# The Prevalence of Depression, Anxiety, and Stress in Women with Recurrent Pregnancy Loss and Infertility Compared to Normal Controls in Oman: A Prospective, Cross-Sectional Study

## TL;DR

Omani women with recurrent pregnancy loss and infertility experience higher stress, anxiety, and depression than fertile women, but the study did not assess male partners.

## Contribution

This study is the first to investigate mental health in Omani women with RPL and infertility using validated Arabic psychological assessments.

## Key findings

- Women with RPL and infertility had significantly higher stress, anxiety, and depression than controls.
- Depression was most prevalent in the RPL group, followed by the infertility group and controls.
- The study used validated Arabic psychological assessments to ensure accurate mental health evaluation.

## Abstract

What are the main findings?
The cross-sectional nature limits the ability to draw causal inferences.The absence of male partner assessments restricts the understanding of the full psychological impact on couples.

The cross-sectional nature limits the ability to draw causal inferences.

The absence of male partner assessments restricts the understanding of the full psychological impact on couples.

What are the implications of the main findings?
This study’s prospective design strengthens the temporal assessment of outcomes.The psychological assessments used are validated in Arabic, ensuring the accurate evaluation of mental health in the target population.

This study’s prospective design strengthens the temporal assessment of outcomes.

The psychological assessments used are validated in Arabic, ensuring the accurate evaluation of mental health in the target population.

Background: Recurrent pregnancy loss (RPL) and infertility are associated with significant psychological morbidity, including stress, anxiety, and depression. While these impacts are well-documented globally, their prevalence and severity in the Omani population remain unexplored. This study investigates the mental health outcomes of Omani women with RPL and infertility compared to fertile controls. Objectives: The objectives of this study are to assess the prevalence of stress, anxiety, and depression in women with recurrent pregnancy loss (RPL) and infertility and compare these rates to women with no fertility concerns in an Omani population. Design: This is a prospective, cross-sectional study. Setting: This study’s setting consisted of Sultan Qaboos University Hospital and Royal Hospital in Muscat, Oman. Participants: This study included 111 women with RPL, 131 women with infertility, and 210 antenatal controls with no fertility issues. Interventions: No clinical interventions were administered as this was an observational study. Participants completed validated psychological assessments (DASS-42 and BDI-II). Primary and secondary outcome measures: Primary outcomes were the prevalence rates of stress, anxiety, and depression assessed using DASS-42 and BDI-II. Secondary outcomes included sociodemographic correlates and risk factors Results: This study included 111 women in the RPL group, 131 in the infertility group, and 210 controls. Among RPL patients, 31% reported stress, ranging from mild to extremely severe, while 35.9% of infertility patients reported stress, compared to 17.1% in the control group (p = 0.003). Anxiety was present in 45% of RPL patients, 45.5% of infertility patients, and 28.1% of controls (p = 0.019). Depression, measured by DASS-42, was the most prevalent in the RPL group (34.2%), followed by the infertility group (33.6%) and controls (13.8%) (p < 0.001). Similar results were observed with BDI-II, with depression rates of 23.4% in the RPL group, 19.1% in the infertility group, and 7.6% in controls (p = 0.02). Conclusions: Women with RPL and infertility in Oman experience significantly higher levels of stress, anxiety, and depression compared to women without fertility concerns. This study did not assess the mental health of male partners, highlighting the need for further research on the psychological impact on both partners. Future studies should focus on developing psychological support interventions and evaluating their impact on patient outcomes.