx.doi.org/10.1080/14647270601050320.CrossRefGoogle ScholarPubMed
Joelsson, LSBerglund, AWånggren, KLood, MRosenblad, ATydén, TDo subfertile women adjust their habits when trying to conceive?. Ups J Med Sci 2016; 121: 184–191. http://dx.doi.org/10.1080/03009734.2016.1176094.CrossRefGoogle ScholarPubMed
Stern, JSalih Joelsson, LTydén, TBerglund, AEkstrand, MHegaard, H, et al.Is pregnancy planning associated with background characteristics and pregnancy planning behavior?. Acta Obstet Gynecol Scand 2015. http://dx.doi.org/10.1111/aogs.12816.CrossRefGoogle Scholar
Tyden, TStern, JNydahl, MBerglund, ALarsson, MRosenblad, A, et al.Pregnancy planning in Sweden – a pilot study among 270 women attending antenatal clinics. Acta Obstet Gynecol Scand 2011; 90: 408–412. http://dx.doi.org/10.1111/j.1600-0412.2010.01055.x.CrossRefGoogle ScholarPubMed
Zigmond, ASSnaith, RPThe Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983; 67: 361–370.CrossRefGoogle ScholarPubMed
SBU, Swedish Council on Health Technology Assessment. Case finding, diagnosis and follow-up of patients with affective disorders; 2012, http://www.sbu.se/sv/publikationer/SBU-utvarderar/diagnostik-och-uppfoljning-av-forstamningssyndrom/.Google Scholar
Matijasevich, AMunhoz, TNTavares, BFBarbosa, A.P.P.N.da Silva, DMAbitante, MS, et al.Validation of the Edinburgh Postnatal Depression Scale (EPDS) for screening of major depressive episode among adults from the general population. BMC Psychiatry 2014;14:284. http://dx.doi.org/10.1186/s12888-014-0284-x.CrossRefGoogle Scholar
Bergink, VKooistra, LLambregtse-van den Berg, MPWijnen, HBunevicius, Rvan Baar, A, et al.Validation of the Edinburgh Depression Scale during pregnancy. J Psychosom Res 2011; 70: 385–389. http://dx.doi.org/10.1016/j.jpsychores.2010.07.008.CrossRefGoogle Scholar
Verhaak, CMSmeenk, J.M.J.van Minnen, AKremer, J.A.M.Kraaimaat, FWA longitudinal, prospective study on emotional adjustment before, during and after consecutive fertility treatment cycles. Hum Reprod 2005; 20: 2253–2260. http://dx.doi.org/10.1093/humrep/dei015.CrossRefGoogle ScholarPubMed
Sundstro, IVolgsten, HSkoog Svanberg, AEkselius, LLundkvist, OSundström Poromaa, I, et al.Prevalence of psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment. Hum Reprod 2008; 23: 1–8. http://dx.doi.org/10.1093/humrep/den154.Google Scholar
Gourounti, KAnagnostopoulos, FVaslamatzis, GThe relation of psychological stress to pregnancy outcome among women undergoing in-vitro fertilization and intracytoplasmic sperm injection. Women Health 2011; 51: 321–339. http://dx.doi.org/10.1080/03630242.2011.574791.CrossRefGoogle ScholarPubMed
An, YSun, ZLi, LZhang, YJi, HRelationship between psychological stress and reproductive outcome in women undergoing in vitro fertilization treatment: psychological and neurohormonal assessment. J Assist Reprod Genet 2013; 30: 35–41. http://dx.doi.org/10.1007/s10815-012-9904-x.CrossRefGoogle ScholarPubMed
Sejbaek, CSHageman, IPinborg, AHougaard, COSchmidt, LIncidence of depression and influence of depression on the number of treatment cycles and births in a national cohort of 42,880 women treated with ART. Hum Reprod 2013; 28: 1100–1109. http://dx.doi.org/10.1093/humrep/des442.CrossRefGoogle Scholar
Cesta, CEViktorin, AOlsson, HJohansson, VSjölander, ABergh, C, et al.Depression, anxiety, and antidepressant treatment in women: association with in vitro fertilization outcome. Fertil Steril 2016;105:1594e3–1602e3. http://dx.doi.org/10.1016/j.fertnstert.2016.01.036.CrossRefGoogle ScholarPubMed
