title: The impact of social relations on the incidence of severe depressive symptoms among infertile women and men.
abstract: BACKGROUND
  The present study investigates anticipated support and perceived appreciation as well as perceived negative aspects of social relations as determinants of the incidence of severe depressive symptoms among women and men in unsuccessful fertility treatment.
  
  
  METHODS
  A prospective cohort study of consecutively recruited, new couples in fertility treatment completed questionnaires immediately before initiating treatment (T1) and at 1-year follow-up (T2) (response rates 80%, 88%). The study population included 695 participants (355 women and 340 men) who had no severe depressive symptoms at T1, who had no child together at T1 and whose treatment had failed. We measured severe depressive symptoms with Mental Health Inventory 5 from Short-Form 36, functional aspects of general social relations and of infertility-specific social relations.
  
  
  RESULTS
  Fifteen per cent of women and 6% of men in unsuccessful treatment reported severe depressive symptoms at T2. Among men, low emotional support, low appreciation and high excessive demands from the partner were significant determinants of the incidence of severe depressive symptoms. Among women and men, low appreciation from the family, many conflicts and high excessive demands from family, friends and neighbours were significant determinants of severe depressive symptoms. The analyses were controlled for gender. Duration of infertility, infertility diagnosis and socio-economic position did not confound the associations.
  
  
  CONCLUSIONS
  More women than men report severe depressive symptoms after 1 year of unsuccessful treatment. It is important to be aware of the possible negative impact of relational strain among fertility patients in unsuccessful treatment.
authors.affiliation: The Institute of Public Health, University of Copenhagen, DK-1014 Copenhagen K, Denmark. r.lund@pubhealth.ku.dk
authors.forename: R
authors.initials: R
authors.lastname: Lund
authors.forename: C S
authors.initials: CS
authors.lastname: Sejbaek
authors.forename: U
authors.initials: U
authors.lastname: Christensen
authors.forename: L
authors.initials: L
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007246:Infertility / Q000523:psychology*; D008297:Male; D027724:Reproductive Techniques, Assisted / Q000523:psychology*; D012737:Sex Factors; D012944:Social Support; D013315:Stress, Psychological