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

Prevalence and contributing factors of depression among women with infertility in low-resource settings: a systematic review and meta-analysis

Background

Depressive symptoms are the most common manifestations of psychiatric disorders among women with infertility. In low-resource settings, the overall prevalence and contributing factors of depressive symptoms among women with infertility remain unknown.

Objectives

To estimate the prevalence and contributing factors of depression among women with infertility in low-resource settings.

Methods

A review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The PubMed, MEDLINE, Google Scholar, and Cochrane databases were used to identify eligible studies published up to 30 November 2024. Three authors independently extracted the data. Studies that reported depression among women with infertility were included in this review. The data were analyzed with STATA version 14, and a meta-analysis was conducted using a random-effects model. Publication bias and heterogeneity were assessed via Eager's tests and I2. Subgroup and sensitivity analyses were performed to identify the potential source/s of heterogeneity. A p-value of 0.05 was declared as statistically significant. The findings were synthesized and presented using texts, tables, and forest plots with measures of effect and 95% confidence interval (CI).

Results

Seventeen published cross-sectional studies that met the inclusion criteria with a total of 3,528 women with infertility were selected for this study. The pooled prevalence of depression among women with infertility was 48.77% (95% CI (35.86, 61.67). Good functioning family {OR 0.71 [95% CI (0.51, 0.97), I2: 0.00%]}, good husband support {OR 0.52 [95% CI (0.34, 0.79), I2: 0.00%]}, primary infertility {OR 2.55 [95% CI (1.36, 4.79), I2: 68.53%]}, history of divorce {OR 4.41 [95% CI (2.11, 9.24), I2: 0.00%]}, and duration of infertility lasting more than 10 years {OR 6.27 [95% CI (2.74, 14.34), I2: 15.26%]} were statistically significant.

Conclusion

Depression was high among women with infertility in low-resource settings such as Africa compared to those in high-income countries, men, and pregnant mothers. Good functioning family, good husband support, primary infertility, history of divorce, and duration of infertility lasting more than 10 years were statistically associated. Therefore, African countries and the stakeholders in collaboration with mental health experts and gynecological care providers should address these problems in order to reduce or prevent depression among women with infertility.

Systematic Review Registration

PROSPERO (ID: CRD42024516458).

Mental health status and the quality of life of infertile women receiving fertility treatment in Bangladesh: A cross-sectional study

Infertility poses significant physical and psychological challenges for women of reproductive age. In low- and middle-income countries, the prevalence of depression among infertile women is alarmingly high, reaching 44.32%. Additionally, over 50% of infertile women worldwide experience varying degrees of decline in their quality of life. Therefore, this study aimed to assess the effects of infertility on the mental health status and quality of life of infertile women in Bangladesh. Between December 2022 and March 2023, 375 infertile women in Dhaka, Bangladesh were selected using simple random sampling for this cross-sectional study. The participants' mental health status was assessed using the Depression Anxiety and Stress Scale (DASS-21), while their quality of life was evaluated by the Short Form-12 (SF-12) scale. The prevalence of depression, anxiety, and stress were 59.7%, 55.0%, and 48.7%, respectively. Multiple logistic regression showed that infertile homemakers had 2.98 (95% CI: 1.30 to 6.80) times the odds of depression than government service holders. Aborted infertile women had 1.8 (95% CI: 1.10 to 3.26) times the odds of depression. Infertile women who married between 20 and 24 years old were 49% (95% CI: 0.27 to 0.98) less anxious than those who married earlier. Low-income infertile women (<30,000 BDT) were 2.29 (95% CI: 1.02 to 5.14) times more likely to be stressed than those with higher incomes (>60,000 BDT). Multiple linear regression analysis suggests that education and infertility diagnosis status significantly affect the Mental Component Summary (MCS-12) scores of the Short Form-12 (SF-12). In contrast, age, occupation, and Body Mass Index (BMI) were the significant predictors for the Physical Component Summary (PCS-12). Policymakers may use lessons learned from this study to incorporate appropriate counseling techniques, social awareness campaigns, and media involvement to control the added burden of infertility on women's psychological health and quality of life.

Evaluation of depression, stress, and anxiety among women with subfertility during the COVID-19 pandemic: A cross-sectional study in Ahvaz, Iran

Background and Aims

Some studies have shown that the levels of stress, anxiety, and depression have increased among subfertile women during the COVID-19 pandemic. This study was designed to evaluate the levels of depression, anxiety, and stress among subfertile women during the COVID-19 pandemic in southwest Iran.

Method

This cross-sectional study was conducted on 190 subfertile women from two infertility centers (Imam Khomeini and Jihad) in Ahvaz, Iran. A demographic questionnaire, and the depression, anxiety, stress scale (DASS-21) were used to assess the level of depression, anxiety, and stress of subfertile women during the COVID-19 pandemic. Data collection started in August 2021 and was completed in December 2021. Mean ± SD or N (%), and multiple linear regression were used to analyze the data.

Result

Results showed that most women experienced moderate depression, anxiety, and stress. However, the percentage of women who experienced very severe anxiety was more than that for depression and stress, and 75 (39.5%) of women had all three disorders together. Anxiety was 0.176 units lower in women who were not affected by COVID-19 (95% CI: -5.781 to -0.629). The depression was 0.216 units lower in women with good and moderate economic status (95% CI: -5.603 to -1.178).

Conclusion

The results of this study showed that most studied women experienced moderate depression, anxiety, and stress, but the percentages of very severe anxiety were more than that for depression and stress. Poor economic status was also a strong predictor of depression among subfertile women. Infection with COVID-19 increased the level of anxiety. Careful evaluation of subfertile women for mental health is recommended especially during crises such as the COVID-19 pandemic.

Prevalence and predictive factors for infertility-related stress among infertile couples: A cross-sectional study from Jordan and the occupied Palestinian territories

OBJECTIVES

To assess the level of infertility-related stress, associated socio-economic, and demographic factors among infertile couples living in Jordan and those living under the chronic Israeli-Palestinian conflict in the occupied Palestinian territories.

METHODS

A cross-sectional study was carried out in a number of fertility and reproductive clinics in Jordan and occupied Palestinian territories over a period of 6 months. Trained clinical pharmacists interviewed the identified couples.

RESULTS

A total of 443 participants were interviewed. Three variables were significantly and independently associated with global stress scores. The need of parenthood appears higher in women than men among infertile couples in Jordan and Palestine (p=0.005). The country of origin (p<0.001) made the greatest contribution of unique variance followed by family type (p=0.035). Additionally, a significant contribution to the model was carried out by the number of clinicians who followed up on the case (p=0.013). The average total cost of treatment since the problem had been diagnosed was 2936±4529 Jordanian dinar, which may be of concern to both Jordanians and Palestinians given the limited resources available in developing nations.

CONCLUSION

This study shows a significant degree of stress among infertile couples. The place of origin, family structure, and presence of medical insurance had a significant impact on the infertility global stress score. This study emphasizes the necessity for specific psychological therapies that are currently lacking in public healthcare practices in both Jordan and Palestine.