In a study that sheds light on the extent of the psychological anguish of infertility, Danish researchers have found women who remained childless after their first work-up for infertility had more psychiatric hospitalizations than women who had at least one child following their medical assessment.
Experts say the findings suggest that mental health counseling may be indicated when a women is unsuccessful in her attempts to have a child.
The study was massive (nearly 100,000 women), and linked all medical and mental health care provided to a women over a 35-year period (1973-2008). This scope sets it apart from the vast majority of similar investigations into infertility and distress.
While prior studies have shown that childlessness can lead to an increased risk for anxiety, mood disorders and depressive symptoms, the new review provides a detailed view of potential risks for infertile women.
Using national databases, the Danish researchers studied women who had received both fertility intervention and assistance for mental issues as documented in centralized medical and psychiatric registries.
Investigators used the information on hospitalizations to create an inclusive group of “all mental disorders.”
Six discharge sub-groups were created from the master list including “alcohol and intoxicant abuse,” “schizophrenia and psychoses,” “affective disorders including depression,” “anxiety, adjustment and obsessive compulsive disorder,” “eating disorders” and “other mental disorders.”
All women were followed from the date of their initial fertility investigation until the date of psychiatric event, date of emigration, date of death, date of hospitalization or 31st December 2008, whichever came first.
Such studies, according to co-author and epidemiologist Dr. Birgitte Baldur-Felskov, could only be possible in places like Denmark, where each citizen has a personal identification number which can be linked to any or all of the country’s diagnostic registries.
Results of the study showed that, over an average follow-up time of 12.6 years (representing 1,248,243 woman-years), 54 percent of the 98,737 women in the cohort did have a baby.
Almost 5000 women from the entire cohort were hospitalized for a psychiatric disorder, the most common discharge diagnosis being “anxiety, adjustment and obsessive compulsive disorders” followed by “affective disorders including depression.”
Women who remained childless after their initial fertility investigation had a statistically significant (18 percent) higher risk of hospitalizations for all mental disorders than the women who went on to have a baby. But infertility was also linked to a significantly greater risk for alcohol/substance abuse (by 103 percent), schizophrenia (by 47 percent) and other mental disorders (by 43 percent).
Nevertheless, the most common mental health diagnoses in the entire cohort (anxiety, adjustment and obsessive compulsive disorders) was not affected by fertility status.
“Our study showed that women who remained childless after fertility evaluation had an 18 percent higher risk of all mental disorders than the women who did have at least one baby,” said Baldur-Felskov.
“These higher risks were evident in alcohol and substance abuse, schizophrenia and eating disorders, although appeared lower in affective disorders including depression. The results suggest that failure to succeed after presenting for fertility investigation may be an important risk modifier for psychiatric disorders.”
The said the outcome of the study “adds an important component to the counseling of women being investigated and treated for infertility. Specialists and other health care personnel working with infertile patients should also be sensitive to the potential for psychiatric disorders among this patient group.”