Fertility treatments and mental health among the wealthy
Choosing in vitro fertilisation (IVF) over other infertility treatments has been linked to lower rates of mental health hospitalisation for women who don't conceive.
A Curtin University-led study suggests this is due to the 'healthy cohort effect', in which those with better mental health opt for the more challenging treatment.
"We know that IVF is emotionally and physically demanding, so it is possible that only mentally robust women select this treatment," Dr Louise Stewart says.
"Women who choose to undergo IVF may be more mentally resilient at the start of treatment than women who do not, and this is reflected in their later reduced risk of a hospital mental health admission.
"A second explanation is that women who undergo IVF are more proactive in seeking care when they need it.
"If they suffer mental health problems after infertility treatment they would be more likely to seek assistance from health care professionals and consequently not get to the point where they would require admission to a hospital."
To explore this second explanation further, the researchers examined social and economic resources.
Hospitalisation rates drop off among richer women
They observed women within the highest socio-economic band had lower rates of mental health hospitalisations.
"We suggest that socially advantaged women in our study have the financial and personal resources to seek out appropriate treatment in primary care—through their GP and, if necessary, by referral to a psychiatrist or psychologist," Dr Stewart says.
"Further, we suggest that this health-seeking behaviour is even more pronounced in women who have IVF."
The study drew on 6,567 women who commenced infertility treatments between 1982 and 2002 in WA.
Of these, 2,623 had IVF while 3,944 opted for other forms of treatment.
A follow up in August 2010 found that 411 women had a hospital admission for a mental health diagnosis, including 93 who had IVF and 318 who had not.
The majority of these admissions were for depression, anxiety, adjustment disorders, reaction to severe stress and disorders due to drug and alcohol use.
Dr Stewart says the current study differs from previous research in that it examines women exclusively who have not conceived, whereas previous studies compared the mental health of those who had had successful IVF with those who had not.
The inclusion of socio-economic status is also a strength.
"Socio-economic status is a powerful and pervasive health-related risk factor, yet it is rarely included in analyses such as ours," Dr Stewart says.