Impact of primary care posttraumatic stress disorder (PC-PTSD) on fertility problem of Iranian women with infertility during the COVID-19 pandemic.

BACKGROUND: Infertility continued to be a major stressor among women with infertility during COVID-19pandemic. This study aimed to evaluate the impact of primary care posttraumatic stress disorder (PC-PTSD) on fertility problem of Iranian women with infertility during COVID-19 pandemic. METHOD: In this cross-sectional study, 386 women with infertility completed the questionnaires of PC-PTSD-5 and Fertility Problem Inventory (FPI) at an infertility center between 2020 and 2022. RESULTS: The mean of fertility problems was 145.20 (± 32.31). In terms of FPI subscales, the means were as follows: Sexual concern 21.80 (± 7.58), social concern 26.53 (± 8.94), relationship concern 26.02 (± 9.18), need for parenthood concern 40.88 (± 8.98), and rejection of childfree lifestyle 29.96 (± 7.69). The highest mean of FPI subscales was related to the need for parenthood concern in women with infertility. The strongest correlation was found between the subscales of sexual concern and social concern followed by sexual concern and relationship concern. The variables of PC-PTSD were a predictor of fertility problems (ß = 0.203, P < .0001). Additionally, the variables of PC-PTSDwere a predictor of sexual concern (ß = 0.248, P < .0001), social concern (ß = 0.237, P < .0001), relationship concern (ß = 0.143, P < .020), and need for parenthood concern (ß = 0.101, P < .010). After adjusting for demographic characteristics, there was a significant relationship between FPI with job (ß=-0.118, P < .031), education (ß=-0.130, P < .023), living place (ß = 0.115, P < .035), smoking (ß = 0.113, P < .036), relationship with husband (ß = 0.118, P < .027), and PC-PTSD symptom (ß = 0.158, P < .0001). In addition, the multivariate linear regression showed a significant association between sexual concern and education (ß=-0.152, P < .008), smoking (ß = 0.129, P < .018), PC-PTSD symptom (ß = 0.207, P < .0001); social concern and job (ß=-0.119, P < .033), PC-PTSD symptom (ß = 0.205, P < .0001); relationship concern and education (ß=-0.121, P < .033), living place (ß = 0.183, P < .001), relationship with husband (ß = 0.219, P < .0001); and rejection of childfree lifestyle and job (ß=-0.154, P < .007). CONCLUSION: Systematic PTSD screening during COVID-19 pandemic by healthcare providers can be uniquely used to identify, evaluate, and treat trauma-related health conditions in infertility settings, which can link women with infertility to mental health services. This can be novel and useful for future policymakers and practitioners in the infertility field.

Depression and anxiety in adolescents and young women with polycystic ovary syndrome: a systematic review and meta-analysis.

OBJECTIVES: To evaluate the depression and anxiety symptoms, or both in adolescents and young women with polycystic ovary syndrome (PCOS) to those without PCOS. CONTENTS: A comprehensive electronic search was conducted to identify observational studies on PCOS patients (January 1991-December 2020). The population study included adolescents and young women (14-29 years of age) in two groups of cases (with PCOS) and controls (without PCOS) who were diagnosed with PCOS using the Rotterdam or National Institutes of Health criteria (NIH). Symptoms of depression, anxiety, or both, reported separately, were of interest. Mean (SD) of depression or anxiety symptoms, or both, as measured by a quantitatively validated scale for both the case and control groups. All eligible studies were quality assessed using the Newcastle-Ottawa Scale (NOS) tool. The initial database search resulted in the discovery of 1,582 papers, of which 806 were selected after screening the titles and abstracts and removing duplicates. A total of 49 papers were found to be suitable for full-text reading. This meta-analysis included ten studies comprising 941 adolescent/young women (391 with PCOS and 550 without PCOS). The standard mean difference (SMD) and its corresponding confidence interval (CI) at 95 % were used to compare depression or anxiety symptoms, or both, between two groups. SUMMARY AND OUTLOOK: The results, which included 192 cases, demonstrated that adolescents/young women with PCOS had significantly more depressive symptoms than those without PCOS (n=360) (SMD 0.72; 95 % CI, 0.09-1.34; Z=2.25, p=0.025; Heterogeneity: I2=89.7 %; p=0.000). Also, the results which included 299 cases demonstrated that adolescents/young women with PCOS had significantly more anxiety symptoms than those without PCOS (n=421) (SMD 0.59; 95 % CI, 0.13-1.05; Z=2.51, p=0.012; Heterogeneity: I2=86.1 %; p=0.000). This meta-analysis demonstrates that adolescent/young women with PCOS have significantly more depression or anxiety symptoms than those without PCOS.

