Assessment of family function impact on depression severity among infertile women attending a teaching hospital in South-South Nigeria

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).

Pathway analysis of the impact of family function and self-efficacy on depression and anxiety in patients undergoing in vitro fertilization-embryo transfer

BACKGROUND

Patients undergoing assisted reproductive technology (ART) experience significant psychological distress due to infertility, with depression and anxiety being the most common manifestations. This study investigates the influence of family support and self-efficacy on the mental health of patients undergoing in vitro fertilization-embryo transfer (IVF-ET). The aim is to assess the direct and indirect effects of family function and self-efficacy on depression and anxiety in IVF-ET patients through pathway analyses, thereby providing novel insights for improving patients' psychological well-being.

METHODS

A cross-sectional study was conducted from March to July 2021, employing convenience sampling to recruit 291 participants from a tertiary care hospital's reproductive medicine center. Data were collected using the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), General Self-Efficacy Scale (GSES), Family APGAR index (APGAR), and a Demographic Characteristics Form. Descriptive analysis, Pearson correlation analysis, and multiple linear regression analysis were performed. A Structural Equation Model (SEM) was utilized for pathway analysis to evaluate the direct and indirect influences of family function and self-efficacy on anxiety and depression.

RESULTS

The scores for the SAS and SDS were 46.15 ± 7.35 and 51.71 ± 8.65, respectively. Multiple regression analysis indicated that family function, self-efficacy, and economic status significantly predicted anxiety and depression. Path analysis revealed that economic status directly (β=-0.447, -0.232) and indirectly (β=-0.066, -0.068) affected anxiety and depression, while family function both directly and indirectly affected depression (β=-0.323, -0.104), directly affected anxiety (β=-0.351), and self-efficacy directly influenced only depression (β=-0.509).

CONCLUSION

The findings underscore the pivotal role of a supportive family environment and self-efficacy in alleviating anxiety and depression among IVF-ET patients. The mediating role of family function between economic status and mental health highlights the importance of integrated support systems. Enhancing family function and self-efficacy as part of comprehensive care for individuals undergoing ART is crucial for promoting patient well-being.

A scoping review of the psychosocial aspects of infertility in African countries

Infertility refers to the inability to conceive after 12 months of regular, unprotected sexual intercourse. Psychosocial aspects of infertility research are predominant in developed countries. A scoping review of psychosocial aspects of infertility research conducted in Africa between 2000 and 2022 was conducted. Twelve databases and grey literature were searched for articles. Studies were included if they were published in English and included findings from patients diagnosed with primary or secondary infertility. A total of 2 372 articles were initially found and screening resulted in 116 articles being included in the scoping review. Most of the studies (81%) were conducted in Nigeria, Ghana and South Africa. Psychosocial aspects explored included quality of life, barriers to treatment, attitudes and stigma, and sociocultural and religious aspects of infertility, among others. The review maps published psychosocial research in the context of infertility in Africa and identifies gaps for future research.

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.

No Baby to Bring Home: Perinatal Loss, Infertility, and Mental Illness-Overview and Recommendations for Care

PURPOSE OF REVIEW

Update readers on the state of the research on mental health, perinatal loss, and infertility with a focus on providing a comprehensive overview to empower clinicians in treating this population.

RECENT FINDINGS

Rates of psychiatric illness are increased in people that experience perinatal loss and infertility. The research remains largely below the clear need for focused screening, prevention, and treatment. Clinicians and researchers need to remain attuned to the impact of perinatal loss and infertility on the mental health of patients and families. Screening, referral, and expanded therapeutic and psychiatric resources are imperative to improving the well-being of these patients and families.

Knowledge, Attitude, and Perceptions about In Vitro Fertilization (IVF) among Women of Childbearing Age in Cape Coast, Ghana

Background

Infertility impacts a lot of considerable negative social effects on the lives of infertile partners, especially females, who repeatedly experience the emotional sequelae of childlessness. The study's goal was to assess women of reproductive ages' awareness of IVF treatments, as well as their attitudes and misunderstandings about them in Cape Coast, Ghana.

