Measurement of Anxiety, Depression and Insomnia Levels of Women Admitted to a Training and Research Hospital and Receiving Infertility Treatment and Medical Social Work Intervention

Abstract

Aim: The aim of this study is to determine the levels of insomnia, anxiety, and depression in women diagnosed with infertility undergoing in vitro fertilization (IVF) treatment and to examine the relationship between these psychological conditions and the socio-demographic characteristics of the women. Additionally, the study seeks to investigate how receiving psychosocial support from social service specialists after being referred to medical social service units can affect the anxiety, depression, and insomnia levels of these women. Method: The study was conducted with 156 female patients diagnosed with infertility who applied to the IVF Unit of an Education and Research Hospital in Istanbul between October and December 2022. Data were collected using the Insomnia Severity Index (ISI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Socio-Demographic Information Form through face-to-face interviews. The data were analyzed using the SPSS 25.00 program, employing frequency, percentage distributions, means, standard deviations, and Spearman’s Correlation tests for independent groups. The Kolmogorov-Smirnov test was used for the normality test. Results: The study found that women with higher education levels, those who were not employed in any income-generating work, and those who had prolonged unprotected sexual intercourse without achieving pregnancy had higher ISI, BAI, and BDI scores. Additionally, women who were referred to medical social service units received psychosocial and economic support, and this support was found to have a positive impact on their lives and treatment outcomes. Conclusion: The study determined that the levels of insomnia, anxiety, and depression were high in women undergoing infertility treatment and that socio-demographic factors were associated with these psychological conditions. It was also found that women who were referred to medical social service units and received psychosocial support had improved treatment outcomes. These findings highlight the importance of addressing not only the physical aspects of infertility treatment but also the psychological and social aspects. The psychosocial support provided by social service specialists can improve the effectiveness of the treatment process and alleviate the emotional burden of the women.

Keywords

• Infertility
• psychosocial support systems
• social work
• psychiatric social work

Ethical Statement

Ethical approval was obtained from the Clinical Research Ethics Committee of Istanbul Training and Research Hospital (Decision No: 2710, Date: 05.02.2021).

Bir Eğitim ve Araştırma Hastanesine Başvuran ve İnfertilite Tedavisi Gören Kadınların Anksiyete, Depresyon Ve Uykusuzluk Düzeylerinin Ölçülmesi ve Tıbbi Sosyal Hizmet Müdahalesi

Abstract

Amaç: Bu çalışmanın amacı, tüp bebek tedavisi gören infertilite tanısı almış kadınların uykusuzluk, anksiyete ve depresyon düzeylerini belirlemek ve bu psikolojik durumların, kadınların sosyo-demografik özellikleri ile ilişkisini incelemektir. Ayrıca, infertilite tedavisi gören kadınların tıbbi sosyal hizmet birimlerine yönlendirilmesi durumunda, sosyal hizmet uzmanlarından alacakları psiko-sosyal desteğin anksiyete, depresyon ve uykusuzluk düzeylerini nasıl etkileyebileceğini araştırmak hedeflenmiştir. Yöntem: Çalışma, İstanbul'da bir Eğitim ve Araştırma Hastanesi'nin Tüp Bebek Ünitesi'ne Ekim, Kasım ve Aralık 2022 tarihlerinde başvuran ve infertilite tanısı almış 156 kadın hasta ile gerçekleştirilmiştir. Veriler, Uykusuzluk Şiddeti İndeksi (UŞİ), Beck Anksiyete Ölçeği (BAÖ), Beck Depresyon Ölçeği (BDÖ) ve Sosyo-Demografik Bilgi Formu kullanılarak yüz yüze görüşme tekniğiyle toplanmıştır. Verilerin analizi için SPSS 25.00 programı kullanılarak sayı, yüzde dağılımları, ortalama, standart sapma ve Bağımsız Gruplarda Spearman Korelasyon testleri uygulanmıştır. Normallik testi için Kolmogorov-Smirnov testi kullanılmıştır. Bulgular: Çalışma bulgularına göre, eğitim düzeyi yüksek, herhangi bir gelir getirici işte çalışmayan ve korunmasız cinsel ilişki süresi uzun olup gebelik elde edemeyen kadınların uykusuzluk (UŞİ), anksiyete (BAÖ) ve depresyon (BDÖ) puanlarının yüksek olduğu görülmüştür. Ayrıca, tıbbi sosyal hizmet birimlerine yönlendirilen kadınların psiko-sosyal ve ekonomik destek aldıkları, bu durumun yaşamları ve tedavi süreçleri üzerinde olumlu etkiler yarattığı tespit edilmiştir. Sonuç: İnfertilite tedavisi gören kadınların uykusuzluk, anksiyete ve depresyon düzeylerinin yüksek olduğu, sosyo-demografik faktörlerin bu psikolojik durumlarla ilişki taşıdığı belirlenmiştir. Tıbbi sosyal hizmet birimlerine yönlendirilen kadınların aldıkları psiko-sosyal destek, tedavi süreçlerini iyileştirmiştir. Bu bulgular, infertilite tedavisinin yalnızca fiziksel yönlerle değil, aynı zamanda psikolojik ve sosyal yönlerle de ele alınması gerektiğini göstermektedir. Sosyal hizmet uzmanlarının kadınlara sağladığı psiko-sosyal destek, tedavi süreçlerinin etkinliğini artırabilir ve kadınların duygusal yüklerini hafifletebilir.

