Crawford Natalie M, Hoff Heather S, Mersereau Jennifer E
Department of Obstetrics and Gynecology, University of North Carolina, 4001 Old Campus Building, CB 7570, Chapel Hill, NC 27599, USA.
Hum Reprod. 2017 Mar 1;32(3):582-587. doi: 10.1093/humrep/dew351.
Are infertile women who screen positive for depression less likely to initiate infertility treatments?
Infertile women who screen positive for depression are less likely to initiate treatment for infertility.
Infertility imposes a psychological burden on many couples. Depression and anxiety have been demonstrated in ~40% of infertile women, which is twice that of fertile women. Further, the psychological burden associated with infertility treatment has been cited as a major factor for discontinuation of infertility care.
STUDY DESIGN, SIZE, DURATION: Prospective, observational study in a clinical-based cohort of 416 women who completed a questionnaire after the new patient visit, from January 2013 until December 2014 inclusive.
PARTICIPANTS/MATERIALS, SETTING, METHODS: All new female infertility patients (n = 959) seen between January 2013 and December 2014 at University of North Carolina Fertility received an electronic questionnaire to screen for mental health disorders and to evaluate their perception of mental health disorders on infertility.
Of 959 surveys sent, 416 women completed the questionnaire (43%). The prevalence screening positive for depression, using the NIH PROMIS screening tool, was 41%. Sixty-two percent of all women initiated infertility treatment, and of these, 81% did so within 4 months. In multivariate analysis, women who screened positive for depression had 0.55 times the odds of initiating treatment for infertility (95% CI: 0.31-0.95). Similarly, women who screened positive for depression had 0.58 times the odds of initiating infertility treatment within 4 months (95% CI: 0.35-0.97), which was the time of censoring from the most recent patient evaluated. Women who screened positive for depression were less likely to pursue treatment with oral medications or IVF (P = 0.01 and P = 0.03, respectively), as compared to women who did not screen positive for depression.
LIMITATIONS, REASONS FOR CAUTION: Questionnaire-based evaluations may result in a lower prevalence of psychological disorder as some participants feign emotional well-being. Although we did not identify differences in women who responded to our survey and those who did not, responder bias may still be present. In addition, infertility is a couple's disease. However, this study only included psychological evaluation of the female partner. We have no information about the women's previous treatment.
Screening for depression is important in the infertility patient population, as further evaluation and psychological interventions may improve compliance with fertility treatments, quality of life, and potentially, the overall chance of pregnancy.
STUDY FUNDING/COMPETING INTERESTS: None.
抑郁症筛查呈阳性的不孕女性开始进行不孕治疗的可能性是否较低？
抑郁症筛查呈阳性的不孕女性开始进行不孕治疗的可能性较低。
不孕给许多夫妇带来心理负担。约40%的不孕女性存在抑郁和焦虑情绪，这一比例是有生育能力女性的两倍。此外，与不孕治疗相关的心理负担被认为是导致停止不孕治疗的主要因素。
研究设计、规模、持续时间：一项前瞻性观察性研究，以2013年1月至2014年12月期间（含）在临床队列中的416名女性为研究对象，这些女性在初诊后完成了一份问卷。
研究对象/材料、研究环境、方法：2013年1月至2014年12月期间在北卡罗来纳大学生育中心就诊的所有新的女性不孕患者（n = 959）均收到一份电子问卷，以筛查心理健康障碍并评估她们对心理健康障碍对不孕影响的看法。
在发放的959份调查问卷中，416名女性完成了问卷（43%）。使用美国国立卫生研究院PROMIS筛查工具，抑郁症筛查呈阳性的患病率为41%。所有女性中有62%开始进行不孕治疗，其中81%在4个月内开始治疗。在多变量分析中，抑郁症筛查呈阳性的女性开始进行不孕治疗的几率为0.55倍（95%置信区间：0.31 - 0.95）。同样，抑郁症筛查呈阳性的女性在4个月内开始进行不孕治疗的几率为0.58倍（95%置信区间：0.35 - 0.97），这是从最近评估的患者开始计算的审查时间。与抑郁症筛查未呈阳性的女性相比，抑郁症筛查呈阳性的女性接受口服药物治疗或体外受精的可能性较小（分别为P = 0.01和P = 0.03）。
局限性、需谨慎的原因：基于问卷的评估可能会导致心理障碍患病率较低，因为一些参与者会假装情绪良好。尽管我们没有发现回复我们调查的女性和未回复的女性之间存在差异，但仍可能存在回复者偏差。此外，不孕是一种夫妻双方的疾病。然而，本研究仅包括对女性伴侣的心理评估。我们没有关于这些女性既往治疗情况的信息。
对不孕患者群体进行抑郁症筛查很重要，因为进一步的评估和心理干预可能会提高对生育治疗的依从性、生活质量，并有可能提高总体怀孕几率。
研究资金/利益冲突：无。
