Infertility treatment and marital relationships: a 1-year prospective study among successfully treated ART couples and their controls

BACKGROUND: Evidence about the effects of infertility and assisted reproduction technique (ART) on marital relationships is discrepant. Here, we examined the impact of ART on marital relationships. The roles of life stressors, infertility and treatment characteristics in predicting marital relations were also evaluated. METHODS: Subjects: 367 couples with singleton IVF/ICSI pregnancies. Controls: 379 couples with spontaneous singleton pregnancies. Women and men were assessed when the child was 2 months (T2) and 12 months old (T3). They further reported stressful life events at T2 and depression in pregnancy. RESULTS: No between-group differences were found in marital satisfaction and dyadic cohesion. Dyadic consensus deteriorated from T2 to T3 only among control women. Sexual affection was low among control men at T2 and stressful life events decreased it further. Depression during pregnancy predicted deteriorated marital relations only in control couples. Several unsuccessful treatment attempts were associated with good dyadic consensus and cohesion among ART women. Spontaneous abortions and multiple parity predicted poor marital satisfaction in ART women, whereas long duration of infertility and multiple parity predicted poor marital relations in ART men. CONCLUSIONS: Successful ART does not constitute a risk for marital adjustment. The shared stress of infertility may even stabilize marital relationships.     

Marital status transitions and psychological distress: longitudinal evidence from a national population sample

BACKGROUND: Evidence is conflicting as to whether the association between marital status and psychological distress is due to selection (i.e. distress influences marital status) or causation (marital status influences distress). We investigate: (i) whether differences in psychological distress pre-date marital transitions; (ii) whether levels of distress change following transitions; and (iii) potential mediating and moderating factors. METHODS: Data on psychological distress (indicated by the Malaise Inventory) and marital status at ages 23 and 33 were analysed for 4514 men and 4842 women from the 1958 birth cohort. RESULTS: Higher levels of distress were found among the divorced and lower levels among the single and the married. Selection was seen in the lower initial mean symptoms of those who married (1.69 for men; 2.84 for women) compared to those remaining single (2.41 for men; 3.26 for women). Causation was indicated by the relative deterioration in distress of those who divorced compared to the continuously married (an increase of 0.31 and 0.03 respectively for men), especially in women (a decrease of 0.18 versus 0.71). This was most evident in women who were downwardly mobile and those with children. Recently separated men and women showed especially large increases in distress. CONCLUSIONS: The relationship between marital status and psychological distress involves selection and causation. Findings failed to support ideas of marriage being protective (through social support), or detrimental (through family roles). Divorce increased distress, with both acute and longer-term components moderated by secondary factors such as childcare and declining socioeconomic status.     

Life events and psychosocial factors in elderly suicides--a case-control study.

BACKGROUND: Stressful life events, such as family conflicts, separation, bereavement, somatic illness and financial problems are common antecedents of suicide. Studies on suicide among younger persons dominate the literature, despite the fact that a large proportion of suicides occur among elderly persons. METHODS: The occurrence of stressful life events was investigated among elderly suicide cases and population controls. The study was conducted in the southwestern part of Sweden and included 85 persons (46 males and 39 females) 65 years and above who had committed suicide from January 1994 to May 1996. Population controls (84 males and 69 females) were randomly selected. Interviews were carried out with the controls and with informants for the suicide cases. Questions on sociodemographic background, mental and somatic health status, and life events (0-6, 7-12 and 13-24 months preceding suicide/interview) were included in the interviews. RESULTS: Somatic illness, family discord and financial trouble were significant risk factors during all three time periods. Other risk factors were mental disorder, lower education, feelings of loneliness and previous suicide in the family. Factors associated with a decreased risk included active participation in organizations and having a hobby. Variables that remained in the multivariate logistic regression model were mental disorder (men, odds ratio (OR) = 62.4, 95% CI 17.9-217.5; women, OR = 55.9, 95% CI 14.1-222.3) and family discord (men, OR = 10.0. 95% CI 1.7-59.8; women, OR = 9.2, 95% CI 1.9-44.8). CONCLUSIONS: Mental disorder and family discord were the two major risk factors for suicide among elderly men and women.     

