Kleanthi Gourounti

Perception of control, coping and psychological stress of infertile women undergoing IVF

The study aimed to examine: (i) the association between perception of infertility controllability and coping strategies; and (ii) the association between perception of infertility controllability and coping strategies to psychological distress, applying multivariate statistical techniques to control for the effects of demographic variables. This cross-sectional study included 137 women with fertility problems undergoing IVF in a public hospital. All participants completed questionnaires that measured fertility-related stress, state anxiety, depressive symptomatology, perception of control and coping strategies. Pearsons correlation coefficients were calculated between all study variables, followed by hierarchical multiple linear regression. Low perception of personal and treatment controllability was associated with frequent use of avoidance coping and high perception of treatment controllability was positively associated with problem-focused coping. Multivariate analysis showed that, when controlling for demographic factors, low perception of personal control and avoidance coping were positively associated with fertility-related stress and state anxiety, and problem-appraisal coping was negatively and significantly associated with fertility-related stress and depressive symptomatology scores. The findings of this study merit the understanding of the role of control perception and coping in psychological stress of infertile women to identify beforehand those women who might be at risk of experiencing high stress and in need of support.

The impact of infertility diagnosis on psychological status of women undergoing fertility treatment

Despite the great number of studies conducted to examine the impact of infertility on the psychological status of women undergoing infertility treatment, little is known about the psychological impact of infertility when it is due to male or female factors and its role in the cause of higher levels of anxiety and stress. The aim of this cross‐sectional study was to assess the impact of infertility diagnosis on infertile womens levels of anxiety, depression and fertility‐related stress. The study involved 404 women undergoing fertility treatment in a public clinic in Athens. The research instruments were three self‐administrated questionnaires. State and trait anxiety, infertility‐related stress (personal, social and marital domain) and depression were measured. Most of the women in this sample had low levels of infertility‐related stress and a low score for depression, but higher scores of state and trait anxiety than the published normative scores. Women with male factor infertility had higher levels of state anxiety (p = 0.007) and social stress (p = 0.007) than women with female, mixed and unknown infertility. Women with idiopathic infertility also had higher levels of trait anxiety (p = 0.001). Thus, the psychological status of women is strongly related to the aetiology of the infertility problem, and as a result it is necessary for women undergoing treatment for infertility to have an individualised psychological support, based on their infertility problem.

The Relation of Psychological Stress to Pregnancy Outcome Among Women Undergoing In-Vitro Fertilization and Intracytoplasmic Sperm Injection

A considerable literature has been accumulated regarding the relation of psychological factors to in-vitro fertilization outcome. However, study findings have been inconsistent, and the association between psychological stress and in-vitro fertilization outcomes is still unclear. The aim of the authors in this study was to examine the relation of infertility-related stress, anxiety, and depressive symptoms to in-vitro fertilization outcome. The sample consisted of 160 women with fertility problems undergoing fertility treatment in a public hospital in Athens, Greece between November 2008 and July 2009. The relation of infertility-related stress, anxiety, and depressive symptoms to in-vitro fertilization outcome was assessed by using hierarchical, sequential logistic regression, while controlling for the effects of relevant biomedical factors. After the embryo transfer, 41 women (26%) had a positive pregnancy outcome. Logistic regression analyses revealed that, controlling for biomedical factors (age, number of oocytes retrieved, and embryos transferred) infertility-specific stress (OR = 0.964, p = .011) and nonspecific anxiety (OR = 0.889, p = .006) were negatively associated with a positive pregnancy outcome after IVF. Psychological stress was negatively associated with in-vitro fertilization outcome, after controlling for biomedical variables. Fertility treatment protocols should consider including counselling interventions to potentially mitigate adverse effects of stress.

Occupational social class, coping responses and infertility-related stress of women undergoing infertility treatment

AIM AND OBJECTIVES The aims of this study were to examine the association between (1) occupational social class and coping responses, (2) coping responses and infertility-related stress and (3) occupational social class and infertility-related distress. BACKGROUND The coping strategies that individuals use in most of the stressful situations vary according to certain factors, such as, the appraised characteristics of the stressful condition, personality dispositions and social resources. DESIGN This study was a cross-sectional survey. METHODS The study involved 404 women undergoing infertility treatment at a public clinic in Athens, Greece. State and trait anxiety (State-Trait Anxiety Inventory), infertility-related stress (Copenhagen Multi-centre Psychosocial Infertility) and coping strategies (Copenhagen Multi-centre Psychosocial Infertility) were measured. RESULTS Women of low/very low social class reported higher levels of active-confronting coping compared with women of higher social class (p < 0·001). A positive correlation between active-avoidance coping and both state and trait anxiety (r = 0·278 and 0·233, respectively, p < 0·01) was observed. The passive-avoidance coping scale was positively correlated with marital and personal stress (r = 0·186 and 0·146, respectively, p < 0·01). All three kinds of stress (marital, personal and social) were positively correlated with both active-avoidance (r = 0·302, 0·423 and 0·211, respectively, p < 0·01) and active-confronting scale (r = 0·150, 0·211 and 0·141, respectively, p < 0·01). CONCLUSIONS Infertile women of the lowest social class used more active-confronting coping and more passive-avoidance coping than women of the highest social class. Factors such as low social class and maladaptive coping strategies might contribute to infertility-related stress and anxiety. RELEVANCE TO CLINICAL PRACTICE Nurses and midwives who work in infertility clinics should aim to identify individuals who are at high risk for infertility stress and adjustment difficulties and they should minimise the identified risk factors for infertility-related stress and strengthen the protective factors.

