Depression and anxiety among women going through medically assisted reproduction: a register-based cohort study

How do the incidence and prevalence of depression and anxiety change for women during the 3 years before and after initiation of medically assisted reproduction (MAR)?

Women initiating MAR experienced a decline in depression and anxiety before treatment initiation, followed by an increase after initiation, returning to pre-treatment levels 3 years later.

Infertility and its treatment are associated with psychological distress, and previous research has examined mental health trajectories shortly before, during, and after treatment. Studies suggest that emotional adjustment varies across treatment phases and outcomes, but population-based evidence on clinical depression and anxiety patterns in a longer period before treatment initiation is lacking.

Nationwide register-based cohort study including all women in Denmark initiating MAR from 2006 to 2018 (n = 64 611) and a matched comparison group of women without MAR (n = 64 611), matched on the date of the first MAR treatment. Depression and anxiety were examined from 3 years before to 3 years after MAR initiation.

Women were identified from the Danish National Register of Assisted Reproductive Technology and matched on age, calendar year, parity, and psychiatric history. Depression and anxiety were defined as hospital diagnoses or filled prescriptions for antidepressants or anxiolytics. Incidence rates were defined as new registrations of depression or anxiety, requiring no registration in the preceding 12 months. Prevalence was defined as the proportion of person-time affected by depression or anxiety based on diagnoses or prescriptions within the preceding 12 months.

Among women undergoing MAR, the incidence rate of depression and anxiety declined from 19 to 11 per 1000 persons per half-year before treatment and rose to 17 three years after, forming a U-shaped pattern. In the comparison group, rates remained stable at about 25 per 1000 half-years. Results were consistent across subgroups defined by psychiatric history, age, and parity, and when restricting outcomes to hospital-based diagnoses.

The study relied on registry data and did not capture untreated or subclinical cases. Information on partnership status, socioeconomic characteristics, and parenthood intentions was unavailable and may differ between groups, potentially influencing both MAR initiation and mental health outcomes.

The findings suggest that women undergoing MAR experience a temporary period of improved mental health before treatment, followed by an increased risk afterwards. These descriptive patterns suggest that mental health varies across phases of fertility treatment and may help identify periods of particular relevance for mental health support in women undergoing MAR.

H.S. is funded by The Novo Nordisk Foundation (grant number 3110412) and The Independent Research Fund Denmark (grant number 2110290). S.E., T.M.-O., and M.B. are funded by The Novo Nordisk Foundation (grant number NNF21OC0072397). S.E. is also funded by The Psychiatric Research Fund in the Region of Southern Denmark (grant number A5752) and The Region of Southern Denmark (grant number A1784). Funding sources had no role in designing, planning, analysing, interpreting, or reviewing the manuscript.

Not applicable.