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The effect of expressive writing intervention for infertile couples: a randomized controlled trial.
Hum Reprod. 2017 02; 32(2):391-402.HR

Abstract

STUDY QUESTION

Is expressive writing intervention (EWI) efficacious in reducing distress and improving pregnancy rates for couples going through ART treatment?

SUMMARY ANSWER

Compared to controls, EWI statistically significantly reduced depressive symptoms but not anxiety and infertility-related distress.

WHAT IS KNOWN ALREADY

ART treatment is considered stressful. So far, various psychological interventions have been tested for their potential in reducing infertility-related distress and the results are generally positive. It remains unclear whether EWI, a brief and potentially cost-effective intervention, could be advantageous.

STUDY DESIGN SIZE, DURATION

Between November 2010 and July 2012, a total of 295 participants (163 women, 132 men) were randomly allocated to EWI or a neutral writing control group.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Participants were couples undergoing IVF/ICSI treatment. Single women and couples with Preimplantation Genetic Diagnosis or acute change of procedure from insemination to IVF, were excluded. EWI participants participated in three 20-min home-based writing exercises focusing on emotional disclosure in relation to infertility/fertility treatment (two sessions) and benefit finding (one session). Controls wrote non-emotionally in three 20-min sessions about their daily activities. The participants completed questionnaires at the beginning of treatment (t1), prior to the pregnancy test (t2), and 3 months later (t3). In total, 26.8% (79/295) were lost to follow-up. Mixed linear models were chosen to compare the two groups over time for psychological outcomes (depression, anxiety and infertility-related distress), and a Chi2 test was employed in order to examine group differences in pregnancy rates MAIN RESULTS AND THE ROLE OF CHANCE: One hundred and fifty-three participants received EWI (women = 83; men = 70) and 142 participants were allocated to the neutral writing control group (women = 83; men = 62). Both women and partners in the EWI group exhibited greater reductions in depressive symptoms compared with controls (P = 0.049; [CI 95%: -0.04; -0.01] Cohen's d = 0.27). The effect of EWI on anxiety did not reach statistical significance. Overall infertility-related distress increased marginally for the partners in the EWI group compared to the partners in the control group (P = 0.06; Cohen's d = 0.17). However, in relation to the personal subdomain, the increase was statistically significant (P = 0.01; Cohen's d = 0.24). EWI had no statistically significant effect on pregnancy rates with 42/83 (50.6%) achieving pregnancy in the EWI group compared with 40/80 (49.4%) in the control group (RR = 0.99 [CI 95% = 0.725, 1.341]; P = 0.94).

LIMITATIONS, REASONS FOR CAUTION

The results for depressive symptoms corresponded to a small effect size and the remaining results failed to reach statistical significance. This could be due to sample characteristics leading to a possible floor-effect, as we did not exclude participants with low levels of emotional distress at baseline. Furthermore, men showed increased infertility-related distress over time.

WIDER IMPLICATIONS OF THE FINDINGS

EWI is a potentially cost-effective and easy to implement home-based intervention, and even small effects may be relevant. When faced with infertility, EWI could thus be a relevant tool for alleviating depressive symptoms by allowing the expression of feelings about infertility that may be perceived as socially unacceptable. However, the implications do not seem to be applicable for men, who presented with increased infertility-related distress over time.

STUDY FUNDING/COMPETING INTERESTS

The present study was supported by research grants from Merck Sharpe and Dohme and The Danish Agency for Science Technology and Innovation as part of a publicly funded PhD. The funding bodies had no influence on the data collection, analysis or conclusions of the study. None of the authors have any conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

Clinicaltrials.gov, trial no. NCT01187095.

TRIAL REGISTRATION DATE

7th September 2010 DATE OF FIRST PATIENT'S ENROLMENT: 23rd November 2010.

Authors+Show Affiliations

Department of Psychology and Behavioral Sciences, Aarhus University, 8000 Aarhus, Denmark yoonf@psy.au.dk.Department of Psychology and Behavioral Sciences, Aarhus University, 8000 Aarhus, Denmark.Department of Psychology and Behavioral Sciences, Aarhus University, 8000 Aarhus, Denmark.Horsens Fertility Clinic, Horsens Hospital, 8700 Horsens, Denmark.The Fertility Clinic, Skive Regional Hospital, 7800 Skive, Denmark.Department of Psychology and Behavioral Sciences, Aarhus University, 8000 Aarhus, Denmark. Department of Oncology, Aarhus University Hospital, 8000 Aarhus Denmark.Center for Preimplantation Genetic Diagnosis/the Fertility Clinic, Aarhus University Hospital, 8200 Aarhus N, Denmark. Health, Aarhus University, 8000 Aarhus, Denmark.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28007790

