Prospective study of depression and anxiety in female fertility preservation and infertility patients

Capsule:
Fertility preservation patients report higher levels of depression and anxiety at the onset of treatment than infertility patients, but infertility patients’ symptoms worsen across treatment.

Authors:
Angela K. Lawson, Ph.D., Susan C. Klock, Ph.D., Mary Ellen Pavone, M.D., Jennifer Hirschfeld-Cytron, M.D., Kristin N. Smith, B.S., Ralph R. Kazer, M.D.

Volume 102, Issue 5, Pages 1377–1384

Abstract:

Objective:
To prospectively assess anxiety, depression, coping, and appraisal in female fertility preservation (FP) patients compared with infertile patients.

Design:
Prospective pre- and post-treatment survey.

Setting:
Academic medical center.

Patient(s):
Forty-seven women with cancer (FP patients) and 91 age-matched infertile patients.

Intervention(s):
None.

Main Outcome Measure(s):
Depression, anxiety, coping, infertility-related stress, appraisal of treatment, and medical outcomes.

Result(s):
FP patients reported more symptoms of anxiety and depression than infertile patients, but infertile patients’ symptoms worsened over time; 44% of FP and 14% of infertile patients’ scores exceeded the clinical cutoff for depression before treatment. The interval between surveys and medical treatment data did not predict changes in mood symptoms. Coping strategies and infertility-related stress did not differ between groups, and avoidant coping predicted higher depression and anxiety scores.

Conclusion(s):
FP patients reported more anxiety and depression than infertile patients at enrollment in treatment, with more than one-third of FP patients reporting clinically significant depressive symptoms. However, infertile patients’ anxiety and depressive symptoms increased across treatment. This increase was not related to time between registration for IVF and oocyte retrieval or the medical aspects of treatment. FP and infertile patients should be provided psychologic consultation before treatment to identify mood and anxiety symptoms and to refer patients for counseling as needed to prevent worsening of symptoms.

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