Primary Appraisal of Infertility: Evaluation of the Psychometric Properties of a Greek Version of the Appraisal of Life Events Scale (ALE) in a Sample of Infertile Women Undergoing Fertility Treatment

The Appraisal of Life Events is a self-report questionnaire that can be used retrospectively, asking respondents to reflect on the impact of a previously experienced event. The aim of this study was to examine the psychometric properties of the Greek version of the Appraisal of Life Events scale. The sample consisted of 137 women facing fertility problems and undergoing fertility treatment in a public hospital in Athens, Greece. The Appraisal of Life Events was ‘forward-backward’ translated from English to Greek language and was then pilot-tested to determine comprehensibility. Factor structure was investigated using exploratory factor analysis. Measures of stress (infertility-related stress, anxiety, depressive symptoms, mood states), personality traits (neuroticism, extraversion, optimism) and coping strategies were used to assess the convergent validity of the Appraisal of Life Events. Cronbachs α was used to measure internal consistency reliability. Two Appraisal of Life Events factors emerged from exploratory factor analysis. The threat and loss items were grouped together to form one factor. The original subscale of the challenge appraisal was reproduced. Convergent validity was confirmed by computing correlations between the two derived Appraisal of Life Events scales and the measures of stress, personality traits, and coping strategies. Internal consistency reliability was satisfactory (α = .79−.95). The Appraisal of Life Events had a meaningful factor structure and satisfactory reliability and convergent validity.

Poor marital support associate with anxiety and worries during pregnancy in Greek pregnant women

OBJECTIVE a wide range of psychosocial variables may influence pregnant womens psychological status. However the association between marital and social support, anxiety and worries during pregnancy is a relatively neglected area of research. Therefore, the aim of this study was to examine the relationship between marital support, social support, antenatal anxiety and pregnancy worries after controlling for the effects of background variables. SETTING public hospital in Athens, Greece. DESIGN a cross-sectional study. PARTICIPANTS 165 pregnant women attending an antenatal clinic for antenatal screening between January 2011 and March 2011. METHODS anxiety was measured using the State scale of the State-Trait Anxiety Inventory, pregnancy worries were measured with the Cambridge Worry Scale, social support with the Social Support Questionnaire-6 and marital satisfaction with the Quality of Marriage Index. Pearsons correlation coefficients were calculated among all study variables, followed by hierarchical multiple linear regression. FINDINGS a STAI score of ≥43 was taken as indicative of anxiety and 44.4% of participants responded with a score of 43 or above. Linear regression analysis showed that conception after IVF treatment and low marital satisfaction were both significantly related to anxiety and pregnancy worries. In addition, low income level was significantly related to pregnancy worry whereas low educational level was related to anxiety. CONCLUSION the risk factors found in this study could help clinicians target anxiety screening to high-risk populations of pregnant women. Health care professionals and midwives in particular should be trained in the detection and management of anxiety and worries during pregnancy.

The validation and translation of Multidimensional Measure of Informed Choice in Greek

OBJECTIVE to translate the original English version of the Multidimensional Measure of Informed Choice (MMIC) into Greek, to adapt it culturally to Greece, and to determine its psychometric properties for the assessment of informed choice in antenatal screening for Down syndrome. DESIGN survey using self-administrated questionnaires. SETTING public hospital in Athens, Greece. PARTICIPANTS 135 pregnant women with gestational age between 11th and 20th week just prior to having antenatal screening for Down syndrome. FINDINGS 96% of women had a positive attitude towards screening and 45% had a good level of knowledge concerning the screening process for Down syndrome. Using a standard measure of informed choice, validated for use in Greek, it was found that 44% of women made an informed choice, and thus 56% of women made an uninformed choice. The internal consistency of the scales was good; Cronbachs alpha was found to be 0.76 for the attitude scale and 0.64 for the knowledge scale, suggesting that all items were appropriate to measure. The performed factor analysis of the attitude scale indicated three factors with an eigenvalue over 1.0. Those factors were responsible for 87% of the variance. KEY CONCLUSIONS this study indicates that the Greek version of the MMIC appears to be a reliable and valid tool for measuring informed choice in antenatal screening for Down syndrome. Due to its short length and consumption of time, it seems to be a practical instrument for use in Greek antenatal clinics.

