持續的生育困擾的確會對婦女造成一定程度之心理壓力，2012年七月初赴伊斯坦堡參加28屆ESHRE會議，一項大型不育婦女心理狀況調查，引起我的注意，先講它的結論：從開始治療不孕後，女性如持續不能生育，長期追蹤研究顯示，這些婦女後來因為精神疾病住院的比率，比治療後至少擁有一個孩子的婦女高18％。
再來介紹這項研究的規模，過去一直有小型研究發表不孕症病人與心理困擾的關係，內容包括不孕女性有較高的情緒障礙和抑鬱症狀，但很少有研究是以大量人口的基礎來追蹤無子女女性的心理狀態。來自丹麥的研究規模很大，囊括了從1973 年到 2008 年約35年間，98,737名透過丹麥的人口登記處，交叉連結出因不孕及心理問題求診的婦女，在哥本哈根丹麥癌症研究中心的流行病學家 Felskov 博士，進行為期12.6年的長期追蹤。調查的範圍包括精神紊亂、精神障礙、酒精和麻醉品濫用、精神分裂症、情感障礙、抑鬱症、焦慮、 適應不良和強迫性行為、飲食失調症和其他心理疾病。
研究結果顯示隨著 12.6 年的追蹤時間，54%的 98,737 婦女仍然無法擁有一個孩子。最後這近十萬名女性中，有近5000名婦女因焦慮、 上癮病、憂鬱症、情感性精神障礙等精神疾患而入院治療。
不過最後無法獲得子女的這一半女性，入院的比率較至少擁有一個孩子的婦女高18％。兩者具統計學的意義。尤其在酒精和藥物濫用、 精神分裂症和飲食障礙存在更明顯的風險。
Felskov 博士建議醫護人員工作時對於不孕症病人（尤其治療未成功者）的心理健康，應當更為關心留意並保持一定的專業敏感。
原文如下:
Childless women with fertility problems at 18% higher risk of hospitalisation for psychiatric disorders: Significant results from a large population study
Istanbul, 2 July 2012: While many small studies have shown a relationship between infertility and psychological distress, reporting a high prevalence of anxiety, mood disorders and depressive symptoms, few have studied the psychological effect of childlessness on a large population basis. Now, based on the largest cohort of women with fertility problems compiled to date, Danish investigators have shown that women who remained childless after their first investigation for infertility had more hospitalisations for psychiatric disorders than women who had at least one child following their investigation.
The results of the study were presented today at the annual meeting of ESHRE (European Society of Human Reproduction and Embryology) by Dr Birgitte Baldur-Felskov, an epidemiologist from the Danish Cancer Research Center in Copenhagen .
Most studies of this kind have been based on single clinics and self-reported psychological effects. This study, however, was a nationwide follow-up of 98,737 Danish women investigated for infertility between 1973 and 2008, who were then cross-linked via Denmark 's population-based registries to the Danish PsychiatricCentral Registry. This provided information on hospitalisations for psychiatric disorders, which were divided into an inclusive group of "all mental disorders", and six discharge sub-groups which comprised "alcohol and intoxicant abuse", "schizophrenia and psychoses", "affective disorders including depression", "anxiety, adjustment and obsessive compulsive disorder", "eating disorders", and "other mental disorders".
All women were followed from the date of their initial fertility investigation until the date of psychiatric event, date of emigration, date of death, date of hospitalisation or 31st December 2008, whichever came first. Such studies, said Dr Baldur-Felskov, could only be possible in somewhere like Denmark , where each citizen has a personal identification number which can be linked to any or all of the country's diagnostic registries.
Results of the study showed that, over an average follow-up time of 12.6 years (representing 1,248,243 woman-years), 54% of the 98,737 women in the cohort did have a baby. Almost 5000 women from the entire cohort were hospitalised for a psychiatric disorder, the most common discharge diagnosis being "anxiety, adjustment and obsessive compulsive disorders" followed by "affective disorders including depression".
However, those women who remained childless after their initial fertility investigation had a statistically significant (18%) higher risk of hospitalisations for all mental disorders than the women who went on to have a baby; the risk was also significantly greater for alcohol/substance abuse (by 103%), schizophrenia (by 47%) and other mental disorders (by 43%). The study also showed that childlessness increased the risk of eating disorders by 47%, although this was not statistically significant.
However, the most commonly seen discharge diagnosis in the entire cohort (anxiety, adjustment and obsessive compulsive disorders) was not affected by fertility status.
Commenting on the study's results, Dr Baldur-Felskov said: "Our study showed that women who remained childless after fertility evaluation had an 18% higher risk of all mental disorders than the women who did have at least one baby. These higher risks were evident in alcohol and substance abuse, schizophrenia and eating
disorders, although appeared lower in affective disorders including depression.
"The results suggest that failure to succeed after presenting for fertility investigation may be an important risk modifier for psychiatric disorders. This adds an important component to the counselling of women being investigated and treated for infertility. Specialists and other healthcare personnel working with infertile patients should also be sensitive to the potential for psychiatric disorders among this patient group."
