L26/P-599 Infertility-Related Anxiety, Depression and Coping Strategies Among Patients and Couples in Central South Africa

Abstract

Abstract Study question What are the prevalence and severity of anxiety and depression, their co-occurrence, and coping strategies among infertile women and couples in central South Africa? Summary answer Infertility patients in central South Africa show high anxiety and depression prevalence, with greater burden and more comorbidity among women, alongside diverse coping patterns. What is known already Infertility affects an estimated 15–20% of couples in sub-Saharan Africa and is frequently accompanied by stigma, blame and emotional distress, predisposing affected individuals to anxiety and depression. While several studies have documented the psychological burden of infertility, fewer have examined both individual- and couple-level patterns together, or explored coping strategies in this context. Study design, size, duration Two complementary prospective cross-sectional surveys were conducted at UAH Participants/materials, setting, methods Two complementary prospective cross-sectional surveys were conducted at UAH, infertility clinic in central SA. In Study 1, infertile women (n = 100) completed sociodemographic questionnaires, the Patient Health Questionnaire-9 (PHQ-9) for depression and the Generalized Anxiety Disorder-7 (GAD-7) for anxiety. In Study 2, couples (n = 235; 115 females, 120 males) completed sociodemographic questionnaires, the PHQ-9, the Hamilton Anxiety Rating Scale (HAM-A), and the Coping Responses Inventory–Adult form (CRI-Adult). Descriptive and comparative statistics were performed; p < 0.05 denoted statistical significance. Main results and the role of chance In Study 1, 53.0% of infertile women screened positive for depression (PHQ-9 ≥10) and 50.0% for anxiety (GAD-7 ≥10); 40.0% had both depression and anxiety. Most women with depression or anxiety were aged 25–34 years and had experienced infertility for 1–5 years. In Study 2, severe anxiety (HAM-A ≥25) was present in 20.9% of females and 4.2% of males (p = 0.0003). Overall, 46.1% of females and 15.8% of males had depression (PHQ-9 ≥10; p < 0.0001). Co-occurring anxiety and depression were significantly more frequent in women (53.9%) than in men (26.7%; p < 0.0001). Women reported higher frequencies of core depressive and anxiety symptoms, including low interest, hopelessness, sleep disturbance, fatigue, negative self-evaluation and suicidal ideation. Across coping domains (CRI-Adult), women used more coping strategies than men, particularly acceptance/resignation, emotional discharge, seeking social support, problem-solving, positive reappraisal, and avoidance (all p < 0.05). Limitations, reasons for caution Limitations include single-centre recruitment limiting generalisability, absence of a fertile comparison group, reliance on self-administered questionnaires with potential response and recall bias, and omission of contextual variables such as polygamy, religion, and extramarital relationships that may influence psychological outcomes among infertile couples. Wider implications of the findings:Infertility in this central South African setting is linked to high anxiety and depression, especially among women, with frequent comorbidity. Women use a wider range of coping strategies, both adaptive and maladaptive. Findings support integrating routine mental health screening and gender-sensitive, couple-focused psychosocial support into infertility care services. Trial registration number Yes