Psychiatric Symptoms in Women with High-risk Pregnancy in the Postpartum Period: A Case-control Study

Abstract Objective: Psychiatric symptoms are common mental issues in pregnancy and the postpartum period. There is limited information regarding the psychiatric symptoms of women with high-risk pregnancy in the postpartum period. This study aimed to compare the severity of psychiatric symptoms and psychological distress in women with high-risk and low-risk pregnancies in the postpartum period. Methods: This case-control study examined 250 women in the postpartum period in two groups with low-risk (n = 112) and high-risk (n = 138) pregnancies. Women completed the Brief Symptom Inventory-53 (BSI-53) and the Risk Postnatal Psychosocial Depression Risk Questionnaire (PPDRQ). Results: The mean severity of psychiatric symptoms in women with high-risk pregnancies was significantly higher than that in women with low-risk pregnancies (39.34 ± 17.51 vs. 30.26 ± 17.08). Additionally, the frequency of psychological distress in women with high-risk pregnancies was approximately twice higher than that in women with low-risk pregnancies (30.3% vs. 15.2%). Furthermore, the risk factors for depression in women with high-risk pregnancies were almost 1.5 times (59.8% vs. 39.8%) higher than the factors in women with low-risk pregnancies. The results of the logistic analysis indicated that high-risk pregnancies could be twice the odds ratio of developing postpartum psychological distress (ß = 2.14, 95% CI 1.4-6.3, p= 0.036). Conclusion: Psychiatric symptoms and the psychological distress index are higher in postpartum women with high-risk pregnancies than in postpartum women with low-risk pregnancies. The study suggests that obstetricians and pregnant women's health care providers should strongly consider screening of psychiatric symptoms in women with high-risk pregnancies both during pregnancy and after delivery as the women's routine care priorities.

Psychiatric Symptoms in Patients and Caregivers with Parkinson's Disease.

OBJECTIVES: Psychiatric disorders in patients with Parkinson's disease (PD) and their caregivers play an important role in patients' treatment and follow-up. Our study aimed to examine the prevalence of psychiatric symptoms among patients with PD and their caregivers, demographic risk factors, and the influence of severity and manifestations of PD on psychiatric distress. METHODS: We included 125 patients with PD and 125 of their primary caregivers in this descriptive cross-sectional study. The severity of PD was evaluated according to the Hoehn and Yahr severity scale from the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale. PD patients and their caregivers completed the Symptom Checklist-25 to determine the presence of psychiatric distress. Also, demographic factors, including age, high level of education, occupation, residence, and cigarette smoking, were assessed in the PD patients and their caregivers. RESULTS: The prevalence of psychiatric distress was 47.2% for PD patients and 18.4% for caregivers. Female sex, city residency, and medical disease were risk factors for more psychiatric symptoms in PD patients. Also, the female sex, single status, living in a village, and having a medical disease were risk factors for greater psychiatric symptoms in caregivers. PD patients in more advanced stages of disease suffered significantly from psychiatric distress, somatization, anxiety, interpersonal sensitivity, obsessive-compulsive disorder, and phobia compared to the lower severity of disease. PD patients with manifestation of postural instability showed a higher score of somatization, phobia, and psychiatric distress as compared with tremor, hypokinesia, and rigidity. CONCLUSIONS: Progression of PD influenced the psychiatric symptoms of both patients and their caregivers. A higher stage of PD is associated with higher scores of psychiatric distress, phobia, and somatization in the patients and their caregivers.