Understanding the heterogeneity of depression through the triad of symptoms, course and risk factors: a longitudinal, population-based study

BACKGROUND: While the sex difference in prevalence rates of unipolar depression is well established, few studies have examined gender differences in clinical features of depression. Even less is known about gender differences in chronic forms of depression. METHODS: 235 male and 400 female outpatients with DSM-III-R chronic major depression or double depression (i.e., major depression superimposed on dysthymia) were administered an extensive battery of clinician-rated and self-report measures. RESULTS: Women were less likely to be married and had a younger age at onset and greater family history of affective disorder compared to men. Symptom profile was similar in men and women, with the exception of more sleep changes, psychomotor retardation and anxiety/somatization in women. Women reported greater severity of illness and were more likely to have received previous treatment for depression with medications and/or psychotherapy. Greater functional impairment was noted by women in the area of marital adjustment, while men showed more work impairment. LIMITATIONS: Since our population consisted of patients enrolling in a clinical trial, study exclusion criteria may have affected gender-related differences found. CONCLUSIONS: Chronicity of depression appears to affect women more seriously than men, as manifested by an earlier age of onset, greater family history of affective disorders, greater symptom reporting, poorer social adjustment and poorer quality of life. These findings represent the largest study to date of gender differences in a population with chronic depressive conditions.     

Domestic violence against women as a risk factor for depressive and anxiety disorders: findings from domestic violence household survey in Tehran,Iran

Domestic violence (DV) especially intimate partner violence is a global health problem responsible for significant part of burden of diseases in women. Mental health problems such as depression and anxiety are possibly results and resulted in IPV. To investigate correlation between IPV and depression and anxiety among married women, in a household survey of married women in Tehran, Iran, at summer 2011, we recruited 615 samples with cluster sampling method and they are directly asked about experience of 23 different types of physical and non-physical IPV during marital life and last 12 months. Depression and anxiety were assessed by Beck depression inventory II (BDI) and Beck Anxiety inventory (BAI). Multinominal regression model was used to assess the independent relationship of factor on IPV. Mean (±SE) age and duration of marriage were 42.6?±?0.9 and 22?±?0.8, respectively. Non-physical violence and physical violence during marital life reported in 77.2 and 35.1 %. Clinically significant depression and anxiety was reported in 15.3 and 32.7 % of women, respectively. The odds ratio (95 % CI) of clinically significant depression and anxiety in DV victims were 5.8 (2.3–14.6) and 2.6 (1.6–4.3). DV as a social factor is significantly correlated factor with depression and anxiety. Comprehensive view and collaborative work to detect and address social determinants of mental illness like DV is a crucial point in mental health promotion programs.     

Prevalence of poor self-rated health and associated risk factors among older adults in Cali,Colombia

Introduction:

Self-rated health (SRH) has beeen considered an important marker of quality of life and an independent predictor of mortality in older adults.

Objective:

To determine the prevalence of poor SRH and identify risk factors associated with poor SRH among older adults residing in the Commune 18 of the city of Cali, Colombia, in 2009.

Methods:

A population-based cross-sectional study with a single-stage cluster sampling design. Sample included 314 persons aged 60 and older. The dependent variable, SRH was dichotomized into good (excellent, very good, good) and poor (fair, poor). Independent variables were sociodemographic, biological, mental, functional and geriatric syndromes. Logistic regression was used for multivariate statistical modeling.

Results:

Overall, 40.1% reported poor SRH (women 42.9%, men 35.0%). Factors independently associated with poor SRH were diabetes mellitus, depression, fear of falling and frailty syndrome (frail and pre-frail vs. non-frail). Widowed men reported poorer health than married men while other marital status (single/separated/divorced) was associated with better self-rated health in women.

Conclusion:

Potential modifiable factors such as depression and frailty syndrome are important determinants for poor SRH in Colombian older adults.

