Alexithymia and fertility-related stress.

The investigation of the relationship between alexithymia, the inability to identify and describe feelings and the absence of fantasies, and fertility-related distress is a relatively neglected area of research. The aims of this study were to examine: (1) the prevalence of alexithymia in a sample of infertile women, and (2) the association between alexithymia, coping strategies, and fertility-related stress. This study included 160 infertile women undergoing in vitro fertilization in a public fertility clinic from September of 2013 to December of 2013. Self-report instruments were used to measure alexithymia (Toronto Alexithymia Scale-20), coping (COPE), and fertility-related stress (Fertility Problem Inventory). Bivariate and multiple linear regression were used. A high alexithymia score was positively associated with age, infertility duration, and low educational and economic level. Multivariate analyses showed that, controlling for demographic factors, high avoidance coping, low problem-appraisal coping, and high alexithymia were positively associated with fertility-related stress (ß = 0.309, p < .001, ß = -0.203, p = .006, ß = 0.151, p = .050, respectively). Results of this study indicated that alexithymia during fertility treatment was associated with maladaptive coping strategies and psychological stress. In addition, the association between alexithymia and duration of infertility may be interpreted as secondary alexithymia acts as a coping strategy in infertile women.

Is the residential combined (psychotherapy plus medication) treatment of patients with severe personality disorder effective in terms of suicidality and impulsivity?

The aim of this study was to compare the effectiveness of combined treatment-medication plus psychodynamic psychotherapy-and psychodynamic psychotherapy alone on the outcome variables of suicidality and impulsivity in a population of adult inpatients with severe personality disorder (SPD). This is a naturalistic-empirical (observational) study under the conditions of clinical practice (an intensive specialized inpatient psychotherapeutic program [SIPP]). The sample consisted of 33 inpatients with SPD who were allocated to two subgroups (groups A and B). The patients in group A received psychodynamic psychotherapy and adjunctive pharmacotherapy, whereas the patients in group B received multimodal psychodynamic psychotherapy only. A statistically significant reduction in suicidality score was observed in the patients in group A, whereas a tendency for significant reduction in impulsivity score was observed in group B after the SIPP termination. Pharmacotherapy combined with multimodal psychodynamic psychotherapy, always within the SIPP, seems more effective in the case of suicidality rather than impulsivity.

Perception of control, coping and psychological stress of infertile women undergoing IVF.

The study aimed to examine: (i) the association between perception of infertility controllability and coping strategies; and (ii) the association between perception of infertility controllability and coping strategies to psychological distress, applying multivariate statistical techniques to control for the effects of demographic variables. This cross-sectional study included 137 women with fertility problems undergoing IVF in a public hospital. All participants completed questionnaires that measured fertility-related stress, state anxiety, depressive symptomatology, perception of control and coping strategies. Pearson's correlation coefficients were calculated between all study variables, followed by hierarchical multiple linear regression. Low perception of personal and treatment controllability was associated with frequent use of avoidance coping and high perception of treatment controllability was positively associated with problem-focused coping. Multivariate analysis showed that, when controlling for demographic factors, low perception of personal control and avoidance coping were positively associated with fertility-related stress and state anxiety, and problem-appraisal coping was negatively and significantly associated with fertility-related stress and depressive symptomatology scores. The findings of this study merit the understanding of the role of control perception and coping in psychological stress of infertile women to identify beforehand those women who might be at risk of experiencing high stress and in need of support.

Occupational social class, coping responses and infertility-related stress of women undergoing infertility treatment.

AIM AND OBJECTIVES: The aims of this study were to examine the association between (1) occupational social class and coping responses, (2) coping responses and infertility-related stress and (3) occupational social class and infertility-related distress. BACKGROUND: The coping strategies that individuals use in most of the stressful situations vary according to certain factors, such as, the appraised characteristics of the stressful condition, personality dispositions and social resources. DESIGN: This study was a cross-sectional survey. METHODS: The study involved 404 women undergoing infertility treatment at a public clinic in Athens, Greece. State and trait anxiety (State-Trait Anxiety Inventory), infertility-related stress (Copenhagen Multi-centre Psychosocial Infertility) and coping strategies (Copenhagen Multi-centre Psychosocial Infertility) were measured. RESULTS: Women of low/very low social class reported higher levels of active-confronting coping compared with women of higher social class (p < 0·001). A positive correlation between active-avoidance coping and both state and trait anxiety (r = 0·278 and 0·233, respectively, p < 0·01) was observed. The passive-avoidance coping scale was positively correlated with marital and personal stress (r = 0·186 and 0·146, respectively, p < 0·01). All three kinds of stress (marital, personal and social) were positively correlated with both active-avoidance (r = 0·302, 0·423 and 0·211, respectively, p < 0·01) and active-confronting scale (r = 0·150, 0·211 and 0·141, respectively, p < 0·01). CONCLUSIONS: Infertile women of the lowest social class used more active-confronting coping and more passive-avoidance coping than women of the highest social class. Factors such as low social class and maladaptive coping strategies might contribute to infertility-related stress and anxiety. RELEVANCE TO CLINICAL PRACTICE: Nurses and midwives who work in infertility clinics should aim to identify individuals who are at high risk for infertility stress and adjustment difficulties and they should minimise the identified risk factors for infertility-related stress and strengthen the protective factors.