Psychological stress and adjustment in pregnancy following assisted reproductive technology and spontaneous conception: A systematic review

ABSTRACT The aim of this review was to examine studies describing the psychological stress and adjustment in pregnancy after an assisted reproductive technology (ART) treatment. A systematic search of the electronic databases was performed. This review considered only quantitative, primary studies in the English language, published during the period 2000–2014 and relevant to the objective. The population of interest was previously infertile pregnant women. Outcome variables were general anxiety, depressive symptoms, pregnancy-specific anxiety, quality of life, self-esteem, pregnancy attitudes and adjustment, and maternal-fetal attachment. Twenty studies met the inclusion and methodological criteria and were included in the review. The review revealed that compared to women who conceive naturally or to general norms, women who conceive after an in vitro fertilization treatment had greater pregnancy-specific anxiety, poorer quality of life, either the same or less depressive symptomatology, the same level of self-esteem, more positive attitudes toward pregnancy demands, and higher levels of maternal-fetal attachment. However, the evidence regarding the general anxiety levels in pregnancy after an ART treatment was inconclusive. Methodological limitations and differences across studies may explain the inconsistencies in their findings regarding the impact of ART. This review provides an insight into psychological reactions and adjustment in pregnancy after an ART treatment.

Women’s Perception of Information and Experiences of Nuchal Translucency Screening in Greece

Objective: First trimester ultrasound (US) screening has become part of antenatal care. The aim of this study was to explore pregnant women’s perceptions of the information given and experiences of first trimester nuchal translucency (NT) screening and to identify the background factors in a woman’s biography that influence her information needs and experiences of NT screening. Methods: This study was a descriptive, prospective survey which involved collecting information from the participants by using a questionnaire and took place in a public hospital in Athens. The sample consisted of 510 consecutive, unselected pregnant women of gestational age between 11 and 14 weeks, who had attended a nuchal translucency (NT) screening. Results: The majority of women felt that they had received either a limited or intermediate amount of information about the US screening and stated that they would have liked to receive more information. However, most of them (98%) answered that their expectations were fulfilled. 82% felt that the US examination was a positive experience, while 16% felt that US examination was a stressful experience. Furthermore, higher rates of positive experiences were observed among women with a higher educational level and greater satisfaction with the information received (χ2(d.f.=6) = 29.411, p = 0.000, χ2(d.f.=3) = 30.171, p = 0.000 respectively). Most women had wished to undertake NT screening to ensure that the fetus was healthy and without any defects and believed that a US examination should be performed at every antenatal visit. Conclusion: This study shows that most women lack information, specifically about the purposes and the diagnostic limitations of NT screening. Health professionals should therefore dedicate more time to discussing with women, and provide appropriate and understandable information tailored to the educational level of women and should emphasize the indications, purposes and limitations of US screening.

Validation of the Childbirth Attitudes Questionnaire in Greek and psychosocial characteristics of pregnant women with fear of childbirth.

BACKGROUND Fear of childbirth has been found to be a factor that influences womens decision about their choice of delivery. The investigation of psychological factors that relate to fear of childbirth as well as the validation of the Childbirth Attitudes Questionnaire (CAQ) can help identify pregnant women with high fear of childbirth. AIM This study aimed to (a) translate and validate the Childbirth Attitude Questionnaire in Greek and (b) explore how fear of childbirth was related to childbirth self-efficacy, state anxiety, depression, neuroticism, self-esteem and optimism. METHODS 145 nulliparous pregnant women, in late pregnancy, attending routine antenatal visit in a private maternity clinic participated. All participants completed the CAQ (fear of childbirth) and other self-report questionnaires that measured childbirth self-efficacy, self-esteem, optimism, neuroticism, state anxiety and depressive symptomatology. Factor structure was investigated using principal axis factoring. Cronbachs α was used to measure internal consistency reliability. Pearsons correlation coefficients were calculated between all study variables, followed by multiple linear regression. FINDINGS The factor analysis suggested the existence of one-factor structure. Construct validity was confirmed by computing correlations between the CAQ and childbirth self-efficacy, self-esteem and optimism. Multivariate analysis showed that childbirth self-efficacy, self-esteem and optimism were negatively and significantly associated with fear of childbirth. CONCLUSION AND IMPLICATIONS FOR PRACTICE The Greek version of the CAQ is a reliable and valid measure. The clinical use of CAQ may enable midwives and other health care professionals to identify pregnant women with low childbirth confidence and to provide information and support.