The effect of depression on quality of life in infertile couples: an actor-partner interdependence model approach

Factors influencing the anxiety and depression status in patients undergoing in vitro fertilization-embryo transfer assisted pregnancy

Women undergoing in vitro fertilization-embryo transfer (IVF-ET) can suffer from anxiety and depression at various levels during the process. This study aimed to assess the anxiety and depression statuses (primary outcome) and influencing factors (secondary outcome) among patients undergoing IVF-ET. A 2019-2020 survey at Northwest Women's and Children's Hospital studied IVF-ET patients, evaluating anxiety and depression with GAD-7 and PHQ-9 alongside demographic data, using logistic regression for influencing factors. Among the 2465 women who undergoing IVF-ET, 27.18% had depression, and 18.46% had anxiety. Bachelors' degree (OR = 0.659, 95%CI: 0.503-0.864), male factor infertility (OR = 0.745, 95%CI: 0.558-0.995), and assessment on the day of starting gonadotropin stimulation (OR = 0.781, 95%CI: 0.626-0.974) were negatively independently associated with depression, while comorbidities (OR = 1.541, 95%CI: 1.281-1.854) and an extended ART strategy (OR = 1.394, 95%CI: 1.162-1.672) were independently associated with depression. High school/technical school education (OR = 0.669, 95%CI: 0.490-0.915) and bachelor's degree (OR = 0.640, 95%CI: 0.472-0.868) were negatively independently associated with anxiety, while an extended ART strategy (OR = 1.476, 95%CI: 1.197-1.820) was independently associated with anxiety. In conclusion, the prevalence of depression and anxiety was high in women undergoing IVF-ET. The study identified factors independently associated with depression and anxiety that could be used to guide the psychological management of women undergoing IVF-ET.

Impulsive Decision-Making, Affective Experiences, and Parental History of Self-Injurious Thoughts and Behaviors within Parent-Adolescent Dyads

Impulsive decision-making, particularly during states of affective intensity, is associated with greater risk of engagement in self-injurious thoughts and behaviors (SITBs) during adolescence. The proximal (dyadic parent-adolescent affect and impulsivity) and distal (family history of SITBs) risk factors that occur within the family system could be relevant processes at stake in the intergenerational transmission of risk. The current study tests the interdependence of parent-adolescent factors associated with risk for SITBs and probes the extent to which parent-adolescent affective states influence their own (actor-effects) and each other's (partner-effects) impulsive decision-making, and further whether these relationships are moderated by a parent's history of SITBs. Participants included 212 (106 dyads) community parents and their adolescents who completed self-report and behavioral tasks related to positive and negative affective states, impulsive decision-making, and lifetime history of SITBs. Application of the Actor-Partner Interdependence Model (APIM) revealed a partner-effect where greater parent negative affect in the past week was associated with elevated adolescent impulsive decision-making among families with a history of SITBs (Estimate = 0.66, Standard Error = 0.13, p < 0.001). In addition, a significant actor-effect was observed where greater positive affect was associated with decreased impulsive decision-making among adolescents (Estimate = -0.21, Standard Error = 0.10, p = 0.03), however, moderating effects of parent history of SITBs were not detected. Findings from the present study shed light on the interdependence of affect and impulsivity within parent-adolescent dyads, and the extent to which these interactions may be particularly salient for families with known vulnerabilities for SITBs.

Determinants of Quality of Life in Serbian Infertile Couples

Background

This study aimed to examine the quality of life and the factors that determine the quality of life of infertile couples.

Methods

The research was conducted as a cross-sectional study at the Gynecology and Obstetrics Clinic "Narodni Front" in Belgrade, the Special Gynecology Hospital "Ferona" in Novi Sad, the Special Hospital for the Treatment of Sterility and In Vitro Fertilization "Spebo Medikal" in Leskovac and the General Hospital in Valjevo, Serbia in 2022, on a sample of 378 infertile couples. The data were collected by means of a questionnaire, the integral part of which is the standardized FertiQoL scale. Independent t-test and one-way ANOVA were used to determine differences. A value of P<0.05 was considered statistically significant.

Results

Women achieve a significantly lower score on the quality of life questionnaire (69.34±11.05) compared to men (73.96±9.87). Women exhibit significantly lower scores in the area of physical, emotional and social functioning (P<0.05). Men who live in the countryside show a lower quality of life score in the emotional (P=0.029) and social (P=0.042) domains. In addition, men over 40 years of age and with a high level of education have a lower quality of life (P=0.08).

Conclusion

Women have a lower quality of life, as do men from rural areas and over 40 years of age. A multi-disciplinary approach and community education, as well as the provision of social support with a special emphasis on emotional and material support, would significantly contribute to improving the quality of life of infertile couples.

The quality of life of men experiencing infertility: a systematic review

BACKGROUND

Men experiencing infertility encounter numerous problems at the individual, family, and social levels as well as quality of life (QOL). This study was designed to investigate the QOL of men experiencing infertility through a systematic review.

MATERIALS AND METHODS

This systematic review was conducted without any time limitation (Retrieval date: July 1, 2023) in international databases such as Scopus, Web of Science, PubMed, and Google Scholar. The search was performed by two reviewers separately using keywords such as QOL, infertility, and men. Studies were selected based on inclusion and exclusion criteria. The quality of the articles were evaluated based on the Newcastle-Ottawa Scale. In the initial search, 308 studies were reviewed, and after removing duplicates and checking the title and abstract, the full text of 87 studies were evaluated.

RESULTS

Finally, 24 studies were included in the final review based on the research objectives. Based on the results, men's QOL scores in different studies varied from 55.15 ± 13.52 to 91.45 ± 13.66%. Of the total reviewed articles, the lowest and highest scores were related to mental health problems and physical dimensions, respectively.