Citation

Frederiksen, Yoon, et al. "The Effect of Expressive Writing Intervention for Infertile Couples: a Randomized Controlled Trial." Human Reproduction (Oxford, England), vol. 32, no. 2, 2017, pp. 391-402.
Frederiksen Y, O'Toole MS, Mehlsen MY, et al. The effect of expressive writing intervention for infertile couples: a randomized controlled trial. Hum Reprod. 2017;32(2):391-402.
Frederiksen, Y., O'Toole, M. S., Mehlsen, M. Y., Hauge, B., Elbaek, H. O., Zachariae, R., & Ingerslev, H. J. (2017). The effect of expressive writing intervention for infertile couples: a randomized controlled trial. Human Reproduction (Oxford, England), 32(2), 391-402. https://doi.org/10.1093/humrep/dew320
Frederiksen Y, et al. The Effect of Expressive Writing Intervention for Infertile Couples: a Randomized Controlled Trial. Hum Reprod. 2017;32(2):391-402. PubMed PMID: 28007790.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of expressive writing intervention for infertile couples: a randomized controlled trial. AU - Frederiksen,Yoon, AU - O'Toole,Mia Skytte, AU - Mehlsen,Mimi Y, AU - Hauge,Benedicte, AU - Elbaek,Helle Olesen, AU - Zachariae,Robert, AU - Ingerslev,Hans Jakob, Y1 - 2016/12/21/ PY - 2015/01/14/received PY - 2016/10/29/revised PY - 2016/11/22/accepted PY - 2016/12/23/pubmed PY - 2018/2/23/medline PY - 2016/12/24/entrez KW - ART treatment KW - anxiety KW - counseling KW - depression KW - distress KW - expressive writing KW - pregnancy SP - 391 EP - 402 JF - Human reproduction (Oxford, England) JO - Hum. Reprod. VL - 32 IS - 2 N2 - STUDY QUESTION: Is expressive writing intervention (EWI) efficacious in reducing distress and improving pregnancy rates for couples going through ART treatment? SUMMARY ANSWER: Compared to controls, EWI statistically significantly reduced depressive symptoms but not anxiety and infertility-related distress. WHAT IS KNOWN ALREADY: ART treatment is considered stressful. So far, various psychological interventions have been tested for their potential in reducing infertility-related distress and the results are generally positive. It remains unclear whether EWI, a brief and potentially cost-effective intervention, could be advantageous. STUDY DESIGN SIZE, DURATION: Between November 2010 and July 2012, a total of 295 participants (163 women, 132 men) were randomly allocated to EWI or a neutral writing control group. PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants were couples undergoing IVF/ICSI treatment. Single women and couples with Preimplantation Genetic Diagnosis or acute change of procedure from insemination to IVF, were excluded. EWI participants participated in three 20-min home-based writing exercises focusing on emotional disclosure in relation to infertility/fertility treatment (two sessions) and benefit finding (one session). Controls wrote non-emotionally in three 20-min sessions about their daily activities. The participants completed questionnaires at the beginning of treatment (t1), prior to the pregnancy test (t2), and 3 months later (t3). In total, 26.8% (79/295) were lost to follow-up. Mixed linear models were chosen to compare the two groups over time for psychological outcomes (depression, anxiety and infertility-related distress), and a Chi2 test was employed in order to examine group differences in pregnancy rates MAIN RESULTS AND THE ROLE OF CHANCE: One hundred and fifty-three participants received EWI (women = 83; men = 70) and 142 participants were allocated to the neutral writing control group (women = 83; men = 62). Both women and partners in the EWI group exhibited greater reductions in depressive symptoms compared with controls (P = 0.049; [CI 95%: -0.04; -0.01] Cohen's d = 0.27). The effect of EWI on anxiety did not reach statistical significance. Overall infertility-related distress increased marginally for the partners in the EWI group compared to the partners in the control group (P = 0.06; Cohen's d = 0.17). However, in relation to the personal subdomain, the increase was statistically significant (P = 0.01; Cohen's d = 0.24). EWI had no statistically significant effect on pregnancy rates with 42/83 (50.6%) achieving pregnancy in the EWI group compared with 40/80 (49.4%) in the control group (RR = 0.99 [CI 95% = 0.725, 1.341]; P = 0.94). LIMITATIONS, REASONS FOR CAUTION: The results for depressive symptoms corresponded to a small effect size and the remaining results failed to reach statistical significance. This could be due to sample characteristics leading to a possible floor-effect, as we did not exclude participants with low levels of emotional distress at baseline. Furthermore, men showed increased infertility-related distress over time. WIDER IMPLICATIONS OF THE FINDINGS: EWI is a potentially cost-effective and easy to implement home-based intervention, and even small effects may be relevant. When faced with infertility, EWI could thus be a relevant tool for alleviating depressive symptoms by allowing the expression of feelings about infertility that may be perceived as socially unacceptable. However, the implications do not seem to be applicable for men, who presented with increased infertility-related distress over time. STUDY FUNDING/COMPETING INTERESTS: The present study was supported by research grants from Merck Sharpe and Dohme and The Danish Agency for Science Technology and Innovation as part of a publicly funded PhD. The funding bodies had no influence on the data collection, analysis or conclusions of the study. None of the authors have any conflicts of interest to declare. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov, trial no. NCT01187095. TRIAL REGISTRATION DATE: 7th September 2010 DATE OF FIRST PATIENT'S ENROLMENT: 23rd November 2010. SN - 1460-2350 UR - https://www.unboundmedicine.com/medline/citation/28007790/The_effect_of_expressive_writing_intervention_for_infertile_couples:_a_randomized_controlled_trial_ L2 - https://academic.oup.com/humrep/article-lookup/doi/10.1093/humrep/dew320 DB - PRIME DP - Unbound Medicine ER -