Predictors of nonresponse to treatment and low adherence to internet-based cognitive behavioral therapy in depressed/anxious women facing the couple's fertility problems: a secondary analysis of a randomized control trial.

BACKGROUND: The study aimed to examine the predictors of treatment nonresponse and low adherence to Internet-based cognitive behavioral therapy and face-to-face therapy for treating depression and anxiety in women facing the couple's fertility problems. METHODS: This is a secondary analysis based on a previous randomized controlled trial including 152 depressed/anxious women facing the couple's fertility problems. The study defines low adherence as receiving less than 4 sessions (out of 8 sessions). Nonresponse to treatment refers to a < 50% reduction in the anxiety and depression total scores. RESULTS: A high level of anxiety/depression score before psychotherapy increases the risk of nonresponse to both Internet-based and face-to-face psychotherapies by 1.4 to 2 times in women facing the couple's fertility problems after the treatment and in the 6-month follow-up. However, 4 factors, including diagnosis of mixed anxiety and depression, low education level, long marriage duration, and infertility caused by mixed female/male factors, reduced the risk of nonresponse to psychotherapies. CONCLUSION: Women facing the couple's fertility problems with high depression and anxiety scores are at risk of poor prognosis in response to psychotherapy. Psychologists and healthcare providers of infertility centers should pay more attention to the timely identification and referral of depressed/anxious patients to psychologists.

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.

Therapist-guided internet-based cognitive behavioral therapy versus face-to-face CBT for depression/anxiety symptoms in infertile women with adjustment disorders: A randomized controlled trial.

OBJECTIVE: The present study compared the effectiveness of ICBT to face-to-face CBT on the improvement of adjustment disorder symptoms in infertile women. Method: In a pragmatic, multi-center (public or private), single-blinded, non-inferior randomized controlled trial (RCT), 152 patients with AD (100 women in public center and 52 women in private canter) were assigned to ICBT and CBT. Primary outcomes were Adjustment Disorder New Module-20 (ADNM-20) and Hospital Anxiety and Depression (HADS). Secondary outcomes were the Fertility Problem Inventory (FPI) and Fertility Adjustment Scale (FAS). Results: "Peaceful mind" ICBT was feasible and accessible for delivering the treatment to infertile women with AD. At end-of-treatment, improvements in ICBT were non-inferior to CBT for symptoms of AD, anxiety, and depression. Additionally, the non-inferiority of ICBT to CBT was maintained at a three-month follow-up. Conclusions: ICBT was non-inferior to CBT in improving mental symptoms in infertile women with AD.

Health-promotion and health-harming behaviours in pregnant women: role of coping strategies, anxiety, and depression.

There is a lack information on psychological predictors of health-promotion and health-harming behaviours during pregnancy. The study aimed to examine whether psychological factors including anxiety, depression, and coping strategies could predict the health-promotion and health-harm behaviours of pregnant women. In a cross-sectional study 200 pregnant women with singleton pregnancies, older than 18 years, and with at least 5 years of education were enrolled. The participants completed four questionnaires during their prenatal care appointments. The questionnaires included the prenatal health behaviour scale (PHBS), Revised Prenatal Coping Inventory (NU-PCI), Beck Depression Inventory (BDI-II), and State-Anxiety Inventory. The results revealed that planning-preparation coping was a strong positive independent variable associated with healthy behaviours (health-promoting behavioural/nutrition (ß = 0.800, p = .001); health-promoting physical activity (ß = 0.191, p = .049)). It was negatively associated with unhealthy behaviours (health-harming behavioural/nutrition (ß = 0.290, p < .001) as well as health-harming physical activity (ß = -0.290, p = .010)). Anxiety was significantly associated negatively with healthy behaviours. Depression was the strongest positive independent variable correlated with health-harming behavioural/nutrition (ß = 0.290, p < .001). Finally, avoidance coping (ß = 0.179, p = .037) was significant for health-harming physical activity.Impact statementWhat is already known on this subject? Previous studies have shown that there is a correlation between psychological factors and healthy behaviours of pregnant women.What do the results of this study add? The findings highlight the significant roles of coping strategies, anxiety, and depression for predicting healthy or unhealthy behaviours of pregnant women.What are the implications of these findings for clinical practice and/or further research? The findings implied that pregnant women who use more adaptive coping strategies, especially planning- preparing coping, reported lower levels of anxiety/depression and engaged more in healthy behaviours. The study also suggests that obstetricians and health care providers should pay more attention to the roles of coping strategies, especially planning-preparation and avoidance coping, anxiety, and depression in improving health-promotion/health-harming behaviours of pregnant women.

Preliminary examination of acceptability, feasibility, and effectiveness of internet-based cognitive behavioral therapy for treatment of depression and anxiety in infertile women.

