Evaluation of Psychological Status and Somatic Symptoms in Infertile Women Treated with Assisted Reproductive Technology in the Post-Epidemic Era of COVID-19

doi:10.12280/gjszjk.20210057

Abstract

Abstract:

Objective: To investigate the application value of psychological status assessment in infertile women who received assisted reproductive technology (ART) in the post-epidemic era of COVID-19. Methods: From June 2020 to November 2020, infertile women who received ART treatment were investigated via the patient health questionnaire scale-15 (PHQ-15), generalized anxiety disorder scale-7 (GAD-7) and patient health questionnaire scale-9 (PHQ-9). The general situation, physical symptoms, anxiety, depression symptoms and other physical and mental health status were evaluated. Cronbach′s α coefficient, Spearman Brown half-split coefficient and two-week-retest reliability were used for the reliability analysis. Confirmatory factor analysis and Spearman correlation analysis were used to analyze the construct validity and criteria validity, respectively. Then the results of the three scales were converted into dichotomous variable (normal and positive results) as dependent variables.Together with patient′s demographic characteristics and infertility-related clinical characteristics which were added as independent variable into the univariate and multivariate logistic regression analysis, respectively(The entry criteria were P<0.1 in univariate analysis). Results: A total of 1 980 patients were included in the study, and the effective recovery rate was 89.6% (1 980/2 210). The Cronbach′s α coefficient and KMO value of PHQ-15, GAD-7 and PHQ-9 were 0.805, 0.863, 0.822 and 0.871, 0.909, 0.890, respectively. These results suggested that the reliability and validity of the three scales were good. Multivariate logistic regression analysis showed that the age of >35 years was the independent risk factor of anxiety, depression and physical symptoms for infertile women. College degree or above and husband smoking were two independent risk factors of anxiety and depression of infertile women. Owned one child was an independent protective factor for depressive symptoms (OR=0.63, 95%CI: 0.41-0.97, P=0.034) and somatic symptoms(OR=0.63, 95%CI: 0.42-0.94, P=0.022). Conclusions: PHQ-15, GAD-7 and PHQ-9 scales can be well used in evaluating the physical and mental health of infertile women who received ART treatment. Patients who were characterized by over 35 years old, college degree or above and husband smoking were vulnerable to anxiety, depression or physical symptoms.

Key words: Anxiety, Manifest anxiety scale, Depression, Reproductive techniques, assisted, Logistic models, Somatic symptoms

WANG Ling-yan, ZHOU Dan, YUE Yan, WANG Yu-yang. Evaluation of Psychological Status and Somatic Symptoms in Infertile Women Treated with Assisted Reproductive Technology in the Post-Epidemic Era of COVID-19[J]. Journal of International Reproductive Health/Family Planning, 2021, 40(5): 366-371.

