title: Suicide in Danish women evaluated for fertility problems.
abstract: BACKGROUND
  Women with fertility problems often experience higher levels of stress, anxiety and depressive symptoms associated with both the infertility diagnosis and eventual fertility treatment. The authors investigated whether women who do not succeed in having a child after an infertility evaluation are at a higher risk of suicide than women who succeed in having a child after an infertility evaluation.
  
  
  METHODS
  A cohort of 51 221 Danish women with primary or secondary infertility and referred to hospitals or private fertility clinics in Denmark during 1973-1998 was established. The cohort was linked to four Danish administrative population-based registries. Each woman was followed from the date of her initial fertility evaluation at the clinic or hospital until 2006. Cox proportional hazards regression analyses was used to calculate hazard ratios (HRs) for suicide and their corresponding 95% confidence intervals (CIs) adjusted for potential confounders.
  
  
  RESULTS
  Women who did not have a child after an initial fertility evaluation had a >2-fold (HR: 2.43; 95% CI: 1.38-3.71) greater risk of suicide than women who had at least one child after a fertility evaluation. Women with secondary infertility, i.e. women who had a child before a fertility evaluation but did not succeed in having one after, also had an increased risk for suicide (HR: 1.68; 95% CI, 0.82-3.41) compared with women who succeeded in having another child, although the risk estimate failed to reach significance.
  
  
  CONCLUSIONS
  Health-care personnel treating women with fertility problems should be aware of the emotional response of their patients in order to recognize and treat possible psychiatric morbidity after fertility problems.
authors.affiliation: Department of Psychosocial Cancer Research, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark. trille@cancer.dk
authors.forename: Trille Kristina
authors.initials: TK
authors.lastname: Kjaer
authors.forename: Allan
authors.initials: A
authors.lastname: Jensen
authors.forename: Susanne Oksbjerg
authors.initials: SO
authors.lastname: Dalton
authors.forename: Christoffer
authors.initials: C
authors.lastname: Johansen
authors.forename: Sven
authors.initials: S
authors.lastname: Schmiedel
authors.forename: Susanne Krüger
authors.initials: SK
authors.lastname: Kjaer
mesh_terms: D000328:Adult; D001007:Anxiety; D003718:Denmark / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000523:psychology* / Q000628:therapy; D008137:Longitudinal Studies; D012044:Regression Analysis; D018570:Risk Assessment; D013315:Stress, Psychological; D013405:Suicide / Q000523:psychology*; D016896:Treatment Outcome