Prevalence of depression and contributing factors among women with infertility in low resource settings: systematic review and meta-analysis

Shimelis Tadesse ¹ Henok Kumsa ² Getnet Gedefaw ³ Fiker Chane ² Gemeda Wakgari Kitil ¹ Alex Ayenew Chereka ⁴ Esuyawkal Mislu ^2*

• ¹ Department of Midwifery, College of Health Science, Mattu University, Mettu, Ethiopia
• ² Department of Midwifery, College of Health Science, Woldia University, Woldia, Ethiopia
• ³ Department of Midwifery, College of Medicine and Health Science, Injibara University, Injibara, Amhara Region, Ethiopia
• ⁴ Department of Health Informatics, College of Health Sciences, Mattu University, Mattu, Ethiopia

Background: Depressive symptoms are the most common psychiatric disorder among women with infertility. In low-resource settings, the overall prevalence, and contributing factors of depressive symptoms among women with infertility remain unknown synthesized. Objectives: To estimate the prevalence and contributing factors of depression among women with infertility in low-resource settings. Methods: A review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, MEDLINE, Google, Google Scholar, EMBASSE, and Hinari, data bases were used to identify eligible studies published up to November 30, 2023. Three authors independently extracted the data. Studies that report depression among women with infertility were included in this review. The data were analyzed with STATA version 14 and meta-analysis was done with random effects model. Publication bias and heterogeneity were assessed by Eager’s tests and I 2. Subgroup and sensitivity analyses were performed to identify the potential source/s of heterogeneity. A p-value of 0.05 was declared as statistically significant. The findings were synthesized and presented using texts, tables, and forest plots with measures of effect and 95% confidence Interval (CI). Results: Seventeen published cross-sectional studies with a total of 3528 women with infertility were taken that met the inclusion criteria. The pooled prevalence of depression among women with infertility was 48.77% (95% CI (35.86, 61.67). Good functioning family (OR 0.71 (95% CI (0.51, 0.97), I2: 0.00%)), husband support (OR 0.52 (95% CI (0.34, 0.79), I2: 0.00%)), primary infertility (OR 2.55 (95% CI (1.36, 4.79), I2: 68.53%)), women’s history of divorce (OR 4.41 (95% CI (2.11, 9.24), I2: 0.00%)), and longer duration of infertility (OR 6.27 (95% CI (2.74, 14.34), I2: 15.26%)) were statistically significant. Conclusion: Depression among women with infertility in low-resource settings, africa was high compared to high-income countries, men, and pregnant mothers. Good functioning family, husband support, primary infertility, women with a history of divorce, and duration of infertility greater than ten years were statistically associated. Therefore, African countries and the stakeholders in collaboration with mental health experts and gynecological care providers shall address these problems to reduce or prevent depression among women with infertility.