     

Depression and risk of heart failure among the elderly: a prospective community-based study

OBJECTIVE: Although the association between depression and the incidence of coronary heart disease has been established in many studies, the impact of depression on the incidence of heart failure has not been previously investigated. METHODS: We examined the effect of depression (assessed by means of the Center for Epidemiological Studies Depression Scale (CES-D) with a cutoff point of > or =21) on the incidence of heart failure in a community sample of persons aged > or =65 years who were participants in the New Haven cohort of the Established Populations for Epidemiological Studies in the Elderly. RESULTS: At baseline 2501 individuals were free of heart failure. Of these, 188 (132 women and 56 men) scored as depressed. Depressed participants were significantly more likely to have hypertension, diabetes, and mobility-related functional limitations and were less likely to be male or married. During the 14-year follow-up period, 313 participants (146 men and 167 women) developed heart failure, defined as hospital admission for heart failure or mortality with heart failure as the underlying cause of death. After adjusting for baseline differences in demographic and comorbidity factors and functional status using Cox regression, depression tended to be associated with a greater risk of heart failure (hazard ratio (HR) = 1.52, 95% confidence interval (CI) = 0.94-2.43, p =.09). This effect was significant in women (HR = 1.96, 95% CI = 1.11-3.46, p =.02) but not in men (HR = 0.62, 95% CI = 0.23-1.71, p =.05 for the interaction term between sex and depression). CONCLUSIONS: Depression is an independent risk factor for heart failure among elderly women but not elderly men.     

Political violence,social integration,and youth functioning: Palestinian youth from the Intifada

Informed by social ecological, social capital, and social disorganization theories, this study tested an ecological model of youth experience in the Palestinian Intifada. The sample included 6,000 Palestinian 14 year olds, assessed in 1994 and 1995 after the end of the conflict. Data from retrospective self‐reports of youth exposure to and involvement in political violence, and self‐reports of current individual functioning (depression and antisocial behavior) and integration in several social contexts (family, peer relations, religion, education, and community), revealed: direct associations between Intifada experience and antisocial behavior and depression (females only); Intifada experience was positively associated with religiosity and unrelated to social integration in family, school, and peer relations; in some cases, social integration in family, education, religion, and peer relations significantly moderated the associations between Intifada experience and youth problems; integration in the several social contexts was directly related in predictable ways to youth problem behaviors, with neighborhood disorganization the most consistent and powerful predictor. The discussion centers around youth resilience to the effects of political violence, the role of psychological meaning children and adolescents can attach to political violence, and the overall salience of social integration in youth development. © 2001 John Wiley & Sons, Inc.     

Factorial structure and correlates of marital adjustment in a Japanese population: A community study

A total of 146 married inhabitants (67 men and 79 women) in a provincial city of Japan were interviewed to examine marital adjustment and its psychosocial determinants. Fifteen items of the Short Marital Adjustment Test (Locke & Wallace, 1959) (LWT), a self-rating questionnaire, were transformed into a semi-structured interview together with two new items. Factor analysis yielded five factors which were interpreted as dyadic consensus, satisfaction, flexibility, home-loving, and interest-sharing. Better marital adjustment in women was correlated with higher standard of living, lower neuroticism, and a more caring father, whereas in men it was correlated with lower psychoticism and a more caring mother. Longitudinal studies are needed to throw more light on the determinants of marital adjustment.     

Exposure to Community Violence and Violence Perpetration: The Protective Effects of Family Functioning

Although research has found that urban youth are exposed to excessive levels of community violence, few studies have focused on the factors that alter the risk of exposure to violence or the processes through which youth who are exposed to community violence do better or worse. This study investigates the risk of exposure to community violence and its relation to violence perpetration among a sample of 263 African American and Latino male youth living in inner-city neighborhoods. The study also examines the role that family functioning plays in moderating the risk. The study finds that youth from struggling families—those that consistently used poor parenting practices and had low levels of emotional cohesion—were more likely to be exposed to community violence. It also finds a relation between exposure to violence and later violence perpetration. However, youth exposed to high levels of community violence but living in families that functioned well across multiple dimensions of parenting and family relationship characteristics perpetrated less violence than similarly exposed youth from less well-functioning families.     

