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The influence of infertility and in vitro fertilization treatment on postpartum and long-term mental health in women
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: It is estimated that about 10-15% of couples suffer from infertility, i.e. the inability to achieve a clinical pregnancy after at least one year of regular, unprotected intercourse and that between 2-5% of births are a result of in vitro fertilization (IVF) treatment. Infertility and its treatment can have adverse effects on psychological well-being. While previous studies on postpartum depression (PPD) in IVF women suffer some methodological issues, there are no published studies on the risk of postpartum psychosis (PPP) after IVF pregnancies. Long-term, most women adjust well emotionally after IVF treatment but some, especially the childless, still suffer negative consequences. Meanwhile, few studies have extended beyond the first decade after treatment. Some studies have found that the childless elderly have social networks of less support potential but most show that psychological well-being is not affected by parental status. None of the studies have focused on the oldest old (≥85 years) and many have excluded those who live in institutional care, thus the frailest.

Objective: The overall aim of this thesis was to study postpartum mental health in women who have undergone IVF treatment, using psychiatric diagnoses as outcomes, while controlling for major PPD and PPP risk factors as well as to determine the influences of childlessness, infertility and IVF treatment on long-term mental health in women. Materials and methods: Studies I-II are register-based, case control studies of 3532 (I) and 10,412 (II) primiparous women included in the Swedish IVF register. A control group of 8,553 (I) and 18,624 (II) primiparous women with spontaneous conceptions was selected from the Medical Birth Register. The main outcomes were PPD and PPP diagnoses the 1st year postpartum collected from the National Patient Register. Studies III-IV are cross-sectional. Study III included 470 women who had undergone IVF treatment 20-23 years previously. The Symptom Checklist-90 was used to investigate self-reported mental health. The results were compared with those from a population-based study and by parental status group. Study IV included 496 85-year olds. Psychological well-being, living situation, demographics and social network was investigated through a questionnaire and an interview.

Results: Study I-II: There were no differences between the IVF and control group in the risk of receiving a PPD or PPP diagnosis. Having previously been diagnosed with any psychiatric, an affective or personality disorder increased  the risk of PPD while any previous psychiatric, psychotic, bipolar, depressive, anxiety or personality disorder diagnosis increased the risk of PPP. None of the women had committed suicide. Study III: The IVF women reported symptoms of higher intensity and were at increased risk of symptoms of depression, obsessive-compulsion and somatisation compared with the reference group. Childless women, compared with parents, reported a higher level of mental health problems as well as symptoms of depression and phobic anxiety. Study IV: No differences in psychological wellbeing, living situation or having friends close by were found across parental status groups. The childless 85-year olds were less likely to have relatives close by and to receive help.

Discussion: This thesis indicates that the risk of receiving a PPD or PPP diagnosis from in- or outpatient psychiatric care or of committing suicide during the first year postpartum is not increased in women who have undergone IVF treatment. Any negative effects of infertility and its treatment might have been mitigated by the “healthy patient effect”; those who choose to enter treatment are generally psychologically robust. A history of mental illness is a major risk factor for PPD and PPP. The risk of some adverse symptoms of mental illness might be increased in women who have undergone IVF treatment twenty years previously, especially in those who have remained childless. The childless elderly appear to have social networks of less support potential but are not more likely to live in institutional care and do not experience more adverse effects on psychological well-being than the elderly who are parents.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. , 110 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1554
National Category
Obstetrics, Gynecology and Reproductive Medicine Public Health, Global Health, Social Medicine and Epidemiology Geriatrics Family Medicine
Identifiers
URN: urn:nbn:se:liu:diva-132764DOI: 10.3384/diss.diva-132764ISBN: 9789176856376 (Print)OAI: oai:DiVA.org:liu-132764DiVA: diva2:1049117
Public defence
2016-12-16, Berzeliussalen, Campus US, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2016-11-23 Created: 2016-11-23 Last updated: 2016-11-23Bibliographically approved
List of papers
1. Risk of postnatal depression or suicide after in vitro fertilisation treatment: a nationwide case–control study
Open this publication in new window or tab >>Risk of postnatal depression or suicide after in vitro fertilisation treatment: a nationwide case–control study
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2016 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objective

To examine whether women who undergo in vitro fertilisation (IVF) treatment are at greater risk of postnatal suicide or postnatal depression (PND) requiring psychiatric care, compared with women who conceive spontaneously.

Design

Case–control study using data from national registers.

Setting

Sweden during the period 2003–2009.

Population

Cases were 3532 primiparous women who had given birth following IVF treatment. An aged-matched control group of 8553 mothers was randomly selected from the medical birth register.

Methods

Logistic regression analyses were performed with PND as the outcome, and with known risk factors of PND as well as IVF/spontaneous birth as covariates.

Main outcome measures

Postnatal depression (PND), defined as diagnoses F32–F39 of the tenth edition of the International Classification of Diseases (ICD–10), within 12 months of childbirth.