Keywords

• İnfertilite
• psikososyal destek sistemleri
• sosyal hizmet
• psikiyatrik sosyal hizmet

References

1. 1. Şirin A. Approaching Couples Undergoing IVF Treatment. 1st ed. İzmir: Ege University Press; 2001.
2. 2. Can G. An examination of anxiety and depression levels in women seeking assisted reproductive techniques [Graduation thesis]. Bornova, İzmir: Ege University, School of Nursing; 2005.
3. 3. Yanikkerem E, Kavlak O, Sevil U. Infertile couples’ problems and nursing approach. J Anatolian Nurs Health Sci. 2008;11(4):112-121.
4. 4. Hajizade-Valokolaee M, Khani S, Fooladi E, Peivandi S. Related factors of violence against women with infertility: A systematic review study based on an ecological approach. Electron Physician. 2017;9(11):5834-5843. doi: 10.19082/5834
5. 5. Cousineau TM, Domar AD. Psychological impact of infertility. Best Pract Res Clin Obstet Gynaecol. 2007;21(2):293-308. doi: 10.1016/j.bpobgyn.2006.12.003
6. 6. Vitale SG, La Rosa VL, Rapisarda AM, Lagana AS. Psychology of infertility and assisted reproductive treatment: The Italian situation. J Psychosom Obstet Gynaecol. 2017;38(1):1-3. doi: 10.1080/0167482X.2016.1244184
7. 7. World Health Organization. Available at: http://www.un.org/millennium/declaration/ares552. Accessed January 10, 2024.
8. 8. Aldemir S, Eser A, Turhan NO, Dalbudak E, Topcu M. Relation of anxiety and depressive symptoms with perceived social support according to gender within infertile couples. Dunsen Adam. 2015;28(4):328-336. doi: 10.5350/Dajpn2015280404