CONCLUSION

The reported findings vary across various studies conducted in different countries. Analysis of the factors affecting these differences is necessary, and it is recommended to design a standard tool for assessing the quality of life of infertile men. Given the importance of the QOL in men experiencing infertility, it is crucial to consider it in the health system. Moreover, a plan should be designed, implemented and evaluated according to each country's contex to improve the quality of life of infertile men.

Anxiety, Depression, and Quality of Life Among Infertile Women: A Case-Control Study

Introduction Pregnancy holds significant cultural and social value for women. However, women facing challenges in conceiving often grapple with emotional distress, including depression and anxiety. The connection between psychological elements (stress, anxiety, and depression) and infertility is complex, influenced by multiple factors, and bidirectional. Infertile women are more likely to develop mental illnesses, marital dissatisfaction, and impaired quality of life compared to the individuals of the fertile group. Thus, the study aimed to assess levels of anxiety, depression, and quality of life among infertile women compared to fertile women. Methods This case-control study conducted at a tertiary care center recruited 100 nulliparous women between the age group of 20 and 38 years with primary or secondary infertility, while those with male factor infertility were excluded. The control group (N=100) comprised normal parous women who had at least one child. The primary objective of the study was to assess the impact of infertility on the mental health and quality of life of women seeking infertility treatment. Outcome measures included standardized tools such as the WHOQOL-BREF questionnaire to assess the quality of life across multiple domains (e.g., physical, psychological, social, and environmental) as well as the Depression Anxiety and Stress Scale (DASS-21) to measure levels of anxiety, depression, and stress. Cronbach's alpha was used to measure the tool's reliability. A P value of <0.05 was considered statistically significant. Results Baseline sociodemographic parameters were comparable between the two groups. The mean age of infertile women was 30.6±3.9 years compared to 31.5±3.2 years in fertile women (P=0.076). Using the WHOQOL-BREF scale, we found that the quality of life was better in the fertile group compared to the infertile group through all the physical, psychological, social, and environmental domains (P<0.001). The infertile group had a significantly higher number of women with anxiety, depression, and stress. The questionnaires showed high internal reliability. Conclusion Infertile women experienced a lower quality of life in various domains, higher levels of anxiety, and increased rates of depression compared to fertile counterparts. The study findings underscore the multidimensional impact of infertility, emphasizing the need for comprehensive healthcare approaches to address the psychosocial challenges faced by women undergoing infertility treatment.

A review of the psychometric properties and implications for the use of the fertility quality of life tool

OBJECTIVES

To analyze and synthesize the reported psychometric properties of the Fertility Quality of Life (FertiQoL) instrument and describe its implications for use in practice and research in men and women with infertility.

METHODS

A systematic literature search was performed to identify all articles using the FertiQoL tool. PubMed, CINAHL, and PsycINFO were searched from September 2006 through May 2022. Studies were eligible for inclusion if they reported psychometric data on the original FertiQoL tool using a sample population of individuals with infertility. Sample size, country of origin, and psychometric data were documented for each study.

RESULTS

The initial search revealed 153 articles that had utilized the FertiQoL. Following abstract, title, and full-text screenings, 53 articles reported psychometric data and met criteria for inclusion. The FertiQoL is a sound measurement with satisfactory reliability and validity. Studies indicated adequate reliability in the overall scale ([Formula: see text]), as well as the core Emotional, Mind/Body, Social, and Relational scales ([Formula: see text]) and two optional Tolerability and Environment fertility treatment subscales ([Formula: see text]). Although the Relational subscale exhibited slightly lower reliability in several studies, the internal consistency for the measurement as a whole was satisfactory. Results also indicate adequate: 1) face and content validity with extensive professional and patient feedback during development; 2) convergent validity with general quality of life, depression, and anxiety measurements; and 3) structural validity using both confirmatory and exploratory factor analyses.

CONCLUSION

The FertiQoL tool is the most commonly used instrument to measure the impact of fertility issues on quality of life in men and women with infertility. Understanding the impact of infertility on quality of life provides valuable insight into the areas of infertility-related care that need to be prioritized, such as mental health or relational stressors. While the instrument has been used in different patient populations with infertility and available in multiple translations, it is necessary to understand the updated psychometric properties and the implications for its use. This review shows that the FertiQoL is reliable and valid for cross-cultural use among individuals with various etiologies of infertility.

Dual mediating effects of social support and fertility stress on mindfulness and fertility quality of life in infertile men: A case-control study

Background

Infertility is one of the three major public health problems in the world, bringing immense physical and psychological damage to men and affecting the quality of men’s fertility life. Thus, the purpose of this study was to analyze the status of social support, fertility stress, mindfulness, and fertility quality of life in infertile men, and to explore the dual mediating effects of social support and fertility stress on mindfulness and fertility quality.

Methods

A case–control group study was conducted, with 246 men in the case group and 149 in the control group. The Social Support Scale, Fertility Stress Scale, Mindfulness Scale, and Fertility Quality of Life Scale were used to establish a structural equation model using Mplus 8.3 to explore social support and fertility stress. Pathway relationships were drawn between mindfulness and fertility quality of life in infertile men.