The relation of psychological stress to pregnancy outcome among women undergoing in-vitro fertilization and intracytoplasmic sperm injection.

A considerable literature has been accumulated regarding the relation of psychological factors to in-vitro fertilization outcome. However, study findings have been inconsistent, and the association between psychological stress and in-vitro fertilization outcomes is still unclear. The aim of the authors in this study was to examine the relation of infertility-related stress, anxiety, and depressive symptoms to in-vitro fertilization outcome. The sample consisted of 160 women with fertility problems undergoing fertility treatment in a public hospital in Athens, Greece between November 2008 and July 2009. The relation of infertility-related stress, anxiety, and depressive symptoms to in-vitro fertilization outcome was assessed by using hierarchical, sequential logistic regression, while controlling for the effects of relevant biomedical factors. After the embryo transfer, 41 women (26%) had a positive pregnancy outcome. Logistic regression analyses revealed that, controlling for biomedical factors (age, number of oocytes retrieved, and embryos transferred) infertility-specific stress (OR = 0.964, p = .011) and nonspecific anxiety (OR = 0.889, p = .006) were negatively associated with a positive pregnancy outcome after IVF. Psychological stress was negatively associated with in-vitro fertilization outcome, after controlling for biomedical variables. Fertility treatment protocols should consider including counselling interventions to potentially mitigate adverse effects of stress.

Primary appraisal of infertility: evaluation of the psychometric properties of a Greek version of the Appraisal of Life Events scale (ALE) in a Sample of infertile women undergoing fertility treatment.

The Appraisal of Life Events is a self-report questionnaire that can be used retrospectively, asking respondents to reflect on the impact of a previously experienced event. The aim of this study was to examine the psychometric properties of the Greek version of the Appraisal of Life Events scale. The sample consisted of 137 women facing fertility problems and undergoing fertility treatment in a public hospital in Athens, Greece. The Appraisal of Life Events was 'forward-backward' translated from English to Greek language and was then pilot-tested to determine comprehensibility. Factor structure was investigated using exploratory factor analysis. Measures of stress (infertility-related stress, anxiety, depressive symptoms, mood states), personality traits (neuroticism, extraversion, optimism) and coping strategies were used to assess the convergent validity of the Appraisal of Life Events. Cronbach's α was used to measure internal consistency reliability. Two Appraisal of Life Events factors emerged from exploratory factor analysis. The threat and loss items were grouped together to form one factor. The original subscale of the challenge appraisal was reproduced. Convergent validity was confirmed by computing correlations between the two derived Appraisal of Life Events scales and the measures of stress, personality traits, and coping strategies. Internal consistency reliability was satisfactory (α = .79-.95). The Appraisal of Life Events had a meaningful factor structure and satisfactory reliability and convergent validity.

Appraisal of life events scale in a sample of Greek infertile women undergoing fertility treatment: a confirmatory factor analysis.

OBJECTIVE: to examine the construct validity of the Greek version of the Appraisal of Life Events (ALE) scale, originally developed by Ferguson et al. (1999), in a sample of infertile women. As there are no data concerning the validity of the ALE scale in infertile populations, a special focus was placed on construct validity through confirmatory factor analysis (CFA). SETTING: public hospital in Athens, Greece. DESIGN: cross-sectional study. PARTICIPANTS: 160 women undergoing fertility treatment with in-vitro fertilisation. METHODS: the ALE scale was 'forward-backward' translated from English to Greek. The translated instrument was then administered to a set of infertile women for pilot testing. CFA was used to test the construct validity of the ALE scale. FINDINGS: CFA supported the superiority of a model with three correlated first-order factors (challenge, threat and loss) and one second-order factor (stress appraisal) that underlay the first-order factors of threat and loss. CONCLUSION: the ALE scale was found to have a multidimensional structure. IMPLICATIONS FOR PRACTICE: the assessment of infertility appraisal during in-vitro fertilisation through a valid instrument may lead to the identification of women who are at greater risk of experiencing high stress, not only during fertility treatment but also during pregnancy and postnatal period in case of a successful IVF treatment.