9. 9. Turan Ş. Türk Kültür Tarihi. Ankara: Bilgi Publications; 1990.
10. 10. Ögel B. Türk Mitolojisi-I. Ankara: TTK Publications; 1998.
11. 11. Yalman A. Cenupta Türkmen Oymakları I. 3rd ed. Ankara: Ministry of Culture Publications; 1993.
12. 12. Selçuk A. A phenomenological approach to beliefs and practices related to childbirth among the Tahtacı people. TÜBAR. 2004;16:163-180.
13. 13. Teke E. Beliefs and practices related to childbirth in Osmaniye [Master's thesis]. Gaziantep: Gaziantep University, Social Sciences Institute, Department of Turkish Language and Literature; 2005.
14. 14. Demirbilek S. A sociological study on gender discrimination. Finans Politik & Ekonomik Yorumlar. 2007;44(511):12-27.
15. 15. Çakırer N, Çalışkan Z. Traditional beliefs and practices related to pregnancy, childbirth, and postpartum in Ağıllı Village, Nevşehir Province. TAF Prev Med Bull. 2010;9(4):343-8.
16. 16. Hasanpoor-Azghdy SB, Simbar M, Vedadhir A. The social consequences of infertility among Iranian women: A qualitative study. Int J Fertil Steril. 2015;8(4):409-420.
17. 17. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: Psychometric properties. J Consult Clin Psychol. 1988;56:893-897.
18. 18. Şahin NH. Reliability and validity of the Beck Depression Inventory for Turkish university students. Psychol J. 1989;7:13.
19. 19. Ulusoy M, Şahin N, Erkmen H. Turkish Version of the Beck Anxiety Inventory: Psychometric properties. J Cogn Psychother. 1998;12:163-172.
20. 20. Hisli N. A study on the validity of the Beck Depression Inventory. Turk J Psychol. 1988;6:118-126.
21. 21. Ceyhun B, Akça F. A study on the validity and reliability of the Jung Depression Scale. In: VIII. National Psychology Congress Scientific Studies. Turkish Psychological Association Publications; 1994:20-26.
22. 22. Bastien CH, Vallieres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2:297-307.
23. 23. Boysan M, Güleç M, Beşiroğlu L. Psychometric properties of the Insomnia Severity Index in a Turkish sample. Anadolu Psikiyatri Derg. 2010;3:242-252.
24. 24. Voncouer, P. Quantitative methods in social service research: Integrating data analysis with social policy. Oxford University Press, 2013.
25. 25. Pallant, J. SPSS survival manual: A step-by-step guide to data analysis using IBM SPSS. 7th ed. Routledge, 2020.
26. 26. Cılga İ. Bilim ve Meslek Olarak Türkiye’de Sosyal Hizmet. Ankara: Hacettepe University Social Services High School Publications; 2004.
27. 27. Payne, M. Modern social work theory. 5th ed. Oxford University Press, 2020.Cochrane JH. Asset Pricing. Princeton: Princeton University Press; 2005.
28. 28. Krause ED, Kaltman S, Goodman LA, Dutton MA. Avoidant coping and PTSD symptoms related to domestic violence exposure: A longitudinal study. J Trauma Stress. 2008;21(1):83-90.
29. 29. Levant RF, Pollack WS, eds. A New Psychology of Men. New York: Basic Books/Hachette Book Group; 1995.
30. 30. Renzetti CM, Curran DJ, Carr PJ. Theories of crime: A reader. Available at: https://uknowledge.uky.edu/crvaw_book/20. Accessed December 8, 2023.
31. 31. Fassino S, Pierò A, Boggio S, Piccioni V, Garzaro L. Anxiety, depression, and anger suppression in infertile couples: A controlled study. Hum Reprod. 2002;17:2986-2994.
32. 32. Greil AL. Infertility and psychological distress: A critical review of the literature. Soc Sci Med. 1997;45:1679-1704.
33. 33. Harlow CR, Fahy UM, Talbot WM, Wardle PG, Hull MG. Stress and stress-related hormones during in vitro fertilization treatment. Hum Reprod. 1996;11:274.
34. 34. Schmidt L, Christensen U, Holstein BE. The social epidemiology of coping with infertility. Hum Reprod. 2005;20:1044-1052.
35. 35. Thiering P, Beaurepaire J, Jones M, Saunders D, Tennant C. Mood state as a predictor of treatment outcome after in vitro fertilization/embryo transfer technology (IVF/ET). J Psychosom Res. 1993;37:481-489.
36. 36. Benli S. Depression and anxiety levels in infertile women and associated factors [Master's thesis]. Konya, Turkey: Selçuk University, Institute of Health Sciences, Department of Nursing; 2010.
37. 37. Karaca A, Ünsal G. İnfertilitenin kadın ruh sağlığı üzerine etkileri ve psikiyatri hemşiresinin rolü. J Psychiatric Nurs. 2012;3;2:80–8.
38. 38. Terzioğlu C, Kamışlı S, Bozdag G. J Psychiatr Nurs. 2021;12(1):43-49.
39. 39. UNICEF. (2024). Over 370 million girls and women globally subjected to sexual assault before age 18. Erişim: https://www.unicef.org
40. 40. Hines DA, Douglas EM. Physical revictimization among men: Gendered patterns of abuse. Journal of Interpersonal Violence. 2024;39(5):2450‑2475.
41. 41. Zhang Y, Li R, Wang J. Infertility-related psychological distress and its socio-environmental determinants: Evidence from assisted reproductive treatment. Journal of Reproductive Psychology. 2024;33(2):111‑125.
42. 42. Kim S, Park H. Social support, resilience, and mental health outcomes in women undergoing IVF-ET. Reproductive Health. 2025;22:45.
43. 43. Greil AL, Slauson-Blevins K, McQuillan J. The experience of infertility: A review of recent literature. Sociol Health Illn. 2010;32(1):140–162. doi:10.1111/j.1467-9566.2009.01213.x.
44. 44. Krieger, N. Methods for the scientific study of discrimination and health: An ecosocial approach. Am J Public Health. 2012;102(5):936–944.
45. 45. Campbell JC. Health consequences of intimate partner violence. Lancet. 2013;373(9657):68–78.