Anxiety and Depression Among Patients Treated at Two Fertility Centres in Nairobi; Prevalence and Associated Factors: a Descriptive Cross-sectional Study With a Sub-group Analysis

Abstract

Background: WHO recognizes infertility as the 5th highest cause of disability under the age of 60 globally. Studies have shown a link between infertility and psychiatric problems, whereby earlier studies blame infertility on psychiatric problems, and recent studies point to psychiatric problems as a sequel of infertility. There is a preponderance of generalized anxiety disorder and depression among infertile individuals. These conditions reduce the chances of achieving a pregnancy and affect continuity of care. Addressing psychological concerns in the management of infertility can improve follow-up and outcomes of the affected patients. Objective: To establish the prevalence of generalized anxiety disorder and depression along with their associated factors among patients undergoing treatment for infertility at two fertility centres in Nairobi. Methodology: Using a cross-sectional study with a sub-group analysis design, 124 patients attending two fertility centres between January and March 2022 were recruited into the study. Questionnaires incorporating the Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) were administered for self-reporting of depressive and anxiety, respectively. Data analysis: Data was analyzed using Statistical Package for Social Science (SPSS) version 26.0. Frequencies and percentages were used to present categorical data while means with standard deviations were used to present continuous data. Sociodemographic and reproductive characteristics were subjected to Pearson’s Chi-square tests, thereafter bivariate and multivariate logistic regression analysis was used to determine the factors associated with generalized anxiety disorder and depression. A p-value of <0.05 was considered to be statistically significant. Results: A total of 124 questionnaires were analysed in the study. The mean age of the study participants was 37 ± 6.212 years. A majority of the participants were female (83%), Christians (94%), married (94%), employed (68%), urban dwellers (73%) and obese (36%). Most of them had not been married before (59%) and most had tertiary education (90%). A minority of them were smokers (2%) and alcohol consumers (20%). The average length of marriage was 8.04±5.11 years. Primary infertility was the most common type of infertility (56%). The mean duration of infertility was 6.12±4.342 years. Female factor was the predominant cause of infertility (40%). Most of the participants were ART naive (63%). ART was the most common treatment modality (55%). Majority of the patients did not have a concomitant illness in the reproductive tract (90%). The prevalence of generalized anxiety disorder was found to be 50% and that of depression was found to be 19%. Factors associated with generalized anxiety 2 disorder were duration of infertility (p=0.03, AOR 1.20, 95%CI 1.02,1.42), previous marriage (p=0.017, AOR 3.02, 95%CI 1.22,7.46), lack of tertiary education (p=6.39, 95%CI 1.38,29.56),and co-existing depression (p=0.003, AOR 8.35, 95%CI 2.09,33.25). Factors associated with depression were duration of infertility (p=0.047, AOR 1.13, 95%CI 1.00,1.28), concomitant illnesses in the reproductive tract p=0.018, AOR 6.12, 95%CI 1.37,27.37) and co-existing generalized anxiety disorder. Conclusion: Depression and generalized anxiety disorder affect patients undergoing treatment for infertility in our setting. Psychological support should be incorporated into the routine management for infertility.