Prevalence of anxiety and its associated factors among infertile patients after 'two-child' policy in Chongqing, China: a cross-sectional study

Network analysis of stress and stigma symptoms and their associations with quality of life among Chinese female infertility patients

BACKGROUND

This study has employed network analysis while investigating the interrelationships among stress and stigma symptoms and their associations with quality of life among Chinese female infertility patients.

METHODS

In this cross-sectional study, 428 female patients who visited the Department of Reproductive Center of Dalian Women and Children's Medical Group with chief complaints of infertility symptoms were recruited using convenience sampling from November 2022 to December 2023. Fertility-related stress and stigma status were examined by the Fertility Problem Inventory (FPI) and Infertility Stigma Scale (ISS), respectively. Quality of life was examined by the Fertility Quality of Life (FertiQoL). Network analysis was conducted to estimate the network of stress and stigma symptoms. The flow network approach was used to identify specific stigma and stress symptoms related to quality of life. Expected influence (EI) and bridge expected influence (bEI) were used to quantify central and bridge symptoms in the network, respectively. The bootstrapping method evaluated the accuracy and robustness of the network estimates.

RESULTS

The average predictability of FPI and ISS symptoms was 0.67. The "relationship concern" was the most central symptom across all centrality indices, followed by "public stigma" and "social concern". The main symptoms bridging the FPI and ISS clusters were "self-devaluation", "social concern", and "relationship concern". The network demonstrated robustness in stability and accuracy tests. In the flow network, "social withdrawal" and "self-devaluation" showed strong negative associations with FertiQoL.

CONCLUSIONS

"Relationship concern," "public stigma," "social concern," and "self-devaluation" have been identified as the main central and bridge symptoms in the stress and stigma network in this study. Notably, stigma symptoms, particularly "social withdrawal" and "self-devaluation", showed stronger associations with FertiQoL compared to stress symptoms, highlighting their importance in potential treatment strategies.

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.

Cortisol dysregulation in anxiety infertile women and the influence on IVF treatment outcome

Introduction

Dysregulation of the stress-regulatory hormone cortisol is associated with anxiety, but its potential impact on infertile women and in vitro fertilization (IVF) treatment remains unclear. This prospective cross-sectional study aimed at evaluating the dysregulation of cortisol and its correlation to anxiety in infertile women. The influence of stress on IVF outcomes was also investigated.

Methods

A point-of-care test was used for the measurement of morning serum cortisol in 110 infertile women and 112 age-matching healthy individuals. A Self-Rating Anxiety Scale (SAS) was used for the anxiety assessment of infertile women, and 109 of them underwent IVF treatment starting with the GnRH-antagonist protocol. If clinical pregnancy was not achieved, more IVF cycles were conducted with adjusted protocols until the patients got pregnant or gave up.

Results

Higher morning serum cortisol level was identified for infertile patients, especially for the elder. Women with no anxiety showed significant differences in cortisol levels, monthly income, and BMI compared with those with severe anxiety. A strong correlation was found between the morning cortisol level and the SAS score. When the cutoff value is 22.25 μg/dL, cortisol concentration could predict the onset of anxiety with high accuracy (95.45%) among infertile women. After IVF treatments, women with high SAS scores (>50) or cortisol levels (>22.25 μg/dL) demonstrated a lower rate of pregnancy (8.0%-10.3%) and more IVF cycles, although the impact of anxiety was not affirmative.

Conclusion

Hypersecretion of cortisol related to anxiety was prevalent among infertile women, but the influence of anxiety on multi-cycle IVF treatment was not affirmative due to the complicated treatment procedures. This study suggested that the assessment of psychological disorders and stress hormone dysregulation should not be overlooked. An anxiety questionnaire and rapid cortisol test might be included in the treatment protocol to provide better medical care.

The technical efficiency of maternal and child health hospitals in China: a case study of Hubei Province

BACKGROUND

Maternal and child health (MCH) hospitals play an essential role in providing MCH services in China, while the supply has become increasingly challenging in the past decade, especially among secondary MCH hospitals. In this study we aimed to evaluate the technical efficiency (TE) of secondary MCH hospitals in Hubei province (China) to generate evidence-based decision-making for efficiency improvement.

METHODS

The data were collected from the Department of Maternal and Child Health of Health Commission of Hubei Province in 2019. A total of 59 out of 74 secondary MCH hospitals were included as our study sample. Four input indicators (number of health professionals, number of beds, number of equipment with value greater than 10,000 RMB Yuan, building area for hospital operations) and three output indicators (number of total diagnostic patients, number of discharged patients, and number of birth deliveries) were selected based on previous literature. TE scores of the sample hospitals were estimated by using Bootstrap-Data Envelopment Analysis (Bootstrap-DEA).

RESULTS

After bias-correction with Bootstrap-DEA model, the average TE score of the MCH hospitals was 0.673. 20 (33.89%) MCH hospitals had TE scores below the average. No MCH hospitals achieved excellent efficiency; 16 (27.11%) MCH hospitals reached good efficiency; and 26 (44.06%) MCH hospitals fell into poor and failing efficiency. Besides, 17 MCH hospitals had TE scores of 1 before bias-corrections, while none of them reached 1 after bias correction.

CONCLUSIONS

Significant capacity variations existed among the secondary MCH hospitals in terms of input and output indicators and their overall TE was low in Hubei of China. For better improvement, the secondary MCH hospitals in Hubei need to improve their internal management and strengthen the construction of their information systems. A series of policy supports are needed from the health and insurance administrations to optimize health resources. Third-party performance evaluation can be piloted to improve efficiency and overall performance of the MCH hospitals. The policy recommendations we raise for MCH hospitals in Hubei can be worth learning for some low- and middle- income countries.