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Mood Disorders, Personality and Grief in Women and Men undergoing in vitro Fertilization Treatment
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Reproductive Health)
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Psychological problems are common in infertile women undergoing in vitro fertilization (IVF) treatment.  The aim of this thesis was to determine the prevalence of psychiatric disorders, such as mood and anxiety disorders, and related risk factors and personality traits in women and men undergoing IVF.

Participants were 1090 consecutive women and men, 545 couples, attending a fertility clinic in Sweden during a two-year period. The Primary Care Evaluation of Mental Disorders (PRIME-MD), based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), was used for evaluating mood and anxiety disorders. The participation rate was 862 (79 %) subjects.

Any psychiatric disorder was present in 31 % of females and in 10 % of males. Major depression was prevalent in 11 % of females and 5 % of males. Only 21 % of the subjects with a psychiatric disorder had some form of treatment. A negative pregnancy test and obesity (BMI ≥ 30) were risk factors for mood disorders in women and the only risk factor for depression in men was unexplained infertility. Anxiety disorders were less common than in the general population and no IVF-related risk factors were identified. The Swedish universities Scales of Personality (SSP), a self-rating questionnaire, was used for evaluation of personality traits. High scores of personality traits related to neuroticism were associated with mood and/or anxiety disorders among both women and men.

Another objective was to explore the experience of childlessness three years after unsuccessful IVF by a qualitative-approach, assessing data by interviews. Failure after IVF was experienced by women in terms of grief, whereas men took upon themselves a supportive role not expressing grief. A need for professional support and counselling in how to handle grief was described. An unstructured end after IVF treatment left unanswered questions. Three years after the end of treatment, men and women were still processing and had not adapted to childlessness, indicating the grieving process was unresolved.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2009. , p. 67
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 489
Keywords [en]
infertility, in vitro fertilization, depression, anxiety, personality, neuroticism, grief, unsuccessful IVF
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:uu:diva-109464ISBN: 978-91-554-7630-4 (print)OAI: oai:DiVA.org:uu-109464DiVA, id: diva2:272520
Public defence
2009-11-27, IX Universitetshuset, Övre Slottsgatan 2, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2009-11-06 Created: 2009-10-15 Last updated: 2011-01-12Bibliographically approved
List of papers
1. Prevalence of psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment
Open this publication in new window or tab >>Prevalence of psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment
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2008 (English)In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 23, no 9, p. 2056-2063Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: This study was undertaken to determine the prevalence of psychiatric disorders in infertile women and men undergoing in vitro fertilization (IVF) treatment. METHODS: Participants were 1090 consecutive women and men, 545 couples, attending a fertility clinic in Sweden during a two-year period. The Primary Care Evaluation of Mental Disorders (PRIME-MD), based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV), was used as the diagnostic tool for evaluating mood and anxiety disorders. RESULTS: Overall, 862 (79.1%) subjects filled in the PRIME-MD patient questionnaire. Any psychiatric diagnosis was present in 30.8% of females and in 10.2% of males in the study sample. Any mood disorder was present in 26.2% of females and 9.2% of males. Major depression was the most common mood disorder, prevalent in 10.9% of females and 5.1% of males. Any anxiety disorder was encountered in 14.8% of females and 4.9% males. Only 21% of the subjects with a psychiatric disorder according to DSM-IV received some form of treatment. CONCLUSIONS: Mood disorders are common in both women and men undergoing IVF treatment. The majority of subjects with a psychiatric disorder were undiagnosed and untreated.

Keywords
Depression, anxiety, women, men, in vitro fertilization
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-17795 (URN)10.1093/humrep/den154 (DOI)000259144600014 ()18583334 (PubMedID)
Available from: 2008-09-01 Created: 2008-09-01 Last updated: 2017-12-08Bibliographically approved
2. Risk factors for psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment
Open this publication in new window or tab >>Risk factors for psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment
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2010 (English)In: Fertility and Sterility, ISSN 0015-0282, E-ISSN 1556-5653, Vol. 93, no 4, p. 1088-1096Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To identify risk factors associated with depression and anxiety in infertile women and men undergoing in vitro fertilization (IVF). DESIGN: Prospective study. SETTING: A university hospital in Sweden during a 2-year period. PATIENT(S): 825 participants (413 women and 412 men). INTERVENTION(S): Primary Care Evaluation of Mental Disorders (PRIME-MD), based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), as the diagnostic tool for evaluating mood and anxiety disorders, and fertility history and outcome of IVF treatment collected from the patients' medical records. MAIN OUTCOME MEASURE(S): Risk factors associated with depression and anxiety disorders. RESULT(S): A negative pregnancy test and obesity were the independent risk factors for any mood disorders in women. Among men, the only independent risk factor for depression was unexplained infertility. No IVF-related risk factors could be identified for any anxiety disorder. CONCLUSION(S): A negative pregnancy test is associated with an increased risk for depression in women undergoing IVF, but no risk of developing anxiety disorders is associated with the pregnancy test result after IVF. Pregnancy test results were not a risk factor for depression or anxiety among men.