Results

There were significant differences between infertile and healthy men in each dimension of the core module of fertility quality of life, in the total score of the treatment module, in the total score of social support, in subjective and objective support, and in the total score of fertility stress, social pressure, sexual pressure, marital relationship, and childless pressure (p &lt; 0.05 in each case). Further, the fertility quality of life in infertile men was positively correlated with mindfulness and social support, and negatively correlated with fertility stress (p &lt; 0.05); mindfulness could directly affect the core and treatment modules of fertility life quality, and indirectly affect the core of fertility life quality through social support (mediation effect accounted for 19.0%), while the treatment module (mediation effect accounted for 13.7%), and the core module indirectly affected fertility life quality through fertility stress (mediation effect accounted for 16.8%).

Conclusion

The fertility quality of life of infertile men is not optimistic. Mindfulness-related interventions and programs can improve their fertility quality of life.

Resilience of infertile families undergoing in vitro fertilization: An application of the double ABC-X model

BACKGROUND

Family resilience plays a crucial role in protecting the mental health and family stability of infertile patients. However, information associated with infertile families resilience is scarce. The double ABC-X model provides a roadmap for this, helps organize knowledge, and lays the foundation for knowledge development.

AIMS

To describe the current situation of family resilience of infertile women, and to test the predictive theoretical model of family resilience based on infertility stigma, individual resilience, coping style, and posttraumatic growth.

DESIGN

A cross-sectional study.

METHODS

A convenience sample of 372 infertile women undergoing in vitro fertilization were recruited between April and August 2020. The Chinese-Family Resilience Assessment Scale, Infertility Stigma Scale, Simplified Coping Style Questionnaire, Chinese version of Connor-Davidson Resilience Scale, and Chinese version of Post Traumatic Growth Inventory were used to measure family resilience, infertility stigma, individual resilience, coping style, and posttraumatic growth. Structural equation models were used to analyze the relationship among these variables.

RESULTS

The results showed that family resilience was related to infertility stigma, positive coping, and individual resilience. Moreover, the path analysis indicated that positive coping and individual resilience mediated the effects of infertility stigma on family resilience.

CONCLUSIONS

A high level of stigma among infertile women should be identified. Interventions for targeting positive coping and individual resilience might ultimately increase their family resilience.

The longitudinal association between possible new sarcopenia and the depression trajectory of individuals and their intimate partners

BACKGROUND

It is currently unknown whether the dynamic nature of depression affects the development of sarcopenia. Herein, this study aims to assess the association between possible new sarcopenia and the depression trajectory of individuals and their intimate partners through a 4-year longitudinal cohort study.

METHODS

Our study included 784 pairs of individuals without possible sarcopenia and their spouses from the China Health and Retirement Longitudinal Study (CHARLS) 2011. All individuals and their spouses received three assessments of the Center for Epidemiologic Studies Depression 10-item (CESD-10) scale in 2011, 2013, and 2015. According to the diagnostic algorithm recommended by the Asian Working Group for Sarcopenia (AWGS) 2019, we evaluated the incidence of possible sarcopenia in individuals in 2015. Latent class analysis (LCA) was used to identify a longitudinal depression trajectory of individuals and their spouses during a 4-year follow-up. Subsequently, we assessed the relationship between possible sarcopenia and depression trajectory using three generalized additive models.

RESULTS

In 2015, 24.87% (195/784) of individuals were diagnosed with possible sarcopenia. LCA identified five depression trajectories: a persistently high risk of depression in individuals and their spouses (reference; class 1 = 34 [4.3%]); a persistently low risk of depression in individuals and their spouses (class 2 = 526 [67.1%]); a high risk of depression in individuals and a low risk of depression in spouses (class 3 = 46 [5.9%]); a low risk of depression in individuals and a high risk of depression in spouses (class 4 = 116 [14.8%]); and a reduced risk of depression in individuals and their spouses (class 5 = 62 [7.9%]). The highest incidence of possible sarcopenia was shown in class 1, followed by classes 3 and 5. Classes 2 (adjusted relative risk (RR) = 0.44, 95% confidence interval (CI): 0.20-0.97) and 4 (adjusted RR = 0.40, 95%CI: 0.17-0.96) had a significantly lower incidence of possible sarcopenia than class 1. Subgroup analysis demonstrated that the incidence of possible sarcopenia in class 4 was obviously higher in women (38.89%) than in men (18.4%).

CONCLUSIONS

Our study indicates a persistently high risk of depression in individuals to develop possible sarcopenia. In addition, a persistently high risk of depression in intimate partners potentially increases the risk of possible new sarcopenia, especially in female individuals who are at low risk of depression.

Prevalence and associated risk factors for anxiety and depression in infertile couples of ART treatment: a cross-sectional study

BACKGROUND

Infertility now is a public health concern and is associated with increased psychological distress.

METHODS

We enrolled 1247 infertile couples and assessed their anxiety and depression status before and during assisted reproductive technology (ART) treatment using the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS). The Chi-square or fisher's exact test was used to analyze the prevalence of anxiety and depression in infertile couples. Multivariate logistical regression was performed to analyze the risk factors for anxiety and depression.

RESULTS

The prevalence of anxiety was 13.5% and 8.7% (p < 0.05), and that of depression was 9.4% and 7.9% (p = 0.2) in female and male partners, respectively. Female SAS and SDS scores were positively associated with male SAS and SDS scores, respectively (r = 0.52 and r = 0.50, respectively, both p < 0.0001), and were positively associated with their own SDS and SAS scores, respectively (r = 0.63 and r = 0.62, respectively, both p < 0.0001). Their own depression or partners' anxiety was associated with the anxiety, and their own anxiety or partners' depression was associated with the depression in infertile couples. No children, unemployment, and low education level were also associated with female anxiety. SAS and SDS scores were significantly decreased during ART treatment.

CONCLUSIONS

Females were more vulnerable to having anxiety than males in infertile couples. Anxiety and depression in infertile couples could interact, therefore, anxiety and depression would be simultaneously counseled, and their partners also should be given supportive psychotherapy.