Mental and personality disorders in infertile women with polycystic ovary: a case-control study.

BACKGROUND: Polycystic Ovarian Syndrome (PCOS) is one of the most common causes of infertility in women. OBJECTIVE: The current study investigated mental and personality disorders in infertile women with and without PCOS. METHODS: This case-control study evaluated 400 infertile women who referred to the Infertility Center in Babol city (North of Iran). Participants were categorized into the case group (201 PCOS) and the control group (199 without PCOS). All of the participants completed the Millon Clinical Multi-axial Inventory-III (MCMI-III). RESULTS: The mean scores for clinical personality patterns were significantly higher for six personality disorders (schizoid, avoidant, antisocial, depressive, sadistic, and negativistic) and for three classes of severe personality disorder patterns (schizotypal, borderline, and paranoid) in infertile women with PCOS than in women without PCOS. The mean scores for eight clinical disorders (somatoform, manic disorder, dysthymia, alcohol-dependence, drug-dependence, post-trauma stress disorder, major depression, and delusion disorder) were also higher in infertile women with PCOS than in women without PCOS. CONCLUSION: The scores of many mental and personality disorders are higher in infertile women with PCOS than in women without PCOS. Thus, clinicians should prioritize recognizing and treating psychological problems of infertile women with PCOS.

Differences between infertile women with and without PCOS in terms of anxiety, coping styles, personality traits, and social adjustment: a case-control study.

PURPOSE: The aim of the study was to identify differences in the level of anxiety, stress coping ways, personality traits, and social adjustments in infertile women with polycystic ovary syndrome (PCOS) compared to those without PCOS. METHODS: In a case-control study, 257 infertile of women were recruited at Fatemeh Azahra Infertility and Reproductive Health Research Center (Babol, Iran) from May 2016 to December 2017. A total of 135 women with PCOS and 122 women without PCOS completed the following questionnaires; State-Trait Anxiety Inventory (STAI), Ways of Coping Questionnaire (WCQ), NEO Five-Factor Inventory (NEO-FFI), and Bell's Adjustment Inventory. RESULTS: Infertile women with PCOS had a higher mean score of trait anxiety than those without PCOS (46.19 ± 5.29 vs 44.49 ± 5.13, P = 0.004), but no difference was observed for state anxiety. The two groups did not have any significant differences in the mean scores of social adjustment and ways of coping, except for social support and problem-focused coping which were higher in the PCOS group. The PCOS personality traits of PCOS infertile women were not different regarding neuroticism, extraversion, agreeableness, conscientiousness. The only exception was that infertile PCOS women had a significantly higher mean score of openness to experience than those without PCOS (P = 0.049). CONCLUSIONS: Clinicians could take advantage of the psychological differences of infertile women with PCOS and without PCOS for better management of PCOS in infertility settings; despite higher levels of anxiety they are more likely to cope with stress and are welcome to new experiences.

The role of long-term psychodynamic psychotherapy in improving attachment patterns, defense styles, and alexithymia in patients with depressive/anxiety disorders / O papel da psicoterapia psicodinâmica de longo prazo na melhora de padrões de apego, estilos de defesa e alexitimia em pacientes com transtornos depressivos e de ansiedade

Abstract Introduction Long-term psychodynamic psychotherapy (LTPP) emphasizes the centrality of intrapsychic and unconscious conflicts and their relation to development. Although there is evidence supporting the efficacy of LTPP in mental disorders, little research has been published on the efficacy of LTPP for depressive and anxiety disorders. Objective To examine whether patients with anxiety and depressive disorders demonstrate improvement in their attachment styles, defense styles, psychiatric symptoms, anxiety/depressive symptoms, and alexithymia with LTPP. Methods In this retrospective, descriptive study, the psychological outcomes of patients who were treated at the psychoanalytic clinic of Babol University of Medical Sciences were assessed. Fourteen patients diagnosed with depressive or anxiety disorder participated in the study of LTPP using the self-psychology approach. The Beck Depression Inventory II, Beck Anxiety Inventory, Adult Attachment Scale, 40-item Defense Style Questionnaire, and the 20-item Toronto Alexithymia Scale were administered at pre-treatment, post-treatment, and 6-month follow-up. Generalized estimating equations were used to analyze changes in psychological outcomes after each of the three assessments. Results The mean scores of depression and anxiety and secure attachment improved significantly after LTPP with self-psychology approach from baseline to post-treatment and follow-up. Also, the mean scores of neurotic and immature defenses, difficulty in identifying feelings, difficulty in describing feelings, externally oriented thinking, and total alexithymia scores decreased significantly from baseline to post-treatment and follow-up. Conclusion Symptoms of anxiety disorders, depressive disorders, insecure attachment styles, alexithymia, and neurotic/immature defense styles improved after the LTPP with self-psychology approach. Moreover, the improvements persisted at the 6-month follow-up.

