不育妇女的功能障碍、精神病症状和生活质量:一项来自土耳其横断面研究（英文）

Disability, psychiatric symptoms, and quality of life in infertile women: a cross-sectional study in Turkey

背景:不孕不育是一种重大的生活危机,它可以导致精神病症状的发展并且对夫妻的生活质量产生负面影响,但其影响程度可能取决于文化背景。目标:我们比较了土耳其城市中生育妇女和不孕妇女的精神病症状程度、功能障碍水平和生活质量。方法:该横断面研究纳入了100名在里泽教育和研究医院的妇产科门诊治疗不孕不育的已婚女性和100名已婚已育的妇女作为对照组。对所有参与者均采用社会人口信息筛查表、医院焦虑抑郁量表(Hospital Anxiety and Depression Scale,HADS)、简单功能障碍问卷(Brief Disability Questionnaire,BDQ)和健康状况问卷(Short Form Health Survey,SF-36)进行评估。结果:不育女性的平均焦虑分量表得分和抑郁分量表得分稍高于对照组,但差异无统计学意义。不孕组妇女中有显著临床焦虑症状的比例(即焦虑分量表得分>11)显著高于育龄妇女(31%v.17%,X^2=5.37,p=0.020),但有显著临床抑郁症状的比例(即抑郁分量表评分HADS>8)在两组间没有显著性差异(43%v.33%,X^2=2.12,p=0.145)。不育女性自我报告前一个月的功能障碍显著比对照组严重,并且不育女性在SF-36的8个分量表中4个(一般健康、活力、社会功能和心理健康)显著差于对照组。与目前工作的不育女性相比,目前没有工作的女性不育患者报告的抑郁和焦虑程度较轻,且一般健康状况、活力和心理健康状况较好。结论:未发现土耳其城市地区中寻求治疗的不孕不育已婚女性并比已婚已育妇女有更严重的抑郁症状,但他们确实报告有较大的躯体和心理障碍并且生活质量较差。不孕不育的负面影响对在职不孕女性妇女比无业的不孕妇女更严重。西方国家这通常报告不孕患者抑郁和焦虑的患病率更高,我们需要更大规模的随访研究以评估这些结果与西方国家报告的结果不同的原因。

Background： Infertility is a major life crisis which can lead to the development of psychiatric symptoms and negative effects on the quality of life of affected couples, but the magnitude of the effects may vary depending on cultural expectations.Aim： We compare the level of psychiatric symptoms, disability, and quality of life in fertile and infertile women in urban Turkey.Methods： This cross-sectional study enrolled 100 married women being treated for infertility at the outpatient department of the Obstetrics and Gynecology Department of the Rize Education and Research Hospital and a control group of 100 fertile married women. All study participants were evaluated with a socio-demographic data screening form, the Hospital Anxiety and Depression Scale（HADS）, the Brief Disability Questionnaire（BDQ）, and the Short Form Health Survey（SF-36）.Results： The mean anxiety subscale score and depression subscale score of HADS were slightly higher in the infertile group than in controls, but the differences were not statistically significant. The proportion of subjects with clinically significant anxiety（i.e., anxiety subscale score of HADS 11） was significantly higher in infertile women than in fertile women（31% v. 17%, X^2=5.37, p=0.020）, but the proportion with clinically significant depressive symptoms（i.e., depression subscale score of HADS 〉8） was not significantly different（43% v. 33%, X^2=2.12, p=0.145）. Self-reported disability over the prior month was significantly worse in the infertile group than in the controls, and 4 of the 8 subscales of the SF-36 – general health, vitality, social functioning, and mental health – were significantly worse in the infertile group. Compared to infertile women who were currently working, infertile women who were not currently working reported less severe depression and anxiety and better general health, vitality, and mental health.Conclusions： Married women from urban Turkey seeking treatment for infertility do not have significantly more severe depressive symptoms than fertile married controls, but they do report greater physical and psychological disability and a poorer quality of life. The negative effects of infertility were more severe in infertile women who were employed than in those who were not employed. Larger follow-up studies are needed to assess the reasons for the differences between these results and those reported in western countries which usually report a higher prevalence of depression and anxiety in infertile patients.