TRIAL REGISTRATION

It was an observational study and had no health care interventions on participants. So it was not registrated.

Sexual Function, Self-Esteem, and Quality of Life in Infertile Couples Undergoing in vitro Fertilization: A Dyadic Approach

Purpose

Infertility has adverse effects on the quality of life (QoL) of infertile couples. Previous studies found important associations between sexual function, self-esteem and QoL, but mainly focused on one individual’s approach rather than both partners. This study adopted a dyadic approach to evaluate the relationship between sexual function and QoL in couples with infertility through mediation and improving self-esteem.

Patients and Methods

Between October 2020 and January 2021, 428 couples with infertility (n=856) undergoing in-vitro fertilization (IVF) at a tertiary hospital in Hefei, China, were registered for the current descriptive cross-sectional research. The dyads’ sociodemographic and clinical features, as well as their sexual function, self-esteem, and QoL were evaluated. The Fertility quality of life scale (FertiQoL), Rosenberg Self-Esteem Scale (RSES), Female Sexual Function Index (FSFI), and International Index of Erectile Function-15 (IIEF-15) were used to evaluate the participants. The Actor-Partner Interdependence Mediation Model (APIMeM) was utilized to examine data from the dyadic relationships.

Results

According to the APIMeM analysis, sexual function of individuals with infertility was directly and indirectly connected with their QoL, mediated through their self-esteem. The women’s sexual function was found to be positively associated with their partner’s QoL, with the women’s self-esteem acting as a complete mediator. The men’s sexual function was found to be positively associated with partner’s QoL, with the men’s self-esteem acting as a complete mediator.

Conclusion

The findings suggest that boosting participants’ self-esteem can help them and their partners have a better QoL. Also, therapies aimed at improving and sustaining self-esteem of couples with infertility could help mitigate the negative influence of low sexual function on their QoL.

The effect of male and female factor infertility on women's anxiety, depression, self-esteem, quality of life and sexual function parameters: a prospective, cross-sectional study from Turkey

OBJECTIVES

Despite the development of diagnosis and treatment methods, the psychological effects of infertility on women were not adequately addressed. This study investigated the effect of male and female factor infertility on women's anxiety, depression, self-esteem, quality of life, and sexual function parameters.

METHODS

In this prospective, cross-sectional study, 480 women [n = 234, with male factor infertility (MFI) (MFI group) and n = 246, with female factor infertility (FFI) (FFI group)], who could not conceive despite unprotected intercourse for 1 year, and 242 fertile healthy women (control group) who had children within the last 1 year were included. Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), Rosenberg Self Esteem Scale (RSES), Fertility Quality of Life (FertiQol) and Female Sexual Function Index (FSFI) questionnaires were used for patients' evaluation.

RESULTS

RSES, BAI and BDI-II scores were significantly higher and FSFI score was significantly lower in the FFI group compared to other groups. RSES, BAI and BDI-II scores were also significantly higher and FSFI score was significantly lower in the MFI group compared to the control group. FertiQol total score was significantly lower in the FFI group compared to the MFI group. RSES score was positively correlated with BDI-II and BAI scores; however, it was negatively correlated with FertiQol and FSFI scores.

CONCLUSIONS

The negative psychological effects of infertility are ignored by many centres, especially in the treatment process of infertility. Regardless of the infertility factor (male or female), we believe that psychological support should be given to all women to improve their life quality.

The effects of intimate relationship characteristics on unprotected anal intercourse among same-sex male couples in China: a dyadic analysis using the actor-partner interdependence model

BACKGROUND

Unprotected anal intercourse (UAI) within the context of concurrent sexual relationship are prevalent among men who have sex with men (MSM) who have regular male sex partners and it aggravates the risk of HIV infection among this community. The aim of this study was to assess the effect of intimate relationship characteristics on UAI among MSM couples at the dyadic level.

METHODS

Two hundred four MSM couples were recruited from a HIV testing clinic from April 2017 to April 2018 in Guangzhou, China. The actor-partner interdependence model (APIM) was applied for dyadic analysis. Each MSM couple was divided into the insertive role and the receptive role according to their regular anal sex role. In this context, actor effect is the impact of an MSM's intimate relationship characteristics on his own UAI, and partner effect is the impact of his partner's intimate relationship characteristics on his UAI.

RESULTS

Of the 408 participants, 58.82% had UAI with regular male sex partner (UAI-RP) and 8.09% had concurrent UAI. Intimate relationship characteristics were associated with concurrent UAI, but not associated with UAI-RP. For the receptive role, his relationship investment exerted significant actor and partner effects on concurrent UAI (AOR actor = 1.31, P < 0.001; AOR partner = 1.17, P < 0.001). Meanwhile, receptive role's violence experience within relationship exerted significant actor effects on his own concurrent UAI (AOR actor = 6.43, P = 0.044).

CONCLUSIONS

Relationship investment and violence experience influenced concurrent UAI among MSM couples and it varied in different sex roles. Additional assistance on empowerment, relationship therapy and sexual agreement is urgently needed to reduce their high possibility on engagement of HIV-related risk behaviors.

