Emotional distress in infertile women in Kuwait

Although previous studies conducted in the Western countries have reported that psychological factors are implicated in the experience of infertility, no study has assessed this relationship in Arab women. We postulate that with all important causal "confounders" such as age, gender, education and general health status controlled, any significant difference in psychological profile can be attributed to infertility.

An Arabic version of the Hospital Anxiety and Depression Scale (HADS) was used to examine the psychological status of 120 Kuwaiti infertile women and an age-matched sample of 125 healthy pregnant women as a control group.

Compared with an age-matched pregnant control sample, the infertile women exhibited significantly higher psychopathology in all HADS parameters in the form of tension, hostility, anxiety, depression, self-blame and suicidal ideation. The illiterate group attributed the causes of their infertility to supernatural causes, such as evil spirits, witchcraft and God's retribution, while the educated group blamed nutritional, marital and psychosexual factors for their infertility. Faith and traditional healers were the first treatment choice among illiterate women, while the educated women opted for an infertility clinic for treatment. Childlessness resulted in social stigmatization for infertile women and placed them at risk of serious social and emotional consequences.

The prevalence and severity of psychological distress in this sample of infertile Kuwaiti women indicate the appropriateness of referring these patients for psychological evaluation. Programs successful in dealing with infertility in Kuwait need to include establishment of a community-based intervention strategy to educate people about infertility and to give guidelines for treatment.