Background: Despite a large body of evidence supporting the effectiveness of internet-based cognitive behavior therapy (ICBT) for the treatment of depression and anxiety, there is no report of the efficacy of ICBT program in the Iranian population. The present study aimed to test the acceptability, feasibility, and effectiveness of ICBT program for the treatment of depression or anxiety in infertile women. Method: This study consisted of two phases. In the first phase, we designed "Peaceful Mind", an eight-session therapist-guided ICBT program. In the second phase, we tested the efficacy of the program by conducting 2-arm parallel group, non-inferiority randomized control trial, between October 2020 and July 2021.60 infertile women diagnosed with depression or anxiety disorders were divided randomly to ICBT treatment (n = 30) and face-to face CBT (n = 30). The participants received individual CBT sessions (60 min, over 8 weeks) and completed the questionnaires at the beginning, in mid-trial, and 8 weeks after the trial. The outcomes comprised Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI, Fertility problem inventory (FPI), Client Satisfaction Questionnaire (CSQ-8), and System usability scale (SUS). Results: The usability scores of the "Peaceful Mind" ICBT (M = 67.07, SD = 17.23, range = 1-100) and satisfaction with the treatment (M = 25.06, SD = 4.18, range = 1-32) were high. Patient adherence to the treatment in the ICBT group (86.6%) was the same as that in the CBT (73.3%). The between-group mean differences at the post-trial were -4.79 (CI 95% = -10.81 to 1.23) for depression scores and -4.15 (CI 95% = -9.52 to 1.22) for anxiety scores; both differences were within the non-inferiority margin points for the lower 95%CI. Conclusion: "Peaceful mind" ICBT was found to be feasible and accessible for delivering the treatment to the patients. The study confirmed that both ICBT face-to face CBT were equally effective in reducing depression and anxiety of the patients.

The prevalence of adjustment disorder and predisposing factors in infertile women.

BACKGROUND: Infertility is a stressful life event that increases the risk of developing mental disorders, particularly adjustment disorder (AD). Given the paucity of data on the prevalence of AD symptoms in infertility, the purpose of this study was to ascertain the prevalence, clinical presentation, and risk factors for AD symptoms in infertile women. METHOD: In a cross-sectional study, 386 infertile women completed questionnaires including the Adjustment Disorder New Module-20 (ADNM), the Fertility Problem Inventory (FPI), the Coronavirus Anxiety Scale (CAS), and the Primary Care Posttraumatic Stress Disorder (PC-PTSD-5) at an infertility center between September 2020 and January 2022. RESULT: The results indicated that 60.1% of infertile women exhibited AD symptoms (based on ADNM > 47.5). In terms of clinical presentation, impulsive behavior was more common. No significant relationship was observed between prevalence and women's age or duration of infertility. Infertility stress (ß = 0.27, p < 0.001), coronavirus anxiety (ß = 0.59, p = 0.13), and a history of unsuccessful assisted reproductive therapies (ß = 2.72, p = 0.008) were several predisposing factors for AD symptoms in infertile women. CONCLUSIONS: The findings suggest that all infertile women be screened from the start of infertility treatment. Additionally, the study suggests that infertility specialists should focus on combining medical and psychological treatments for individuals predisposed to AD, particularly infertile women who exhibit impulsive behaviors.

Does infertility develop posttraumatic growth or anxiety/depressive symptoms? Roles of personality traits, resilience, and social support.

PURPOSE: This study aimed to explore levels of posttraumatic growth (PTG) and anxiety/depressive symptoms and the role of personality traits, resilience, and social support as predictors of PTG in infertile men/women. DESIGN AND METHODS: In our cross-sectional study, 162 infertile individuals (40 men and 122 women) completed the research questionnaires, including PTG, State-Trait Anxiety Inventory, Fertility Problem Inventory, NEO Five-Factor Inventory, Perceived Social Support, Kobasa hardiness short 20-item, and Beck Inventory Depression (BDI-II). RESULTS: The prevalence of PTG was higher than that of anxiety/depressive symptoms (55.6% vs. 45.7%/40.7%). Neuroticism (ß = 0.54 ± 0.25, p < 0.03), extroversion (ß = 0.69 ± 0.26, p < 0.01), and resilience (ß = 0.33 ± 0.12, p < 0.008) were positive predictors of PTG. PRACTICE IMPLICATIONS: Infertile men/women with high level of resilience, extroversion, and neuroticism may have more tendency toward personal growth rather than distress. Practitioners ought to direct counseling to promote factors of personal growth.

Role of social capital and self-efficacy as determinants of stress in pregnancy.

OBJECTIVES: The study investigated the role of social capital, self-efficacy, and depression as determinants of stress during pregnancy. MATERIALS AND METHODS: In a cross-sectional study, 200 low-risk pregnant women with at least 5 years of education and ages 18 or more were enrolled in public obstetric clinics of Babol University of Medical Sciences. The participants completed four questionnaires including Social Capital, Revised Prenatal Distress Questionnaire (NuPDQ), Perceived Stress, and General Self-efficacy. RESULTS: Women at late phase of pregnancy had lower mean scores of total social capital (61.5 ± 17.1 vs. 47.1 ± 18.1) and self-efficacy (60.1 ± 9.7 vs. 55.1 ± 15.2) compared to those at early pregnancy. Social capital was the negative independent variable associated with pregnancy-specific stress in the adjusted model (ß = -0.418, P = 0.020). Both social capital (ß = -0.563, P ≤ 0.001) and self-efficacy (ß = -0.330, P ≤ 0.001) were negative independent variables associated with general stress. CONCLUSIONS: Our findings suggest that health professionals should note the benefits of social capital in stress management and encourage women in establishing stronger relations and neighborhood environments during pregnancy.