Family resilience is a protective buffer in the relationship between infertility-related stress and psychological distress among females preparing for their first in vitro fertilization-embryo transfer

The present study aimed to evaluate psychological distress and scrutinized whether family resilience plays a moderating role in the association between infertility-related stress and psychological distress among infertile females preparing for their first IVF-ET. A total of 492 infertile females completed self-reported measures including the Kessler 10 Psychological Distress Scale (K10), the fertility problem inventory (FPI), and the Family Resilience Assessment Scale (FRAS). The results showed 21 (65.2%) participants reported moderate or higher levels of psychological distress. While controlling for economic status, we found psychological distress to be positively linked to infertility-related stress (β=0.483, P<0.001), and negatively related to family resilience (β=-0.145, P=0.001). The simple slopes analysis showed that infertility-related stress had a weaker positive association with psychological distress for individuals at 1 SD (β = 0.443, P < 0.001) above the mean on family resilience compared to those at 1 SD (β = 0.537, P < 0.001) below the mean. Thus, it suggests that clinical practice should conduct family resilience-oriented interventions to facilitate family resilience among infertile females preparing for their first IVF-ET, with the goal to reduce psychological distress.

Effects of Mind-Body Programs on Infertile Women: A Systematic Review and Meta-analysis of Randomized Controlled Trials

PURPOSE

This study was to systematically review randomized controlled trials and conduct a meta analysis. The results of randomized controlled trials were integrated and analyzed to assess the effects of mind-body programs on anxiety, depression, quality of life, and pregnancy rate in infertile women.

METHODS

Using electronic databases (i.e., Research Information Sharing Service, Korean Studies Information Service System, Korean Medical Database, National Digital Science Library, Cochrane Library, PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and PsycARTICLES), 10 of 2,259 studies were included for meta-analysis. To estimate the effect size, a meta-analysis of the studies was performed using RevMan 5.3.

RESULTS

The mind-body program was effective in relieving anxiety [standardized mean difference (SMD) = -3.44; 95% confidence interval (CI) = -5.94, -0.95; p = .007; I² = 69%] and depression (SMD = -5.79; 95% CI = -10.36, -1.22; p = .010; I² = 86%). Furthermore, it was effective in enhancing the quality of life (SMD = 7.40; 95% CI = 2.92, 11.88; p = .001; I² = 53%) and pregnancy rate (SMD = 2.06; 95% CI = 1.08, 3.95; p = .030; I² = 73%). The mind-body program was found to relieve anxiety and depression in infertile women and improve their quality of life, thereby positively affecting the pregnancy rate.

CONCLUSION

The mind-body program was found to relieve anxiety and depression in infertile women and improve their quality of life, thereby positively affecting the pregnancy rate. The mind-body program needs to be considered to a wider audience for positive effects on emotions and pregnancy outcomes of infertile women.

The Analysis of Anxiety and Depression in Different Stages of in vitro Fertilization-Embryo Transfer in Couples in China

BACKGROUND

This study aimed to examine the differences in anxiety and depression between infertile Chinese couples in diverse stages of in vitro fertilization-embryo transfer (IVF-ET) and their relationship with the IVF-ET outcomes.

METHODS

From February 2016 to December 2018, a total of 247 couples that were undergoing IVF-ET were randomly selected for this study. On the day they started their treatment (T1), the day human chorionic gonadotropin was administered (T2), and 4 days after the embryo transfer (T3), self-designed questionnaires, the Self-Rating Anxiety Scale, and the Self-Rating Depression Scale were completed to investigate anxiety and depression in different stages.

RESULTS

Age had an effect on the anxiety and depression in women. Male infertility type and the cause of infertility had an effect on the anxiety and depression in men. The incidence of anxiety in women in the T1, T2, and T3 stages was 29.96%, 44.94%, and 17.81%, respectively. The anxiety scores of women were 46.14 ± 8.37, 50.83 ± 8.50, and 44.09 ± 8.17, respectively, which were significantly higher than those of men (p < 0.05). The anxiety score in stage T2 was the highest in women, and the depression score of women in stage T1 was the highest. The incidence of anxiety in men in the T1, T2, and T3 stages was 20.65%, 8.50%, and 6.07%, respectively. The incidence of anxiety was not significantly different in diverse stages (p > 0.05), and the same result was obtained for the incidence of depression. The anxiety and depression scores of the infertile couples in different stages were not related to the outcome of IVF-ET.

CONCLUSION

The incidence of anxiety and depression in infertile couples in diverse stages of IVF-ET is different, especially in women, and the anxiety and depression of infertile couples in the process of IVF-ET may not be related to the outcome of assisted pregnancy.

Application of the actor-partner interdependence model in parent-adolescent emotion regulation and depression

BACKGROUND

The family environment is an important context for the development and maintenance of depressive symptoms within families. In this study, we evaluated whether parent and adolescent self-reports of emotion regulation constructs are linked with their own (actor effects) and each other's (partner effects) depressive symptoms.

METHODS

Participants were 123 adolescent-parent dyads, recruited from adolescent inpatient and partial hospitalization programs, who completed self-report assessments of emotion dysregulation and depression.

RESULTS

Using the Actor-Partner Interdependence Model (APIM), results revealed expected actor effects for emotion regulation strategies, but not impulsiveness. A significant partner effect for parents' impulsiveness and adolescents' depressive symptoms was observed, demonstrating the interdependent nature of these characteristics in the sample. Interpretation of APIM model coefficients indicated that greater parent impulsiveness was associated with less adolescent depression symptom severity.

LIMITATIONS

Limitations include a small sample of primarily Caucasian adolescents who were receiving intensive psychiatric services making generalizability more challenging. The sample also consisted of largely mothers which is important to consider given there are known gender differences in rates of depression and sensitivity to interpersonal processes.

CONCLUSIONS

Overall, findings shed light on the nature of these characteristics within the families of depressed adolescents and the role of emotion regulation in the parent-child relationship. Implications of this work and future studies are discussed.