Methods

A total of 437 reproductive-age women in Cape Coast Metropolis were recruited using a simple random sampling approach for this Cross-Sectional Descriptive study. Data were collected with a semistructured interviewer-administered questionnaire and were analyzed using IBM SPSS version 26.0, and p ≤ 0.05 was considered significant.

Results

The mean age was calculated to be 25.33 ± 0.066 years with a greater proportion, 65.7% within 15–24 years, 76.5% had no or had never had a child before. 93.4% were of the Christian faith, 66.8% were aware of IVF, and 74.8% think IVF offers hope. Although 41.4% believe it is not a natural procedure and 44.6% believe IVF children are normal but not natural. While 72.1% believe the treatment is very costly, and 40.7% believe it is not affordable or accessible. The majority believe IVF kids are legitimate (76.9%), and so should be welcomed by society (86.5%). The overall opinion of IVF service acceptability was 81.7% good. Seventy-two and three percent did not know whether IVF services are available in Cape Coast. Also, 48.1% were aware that IVF may result in pregnancy failure, with fewer than half (43.5%) believing it could be linked to genetic problems in the baby. The majority (60.4%) were willing to use IVF services, and 82.8% will utilize just their husband's sperm technique. While others may not want to undergo any form of IVF technique because they desire to conceive naturally (51.0%) and 22.4% may be unable to pay for it. Educational status and awareness of the availability of IVF services were factors that were significantly associated with their overall good perception of IVF services. Also, age, marital status, number of live children, occupation, educational status, awareness, and their overall perception were factors that are significantly associated with their preparedness to utilize IVF services.

Conclusion

Overall, women's opinions of IVF and their readiness to use them were favorable, and they think it offers hope for their condition since they were well-informed about its forms and that infertility may be a result of several factors, all of which may need IVF services. It does not matter if it is difficult to obtain, expensive, or unavailable. It is recommended that the government collaborates with healthcare providers to investigate ways through the mass media in the drive to clear the misconceptions and improve the public understanding of the IVF procedure towards its utilization, thereby reducing the burden of childlessness and the resulting psychological disorders among couples, this has implications for joyful homes and societal growth.

The relationship between protective factors and common mental disorders among female urban slum dwellers in Ibadan, Nigeria

BACKGROUND

On the African continent, many people live in conditions of adversity known to be associated with the onset of mental disorders, yet not all develop a mental disorder. The prevalence of common mental disorders such as depression and anxiety in the general population of Nigeria is comparatively low. Prevalence data of mental disorders in slum settings in Nigeria is sparse. There is a need to better understand the relationship between protective factors and the occurrence of common mental disorders in the Nigerian slum context. This study aimed to describe the relationship between protective factors and the occurrence of common mental disorders among female urban slum dwellers in Ibadan, Nigeria.

METHODS AND FINDINGS

A cross sectional household survey of 550 women was conducted in slum settlements in Ibadan, Nigeria. Interviewer administered questionnaires were completed to elicit information on protective factors (social connectedness, self-esteem, social support, resilience) and common mental disorders (depression, anxiety and stress). The DASS-21 was used to measure common mental disorders and protective factors were measured using the Social Connectedness Scale, Multidimensional Scale of Perceived Social Support, Resilience scale and the Rosenberg Self Esteem Scale. A multivariable logistic regression model was employed to examine associations while adjusting for relevant confounders. Common mental disorders were reported by 14.0% of the respondents. Resilience and social support were found to be protective against reporting symptoms of common mental disorders. Women who reported higher levels of social support and resilience were less likely to report common mental disorders (OR:0.96, 95% CI 0.93, 0.98) and (OR:0.95, 95% CI 0.91, 0.99) respectively. Women who were 65 years and older were also less likely to report the occurrence of common mental disorders (OR:0.38, 95% CI 0.15, 0.98) compared to those aged 18-34 years.

CONCLUSION

Social support and resilience appear to be protective against common mental disorders among these respondents. Further research should be conducted to explore the pathways through which protective factors reduce the likelihood of the occurrence of common mental disorders. This would be important in the development of mental health interventions.