The effect of marital status on survival in late-stage cancer patients: An analysis based on surveillance, epidemiology, and end results (SEER) data, in the United States

Recently findings that marital status is associated with survival in patients with late-stage prostate cancer led to an examination of the generalizability of this association for all cancers. We restricted the investigation to patients with late-stage cancer using population-based data collected from 261,070 patients with late-stage cancer at multiple sites in the United States to determine relations between marital status and survival. After controlling for age, race, and treatment, married patients with cancers of all major primary sites had significantly better survival than single, separated, divorced, or widowed patients. Although single and widowed patients had the poorest prognosis in general, single patients appeared to show the most consistently poor survival across the different types of cancers. Survival differences by marital status were more pronounced in men than in women. This observation raises the possibility that some characteristics associated with being married delay death from cancer. These findings require investigators to ask new questions about the effect of being married and its possible correlates, such as general health status, access to health care, and socioeconomic status. Known correlates of marital status, such as available social support and social isolation also merit attention in relation to these findings.     

Adolescent and family predictors of physical aggression, communication, and satisfaction in young adult couples: a prospective analysis

This study tested a model wherein the family conflict, depression, and antisocial behavior of 254 adolescents (mean age = 17 years; 63% female) are prospectively related to functioning within a marital (51%) or dating relationship in young adulthood (mean age = 23 years). Family aversive communication in adolescence and adolescent antisocial behavior predicted couple physical aggression. Family aversive communication predicted dyadic satisfaction and aversive couple communication for married women and dating men. Among those with partners who reported little antisocial behavior, adolescent antisocial behavior inversely predicted couple satisfaction and facilitative behavior. Partner antisocial behavior did not mediate the relation between adolescent characteristics and couple functioning. Findings emphasize the importance of the early family environment and psychopathology of the adolescent in the development of adaptive couple relationships.     

HIV infection in rural villages of Cameroon

OBJECTIVE: To evaluate HIV-1 antibody seroprevalence and risk factors for HIV seropositivity in rural areas of Cameroon. METHOD: The prevalences of HIV antibodies in 53 villages in rural Cameroon visited during May-October 2000 were determined with an HIV1/2 rapid assay, standard ELISA, and western blot. Demographic data and risk factors were elicited via face-to-face interviews with a structured questionnaire. RESULTS: HIV seroprevalence was 5.8% (243/4156, 95% confidence interval [CI] = 5.1-6.6) overall, 6.3% (151/2394, 95% CI = 5.4-7.4) among females and 5.2% (92/1762, 95% CI = 4.3-6.4) among males. HIV seroprevalence among persons aged 15 - 70 years did not differ significantly by province (5.6% in Center, 4.5% in East, 6.9% in South, and 5.8% in South-West) ( =.10). Analysis of age- and gender-standardized prevalence by village across provinces indicated a near-significant difference (nonparametric Wilcoxon signed rank test, =.06), with highest prevalence in South-West, followed by South, Center, and East. Multivariate analysis revealed that single women were significantly more likely to be HIV seropositive than were married or widowed women. Women with a history of sexual relations while traveling were at significantly increased risk of HIV seropositivity (OR adjusted for age and marital status = 2.4, 95% CI = 1.4-9.7). Among men, those who reported ever having a sexually transmitted disease were at significantly increased risk of HIV-seropositivity (OR adjusted for age = 1.8, 95% CI = 1.1-2.8). CONCLUSION: We have documented a wide range of HIV prevalences among rural villages of Cameroon. Age, marital status (in women) and sexual risk factors appear to be associated with HIV infection in this setting.     

Social class differences in rates of premature mortality among adults in the city of Wrocław,Poland

Mortality rates among adult men and women, inhabitants of the city of Wroc?aw, were studied within 5-year age classes between 20 and 64 years of age relative to two social variables: education and marital status of the deceased. Age- and sex-specific mortality rates reveal a systematic social gradient. They are highest among persons with primary or “basic vocational” school education, lower among those with secondary school education, and lowest among those with college education. This gradient consistently appears in each of the age classes of males and females, although it is more pronounced among males. In both sexes, married persons have lower rates of mortality than those who have never married or were divorced or widowed. Among females, marital status appears to have a stronger effect on age-specific rates of mortality than educational status; the reverse is the case among males. © 1993 Wiley-Liss, Inc.     

