Kruper, A., Cusatis, R., Sandlow, J., Schoyer, K., Davis, J. B., & Flynn, K. E. (2018). Importance of baseline psychological screening in infertility for men & women. Fertility and Sterility. https://doi.org/10.1016/j.fertnstert.2018.07.453
Kruper A, Cusatis R, Sandlow J, Schoyer K, Davis JB, Flynn KE. Importance of baseline psychological screening in infertility for men & women. Fertility and Sterility. 2018. doi:10.1016/j.fertnstert.2018.07.453
Kruper, A., et al. "Importance of baseline psychological screening in infertility for men & women." Fertility and Sterility, 2018.
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RRM Academy Synopsis
Baseline psychological status predicts later anxiety in infertility
Anxiety and depression at the start of specialist care predicted anxiety and depression a year later, in a prospective cohort of 88 women and 63 men. The authors report scores worsened over time. Infertility diagnosis and IUI or IVF showed no link to 12-month anxiety or depression.
Key Findings
The authors conclude that baseline psychological status is predictive of later anxiety and depression, and that scores worsened over the course of infertility treatment.
Of the participants, 54% were pregnant or parenting a child by 12 months, through birth, adoption or fostering. Those participants had significantly better FertiQoL scores and less depression at the 12-month mark.
Participants with more anxiety at 12 months had more anxiety at baseline and lower relationship satisfaction. The same two links held for depression.
Male-factor, female-factor and unexplained infertility diagnoses, and IUI or IVF, showed no relation to FertiQoL, anxiety or depression scores a year on.
The authors call early identification of needs and treatment resources imperative, and say behavioral health services inside the clinic ease access and reduce stigma.
Interpretation
This is a conference abstract, so full methods and tables are unavailable. The study followed people over time and used hierarchical linear modeling, which accounts for partners in the same couple. The links it reports are associations. Participants were 88 women and 63 men, mean age 34, who had a reproductive specialist consultation, and the findings apply to that group. The abstract gives no dropout figures.
RRM Context
Restorative reproductive medicine treats the whole person and the couple. Emotional health belongs in that care from the first visit. The study enrolled men and women, and it linked later anxiety and depression to relationship satisfaction. A couple-centered approach fits that link.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
By identifying psychological concerns early in the infertility treatment process, patients can be referred for behavioral health interventions rather than allowing conditions to emerge, worsen, or further impact their health. The aim of this study was to assess the psychological impact of infertility over time for men and women.
Design
Longitudinal prospective cohort study.
Materials and Methods
Couples and individuals with a reproductive specialist consultation were recruited to complete two questionnaires: prior to initial consultation and at 12 months. PROMIS Anxiety and Depression 4-item short forms and Fertility Quality of Life (FertiQoL) were administered at both time points. We analyzed the relationships between FertiQoL, Anxiety, and Depression at 12 months, fertility-related events and outcomes (infertility diagnoses, medical treatments for infertility, pregnancy/parenting status), and sociodemographic characteristics (gender, age, race, education, relationship satisfaction) using hierarchical linear modeling to account for nonindependence of the participants who were part of a couple. We considered a two-tailed alpha level of 0.05 to be significant.
Results
A total of 88 women and 63 men provided data at both time points; mean age 34 years. At baseline, mean (SD) anxiety scores were 50.6 (8) for women, 48.4 (8) for men; depression scores were 46.8 (6) for women and 44.9 (4) for men. Baseline FertiQoL scores were 68.9 (15) for women and 79.8 (12) for men. By 12 months, 54% of participants were pregnant or parenting a child (birth or adoption/fostering). Those who were pregnant/parenting by 12 months reported significantly better FertiQoL scores and had lower depression at 12 months. Higher anxiety at 12 months was related to baseline anxiety and lower relationship satisfaction. Likewise, higher depression at 12 months was related to baseline depression and lower relationship satisfaction. Neither infertility diagnoses (male-factor, femalefactor, or unexplained) nor invasive medical treatments (IUI or IVF) were related to anxiety, depression, or FertiQoL scores at 12 months.
Conclusions
Baseline psychological status is predictive of subsequent anxiety and depression during ongoing infertility treatment, with scores worsening over time. It is imperative that early identification of needs and provision of treatment resources be provided to patients. Embedding behavioral health services within the clinic promotes ease of access to care and reduces stigma of seeking treatment. After this research was conducted, the addition of a clinical health psychologist in the clinic has afforded opportunities to implement screening measures and promote early intervention.
Mental Health and Psychosocial Care › Infertility Distress › Anxiety and Depression in Infertility
Abbey Kruper, Rachel N. Cusatis, Kate D. Schoyer, Joseph B. Davis, Kathryn E. Flynn
A Kruper, R Cusatis, Catherine Schoyer, Katherine Schoyer, Kathryn Schoyer, K Schoyer, Joe Davis, Joey Davis, J Davis, Kathy Flynn, Kate Flynn, K Flynn
DOI 10.1016/j.fertnstert.2018.07.453 10.1016/j.fertnstert.2018.07.453 Kruper et al. 2018, Kruper 2018