The Four-item Patient Health Questionnaire for Anxiety and Depression: A Validation Study in Infertile Patients

Background

The most common mental disorders in infertile patients are depression and anxiety. The four-item Patient Health Questionnaire-4 (PHQ-4) is a widely used tool that consists of the PHQ-2 depression and Generalized Anxiety Disorder-2 (GAD-2) scales. Given that PHQ-4 has not been validated in infertile patients, this study aimed to examine its reliability and validity in this population.

Materials and Methods

Participants in this cross-sectional study consisted of 539 infertile patients from a referral fertility centre in Tehran, Iran. The PHQ-4, Hospital Anxiety and Depression Scale (HADS), World Health Organi- sation-Five Well-Being Index (WHO-5), Penn State Worry Questionnaire (PSWQ) and demographic/infertility ques- tionnaires were administered to all participants. Factor structure and internal consistency of PHQ-4 were evaluated via confirmatory factor analysis (CFA) and Cronbach’s alpha, respectively. The convergent validity of this scale was examined by its relationship with HADS, WHO-5 and PSWQ.

Results

CFA results provided support for a two-factor model of PHQ-4. Internal consistency of the PHQ-4 and its subscales both were elevated with Cronbach’s alpha coefficients of 0.767 (PHQ-4), 0.780 (PHQ-2) and 0.814 (GAD-2). Inter-item correlations were between 0.386 and 0.639, and corrected item-total correlations were between 0.576 and 0.687. PHQ-4, PHQ-2 and GAD-2 showed positive correlations with measures of HADS-anxiety, HADS-depression, and PSWQ and neg- ative correlations with WHO-5, which confirmed convergent validity. Among demographic/fertility variables, we observed that gender, infertility duration, and failure in previous treatment were correlated with PHQ-4 and its subscales scores.

Conclusion

The PHQ-4 is a reliable and valid ultra-brief screening instrument for measuring both anxiety and depres- sive symptoms in infertile patients.

Effect of resilience on infertile couples' quality of life: an actor-partner interdependence model approach

Background

Infertility is an emerging socioeconomic issue affecting an individual’s life and the nation. However, only few studies have examined the influence of resilience on the quality of life (QoL) of spouses as actors and partners. Hence, this study aimed to analyze the influence of resilience, a positive factor that infertile couples may have, on QoL using the actor–partner interdependence model (APIM).

Methods

By the analyses of couples’ data, we analyzed the effect of resilience on the QoL of infertile couples as actors and partners. This cross-sectional study included 150 infertile couples. The Fertility Quality of Life and Resilience Scale was used to measure couples’ QoL and resilience. APIM was applied to analyze QoL.

Results

In terms of actor effects, the resilience of both wives (β = 0.201, p <  0.001) and husbands (β = 0.713, p <  0.001) had a significant effect on individual QoL. With regard to partner effects, husbands’ resilience (β = 0.351, p <  0.001) had a significant impact on wives’ QoL and the wives’ resilience (β = 0.219, p = 0.009) had a significant impact on husbands’ QoL.

Conclusions

The resilience of an infertile actor was found to affect both his/her own QoL and his/her partner’s QoL. In the future, if a program is to be developed to improve couples’ QoL, both spouses should work together to improve their resilience, thereby improving their QoL.

The prevalence of depression among Iranian infertile couples: an update systematic review and meta-analysis

Background

Depression is a common mental disorder. Infertility can lead to depression. The current systematic review and meta-analysis were conducted to estimate the pooled prevalence of depression among Iranian infertile couples. Seven electronic databases (Google Scholar, MagIran, SID, Science Direct, PubMed, Scopus, Web of Science) were searched, up to August 2019, for relevant published studies. The pooled prevalence of depression also pooled mean of depression score was determined using a random-effects model with a 95% confidence interval (95% CI). All analyses performed using Stata ver11 (Stata Corporation, College Station, TX, USA). The 0.05 was considered a significant level.

The main body

Totally, 230 studies were retrieved and 31 studies included in the meta-analysis. The pooled prevalence of depression among infertile couples was about 35.3% (95 % CI 24.1–46.5), and the prevalence of depression among females and males was 48.7% (95% CI 24.0–73.3) and 9% (95% CI 0% to 23.7%), respectively.

Conclusions

Our findings suggest a high prevalence of depression in infertile couples. The results can highlight an important and growing mental disorder among infertile couples that may be overlooked.

[Factors influencing infertility-related quality of life in infertile women]

Purpose

Infertile women experience various physical, psychological, and relational problems that affect their infertility-related quality of life (QoL). This study investigated infertile women's infertility-related QoL with the goal of identifying how it is influenced by fatigue, depression, and marital intimacy.

Methods

A sample of 140 infertile women was surveyed in a cross-sectional study. Data were collected from February to April 2018 using self-report structured questionnaires at three infertility clinics located in Jeonju, Korea. Data were analyzed using the independent t-test, analysis of variance, Pearson correlation coefficients, and stepwise multiple regression analysis in SPSS for Windows version 25.0. The subjects agreed to complete a face-to-face interview, including administration of the Fatigue Severity Scale, Depression Anxiety Stress Scale-21, Marital Intimacy Scale, and the Fertility Quality of Life tool.

Results

The mean age of the participants was 35.6±4.3 years. Infertility-related QoL was negatively correlated with fatigue (r=-.42, p<.001) and depression (r=-.56, p<.001), and positively correlated with marital intimacy (r=.30, p<.001). Multiple regression analysis showed that depression (β=-0.44, p<.001), fatigue (β=-0.27, p<.001), and husband's attitude (β=-0.19, p=.007) had significant effects on the QoL of infertile women, accounting for 40.5% of the variance in infertility-related QoL.

