Analysis of severe psychological stressors in women during fertility treatment: Japan-Female Employment and Mental health in Assisted reproductive technology (J-FEMA) study

Abstract

Purpose To identify risk factors for severe psychological stress in women undergoing fertility treatment. Methods This cross-sectional, multi-center study was conducted from August to December 2018. We recruited 1672 subjects who completed an anonymous, self-reported questionnaire regarding fertility treatment, conditions at work and home, and psychological stress using K6 score, which estimates psychological distress during the previous 30 days. We further focused our analysis on 1335 subjects who were working when starting fertility treatment. Results Of 1672 women, mean K6 score (range 0-24) was 4.8 ± 4.4, including 103 women (6.2%) with K6 score ≥ 13 (high K6), and classified as probable severe psychological distress. Multivariate logistic regression analysis showed that high K6 was strongly associated with low annual family income of ≤ USD55,700 (JPY6 million) (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.04−3.42), infertility duration of ≥ 2 years (OR 1.87, 95% CI 1.08−3.25), and no experience of childbirth (OR 2.04, 95% CI 1.05−3.97). Focusing on 1335 working women, 266 (19.9%) experienced resignation from work. High K6 was strongly associated with low family income (OR 2.83, 95% CI 1.52−5.28), cessation of professional duties (OR 2.08, 95% CI 1.05-4.14), infertility-related harassment in the workplace (OR 2.07, 95% CI 1.08−3.98), and perceived difficulties to continue working during fertility treatment (OR 2.94, 95% CI 1.15−7.50). Conclusion Severe psychological stressors in women during fertility treatment included low family income, long infertility duration, childlessness, infertility-related harassment, and perceived difficulty in working conditions or cessation from work. Establishment of mental health care support systems is urgently required in this population.

The social determinants of mental health disorders among women with infertility: a systematic review

“…Employment status had significant associations with various mental health conditions [ 47 , 48 , 53 , 58 – 60 ]. Employed women had lower anxiety, depression and stress levels [ 47 , 60 ].…”

“…Employed women had lower anxiety, depression and stress levels [ 47 , 60 ]. Conversely, perceived difficulties to continue working during fertility treatment and infertility-related harassment in the workplace were associated with higher rates of psychological distress [ 53 ].…”

“…Lower income was associated with higher anxiety [ 44 ] and women from lower social class also scored high on the state anxiety scale (STAI) compared to women of medium and higher social classes [ 43 ]. Higher individual and family incomes reduced depression risk [ 45 , 50 ], while inadequate family income was associated with higher rates of psychological distress [ 53 ]. Moreover, women who reported depression and anxiety indicated they faced significant financial problems due to infertility treatment [ 42 ].…”

Assisted Reproductive Technologies and Work, Employment and Society: Extending the Debate on Organisational Involvement in/Responsibilities around Fertility and Reproduction

“…Whilst evidence is limited, the same can be seen elsewhere. A 2017 Japanese government survey (in Ikemoto et al, 2021) reported little ART-related provision, with just 6.2% of responding organisations offering leave, and 1.9% offering financial subsidy.…”

Occupational stress and related factors among childless working women in their 20s–40s: A pregnancy perspective

“…A 2018 survey found that 7.4% of women who underwent infertility treatment experienced harassment because of it 11) . Of the women who were working at the start of infertility treatment, 16.7-50.1%, or one in 2-6, had left the workforce 10,12,13) , with the lack of workplace support being one of the risk factors for leaving 10,13) . Thus, women are subjected to various occupational stressors owing to pregnancy and childbirth.…”