April 26, 2021
FACTS Infertility Awareness Series
Depression Among Infertile Women in Nigeria: A Research Review
By Jeong (Edward) Lee
Editor’s Note: As part of the FACTS series to raise awareness about infertility, this month we published a systematic review about fertility awareness-based methods (FABMs) and subfertility and a review of the impact of lifestyle factors on infertility. We also examined the impact of stress on fertility and published an interview with an obstetrician gynecologist who incorporates FABMs as powerful tools for women’s health.
This week’s research study was reviewed by fourth-year medical student, Jeong Lee, while on the FACTS elective. The research[i] article summarized below is titled, “Depression among infertile women in Ogbomosoland,” and it was published by Oladeji and OlaOlorun in 2017. This month’s series will conclude later this week with an inspiring story of a mother and daughter, and how FABMs brought healing to each of them and ignited their passion to impact entire communities through education. We hope you enjoy and share these articles and help us share the FACTS!
Infertility affects up to 168 million people worldwide. In other words, about 15% of the global population suffers from infertility,[ii] which the World Health Organization (WHO) currently defines as the inability for a biological female to conceive a child after attempting to get pregnant for at least 12 months. There are two ways to categorize infertility: primary and secondary. Primary infertility applies to women who have never conceived, and secondary infertility applies to women who have conceived at least once. This study focuses on both primary and secondary infertility and its relationship with depression among women in Ogbomosoland, Nigeria.
Globally, depression is the fourth leading cause of disability, but the WHO predicts it will be the leading cause by 2030.[iii] In Nigeria, a study from 2006 revealed evidence of anxiety in 37.5% and depression in 42.9% of women with infertility.[iv] It is important to address depression, since its presence can keep patients from seeking medical care both for depression and for infertility. This research attempts to determine the prevalence of depression in Nigerian women with infertility in Ogbomosoland and to examine socio-demographic characteristics found in these women.
The study included women who had either primary or secondary infertility, and the data was collected over three months in 2015. The criteria for infertility included adult women who reported an inability to conceive despite having unprotected heterosexual intercourse regularly for at least the previous 12 months. It was a cross-sectional study from a hospital with 240 beds in Ogbomosoland that evaluated approximately 10 heterosexual couples daily in the gynecology clinic. The informed consent was prepared by two translators who speak both English and Yoruba and used forward and backward translations to ensure the delivery of clear communication to every participant.
Each participant was screened for depression with the patient health questionnaire-9 (PHQ-9) to assess the degree to which infertility influenced their social event participation and functionality. Severity of depression was defined with PHQ-9 scores as follows: 0-4 (no depression), 5-9 (sub-threshold level of depression), 10-14 (mild depression), 15-19 (moderate depression), and above 20 (severe depression). Participants assessed their social functioning by choosing ‘not difficult at all,’ ‘somewhat difficult,’ ‘very difficult,’ or ‘extremely difficult.’ The association between depression and social functioning was determined with Fisher’s exact test and Pearson’s chi-square (statistical significance 0.05 and 95% confidence interval).
A total of 110 eligible women participated in the study, with their ages ranging from 24 to 49 and a mean of 34.5 ± 5.7. Depression prevalence among the participants was 52.7% with no statistical significance between age and depression. There were many interesting results that did not yield any statistical significance. Women who received an education beyond primary education demonstrated higher rates of depression compared to women with a primary education, but there was no statistical significance. Women who were married for more than 10 years reported higher rates of depression than those who were married less than 10 years, but the result was also not statistically significant.
Higher rates of depression were seen in women with secondary infertility compared to primary infertility; however, there was still no statistical significance. Women with at least one male child had lower rates of depression compared to women with no child or with one female child, but there was no statistical significance. The only factor that yielded statistical significance in this study was the association between depression and participants’ level of social functioning.
This research attempted to find associations among various factors related to depression and infertility. Although the study may have greater impact with more statistical significance, it adds valuable information to the growing body of literature in this important topic. If the research had been conducted throughout Nigeria or included more participants from around the world, the result could have possibly produced statistical significance. Nevertheless, the study was done comprehensively to include factors such as Nigeria’s patriarchal society to contemplate infertility and the impact of not only biological but also cultural aspects. For example, a Nigerian woman suffering from secondary infertility who already has a male child (as opposed to a female child) appeared less likely to have depression, although the finding was not statistically significant.
Cultural stigmatization can result in and contribute to medical conditions. One of the osteopathic medicine principles is that body, mind, and spirit are all interconnected. This research hinted that the body and mind are interacting with each other, which is one reason patients should be treated holistically. In the future, it would be interesting to explore causation further—whether infertility is causing depression, and how much depression contributes to infertility. Such a study would take longer than three months, but determining causality would facilitate the provision of resources and treatments to address the root cause.
Fertility awareness-based methods (FABMs) are an additional tool that helps women regardless of their reason for seeking care at a gynecology or primary care clinic. The empowering nature of charting the female cyclewhile using FABMs to learn more about her body contributes to a woman’s sense of autonomy, which impacts mental health. Additionally, fertility awareness-based methods may be used to facilitate the diagnosis and treatment of infertility. If research could be done with a control clinic without FABMs and a clinic that utilizes FABMs, it may elicit eye-opening results. The study would very possibly aid in lowering the prevalence of depression and infertility globally.
[i] Oladeji, SA, OlaOlorun, AD. (2018) Depression among infertile women in Ogbomosoland. South African Family Practice 2018; 60(2):41-45. DOI: 10.1080/20786190.2017.1370840.
[ii] Tabong PTN, Adongo PB (2013) Understanding the Social Meaning of Infertility and Childbearing: A Qualitative Study of the Perception of Childbearing and Childlessness in Northern Ghana. PLOS ONE 8(1): e54429. https://doi.org/10.1371/journal.pone.0054429.
[iii] World Health Organization. Depression: a global crisis: world mental health day. Geneva: World Health Organization Links; 2012.
[iv] Upkong D, Orji E. Mental health of infertile women in Nigeria. Turk J Psychi [Turk psikiyatri dergisi]. 2006 Winter;17(4):259–65. PubMed PMID: 17183442. Epub 2006/12/22.
About the Author
Author Bio: Jeong (Edward) Lee is a fourth-year medical student from PCOM-GA. He plans to pursue family medicine, and the FACTS elective through Georgetown University School of Medicine prepared him well to serve his future gynecology patients more holistically.
WHAT’S IN YOUR TOOLBOX?
The FACTS 2021 CME Conference
Fertility Awareness – Expanding Care for Women’s Health
Our 2021 two-day CME virtual conference is just a few weeks away! We are looking forward to this year’s event as an opportunity to connect with one another, to learn more about fertility awareness, and to explore timely topics in women’s reproductive health together. Expand your toolbox and join us! Click here for more details and registration information.We hope to “see” you there!
• FABM overview and their applications for:
– Hypothalamic Amenorrhea
– Thyroid Dysfunction
– Recurrent Pregnancy Loss
– Adolescence and Body Literacy
– Polycystic Ovarian Syndrome (PCOS)
• Fem Tech – NeoFertility and FEMM
• Functional Medicine in Women’s Health and FABMs
• Extensive Q&A with our expert panels
• Bonus Pre-conference Presentations!
• CME Credit*
*AAFP (American Academy of Family Physicians) CME credit is pending.
Can’t make it on these days?! Not to worry – Your registration will also allow access to these presentations through the end of 2021!