Conclusion

The study provides insights into how infertile women's infertility-related QoL was influenced by depression, fatigue, and their husbands' attitudes regarding infertility treatment. To improve infertile women's infertility-related QoL, healthcare providers should consider developing strategies to decrease depression and fatigue in infertile women and to address their husbands' attitudes.

Effectiveness of a Spousal Support Program in Improving the Quality of Life of Male Patients Undergoing Infertility Treatment: A Pilot Study

Background:

There are various causes of male infertility. Infertile men usually have a low quality of life (QoL) and a high level of stress compared with men without infertility problems. The present study aimed to examine the effects of a spousal support program to enhance the QoL of male patients undergoing infertility treatment

Methods:

The present quasi-experimental study (pretest-posttest) was conducted among 38 infertile couples in Tokyo (Japan) during April-August 2018. The levels of QoL, distress, and spousal support were measured using self-administered valid and reliable questionnaires. The paired t test was used to analyze pre- and post-intervention data with SPSS software (version 23.0). P<0.05 was considered statistically significant

Results:

There were significant differences between the pre-test and post-test scores for the relational and emotional sub-scales of QoL. The paired t test results showed that the post-test emotional sub-scale (66.9±16.9) was significantly higher than the pre-test emotional sub-scale (58.5±13.5; t (30)=2.2, P=0.04). Similarly, the post-test relational sub-scale (71.2±21.6) was significantly higher than its pre-test score (60.8±13.7; t (30)=2.3, P=0.03). The majority of the participants 23 (74.2%) expressed satisfaction with the program.

Conclusion:

The spousal support program was well-received and significantly improved part of the QoL of men who were infertile due to various causes

Quality of Life and General Health in Pregnant Women Conceived with Assisted Reproductive Technology: A Case-Control Study

Background

Infertility affects different aspects of life including the quality of life (QOL) in infertile couples. Many infertile couples conceive via using assisted reproductive technology (ART). However, the effect of pregnancy and childbearing on QOL is not known in these couples. This study aimed to evaluate QOL and general health during pregnancy and after successful treatment of infertility, in women conceived with ART.

Materials and Methods

In this case-control study, QOL and general heath were evaluated in 40 women conceived with ART and 40 women who conceived spontaneously and served as the control group. WHO quality of life- BREF (WHOQOL-BREF) inventory was used to evaluate QOL and General Health Questionnaire-28 (GHQ-28) was applied to evaluate general health. These two questionnaires were completed in the first and second trimester of pregnancy and results were compared between the two groups.

Results

Mean age of women was 29.4 ± 4.4 and 29.6 ± 5 years in ART and control group, respectively. QOL in women conceived with ART was similar to QOL in the control group in the first and second trimester of pregnancy while general health score (distress level) in women conceived with ART was significantly higher than that of the control group in both trimesters. Although distress level decreased in the second trimester in ART group, but yet, it was higher than that recorded for the control group.

Conclusion

After pregnancy, QOL in women conceived with ART is similar to women conceived spontaneously. However, these women experience higher distress level in the first and second trimester of pregnancy compared to women conceived spontaneously.

The reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) and PHQ-2 in patients with infertility

Background

Depression in patients with infertility often goes undiagnosed and untreated. The Patient Health Questionnaire-9 (PHQ-9) and its ultra-brief version (i.e. PHQ-2) are widely used measures of depressive symptoms. These scales have not been validated in patients with infertility. The aim of the present study was to examine the reliability and validity of the PHQ-9 and PHQ-2 in patients with infertility.

Methods

In this cross-sectional study, a total of 539 patients with infertility from a referral infertility clinic in Tehran, Iran completed the PHQ-9, along with other relevant scales: the WHO-five Well-being Index (WHO-5), the Hospital Anxiety and Depression Scale (HADS), and the Generalized Anxiety Disorder-7 (GAD-7). Factor structure and internal consistency of PHQ-9 were examined via confirmatory factor analysis (CFA) and Cronbach’s alpha, respectively. Convergent validity was evaluated by relationship with WHO-5, HADS and GAD-7.

Results

The mean total PHQ-9 and PHQ-2 scores were 8.47 ± 6.17 and 2.42 ± 1.86, respectively, and using a cut-off value of 10 (for PHQ-9) and 3 (for PHQ-2), the prevalence of depressive symptoms was 38.6 and 43.6%, respectively. The Cronbach’s alphas for PHQ-9 and PHQ-2 were, respectively, 0.851 and 0.767, indicating good internal consistency. The CFA results confirmed the one-factor model of the PHQ-9 (χ²/df = 4.29; CFI = 0.98; RMSEA = 0.078 and SRMR = 0.044). Both PHQ-9 and PHQ-2 showed moderate to strong correlation with the measures of WHO-5, HADS-depression, HADS-anxiety, and the GAD-7, confirming convergent validity. In univariate analysis, female sex, long infertility duration, and unsuccessful treatment were significantly associated with depression symptoms.

Conclusion

Both PHQ-9 and PHQ-2 are brief and easy to use measures of depressive symptoms with good psychometric properties that appear suitable for routine use in patients with infertility.

The effects of depression, anxiety and stress symptoms on the clinical pregnancy rate in women undergoing IVF treatment

OBJECTIVE

Women undergoing assisted reproductive technology treatment, are often anxious and depressed because of their fertility problem and the uncertainties of the treatment with which they have to deal. On the other hand, recent studies have shown that the effects of psychological distress on the IVF treatment outcome is unclear. This study aimed to examine the effects of anxiety, depression, and stress symptoms before IVF treatment on the clinical pregnancy rate, controlling for known confounders.