Milazzo, AMnatzaganian, GElshaug, AGHemphill, SAHiller, JEHealth, A, et al.Depression and anxiety outcomes associated with failed assisted reproductive technologies: a systematic review and meta-analysis. PLoS One 2016; 41: 1–19. http://dx.doi.org/10.1371/journal.pone.0165805.Google Scholar
Andersson, LSundström-Poromaa, IBixo, MWulff, MBondestam, KAström, MPoint prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study. Am J Obstet Gynecol 2003; 189: 148–154. http://dx.doi.org/10.1067/mob.2003.336.CrossRefGoogle ScholarPubMed
Rubertsson, CHellström, JCross, MSydsjö, GHellstr??m, JCross, M, et al.Anxiety in early pregnancy: prevalence and contributing factors. Arch Womens Ment Health 2014; 17: 221–228. http://dx.doi.org/10.1007/s00737-013-0409-0.CrossRefGoogle ScholarPubMed
Peterson, BDSejbaek, CSPirritano, MSchmidt, LAre severe depressive symptoms associated with infertility-related distress in individuals and their partners?. Hum Reprod 2014; 29: 76–82. http://dx.doi.org/10.1093/humrep/det412.CrossRefGoogle ScholarPubMed
Volgsten, HSkoog Svanberg, AEkselius, LLundkvistrjan, Sundstrm Poromaa, IRisk factors for psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment. Fertil Steril 2010; 93: 1088–1096. http://dx.doi.org/10.1016/j.fertnstert.2008.11.008.CrossRefGoogle ScholarPubMed
Yadav, RKMagan, DMehta, NSharma, RMahapatra, SCEfficacy of a short-term yoga-based lifestyle intervention in reducing stress and inflammation: preliminary results. J Altern Complement Med 2012; 18: 662–667. http://dx.doi.org/10.1089/acm.2011.0265.CrossRefGoogle ScholarPubMed
Gu, JStrauss, CBond, RCavanagh, KHow do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clin Psychol Rev 2015; 37: 1–12. http://dx.doi.org/10.1016/j.cpr.2015.01.006.CrossRefGoogle ScholarPubMed
Balk, JCatov, JHorn, BGecsi, KWakim, AThe relationship between perceived stress, acupuncture, and pregnancy rates among IVF patients: a pilot study. Complement Ther Clin Pract 2010; 16: 154–157. http://dx.doi.org/10.1016/j.ctcp.2009.11.004.CrossRefGoogle Scholar
Facchinetti, FTarabusi, MVolpe, ACognitive-behavioral treatment decreases cardiovascular and neuroendocrine reaction to stress in women waiting for assisted reproduction. Psychoneuroendocrinology 2004; 29: 162–173. http://dx.doi.org/10.1016/S0306-4530(02)00170-1.CrossRefGoogle ScholarPubMed
Ying, LWu, LHLoke, AYThe effects of psychosocial interventions on the mental health, pregnancy rates, and marital function of infertile couples undergoing in vitro fertilization: a systematic review. J Assist Reprod Genet 2016; 33: 689–701. http://dx.doi.org/10.1007/s10815-016-0690-8.CrossRefGoogle ScholarPubMed
Molarius, ABerglund, KEriksson, CEriksson, HGLindén-Boström, MNordström, E, et al.Mental health symptoms in relation to socio-economic conditions and lifestyle factors – a population-based study in Sweden. BMC Public Health 2009;9:302. http://dx.doi.org/10.1186/1471-2458-9-302.CrossRefGoogle ScholarPubMed
Q-IVF, Swedish National Quality IVF Registry; 2015; 1–28, Available: http://www.ucr.uu.se/qivf/.Google Scholar
National Board of Health Welfare The Swedish Medical Birth Register – Pregnancies, births and newborns – Medical Birth Register 1973–2013 – Assisted fertilization 1991–2012; 2015; 2014–2015, https://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/20009/2015-12-27.pdf.Google Scholar
Submit a response

Comments

No Comments have been published for this article.