Research Article| Volume 158, ISSUE 2, P235-241, October 2011

Prevalence and incidence of depressive and anxious symptoms in couples undergoing assisted reproductive treatment in an Italian infertility department



      We have conducted a longitudinal observational study in order to evaluate the prevalence and the incidence of depressive and anxious symptoms in women and men seeking infertility treatment and to analyze associated factors or risk factors for these kinds of disorders.

      Study design

      A total of 1000 consecutive couples that visited our center for the first time were asked to join this study. Depressive and anxious symptoms were assessed with self-rating Zung Depression Scale (ZDS) and Zung Anxiety Scale (ZAS) questionnaires. A second assessment was planned at the time of β HCG dosage (or at the moment of cycle suspension). A standard questionnaire was used to investigate socio-demographic information and the psychological aspects of couples undergoing in vitro fertilization (IVF) treatment. The fertility history and outcome of IVF treatment were collected from patients’ medical records.


      14.7% of women had anxious symptoms and 17.9% depressive symptoms, whereas 4.5% of men had anxious symptoms and 6.9% depressive symptoms. Women with depressive and anxious symptoms were younger, more often had an anxious partner and had a longer history of infertility. Men with depressive and anxious symptoms more frequently had a temporary job, they had an anxious partner and they were more frequently at the first in vitro fertilization (IVF) cycle.
      The incidence of depressive and/or anxious symptoms was 18.5% in women and 7.4% in men. Age and previous IVF treatments seem not to be associated with incidence of depressive or anxious symptoms.


      Both the prevalence and incidence of depressive and/or anxious symptoms in couples undergoing IVF treatment were worthy of note and should not be underestimated. More attention must be paid to psychological aspects in young women and in couples with a long history of infertility or previous failure treatments. Having an anxious partner was associated with anxious and depressive symptoms. For this reason, both males and females might benefit from psychological intervention, which could also help them to be supportive to each other.


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        • Cwikel J.
        • Gidron Y.
        • Sheiner E.
        Psychological interactions with infertility among women.
        Eur J Obstet Gynecol Reprod Biol. 2004; 117: 126-131
        • Wilkins K.M.
        • Warnock J.K.
        • Serrano E.
        Depressive symptoms related to infertility and infertility treatments.
        Psychiatr Clin North Am. 2010; 33: 309-321
        • Volgsten H.
        • Skoog Svanberg A.
        • Ekselius L.
        • Lundkvist O.
        • Sundstrom P.
        Prevalence of psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment.
        Hum Reprod. 2008; 20: 2253-2260
        • Chen T.H.
        • Chang S.P.
        • Tsai C.F.
        • Juang K.D.
        Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic.
        Hum Reprod. 2004; 19: 2313-2318
        • Csemiczky G.
        • Landgren B.M.
        • Collins A.
        The influence of stress and state anxiety on the outcome of IVF-treatment: psychological and endocrinological assessment of Swedish women entering IVF treatment.
        Acta Obstet Gynecol Scand. 2000; 79: 113-118
        • Zorn B.
        • Auger J.
        • Velikonja V.
        • Kolbezen M.
        • Meden-Vrtovec H.
        Psychological factors in male partners of infertile couples: relationship with semen quality and early miscarriage.
        Int J Androl. 2008; 31: 557-564
        • Lund R.
        • Sejbaek C.S.
        • Christensen U.
        • Schmidt L.
        The impact of social relations on the incidence of severe depressive symptoms among infertile women and men.
        Hum Reprod. 2009; 24: 2810-2820
        • Zung W.W.
        • Richards C.B.
        • Short M.J.
        Self-rating depression scale in an outpatient clinic. Further validation of the SDS.
        Arch Gen Psychiatry. 1965; 13: 508-515
        • Zung W.W.
        Prevalence of clinically significant anxiety in a family practice setting.
        Am J Psychiatry. 1986; 143: 1471-1472
        • Agrell B.
        • Dehlin O.
        Comparison of six depression rating scales in geriatic stroke patients.
        Stroke. 1989; 20: 1190-1194
        • Gabrys J.B.
        • Peters K.
        Reliability, discriminant and predictive validity of the Zung Self-Rating Depression Scale.
        Psychol Rep. 1985; 57: 1091-1096
        • Biggs J.T.
        • Wilie L.T.
        • Ziegler V.E.
        Validity of the Zung Self-Rating Depression Scale.
        Br J Psychiatry. 1978; 132: 381-385
        • Parissis J.T.
        • Nikolaou M.
        • Farmakis D.
        • et al.
        Clinical and prognostic implications of self-rating depression scales and plasma B-type natriuretic peptide in hospitalised patients with chronic heart failure.
        Heart. 2008; 94: 585-589
        • Bradshaw G.
        • Parker G.
        Depression in general practice attenders.
        Aust N Z J Psychiatry. 1983; 17: 361-365
        • Shiotani I.
        • Sato H.
        • Kinjo K.
        • et al.
        Depressive symptoms predict 12-month prognosis in elderly patients with acute myocardial infarction.
        J Cardiovasc Risk. 2002; 9: 153-160
        • Breslow N.E.
        • Day N.E.
        Statistical methods in cancer research. vol.I. The analysis of case-control studies.
        IARC Scientific Publications No.32, Lyon, France1980
      1. Scaravelli, G., VigilianoV, De Luca, R.,et al., Attività del Registro Nazionale della Procreazione Medicalmente Assistita IV report – dati 2008. Istituto Superiore di Sanità, Centro Nazionale di Epidemiologia Sorveglianza e Promozione della Salute – Registro Nazionale della Procreazione Medicalmente Assistita. 2010.

