title: Mental health of mothers and fathers of twins conceived via assisted reproduction treatment: a 1-year prospective study.
abstract: BACKGROUND
  Although twin deliveries after assisted reproduction treatment (ART) are common, the mental health of the parents has scarcely been addressed. Therefore, we evaluated the psychological well-being of ART and spontaneously conceiving parents of twins and singletons. Furthermore, the impact of parity and children's health-related factors on mental health was evaluated.
  
  
  METHODS
  We conducted a prospective longitudinal questionnaire study among ART parents of 91 pairs of twins and of 367 singletons and on control parents of 20 pairs of twins and of 379 singletons in the 2nd trimester of pregnancy (T1), and when the children were 2 months (T2) and 1-year old (T3). Symptoms of depression and anxiety, sleeping difficulties and social dysfunction were addressed via a questionnaire. The effects of parity and child-related factors were assessed at T2.
  
  
  RESULTS
  At T1, ART mothers of twins showed fewer symptoms of depression than control mothers of twins (P < 0.05). At T2, both ART and control mothers of twins had more symptoms of depression and anxiety than all mothers of singletons (F = 5.20, P < 0.05 and F = 3.93, P < 0.05, respectively). At T3, both ART and control mothers of twins continued to report more symptoms of depression than the mothers of singletons (F = 10.01, P < 0.01), but a difference in anxiety symptoms was seen only in the control group. All fathers had similar mental health at T1. At T2, ART and control fathers of twins reported more symptoms of depression (F = 4.15, P < 0.05) and social dysfunction than fathers of singletons. At T3, both ART and control fathers of twins had more symptoms of depression (F = 4.29, P < 0.05) and anxiety (F = 5.40, P < 0.05) than fathers of singletons. Control fathers of twins had more sleeping difficulties than fathers of singletons (F = 6.66, P < 0.01). Parity did not differently affect parental mental health at T2 in the study groups. Prematurity did not affect maternal mental health, but it had a negative impact on control fathers' social dysfunction (F = 3.34, P < 0.05).
  
  
  CONCLUSIONS
  Twin parenthood, but not ART, has a negative impact on the mental health of mothers and fathers during the transition to parenthood. ART parents' mental health was not affected by parity or children's health-related factors.
authors.affiliation: Infertility Clinic, The Family Federation of Finland, PO Box 849, 00101 Helsinki, Finland. sirpa.vilska@fimnet.fi
authors.forename: S
authors.initials: S
authors.lastname: Vilska
authors.forename: L
authors.initials: L
authors.lastname: Unkila-Kallio
authors.forename: R-L
authors.initials: RL
authors.lastname: Punamäki
authors.forename: P
authors.initials: P
authors.lastname: Poikkeus
authors.forename: L
authors.initials: L
authors.lastname: Repokari
authors.forename: J
authors.initials: J
authors.lastname: Sinkkonen
authors.forename: A
authors.initials: A
authors.lastname: Tiitinen
authors.forename: M
authors.initials: M
authors.lastname: Tulppala
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D019052:Depression, Postpartum / Q000453:epidemiology; D005220:Fathers / Q000523:psychology*; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D009035:Mothers / Q000523:psychology*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second / Q000523:psychology; D011272:Pregnancy, Multiple / Q000523:psychology*; D047928:Premature Birth / Q000523:psychology; D011446:Prospective Studies; D012893:Sleep Wake Disorders / Q000453:epidemiology; D012920:Social Behavior Disorders / Q000453:epidemiology; D014427:Twins