Resumo Introdução A psicoterapia psicodinâmica de longo prazo (PPLP) enfatiza a centralidade dos conflitos intrapsíquicos e inconscientes e sua relação com o desenvolvimento. Apesar da evidência em favor da eficácia da PPLP em transtornos mentais, há poucos dados sobre a eficácia da PPLP em transtornos de depressão/ansiedade. Objetivo Examinar se pacientes com transtornos de depressão/ansiedade demonstram melhora em seus estilos de apego, estilos defensivos, sintomas psiquiátricos, sintomas de ansiedade/depressão e alexitimia com PPLP. Métodos Neste estudo retrospectivo, descritivo, os desfechos psicológicos de pacientes tratados na clínica psicanalítica da Babol University of Medical Sciences foram avaliados. Quatorze pacientes com diagnóstico de transtorno de depressão ou ansiedade participaram do estudo sobre PPLP com abordagem de psicologia do self. O Inventário de Depressão de Beck II, o Inventário de Ansiedade de Beck, a Escala de Apego do Adulto, o Questionário de Estilo de Defesa-40 e a Escala de Alexitimia de Toronto-20 foram administrados antes e após o tratamento e no seguimento de 6 meses. Equações de estimação generalizadas foram usadas para analisar mudanças nos desfechos psicológicos após cada avaliação. Resultados Os escores médios de depressão/ansiedade e apego seguro melhoraram significativamente após PPLP com abordagem de psicologia do self do início do estudo ao pós-tratamento e seguimento. Além disso, os escores médios de defesas neuróticas e imaturas, dificuldade em identificar sentimentos, dificuldade em descrever sentimentos, pensamentos orientados externamente e escores totais de alexitimia diminuíram significativamente do início do estudo ao pós-tratamento e seguimento. Conclusão Sintomas de transtornos de ansiedade, transtornos depressivos, estilos de apego inseguro, alexitimia e estilos de defesa neuróticos/imaturos melhoraram após PPLP com abordagem de psicologia do self. Além disso, as melhoras persistiram no seguimento de 6 meses.

Psychosocial Predictors of Cognitive Impairment in the Elderly: A Cross-Sectional Study.

Objective: Cognitive impairment is a major public health problem among elderly population. The aim of this study was to assess some psychosocial predictors of cognitive impairment (age, education, living alone, smoking, depression and social support) in the Iranian elderly population. Method : A total of 1612 elderly (over 60 years) were enrolled in this cross-sectional study. Cognitive function was assessed using Mini Mental State Examination (MMSE). In addition, data from psychological tests and demographic characteristics were analyzed. Results: Older age, low education level, living alone, smoking, depressive symptoms, and lower social support were associated with an increased risk of cognitive impairment. Ages 70 to 74 (OR = 3.47; 95% CI, 2.13-5.65), 75 to79 (OR = 3.05; 95% CI, 2.11-4.41) and 80 to 85 (OR = 5.81; 95% CI, 2.99-11.22) and depression symptoms (OR = 1.64; 95% CI, 1.27-2.13) were significant positive predictors, whereas social support with scores ranging from 26 to 30 (OR =0. 32; 95% CI, 0.16-0.62) and 31 to 33 (OR =0.29; 95% CI, 0.14-0.61) and more than 5 years of education (OR = 0.19; 95% CI, 0.14-0.27) were the negative predictors of cognitive impairment. Conclusion: The findings suggest older age and depression as positive predictive factors and higher education level and social support as negative predictive factors of cognitive impairment in the elderly population.