Keywords
Depression, anxiety, women, men, infertility, in vitro fertilization, risk factors
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-103011 (URN)10.1016/j.fertnstert.2008.11.008 (DOI)000275541000010 ()19118826 (PubMedID)
Available from: 2009-05-13 Created: 2009-05-13 Last updated: 2017-12-13Bibliographically approved
3. Personality traits associated with depressive and anxiety disorders in infertile women and men undergoing in vitro fertilization treatment
Open this publication in new window or tab >>Personality traits associated with depressive and anxiety disorders in infertile women and men undergoing in vitro fertilization treatment
2010 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 89, no 1, p. 27-34Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To assess which personality traits are associated with depressive and/or anxiety disorders in infertile women and men undergoing in vitro fertilization (IVF). DESIGN: Prospective study. SETTING: A university hospital in Sweden. POPULATION: A total of 856 eligible women and men, 428 couples, were approached to participate. Overall 643 (75.1%) subjects filled out the Swedish Universities Scales of Personality (SSP) questionnaire. The response rates were 323 women (75.5%) and 320 men (74.8%). METHODS: The SSP, a self-rating personality trait questionnaire, was used for evaluation. Main outcome measures. Personality traits associated with depression and/or anxiety disorders. RESULTS: Higher mean scores on all neuroticism-related personality traits were found in women and men with depressive and/or anxiety disorders compared to women and men with no diagnosis. High scores of neuroticism and a negative pregnancy test after IVF were associated with depressive and/or anxiety disorders among women. Among men, high scores of neuroticism and unexplained or male infertility factor were associated with depressive and/or anxiety disorders. High neuroticism scores were negatively associated with live birth (p < 0.05). CONCLUSION: High scores on neuroticism-related personality traits were associated with depressive and/or anxiety disorders in women and men undergoing IVF.

Keywords
Anxiety, depression, infertility, personality, neuroticism
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-131186 (URN)10.3109/00016340903447396 (DOI)000275251200006 ()19947903 (PubMedID)
Available from: 2010-09-27 Created: 2010-09-27 Last updated: 2017-12-12Bibliographically approved
4. Unresolved grief in women and men in Sweden three years after undergoing unsuccessful in vitro fertilization treatment
Open this publication in new window or tab >>Unresolved grief in women and men in Sweden three years after undergoing unsuccessful in vitro fertilization treatment
2010 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 89, no 10, p. 1290-1297Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Grief is a common reaction in women after a diagnosis of infertility. The study explored the experience of childlessness in both women and men three years after undergoing unsuccessful in vitro fertilization (IVF).

METHODS: Participants (10 women and 9 men) who had attended a fertility clinic in Sweden were interviewed individually. The methodological approach was qualitative with semi-structured interviews and qualitative content analysis.

RESULTS: Unsuccessful IVF was experienced by women in terms of grief, whereas men took upon themselves a supportive role and did not express grief. A need for professional support and counselling in how to handle grief was described. An unstructured end after IVF treatment left unanswered questions. Partner relations were affected in both positive and negative ways and an experience of being excluded with no understanding and lack of support from their social network was revealed. Three years after the end of IVF treatment, both men and women were still processing childlessness and had not adapted to being childless, indicating the grieving process was unresolved.

CONCLUSIONS: The grieving process after unsuccessful IVF treatment was hampered among both men and women. The provision of additional individual support during IVF is recommended as men and women in this study experienced childlessness differently. Support and counselling concerning grief reactions following IVF failure, and a structured end after IVF may facilitate the grieving process after unsuccessful IVF treatment.

Keywords
Childlessness, depression, grief, unsuccessful IVF, qualitative interviews
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-109456 (URN)10.3109/00016349.2010.512063 (DOI)000282963700009 ()20846062 (PubMedID)
Available from: 2009-10-15 Created: 2009-10-15 Last updated: 2017-12-12Bibliographically approved

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