Frederiksen Yoon, O'Toole Mia Skytte, Mehlsen Mimi Y, Hauge Benedicte, Elbaek Helle Olesen, Zachariae Robert, Ingerslev Hans Jakob
Department of Psychology and Behavioral Sciences, Aarhus University, 8000 Aarhus, Denmark
Department of Psychology and Behavioral Sciences, Aarhus University, 8000 Aarhus, Denmark.
Hum Reprod. 2017 Feb;32(2):391-402. doi: 10.1093/humrep/dew320. Epub 2016 Dec 21.
Is expressive writing intervention (EWI) efficacious in reducing distress and improving pregnancy rates for couples going through ART treatment?
Compared to controls, EWI statistically significantly reduced depressive symptoms but not anxiety and infertility-related distress.
ART treatment is considered stressful. So far, various psychological interventions have been tested for their potential in reducing infertility-related distress and the results are generally positive. It remains unclear whether EWI, a brief and potentially cost-effective intervention, could be advantageous.
STUDY DESIGN SIZE, DURATION: Between November 2010 and July 2012, a total of 295 participants (163 women, 132 men) were randomly allocated to EWI or a neutral writing control group.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants were couples undergoing IVF/ICSI treatment. Single women and couples with Preimplantation Genetic Diagnosis or acute change of procedure from insemination to IVF, were excluded. EWI participants participated in three 20-min home-based writing exercises focusing on emotional disclosure in relation to infertility/fertility treatment (two sessions) and benefit finding (one session). Controls wrote non-emotionally in three 20-min sessions about their daily activities. The participants completed questionnaires at the beginning of treatment (t1), prior to the pregnancy test (t2), and 3 months later (t3). In total, 26.8% (79/295) were lost to follow-up. Mixed linear models were chosen to compare the two groups over time for psychological outcomes (depression, anxiety and infertility-related distress), and a Chi test was employed in order to examine group differences in pregnancy rates MAIN RESULTS AND THE ROLE OF CHANCE: One hundred and fifty-three participants received EWI (women = 83; men = 70) and 142 participants were allocated to the neutral writing control group (women = 83; men = 62). Both women and partners in the EWI group exhibited greater reductions in depressive symptoms compared with controls (P = 0.049; [CI 95%: -0.04; -0.01] Cohen's d = 0.27). The effect of EWI on anxiety did not reach statistical significance. Overall infertility-related distress increased marginally for the partners in the EWI group compared to the partners in the control group (P = 0.06; Cohen's d = 0.17). However, in relation to the personal subdomain, the increase was statistically significant (P = 0.01; Cohen's d = 0.24). EWI had no statistically significant effect on pregnancy rates with 42/83 (50.6%) achieving pregnancy in the EWI group compared with 40/80 (49.4%) in the control group (RR = 0.99 [CI 95% = 0.725, 1.341]; P = 0.94).
LIMITATIONS, REASONS FOR CAUTION: The results for depressive symptoms corresponded to a small effect size and the remaining results failed to reach statistical significance. This could be due to sample characteristics leading to a possible floor-effect, as we did not exclude participants with low levels of emotional distress at baseline. Furthermore, men showed increased infertility-related distress over time.
EWI is a potentially cost-effective and easy to implement home-based intervention, and even small effects may be relevant. When faced with infertility, EWI could thus be a relevant tool for alleviating depressive symptoms by allowing the expression of feelings about infertility that may be perceived as socially unacceptable. However, the implications do not seem to be applicable for men, who presented with increased infertility-related distress over time.
STUDY FUNDING/COMPETING INTERESTS: The present study was supported by research grants from Merck Sharpe and Dohme and The Danish Agency for Science Technology and Innovation as part of a publicly funded PhD. The funding bodies had no influence on the data collection, analysis or conclusions of the study. None of the authors have any conflicts of interest to declare.
Clinicaltrials.gov, trial no. NCT01187095.
7th September 2010 DATE OF FIRST PATIENT'S ENROLMENT: 23rd November 2010.
表达性写作干预（EWI）对于接受辅助生殖技术（ART）治疗的夫妇减轻痛苦并提高妊娠率是否有效？
与对照组相比，EWI在统计学上显著降低了抑郁症状，但对焦虑和与不孕相关的痛苦没有影响。
ART治疗被认为具有压力。到目前为止，已经对各种心理干预措施在减轻与不孕相关痛苦方面的潜力进行了测试，结果总体上是积极的。尚不清楚EWI这种简短且可能具有成本效益的干预措施是否具有优势。
研究设计、规模、持续时间：2010年11月至2012年7月期间，共有295名参与者（163名女性，132名男性）被随机分配到EWI组或中性写作对照组。
参与者/材料、设置、方法：参与者为接受体外受精/卵胞浆内单精子注射（IVF/ICSI）治疗的夫妇。排除单身女性以及接受植入前基因诊断或从人工授精突然改为IVF治疗的夫妇。EWI组的参与者参加了三次20分钟的家庭写作练习，重点是关于不孕/生育治疗的情感表露（两节课）和益处发现（一节课）。对照组在三次20分钟的课程中就其日常活动进行非情感性写作。参与者在治疗开始时（t1）、妊娠试验前（t2）以及3个月后（t3）完成问卷。总共有26.8%（79/295）的参与者失访。选择混合线性模型来比较两组在不同时间的心理结果（抑郁、焦虑和与不孕相关的痛苦），并采用卡方检验来检查两组在妊娠率方面的差异。主要结果及机遇的作用：153名参与者接受了EWI（女性 = 83名；男性 = 70名），142名参与者被分配到中性写作对照组（女性 = 83名；男性 = 62名）。与对照组相比，EWI组的女性和伴侣的抑郁症状减轻程度更大（P = 0.049；[95%置信区间：-0.04；-0.01]，科恩d值 = 0.27）。EWI对焦虑的影响未达到统计学显著性。与对照组的伴侣相比，EWI组的伴侣总体上与不孕相关的痛苦略有增加（P = 0.06；科恩d值 = 0.17）。然而，在个人子领域方面，这种增加具有统计学显著性（P = 0.01；科恩d值 = 0.24）。EWI对妊娠率没有统计学上的显著影响，EWI组中有42/83（50.6%）的人怀孕，而对照组为40/80（49.4%）（相对风险 = 0.99 [95%置信区间 = 0.725, 1.341]；P = 0.94）。
局限性、谨慎原因：抑郁症状的结果对应的效应量较小，其余结果未达到统计学显著性。这可能是由于样本特征导致可能出现下限效应，因为我们没有排除基线时情绪痛苦水平较低的参与者。此外，随着时间的推移，男性表现出与不孕相关的痛苦增加。
EWI是一种潜在具有成本效益且易于实施的家庭干预措施，即使是小的效果也可能具有相关性。因此，当面临不孕问题时，EWI可能是一种通过允许表达可能被视为社会不可接受的关于不孕的感受来减轻抑郁症状的相关工具。然而，这些影响似乎不适用于男性，随着时间的推移，男性表现出与不孕相关的痛苦增加。
研究资金/利益冲突：本研究由默克雪兰诺公司以及丹麦科学技术与创新局的研究资助支持，作为一项公共资助博士研究的一部分。资助机构对研究的数据收集、分析或结论没有影响。作者均无利益冲突需要声明。
Clinicaltrials.gov，试验编号NCT01187095。
2010年9月7日。
2010年11月23日。
