ABSTRACT
OBJECTIVE: To determine the extent to which fertility patients and partners received mental health services (MHS) and were provided with information about MHS by their fertility clinics, and whether the use of MHS, or the provision of information about MHS by fertility clinics, was targeted to the most distressed individuals. DESIGN: Prospective longitudinal cohort study. SETTING: Five fertility practices. PATIENT(S): A total of 352 women and 274 men seeking treatment for infertility. INTERVENTION(S): No interventions administered. MAIN OUTCOME MEASURE(S): Depression, anxiety, and MHS information provision and use. RESULT(S): We found that 56.5% of women and 32.1% of men scored in the clinical range for depressive symptomatology at one or more assessments and that 75.9% of women and 60.6% of men scored in the clinical range for anxiety symptomatology at one or more assessments. Depression and anxiety were higher for women and men who remained infertile compared with those who were successful. Overall, 21% of women and 11.3% of men reported that they had received MHS, and 26.7% of women and 24.1% of men reported that a fertility clinic made information available to them about MHS. Women and men who reported significant depressive or anxiety symptoms, even those with prolonged symptoms, were no more likely than other patients to have received information about MHS. CONCLUSION(S): Psychological distress is common during fertility treatment, but most patients and partners do not receive and are not referred for MHS. Furthermore, MHS use and referral is not targeted to those at high risk for serious psychological distress. More attention needs to be given to the mental health needs of our patients and their partners.
Subject(s)
Anxiety/therapy , Consumer Health Information , Depression/therapy , Health Services Accessibility , Health Services Needs and Demand , Infertility/therapy , Mental Health Services , Mental Health , Spouses/psychology , Stress, Psychological/therapy , Anxiety/diagnosis , Anxiety/psychology , Depression/diagnosis , Depression/etiology , Depression/psychology , Female , Fertility , Humans , Infertility/complications , Infertility/physiopathology , Infertility/psychology , Longitudinal Studies , Male , Prospective Studies , Risk Factors , Stress, Psychological/diagnosis , Stress, Psychological/etiology , Stress, Psychological/psychology , Surveys and Questionnaires , United StatesABSTRACT
OBJECTIVE: To describe parents' disclosure decision-making process. DESIGN: In-depth ethnographic interviews. SETTING: Participants were recruited from 11 medical infertility practices and 1 sperm bank in Northern California. PATIENT(S): One hundred forty-one married couples who had conceived a child using donor gametes (62 with donor sperm, 79 with donor oocytes). INTERVENTION(S): Husbands and wives were interviewed together and separately. MAIN OUTCOME MEASURE(S): Thematic analysis of interview transcripts. RESULT(S): Ninety-five percent of couples came to a united disclosure decision, some "intuitively," but most after discussions influenced by the couples' local sociopolitical environment, professional opinion, counseling, religious and cultural background, family relationships, and individual personal, psychological, and ethical beliefs. Couples who were not initially in agreement ultimately came to a decision after one partner deferred to the wishes or opinions of the other. Deferral could reflect the result of a prior agreement, one partner's recognition of the other's experiential or emotional expertise, or direct persuasion. In disclosing couples, men frequently deferred to their wives, whereas, in nondisclosing couples, women always deferred to their husbands. CONCLUSION(S): Although the majority of couples were in initial agreement about disclosure, for many the disclosure decision was a complex, negotiated process reflecting a wide range of influences and contexts.
