Document Type : Short Communication
Authors
1 Department of Psychiatry, Kasturba Medical College, MAHE, Manipal, Karnataka, India
2 Department of Obstetrics and Gynaecology, The Manipal Assisted Reproduction Centre, Kasturba Medical College, MAHE, Manipal, Karnataka, India
Abstract
Keywords
Globally, depression and anxiety are among the top
causes for disease burden especially in middle-income
countries such as India (
Female infertility can be attributed to factors such as
sexual dysfunctions, dyspareunia and vaginal causes,
congenital defects in the genital tract, infections, chronic
ill-health, cervical factors, uterine factors, tubal factors,
ovarian factors, peritoneal and endocrinal factors (
Previous studies have suggested that adjustment
disorders are more commonly found in women than men
(
fertile couples have significant adjustment problems. The
clinical and subclinical features of emotional distress
may be present in the couples during their 1st visit to the
infertility expert (
This research was planned knowing that: i. In India the rates of depression and anxiety rise in women above the age of 18 years, ii. Both these disorders contribute to considerable disease burdens and disability in work, family life and social functioning, and iii. There is a lack of empirical investigations estimating the prevalence of psychiatric disorders "in infertile women" in the Indian sub-continent. In this context, the aim of this study is to estimate the prevalence of psychiatric disorders in women seeking fertility treatments in a clinic based in Southern India.
The study is cross sectional and uses a convenience
sample which is a part of a larger investigation of
predictors of distress in infertile women (
The study is cross sectional and uses a convenience
sample which is a part of a larger investigation of
predictors of distress in infertile women (
The data in this study was collected using the following study tools. A brief form was compiled by the researchers for assessing socio-demographic variables. The second tool was the World Health Organization ‘International Classification of Diseases-Clinical Descriptive and Diagnostic Guidelines, 10th revision’ (ICD-10) (30). For the study, each woman’s history of psychological problems/psychiatric disorders was collected during a detailed psychological consultation. It was conducted by the principal investigator, a licensed Clinical Psychologist trained in the use of ICD. The psychiatric history provided by the participants was corroborated for reliability and validity with the accompanying relative.
Data collection in this study involved the following steps. After ethical clearance, participants were enrolled on the basis that they met the inclusion criteria. The purpose of the study and its implications were explained, together with the participants’ right to complete confidentiality and their right to withdraw from the study. Informed consent was taken from all of the women and their accompanying relatives who were willing to take part. Thereafter, the women completed the structured interview for the assessment of relevant socio-demographic and clinical variables. The assessment of the presence of psychiatric disorder was done using the ICD-10. Those found to have a significant psychiatric disorder were psycho-educated on their levels of distress and given the option of a consultation in the Department of Psychiatry and given a referral for the same.
All statistical analyses are carried out using SPSS version 15.0 (SPSS Inc., Chicago, IL, USA).
Figure 1 presents the frequency counts and percentage of women with and without mental health problems. Table 1 presents details of various psychiatric disorders prevalent in the participants.
Frequency counts and percentage of women detected with and without mental health problems.
Details of various psychiatric disorders prevalent in the participants
Details of various psychiatric disorders in infertile women (n=134) | Frequency data n (%) |
---|---|
i. Adjustment disorder (ICD 10 code F43.2) | 49 (16) |
ii. Anxiety NOS (ICD 10 code F41.9) | 29 (10) |
iii. Mixed anxiety and depressive disorder (ICD 10 code F41.2) | 26 (9) |
iv. Dysthymic disorder (ICD 10 code F41.2) | 15 (5) |
v. Major depressive disorder (ICD code 10 F 32) | 12(4) |
vi. Other anxiety disorders (social phobia, generalized anxiety disorder, obsessive compulsive disorder) (ICD 10 codes F40, F41.1, F42 respectively) | 3 (1) |
ICD; International classification of diseases and NOS; Not otherwise specified.
Results of this study reveal that the criterion for significant psychiatric disorder is met by 45% (134 out of 300) of the participants. This is followed by the ‘off and on’ presence of psychological problems reported by 33% (100 out of 300) of the women who partially met the criteria for an ICD-10 diagnosis of disorder, but did not meet the time duration requirement). Lastly 22% (66 out of 300) of the women are found to be free from any psychological or psychiatric problem.
Based on the current data serious psychopathology is
found to be quite widespread in infertility. Additionally, a
sizeable proportion of women suffer from sub-threshold
symptoms of anxiety and depression, although they did not
fulfil the minimum duration for any specific psychiatric
disorder in ICD-10. The present findings are somewhat
similar to recent research which showed that 54% (27 out
of 50) of infertile females have a significant psychiatric
disorder (
The most common psychiatric diagnosis established
in the present research is Adjustment Disorder with
mixed affective features (found in 49 out of 300,
roughly 16% of women). This is followed by anxiety
disorder (unspecified) reported by nearly 10% (29 out
of 134) of the participants and lastly mixed anxiety
and depressive disorder reported by around 9% (26
out of 300) of women. Other psychiatric conditions,
such as social phobia, generalized anxiety disorder and
obsessive compulsive disorder were reported by 1% (3
out of 300) of the women. These findings are similar
to those observed by other researchers who have also
shown that adjustment disorders, anxiety disorders and
mood disorders are frequently manifested in infertile
women (
Dysthymic features are reported by patients in the
present study. Yet, severe depressive features, suicidal
ideations or hopelessness are not reported. The results
of this study are similar to other studies demonstrating
that mild depression is more prevalent than moderate or
severe depression, particularly in Indian contexts (
This study has certain limitations. Firstly, is the lack of
separate assessments of the husbands of the women who
participated in this research. Secondly, an unstructured
psychiatric interview schedule was included as a
measure to tap psychiatric disorders in this study. This
could have been supplemented with a structured tool for
increasing the diagnostic validity of presence of a specific
psychiatric disorder. Thirdly, reporting/recall biases of
the participants could have crept in our data. Further
studies conducted on this subject may consider drawing
comparisons between mental health issues in i. Infertile
women in comparison to fertile controls, ii. In women
who conceive with treatments versus those who do not,
and iii. In women who remain childless versus whose who
go on to adopt. Additionally, psychiatric/psychological
disorder is known to be associated with variables like age,
gender, occupation, treatment type, length and history,
duration of infertility, costs of evaluation or cure and
other psychosocial variables (
Over the past fifty years, most countries have come up with evidenced based committee reports on assessing the psychological endurance of couples prior to commencement of infertility treatments as well as protecting their overall wellbeing at all stages of the treatment process.
In conclusion, our data reveals that the prevalence of psychiatric disorders is high in infertile women. Ensuring the emotional wellbeing of patients seeking fertility treatments in India is an important component of comprehensive clinical care.