        • Sheiner E.K.
        • Sheiner E.
        • Carel R.
        • Potashnik G.
        • Shoham-Vardi I.
        Potential association between male infertility and occupational psychological stress.
        J Occup Environ Med. 2002; 44: 1093-1099
        • Faravelli C.
        • Guerrini Degl’Innocenti B.
        • Giardinelli L.
        Epidemiology of anxiety disorders in Florence.
        Acta Psychiatr Scand. 1989; 79: 308-312
        • Alonso J.
        • Angermeyer M.C.
        • Bernert S.
        • et al.
        Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.
        Acta Psychiatr Scand. 2004; 420: 21-27
        • Leray E.
        • Camara A.
        • Drapier D.
        • et al.
        Prevalence, characteristics and comorbidities of anxiety disorders in France: results from the “Mental Health in General Population” Survey (MHGP).
        Eur Psychiatry. 2010; ([Epub ahead of print])
        • Benson S.
        • Hahn S.
        • Tan S.
        • Mann K.
        • Janssen O.E.
        • Schedlowski M.
        Prevalence and implications of anxiety in polycystic ovary syndrome: results of an internet- based survey in Germany.
        Hum Reprod. 2009; 24: 1446-1451
        • Edelmann R.J.
        • Connolly K.J.
        • Bartlett H.
        Coping strategies and psychological adjustment of couples presenting for IVF.
        J Psychosom Res. 1994; 38: 355-364
        • Beaurepaire J.
        • Jones M.
        • Thiering P.
        • Saunders D.
        • Tennant C.
        Psychological adjustment to infertility and its treatment: male and female responses at different stages of IVF/ET treatment.
        J Psychosom Res. 1994; 38: 229-240
        • Demyttenaere K.
        • Bonte L.
        • Gheldof M.
        • et al.
        Coping style and depression level influence outcome in in vitro fertilization.
        Fertil Steril. 1998; 69: 1026-1033
        • Ragni G.
        • Mosconi P.
        • Baldini M.P.
        • et al.
        Health-related quality of life and need for IVF in 1000 Italian infertile couples.
        Hum Reprod. 2005; 20: 1286-1291
        • Newton C.R.
        • Hearn M.T.
        • Yuzpe A.A.
        Psychological assessment and follow-up after in vitro fertilization: assessing the impact of failure.
        Fertil Steril. 1990; 54: 879-886
        • Shaw P.
        • Johnston M.
        • Shaw R.
        Couselling needs, emotional and relationship problems in couples awaiting IVF.
        J Psychosom Obstet Gynaecol. 1988; 9: 171-180
        • Peterson B.D.
        • Newton C.R.
        • Rosen K.H.
        • Skaggs G.E.
        The relationship between coping and depression in men and women referred for in vitro fertilization.
        Fertil Steril. 2006; 85: 802-804
        • Kessler R.C.
        Epidemiology of women and depression.
        J Affect Disord. 2003; 74: 5-13
        • Breslau N.
        • Schultz L.
        • Peterson E.
        Sex differences in depression: a role for preexisting anxiety.
        Psychiatry Res. 1995; 58: 1-12
        • Verhaak C.M.
        • Smeenk J.M.J.
        • Evers A.W.M.
        • vanMinnen A.
        • Kremer J.A.
        • Kraaimaat F.W.
        Predicting emotional response to unsuccessful fertility treatment: a prospective study.
        J Behav Med. 2005; 28: 181-190
        • Volgsten H.
        • Skoog Svanberg A.
        • Ekselius L.
        • Lundkvist O.
        • Sundstrom P.
        Risk factors for psychiatric disorders in infertile women and men undergoing in vitro fertilization.
        Fertil Steril. 2008; ([Epub ahead of print])
        • Beutel M.
        • Kupfer J.
        • Kirchmeyer P.
        • et al.
        Treatment related stresses and depression in couples undergoing assisted reproductive treatment by IVF or ICSI.
        Andrologia. 1998; 31: 27-35
        • Yong P.
        • Martin C.
        • Thong J.
        A comparison of psychological functioning in women at different stages of in vitro ferilization treatment using the mean affect adjective checklist.
        J Assist Reprod Genet. 2000; 17: 553-556
        • Verhaak C.M.
        • Smeenk J.M.J.
        • Nahuis M.J.
        • Kremer J.A.
        • Braat D.D.M.
        Long term psychological adjustment to IVF/ICSI treatment in women.
        Hum Reprod. 2007; 22: 305-308
        • Verhaak C.M.
        • Smeenk J.M.J.
        • vanMinnen A.
        • Kremer J.A.
        • Kraaimaat F.W.
        A longitudinal, prospective study on emotional adjustment before, during and after consecutive fertility treatment cycles.
        Hum Reprod. 2005; 8: 2253-2260
        • Eppin-Jordan J.E.
        • Compas B.E.
        • Osowiecki D.M.
        • et al.
        Psychological adjustment in breast cancer: processes of emotional distress.
        Health Psychol. 1999; 18: 315-316
        • Osowiecki D.M.
        • Compass B.E.
        A prospective study of coping, perceiving control and psychological adaptation to breast cancer.
        Cogn Ther Res. 1999; 23: 169-180