Who is at risk of emotional problems and how do you know? Screening of women going for IVF treatment

Abstract

Fertility problems are accompanied by a lot of emotional distress, resulting in a considerable proportion of female patients showing severe maladjustment after assisted reproductive technology. Although this interferes with their daily life, emotional distress has also shown to be related to dropout of treatment and deterioration of health behaviour. Early identification of women at risk enables the provision of timely psychosocial support and the focusing psychosocial resources on those who need it most. This study investigated the psychometric characteristics of a screening tool SCREENIVF to identify women at risk of emotional problems at an early stage of treatment. Risk factors for emotional maladjustment were identified in a previous study and incorporated in SCREENIVF which consists of 34 items on general and infertility specific psychological factors. A group of 279 women in their first IVF treatment cycle completed SCREENIVF at both pretreatment and 3-4 weeks after the pregnancy test. Linear Regression analyses were performed to investigate the predictive value of SCREENIVF, and sensitivity and specificity as well as likelihood ratios were described. SCREENIVF successfully identified 75% of the patients as at risk or not at risk. The negative predictive value was high: 89%. The positive predictive value was low (48% in the total sample and 56% after unsuccessful treatment). Sensitivity was 69%, specificity was 77%. For its use as a first screening for emotional problems, SCREENIVF is an acceptable instrument to identify women at risk. These women could be offered more detailed diagnostics e.g. an interview to further investigate to what extent they could benefit from psychological treatment. In addition, physicians can anticipate on this risk profile when communicating with these patients.