Associations of psychosocial factors with pregnancy healthy life styles.

Healthy behaviors in pregnant women have a major effect on pregnancy outcomes; however, only few studies have explored the relationship of multiple psychosocial factors with healthy lifestyles during pregnancy. The objective of this study was to investigate whether the five psychosocial factors of anxiety, stress, depression, marital dissatisfaction, and social support are associated with six domains of healthy lifestyles in pregnant women, including nutrition, physical activity, health responsibility, stress management, interpersonal relationships, and self-actualization. In this cross-sectional study, 445 pregnant women from the obstetrics clinics of the teaching hospitals of Babol University of Medical Sciences were included. The subjects answered six questionnaires, including the Health-Promoting Lifestyle Profile, Beck Depression Inventory, Prenatal Distress Questionnaire, State-Trait Anxiety Inventory, Social Support Questionnaire, and Marital Satisfaction Scale. We developed a series of simple linear regression models based on each subscale of lifestyle (nutrition, physical activity, health responsibility, stress management, interpersonal relationships, and self-actualization) as the dependent variables and the five psychological variables (anxiety, stress, depression, marital dissatisfaction, and social support) as the independent variables. State and trait anxieties were the strongest negative predictors of all aspects of a healthy lifestyle. Furthermore, depression was negatively associated with all of the six subscales of a healthy lifestyle. Pregnancy-specific stress was the only negative predictor of stress management and self-actualization. Marital dissatisfaction was negatively associated with nutrition, stress management, health responsibility, and self-actualization. Social support had negative and positive associations with healthy behaviors. The study suggests that more attention should be paid to identifying the psychological risk factors in pregnancy in addition to providing suitable interventions for improving the lifestyle of pregnant women.

Marital Intimacy and Predictive Factors Among Infertile Women in Northern Iran.

INTRODUCTION: Infertility is a stressful state that may decrease attachment between spouses. Marital intimacy is a real need in infertile women. AIM: The aim of this study was to evaluate marital intimacy and predictive factors among infertile women in Northern Iran. MATERIALS AND METHODS: This cross-sectional study was conducted at Fatemeh Zahra Infertility and Reproductive Health Center of Babol Medical Sciences University in 2014. A total of 221 infertile women participated in this study. The instrument used in this research was Marital Intimacy Need Questionnaire (MINQ). Statistical analyses was performed using linear and logistic regression with p<0.05 indicating statistical significance. RESULTS: An 88.5% of infertile women had good marital intimacy. The mean and standard deviation of the marital intimacy was 349.11±49.26 and in marital intimacy domains including: emotional (42.28±7.23), psychological (41.84±7.59), intellectual (42.56±7.46), sexual (42.90±7.41), physical (43.59±6.96), spiritual (51.61±8.06), aesthetic (42.66±6.75), and social intimacy (42.59±6.89). The highest mean of marital intimacy domains is related to spirituality in infertile women. Physical and sexual domains had the high mean in infertile women. The lowest mean in marital intimacy domains was psychological intimacy. There was a significant correlation between the domains of marital intimacy. The strongest correlation was between the physical and sexual intimacy (r=0.85). There was a significant inverse association in marital intimacy with the age difference of spouses (p<0.01), and tobacco use (p<0.02). There was a statistically significant association in the marital intimacy with husband's occupation, and cause of infertility (p<0.02). CONCLUSION: Early screening and psychosocial intervention strategies suggest in the setting of female infertility to identify and prevent the predictive factors that may cause marital conflict.

Gender-Specific Predictors of Depressive Symptoms among Community Elderly.

