Female Infertility Patients And Their Male Partners Under-Report Anxiety And Depression

BACKGROUND: Depression and anxiety scored by validated questionnaires have been shown to occur more frequently in fertility patients than in the general population. Studies suggest that treatment of these conditions can improve fertility rates. OBJECTIVE(S): The objective of this study was to compare self-reported anxiety and depression with objective scores on PHQ-9 (validated depression scale) and GAD-7 (validated anxiety scale) for both male and female infertility patients. MATERIALS AND METHOD(S): New female patients and their partners presenting to an infertility clinic for evaluation and treatment were offered participation. Each couple had already completed a self-reported history with review of systems which included anxiety and depression. Consenting female and male patients completed PHQ-9 and GAD-7 scales. PHQ-9 was scored as follows: score of 5-9 indicating mild depression, 10-14 moderate, 15-19 moderately severe, 20 or greater severe depression. GAD-7 was scored as follows: score 5-9 indicating mild anxiety, 10-14 moderate anxiety, and 15 or above indicating severe anxiety. Self-reported depression and anxiety were then compared with GAD-7 and PHQ-9 using Student's t-test. RESULT(S): Fifty-nine females and 48 male partners completed questionnaires. Overall, 10/59 females and 1/48 males self-reported depression. Eight of 59 females and 1/48 males self-reported anxiety. Of females denying depression, 18 scored 5 or greater on the PHQ-9: 15 were within the mild range, 2 within the moderate range, and 1 within the severe range. Of the females denying anxiety, 20 scored 5 or greater on the GAD-7: 13 were within mild range, 5 within moderate range, and 2 within severe range. Total prevalence of female depression based on objective scoring was 42% and anxiety was 41%. Of males denying depression, 7 (14.9%) scored between 5-9 on the PHQ-9. Of males denying anxiety, 11 (23.4%) scored 5 or greater on the GAD-7: 7 mild, 3 moderate, and 1 severe. CONCLUSION(S): Based on history alone, we found an increased rate of depression and anxiety over that of the general population. Depression and anxiety is much more common in our patients than even they are aware of when comparing self-reports to objective scales. Routine history and physical is not sensitive for detecting depression and anxiety, even when specifically asked on written review of systems. Patients presenting for fertility evaluation should be screened for the presence of depression and anxiety with objective scales.