RESULTS

In total, 142 women undergoing IVF treatment participated in this prospective study. The clinical pregnancy rate was 26.8% in this study. Controlling for age, infertility duration, and cause of infertility, there were no relationship between IVF outcome and anxiety (relative risk (RR) = 1.00; 95% CI 0.91-1.09), depression (RR = 0.96; 95% CI 0.88-1.05), and stress (RR = 1.01; 95% CI 0.96-1.07) symptoms. High woman's age and women with both cause of infertility were independent predictors of IVF clinical pregnancy rate. In sum, we found that anxiety, depression, and stress symptoms were not associated with the IVF clinical pregnancy rate.

Application of the dyadic data analysis in behavioral medicine research: marital satisfaction and anxiety in infertile couples

BACKGROUND

Dyadic data analysis (DDA) is increasingly being used to better understand, analyze and model intra- and inter-personal mechanisms of health in various types of dyads such as husband-wife, caregiver-patient, doctor-patient, and parent-child. A key strength of the DDA is its flexibility to take the nonindependence available in the dyads into account. In this article, we illustrate the value of using DDA to examine how anxiety is associated with marital satisfaction in infertile couples.

METHODS

This cross-sectional study included 141 infertile couples from a referral infertility clinic in Tehran, Iran between February and May 2017. Anxiety and marital satisfaction were measured by the anxiety subscale of the Hospital Anxiety and Depression Scale and 10-Item ENRICH Marital Satisfaction Scale, respectively. We apply and compare tree different dyadic models to explore the effect of anxiety on marital satisfaction, including the Actor-Partner Interdependence Model (APIM), Mutual Influence Model (MIM), and Common Fate Model (CFM).

RESULTS

This study demonstrated a practical application of the dyadic models. These dyadic models provide results that appear to give different interpretations of the data. The APIM analysis revealed that both men's and women's anxiety excreted an actor effect on their own marital satisfaction. In addition, women's anxiety exerted a significant partner effect on their husbands' marital satisfaction. In MIM analysis, in addition to significant actor effects of anxiety on marital satisfaction, women's reports of marital satisfaction significantly predicted men's marital satisfaction. The CFM analysis revealed that higher couple anxiety scores predicted lower couple marital satisfaction scores.

CONCLUSION

In sum, the study highlights the usefulness of DDA to explore and test the phenomena with inherently dyadic nature. With regard to our empirical data, the findings confirmed that marital satisfaction was influenced by anxiety in infertile couples at both individual and dyadic level; thus, interventions to improve marital satisfaction should include both men and women. In addition, future studies should consider using DDA when dyadic data are available.

The relationship between marital satisfaction and depression in infertile couples: an actor-partner interdependence model approach

BACKGROUND

Much evidence consistent with the Marital Discord Model of Depression (MDMD) suggests that marital discord is associated with depression, but no studies examine the relationship between marital satisfaction and depression at the dyadic level in infertile couples. This study examined the effect of actors' and partners' marital satisfaction on depressive symptoms in husband-wife dyads with infertility using an innovative dyadic analysis approach, the Actor-Partner Interdependence Model (APIM).

METHODS

In this cross-sectional study, the sample comprised of 141 infertile couples in the evaluation phase of treatment. We collected data in a referral infertility center in Tehran, Iran between February and May 2017. Marital satisfaction and depression were measured using ENRICH marital satisfaction scale and Hospital Anxiety and Depression Scale, respectively, before starting the treatment. Dyadic analysis applying the APIM was used. In this study, actor effect is the impact of a person's marital satisfaction on his/her own depression. Partner effect is the impact of a person's marital satisfaction on his/her partner's depression.

RESULTS

The APIM analysis revealed that both men and women's marital satisfaction excreted an actor effect on their own depression (β = - 0.412, P < 0.001; β = - 0.263, P = 0.002, respectively). Furthermore, men's marital satisfaction exerted a significant partner effect on their wives' depression symptoms (β = - 0.170, p = 0.047). However, the wives' marital satisfaction was not related to their husbands' depressive symptoms (β = - 0.028, P = 0.735).

CONCLUSIONS

The findings support that the MDMD is a valid theoretical model for the conceptualization of marital satisfaction and depressive symptoms among infertile couples and suggest that interventions to reduce depressive symptoms should include both men and women.

Prevalence of generalized anxiety disorder and its related factors among infertile patients in Iran: a cross-sectional study

BACKGROUND

Generalized anxiety disorder (GAD) is one of the most prevalent anxiety disorders among infertile patients. This study aimed to determine the prevalence of GAD and its associated factors among infertile patients in Tehran, Iran.

METHODS

This cross-sectional study included 1146 infertile patients in a referral fertility center in Tehran, Iran between May and October 2017. GAD was measured using the Generalized Anxiety Disorder-7 (GAD-7) scale. The associations between GAD and demographic/fertility characteristics were estimated using simple and multiple logistic regression with odds ratio (OR) and 95% confidence interval (CI).

RESULTS

The mean total GAD-7 score was 6.61 (SD = 5.32). Using a cut-off value of 10, the prevalence of GAD was 28.3%. In adjusted analysis, female sex (OR = 2.54, 95% CI = 1.88-3.42, P < 0.001), low educational level (OR = 1.45, 95% CI = 1.08-1.94, P = 0.012), high infertility duration (OR = 1.05, 95% CI = 1.01-1.09, P = 0.013), and treatment failure (OR = 1.52, 95% CI = 1.13-2.04, P = 0.006) were associated with GAD.

CONCLUSIONS

The prevalence of GAD is relatively high in infertile patients. We conclude that all infertile patients should be screened for symptoms of GAD and treated for this disorder as need arises.