Fertility treatment patients and their partners are far more likely to suffer from major depressive disorder (MDD) than the general population, according to new research from San Francisco State University.
In addition, one of the most important factors in predicting a patient’s risk for MDD is whether the individual has had a previous diagnosis of major depression.
It is well-known that MDD is a recurring disease and that it is likely to make a comeback during stressful life events such as fertility treatment. Yet depression history is not something that fertility treatment providers typically screen for, said Dr. Sarah Holley, an assistant professor of psychology at SF State and lead author of the study.
“The things that are typically assessed, such as whether you are feeling down or anxious when treatment begins, can be really useful information, but our research shows that a past history of MDD is actually a stronger indicator of whether a fertility patient will develop MDD during treatment,” said Holley.
“This suggests it would be useful to include an assessment of a history of MDD as part of a pre-treatment screener.”
Screening for previous episodes of MDD, Holley added, would give at-risk patients the opportunity to receive further counseling or support during fertility treatment.
MDD can lead to withdrawal, isolation from friends and family and lost work, and is a major risk factor for suicide.
To be diagnosed with MDD, an individual must, for a two-week period, experience a depressed mood or pervasive loss of interest or pleasure, plus four other symptom criteria such as disturbances in sleep or appetite, feelings of worthlessness or guilt, indecision or thoughts of suicide.
“Qualifying for MDD is more serious than experiencing low mood or crying a lot, which are some of the things that go into the type of standard depression inventories given to patients,” Holley said. “It’s a really debilitating disorder, and actually one of the leading causes of disability in this country.”
For the study, researchers surveyed 174 women and 144 male partners who had unsuccessfully gone through fertility treatment.
The results indicate that fertility treatment patients suffer from notably high rates of MDD: 39.1 percent of the women and 15.3 percent of the men met the criteria for MDD during the 18-month course of the study, compared with the U.S. annual prevalence rate for MDD of 8.4 percent of women and 5.2 percent of men.
The researchers compared a patient’s past history of MDD with other well-established risk factors, such as baseline levels of depression and anxiety symptoms, as well as partner support. They found it was a stronger predictor of whether patients and partners ultimately developed MDD during fertility treatment than these more commonly screened-for indicators.
“People often describe fertility treatment as one of the most distressing things they’ve ever experienced,” Holley said. “It’s a prolonged process filled with uncertainty, and often it is very expensive. It can be very physically demanding, especially for women. It can have a profound effect on a couple’s relationship.”
MDD can lead to a couple dropping out of fertility treatment altogether, she added. Also, if treatment is ultimately successful, MDD during treatment could extend into the prenatal or post-partum periods.
“Helping patients and partners either before the depression takes hold, or being able to identify it and treat it as soon as possible, has the potential to help them through the very stressful process of treatment and possibly beyond,” she said.
Future research will assess the rates of MDD among same-sex couples who are undergoing fertility treatment to see whether the risk factors vary for sexual minority patients compared with their heterosexual counterparts.
The findings are published in the journal Fertility and Sterility.
Source: San Francisco State University