title: A systematic review of psychosocial factors associated with emotional adjustment in in vitro fertilization patients.
abstract: BACKGROUND
  IVF treatment is usually stressful for patients, but individual differences in emotional response do exist. Differences in the stress response may be related to reproductive outcomes as well as to the development of psychiatric problems. This review collates research exploring which psychosocial factors (e.g. personality traits and coping strategies) are associated with the emotional adjustment of IVF patients. The aim is to reveal what is currently known about risk and protective factors for coping with the stress of IVF treatment and where further enquiry would be most beneficial.
  
  
  METHODS
  The databases, MEDLINE/PUBMED (US National Library of Medicine), PsycINFO (American Psychological Association), Web of Science (Social Sciences Citation Index) and EMbase, were searched from 1978 to September 2012 using relevant key words. All published peer-reviewed studies exploring associations between psychosocial factors and emotional adjustment outcomes were considered for inclusion.
  
  
  RESULTS
  There were 23 studies identified for review. One-third of the psychosocial factors explored were found to be significantly related to emotional adjustment outcome measures. Neuroticism and the use of escapist coping strategies were positively associated with distress by multiple studies. Social support was negatively associated with distress by several studies. A number of other psychosocial variables appear to be associated with distress, including self-criticism, dependency, situation appraisals and attachment style, but these have only been explored by one or two studies at most. There is a paucity of research using positive emotional outcome measures (e.g. well-being, positive affect, happiness or life satisfaction) to quantify emotional adjustment.
  
  
  CONCLUSIONS
  Whilst some psychosocial variables appear to be consistently associated with distress for IVF patients, two-thirds of the variables tested to date do not appear to be associated with emotional adjustment. This review highlights key psychosocial factors to assist the identification of patients at high risk of psychological distress. These findings highlight at least two psychological factors that may be amenable to alteration with psychological or educational interventions. Future work should explore whether experimental manipulation of such psychosocial factors can provide effective stress reduction in this clinical context.
authors.affiliation: Department of Clinical Sciences, University of Bristol, Whitson Street, Bristol BS1 3NY, UK mdher@bristol.ac.uk.
authors.forename: Helen E
authors.initials: HE
authors.lastname: Rockliff
authors.affiliation: Department of Clinical Sciences, University of Bristol, Whitson Street, Bristol BS1 3NY, UK.
authors.forename: Stafford L
authors.initials: SL
authors.lastname: Lightman
authors.affiliation: Department of Clinical Sciences, University of Bristol, Whitson Street, Bristol BS1 3NY, UK.
authors.forename: Emily
authors.initials: E
authors.lastname: Rhidian
authors.affiliation: School of Community Health Sciences, University of Nottingham, Nottingham NG7 2RD, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Buchanan
authors.affiliation: Bristol Centre for Reproductive Medicine, Southmead Hospital, Bristol BS10 5NB, UK.
authors.forename: Uma
authors.initials: U
authors.lastname: Gordon
authors.affiliation: School of Community Health Sciences, University of Nottingham, Nottingham NG7 2RD, UK.
authors.forename: Kavita
authors.initials: K
authors.lastname: Vedhara
mesh_terms: D000223:Adaptation, Psychological; D001007:Anxiety / Q000209:etiology; D003863:Depression / Q000209:etiology; D004644:Emotions; D005260:Female; D005307:Fertilization in Vitro / Q000523:psychology*; D006801:Humans; D007246:Infertility / Q000523:psychology / Q000628:therapy; D008297:Male; D008393:Marriage / Q000523:psychology; D009769:Object Attachment; D010549:Personal Satisfaction; D010551:Personality; D012944:Social Support; D013315:Stress, Psychological / Q000209:etiology*
keywords: IVF/ICSI; coping; emotion; stress; systematic review