Results

Initial analyses showed that PND was more common in the control group than in the IVF group (0.8 versus 0.4%; P = 0.04); however, these differences disappeared when confounding factors were controlled for. A history of any psychiatric illness (P = 0.000; odds ratio, OR = 25.5; 95% confidence interval, 95% CI = 11.7–55.5), any previous affective disorder (P = 0.000; OR = 26.0; 95% CI = 10.5–64.0), or specifically a personality disorder (P = 0.028; OR = 3.8; 95% CI = 1.2–12.7) increased the risk of PND. No woman in either group committed suicide during the first year after childbirth.

Conclusions

Whereas mothers who receive IVF treatment are not at increased risk of PND, the risk is increased among mothers with a history of mental illness. Tweetable abstract A Swedish study on 3532 women showed that IVF treatment does not increase the risk of postnatal depression.

Place, publisher, year, edition, pages
Chichester: Wiley-Blackwell Publishing Inc., 2016
Keyword
In vitro fertilisation, infertility treatment, postnatal depression, postnatal mental illness
National Category
Obstetrics, Gynecology and Reproductive Medicine Public Health, Global Health, Social Medicine and Epidemiology Geriatrics Family Medicine
Identifiers
urn:nbn:se:liu:diva-132763 (URN)10.1111/1471-0528.13788 (DOI)26663705 (PubMedID)
Available from: 2016-11-23 Created: 2016-11-23 Last updated: 2016-12-01Bibliographically approved
2. Mental health in women 20-23 years after IVF treatment: a Swedish cross-sectional study
Open this publication in new window or tab >>Mental health in women 20-23 years after IVF treatment: a Swedish cross-sectional study
2015 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, no 10, e009426- p.Article in journal (Refereed) Published
Abstract [en]

Objective To assess self-perceived mental health in women treated with in vitro fertilisation (IVF) 20-23years previously, while comparing them to a reference group, and to determine any differences in mental health between those who had given birth, those who had adopted a child, those who had given birth and adopted a child and those who remained childless. Design A cross-sectional study. Setting A Center of Reproductive Medicine (RMC) at a Swedish University hospital. Participants 520 women who had undergone at least one IVF cycle at the University Hospital in Linkoping between 1986 and 1989. 504 of 520 women (97%) were eligible for follow-up. While 34 women declined, 93 per cent (n=470) of the women agreed to participate. The reference group consisted of 150 women of the Swedish population included in a study that was used to validate the Symptom CheckList (SCL)-90. Interventions Follow-up was conducted in 2008-2009. The SCL-90 was used to measure the womens self-perceived mental health and a questionnaire specific for this study was used to retain demographic information. Outcome measures The SCL-90 assesses 9 primary dimensions; somatisation, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism. There is also a global index of distress. Results Women who had previously undergone IVF treatment were at increased risk of symptoms of depression (p=0.017), obsessive-compulsion (p=0.02) and somatisation (p0.001) when compared to a reference group. In addition, the women who have remained childless are at increased risk of symptoms of depression (p=0.009) and phobic anxiety (p=0.017). Conclusions The majority of the women who have been treated with IVF 20-23years previously appear to be in good mental health. However, women who remain childless and/or without partner after unsuccessful infertility treatment constitute a vulnerable group even later on in life.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2015
Keyword
Infertility; childlessness; MENTAL HEALTH; IVF; depression
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-123849 (URN)10.1136/bmjopen-2015-009426 (DOI)000365467600111 ()26510732 (PubMedID)
Note

Funding Agencies|Health Research Council in the south east of Sweden

Available from: 2016-01-11 Created: 2016-01-11 Last updated: 2016-11-23
3. The influences of childlessness on the psychological well-being and social network of the oldest old
Open this publication in new window or tab >>The influences of childlessness on the psychological well-being and social network of the oldest old
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2011 (English)In: BMC Geriatrics, ISSN 1471-2318, Vol. 11, no 78Article in journal (Refereed) Published
Abstract [en]

Background: The ELSA 85 project is a population-based study with the purpose to learn more about the “elderly elderly”. The aim of this part of the ELSA 85 study is to explore the effects of childlessness on the psychological wellbeing, living situation and social support of 85-year old individuals.

Methods: A postal questionnaire was sent to all (650) 85-year old men and women living in Linköping Municipality in 2007. Psychological well-being and social network was measured using a number of questions.

Results: 496 individuals participated in the study. No differences in psychological wellbeing were found between the 85-year olds who were childless and those who were parents. The childless 85-year olds were less likely to have relatives close by and to receive help than those who were parents. Individuals of both groups were equally likely to end up in institutional care, to have friends close by and to be in contact with neighbours.

Conclusions: Even though elderly childless individuals have social networks of less support potential than those who are parents there are no differences in certain psychological wellbeing indicators between the two groups. Apparently, childless elderly individuals find ways to cope with whatever negative effects of childlessness they may have experienced.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-73616 (URN)10.1186/1471-2318-11-78 (DOI)000208731700078 ()
Available from: 2012-01-10 Created: 2012-01-10 Last updated: 2016-11-23Bibliographically approved

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