Sleep complaints in middle‐aged women and men: the contribution of working conditions and work–family conflicts

This study aimed to examine how physical working conditions, psychosocial working conditions and work–family conflicts are associated with sleep complaints, and whether health behaviours explain these associations. We used pooled postal questionnaire surveys collected in 2001–2002 among 40–60‐year‐old employees of the City of Helsinki (n = 5819, response rate 66%). Participants were classified as having sleep complaints if they reported sleep complaints at least once a week on average (24% of women and 20% of men). Independent variables included environmental work exposures, physical workload, computer work, Karasek’s job strain and work–family conflicts. Age, marital status, occupational class, work arrangements, health behaviours and obesity were adjusted for. Most working conditions were associated strongly with sleep complaints after adjustment for age only. After adjustment for work–family conflicts, the associations somewhat attenuated. Work–family conflicts were also associated strongly with women’s [odds ratio (OR) 5.90; confidence interval (CI) 4.16–8.38] and men’s sleep (OR 2.56; CI 1.34–4.87). The associations remained robust even after controlling for unhealthy behaviours, obesity, health status, depression and medications. Physically strenuous working conditions, psychosocial job strain and work–family conflicts may increase sleep complaints. Efforts to support employees to cope with psychosocial stress and reach a better balance between paid work and family life might reduce sleep complaints. Sleep complaints need to be taken into account in worksite health promotion and occupational health care in order to reduce the burden of poor sleep.     

Psychological and physical sequelae of intimate partner violence among women with limitations in their activities of daily living

Summary Objective: To compare the psychological and physical sequelae of physical/sexual intimate partner violence in women with and without activity limitations. Methods: We analyzed data from the Canadian 1999 General Social Survey. We included women reporting intimate partner violence in the previous 5 years (n = 897). Results: As a result of the violence, women with activity limitations were significantly more likely to feel ashamed/guilty (21.7 vs. 14.5%), depression/anxiety (31.5 vs. 19.8%), fearful (43.0 vs. 33.0%), lowered self-esteem (35.2 vs. 21.1%), increased caution/awareness (20.3 vs. 10.9%), and problems relating to men (16.4 vs. 5.4%). Significantly more women with activity limitations reported physical injury from violence (57.0 vs. 36.6%) and having to take time off from everyday activities (42.1 vs. 30.3%). Women with activity limitations had higher medication use for sleeping problems (OR = 3.17, 95% CI = 1.36, 5.73), anxiety (OR = 3.29, 95% CI = 1.75, 6.19) and depression (OR = 2.63, 95% CI = 1.41, 4.90). Conclusion: Results suggest an additive effect between intimate partner violence and activity limitations that adds disproportionately to the burden of health for women with activity limitations.     

Body mass index,overweight and obesity in married and never married men and women in Poland

The study examined the relationship between marital status and the body mass index (BMI) and the prevalence of overweight and obesity in the Polish population. The sample included 2,266 men and 4,122 women, 25–60 years of age, who were occupationally active inhabitants of Wroclaw, in southwestern Poland. Marital status was defined by two categories: never married and presently married, and two groups in each category were established on the basis of educational level: well‐educated (12 or more years in school) and poorly educated (less than 12 years in school). The subjects were also divided into four age groups: 25–30, 31–40, 41–50, and 51–60 years. Height and weight were measured and the BMI was calculated. Three categories of the BMI were established: normal, BMI < 25.0 kg/m², overweight, BMI ≥ 25 < 30 kg/m², and obese, BMI ≥ 30 kg/m². In each age and educational group, married individuals had a higher BMI than those who were never married. With the exception of well‐educated males 51–60 years, differences in the BMI between married and never married individuals increased with age. In general, married men and women were more likely to be overweight and obese than never married individuals. The results indicated a significant association (P < 0.001) between marital status and the BMI in both sexes. After age, marital status was the most important predictor of overweight/obesity among men (P < 0.001), whereas educational level did not have a significant role. Among women, age, marital status, and education were significantly (P < 0.001) related to the BMI. Am. J. Hum. Biol. 14:468–475, 2002.© 2002 Wiley‐Liss, Inc.     