Figures/Tables 5

References 19

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变量	GAD-7量表					PHQ-9量表					PHQ-15量表
变量	正常（n=1 461）	轻度焦虑（n=449）	中度焦虑（n=59）	重度焦虑（n=11）	P	正常（n=1 344）	轻度抑郁（n=559）	中度抑郁（n=63）	重度抑郁（n=14）	P	正常（n=1 225）	轻度躯体症状（n=573）	中度躯体症状（n=156）	重度躯体症状（n=26）	P
BMI（kg/m²）	21.9±3.0	21.6±2.8	22.1±3.0	22.6±3.7	0.197	21.9±2.9	21.8±2.9	21.6±3.2	21.5±1.4	0.778	21.9±2.9	21.8±3.0	21.7±2.7	21.8±3.4	0.720
年龄（例）					0.002					<0.001					0.012
20~29岁	456	144	13	6		411	182	20	6		368	191	52	8
30~35岁	671	239	33	4		620	293	32	2		567	283	82	15
>35岁	334	66	13	1		313	84	11	6		290	99	22	3
职业（例）					0.031					0.638					0.958
无业	244	59	7	0		222	78	9	1		186	95	26	3
自由职业	390	103	10	3		336	153	14	3		317	140	42	7
企业事业单位	827	287	42	8		786	328	40	10		722	338	88	16
学历（例）					<0.001					0.027					0.222
初中及以下	326	62	9	3		293	89	14	4		259	112	22	7
高中及中专	261	80	6	0		241	99	7	0		225	91	26	5
大专及以上	874	307	44	8		810	371	42	10		741	370	108	14
住址（例）					0.043					0.441					0.246
农村	375	89	10	3		337	121	15	4		308	126	34	9
城镇	1 086	360	49	8		1 007	438	48	10		917	447	122	17
吸烟史（例）					0.478					0.089					<0.010
是	8	5	1	0		7	5	2	0		8	3	1	2
否	1 453	444	58	11		1 337	554	61	14		1 217	570	155	24
男方吸烟史（例）					0.094					0.077					0.405
是	261	61	6	2		241	80	9	0		215	89	24	2
否	1 200	388	53	9		1 103	479	54	14		1 010	484	132	24
移植次数（例）					0.092					0.008					0.047
1	1 076	338	37	8		993	414	47	5		890	436	116	17
2	228	72	9	1		208	88	11	3		187	97	21	5
3次及以上	157	39	13	2		143	57	5	6		148	40	19	4
不孕时间（例）					0.980					0.903					0.156
<2年	747	237	31	5		695	287	29	9		658	276	73	13
2~5年	502	150	20	5		459	189	25	4		398	217	53	9
>5年	212	62	8	1		190	83	9	1		169	80	30	4
不孕类型（例）					0.181					0.091					0.797
原发不孕	704	242	28	6		642	300	33	5		592	291	83	14
继发不孕	643	165	27	5		595	210	26	9		535	234	60	11
其他	114	42	4	0		107	49	4	0		98	48	13	1
合并症（例）					0.437					0.029					0.695
无	1 120	353	41	8		1 021	446	42	13		946	433	124	19
有*	341	96	18	3		323	113	21	1		279	140	32	7
现有子女（例）					0.164					0.028					0.010
0	1 321	422	57	11		1 208	529	60	14		1 098	540	148	25
1	130	24	2	0		125	28	3	0		115	33	7	1
2个及以上	10	3	0	0		11	2	0	0		12	0	1	0
流产史（例）					0.459					0.065					0.741
无	899	290	33	6		813	368	41	6		749	361	101	17
有	562	159	26	5		531	191	22	8		476	212	55	9
流产次数（例）					0.298					0.084					0.802
0	899	290	33	6		813	368	41	6		749	361	101	17
1,2	462	136	25	4		436	164	19	8		392	178	49	8
3次及以上	100	23	1	1		95	27	3	0		84	34	6	1