BACKGROUND: We aimed to determine the gender-specific predictors of depressive symptoms among an Iranian elderly community population. STUDY DESIGN: A cross-sectional study. METHODS: This study was performed on elderly subjects (aged ≥60 yr) who participated in the Amirkola Health and Aging Project, Amirkola, Babol, northern Iran in 2011-12. Depression was assessed by the Geriatric Depression Scale. Fourteen variables, including marital status, age, education, occupation, living alone, social support, dependency in daily activities, physical activity, smoking, body mass index, chronic pain, medicine use, comorbidities, and cognitive impairment, were analyzed as predictors of depression. RESULTS: In males, age group of 80-84 yr (odds ratio (OR)=0.22, 95% confidence interval (CI): 0.09, 0.55), occupation (OR=0.62, 95% CI: 0.42, 0.90) and social support (OR=0.82, 95% CI: 0.77, 0.88) had protective effects against depression, and smoking (OR=1.67, 95% CI: 1.15, 2.44), cognitive impairment (OR=2.18, 95% CI: 1.34, 3.45) and comorbidities(OR=1.42, 95% CI: 1.27, 1.60) were found as risk factors. In females, social support (OR=0.97, 95% CI: 0.65, 1.44) and higher education (OR=0.10, 95% CI: 0.01, 0.84) were two protective factors against depression, and being unmarried (OR=1.88, 95% CI: 1.13, 2.35), cognitive impairment (OR=1.50, 95% CI: 1.01, 2.21), comorbidities(OR=1.30, 95% CI: 1.18, 1.44) and chronic pain (OR=1.57, 95% CI: 1.01, 2.44) were four positive predictors of depression. CONCLUSIONS: There were both similarities and differences in predictors of depression between old males and females. These findings suggest physicians and healthcare executives consider gender-specific risk/protective factors to improve preventive mental health programs in older males and females.

Endometrial thickness and pregnancy outcome after intrauterine insemination.

OBJECTIVES: To investigate whether endometrial thickness on the day of hCG administration is a predictor of intrauterine insemination (IUI) success. DESIGN: A retrospective study. PATIENT(S): Two hundred forty-nine women undergoing IUI cycles. SETTING: University hospital-based infertility center. INTERVENTION(S): Endometrial thickness on the day of hCG administration, cycle parameters, and sperm quality were compared between pregnant and nonpregnant patients. A similar comparison was made between ongoing pregnancies and those that resulted in a loss. MAIN OUTCOME MEASURE(S): Endometrial thickness versus IUI outcome. RESULT(S): The overall pregnancy rate was 15%. Mean (+/- standard deviation) endometrial thickness on the day of hCG administration was significantly greater in cycles where pregnancy was achieved (10.1 +/- 3.0 vs. 7.7 +/- 3.5). In the univariate analysis, the following variables affected the pregnancy rate: the woman's age, duration of infertility, the number of IUI cycles, the number of follicles, the diameter of the dominant follicle, the duration of follicle maturation, and sperm count, motility, and morphology. In the multivariate analysis, the strongest predictor of IUI success was the number of IUI cycles. The woman's age was negatively associated with pregnancy outcome, while endometrial thickness and the total motile sperm count were positively associated with pregnancy outcome. CONCLUSION(S): The results of the present study suggest that clinicians providing IUI for infertile couples must pay close attention to endometrial development as well as to follicle growth and sperm motility.

Comparison of in vitro fertilization outcome in women with and without sonographic evidence of polycystic ovarian morphology.

OBJECTIVE: This study compared the outcome of in vitro fertilization (IVF) treatment in women who had polycystic ovaries (PCO) seen on an ultrasound scan, but who had no clinical symptomatology associated with polycystic ovary syndrome, with that of women who had normal ovarian morphology on ultrasound examination. METHODS: Outcome of IVF 39 women with PCO evidence by ultrasound compared with 102 women, who had normal ovarian morphology by ultrasound. All 141 women had normal early follicular phase serum follicle stimulating hormone (FSH) concentration, were less than 40 years of age and used the long protocol pituitary suppression with gonadotropin-releasing hormone agonist therapy. RESULTS: On average, the women with PCO produced more follicles and oocytes than the women with normal ovaries, but the fertilization cleavage and pregnancy rates were similar. CONCLUSION: Although the response to follicular stimulation in PCO women is better than that for women with normal ovaries, the outcome of pregnancy in vitro fertilization is similar.