成都地区55周岁及以上人群中抑郁症患病率调查

目的了解成都地区55周岁及以上人群中抑郁症患病率及其影响因素。方法本文采用分层随机整群抽样方法,从成都市所辖地区抽取10个区市县。按农业人口和非农业人口所占比例确定应查城乡55周岁及以上人口数。调查由两阶段组成,先用流调用抑郁自评量表(CES-D)筛查,然后用DSM-Ⅲ-R定式临床检查(SCID-P)进行诊断复查。应查5587人,实查5385人,其中5350人完成了CES-D检查,35人因耳聋(且不识字),失语无法完成CES-D,改用SCID-P询问家属或其他知情者。外出171人,拒查31人,漏查率3.6%。结果发现CES-D评分≥16分者168人,为被调查人口的3.14%。诊断复查发现各类抑郁症的患病率分别为适应性障碍0.85%。心境恶劣障碍0.76%,躯体疾病所致抑郁心境0.52%,重型抑郁症0.45%。各类抑郁症总患病率为2.62%,其中男性1.60%,女性3.54%,女性患病率显著高于男性。多元逐步回归分析表明日常生活能力受损、女性以及认知功能下降老人有抑郁症状者较多。结论本文结果表明我国抑郁症患病率较低。适应性障碍,心境恶劣障碍和躯体疾病引起的抑郁是主要的抑郁类型。     

Marital quality, marital disruption, and immune function

Marital disruption is associated with significant increases in a variety of psychologic and physical disorders. In order to examine psychologic and physiologic mediators, self-report data and blood samples were obtained from 38 married women and 38 separated/divorced women. Among married subjects, poorer marital quality was associated with greater depression and a poorer response on three qualitative measures of immune function. Women who had been separated 1 year or less had significantly poorer qualitative and quantitative immune function than their sociodemographically matched married counterparts. Among the separated/divorced cohort, shorter separation periods and greater attachment to the (ex)husband were associated with poorer immune function and greater depression. These data are consistent with epidemiologic evidence linking marital disruption with increased morbidity and mortality.     

Poverty, violence and depression during pregnancy: a survey of mothers attending a public hospital in Brazil

BACKGROUND: Depression in women is associated with social deprivation and violence. We describe the prevalence and risk factors for depression during pregnancy, in particular the association with poverty and violence, in a Brazilian setting. METHOD: A cross-sectional survey of women in the third trimester of pregnancy attending a public hospital maternity clinic from August 2003 to July 2004 in Rio de Janeiro. Participants were interviewed about their sociodemographic status, obstetric and medical conditions, substance use, stressful life events, and social support. Depression was diagnosed through the Composite International Diagnostic Interview (CIDI). RESULTS: A total of 230 of 240 eligible women consented to participate. The 12-month prevalence of depression was 19.1% (95% CI 14.4-24.9). On multivariate analyses, having been educated beyond primary school was protective (OR 0.5, 95% CI 0.2-0.9). Risk factors were: being divorced or widowed (OR 4.9, 95% CI 1.3-18.3); a history of depression before pregnancy (OR 7.9, 95% CI 3.1-20.5); loss of an intimate relationship (OR 8.4, 95% CI 3.3-21.4), experienced financial difficulties (OR 6.6, 95% CI 2.5-17.2) and having been exposed to violence in the previous year (OR 4.2, 95% CI 1.5-11.8). CONCLUSIONS: Depression is common during pregnancy and is associated with indicators of socio-economic deprivation, violence and the loss of an intimate relationship, and with a previous history of depression. Psychosocial interventions and appropriate social policies need to be implemented in this population to reduce the burden of maternal depression.