变量	GAD-7量表					PHQ-9量表					PHQ-15量表
变量	正常（n=1 461）	轻度焦虑（n=449）	中度焦虑（n=59）	重度焦虑（n=11）	P	正常（n=1 344）	轻度抑郁（n=559）	中度抑郁（n=63）	重度抑郁（n=14）	P	正常（n=1 225）	轻度躯体症状（n=573）	中度躯体症状（n=156）	重度躯体症状（n=26）	P
BMI（kg/m²）	21.9±3.0	21.6±2.8	22.1±3.0	22.6±3.7	0.197	21.9±2.9	21.8±2.9	21.6±3.2	21.5±1.4	0.778	21.9±2.9	21.8±3.0	21.7±2.7	21.8±3.4	0.720
年龄（例）					0.002					<0.001					0.012
20~29岁	456	144	13	6		411	182	20	6		368	191	52	8
30~35岁	671	239	33	4		620	293	32	2		567	283	82	15
>35岁	334	66	13	1		313	84	11	6		290	99	22	3
职业（例）					0.031					0.638					0.958
无业	244	59	7	0		222	78	9	1		186	95	26	3
自由职业	390	103	10	3		336	153	14	3		317	140	42	7
企业事业单位	827	287	42	8		786	328	40	10		722	338	88	16
学历（例）					<0.001					0.027					0.222
初中及以下	326	62	9	3		293	89	14	4		259	112	22	7
高中及中专	261	80	6	0		241	99	7	0		225	91	26	5
大专及以上	874	307	44	8		810	371	42	10		741	370	108	14
住址（例）					0.043					0.441					0.246
农村	375	89	10	3		337	121	15	4		308	126	34	9
城镇	1 086	360	49	8		1 007	438	48	10		917	447	122	17
吸烟史（例）					0.478					0.089					<0.010
是	8	5	1	0		7	5	2	0		8	3	1	2
否	1 453	444	58	11		1 337	554	61	14		1 217	570	155	24
男方吸烟史（例）					0.094					0.077					0.405
是	261	61	6	2		241	80	9	0		215	89	24	2
否	1 200	388	53	9		1 103	479	54	14		1 010	484	132	24
移植次数（例）					0.092					0.008					0.047
1	1 076	338	37	8		993	414	47	5		890	436	116	17
2	228	72	9	1		208	88	11	3		187	97	21	5
3次及以上	157	39	13	2		143	57	5	6		148	40	19	4
不孕时间（例）					0.980					0.903					0.156
<2年	747	237	31	5		695	287	29	9		658	276	73	13
2~5年	502	150	20	5		459	189	25	4		398	217	53	9
>5年	212	62	8	1		190	83	9	1		169	80	30	4
不孕类型（例）					0.181					0.091					0.797
原发不孕	704	242	28	6		642	300	33	5		592	291	83	14
继发不孕	643	165	27	5		595	210	26	9		535	234	60	11
其他	114	42	4	0		107	49	4	0		98	48	13	1
合并症（例）					0.437					0.029					0.695
无	1 120	353	41	8		1 021	446	42	13		946	433	124	19
有*	341	96	18	3		323	113	21	1		279	140	32	7
现有子女（例）					0.164					0.028					0.010
0	1 321	422	57	11		1 208	529	60	14		1 098	540	148	25
1	130	24	2	0		125	28	3	0		115	33	7	1
2个及以上	10	3	0	0		11	2	0	0		12	0	1	0
流产史（例）					0.459					0.065					0.741
无	899	290	33	6		813	368	41	6		749	361	101	17
有	562	159	26	5		531	191	22	8		476	212	55	9
流产次数（例）					0.298					0.084					0.802
0	899	290	33	6		813	368	41	6		749	361	101	17
1,2	462	136	25	4		436	164	19	8		392	178	49	8
3次及以上	100	23	1	1		95	27	3	0		84	34	6	1

量表名称	信度分析				结构效度分析
量表名称	项数	Cronbach′s α	Spearman-Brown分半系数	重测信度	KMO值	Bartlett球形度检验卡方值	P
PHQ-15	15	0.805	0.749	0.871	0.871*	4 295.4	<0.001
GAD-7	7	0.863	0.846	0.883	0.909	5 282.6	<0.001
PHQ-9	9	0.822	0.785	0.874	0.890	4 508.3	<0.001

量表名称	信度分析				结构效度分析
量表名称	项数	Cronbach′s α	Spearman-Brown分半系数	重测信度	KMO值	Bartlett球形度检验卡方值	P
PHQ-15	15	0.805	0.749	0.871	0.871*	4 295.4	<0.001
GAD-7	7	0.863	0.846	0.883	0.909	5 282.6	<0.001
PHQ-9	9	0.822	0.785	0.874	0.890	4 508.3	<0.001

变量	回归系数	标准误	Wald χ²	P	OR	95%CI
年龄
20~29岁	1	1	1	1	1	1
30~35岁	0.473	0.173	0.452	0.811	1.03	0.81~1.32
>35岁	0.504	0.151	11.130	0.014	1.54	1.10~2.17
学历
初中及以下	1	1	1	1	1	1
高中及中专	-0.359	0.171	0.417	0.141	1.31	0.91~1.89
大专及以上	-0.084	0.154	4.298	0.035	1.44	1.03~2.03
男方吸烟史
无	1	1	1	1	1	1
有	0.325	0.149	4.740	0.025	1.40	1.04~1.89