Data from: Efficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men: a systematic review and meta-analysis

Objective: To evaluate the evidence on the efficacy of psychosocial interventions for improving pregnancy rates and reducing distress for couples in treatment with assisted reproductive technology (ART). Design: Systematic review and meta-analysis. Data sources PsycINFO, PubMed, Embase, CINAHL, Web of Science and The Cochrane Library between 1978 and April 2014. Study selection Studies were considered eligible if they evaluated the effect of any psychosocial intervention on clinical pregnancy and/or distress in infertile participants, used a quantitative approach, and were published in English. Data extraction Study characteristics and results were extracted and the methodological quality assessed. Effect sizes (Hedges g) were pooled using a random effect model. Heterogeneity was assessed using the Q statistic and I2, and publication bias evaluated using Eggers’ method. Possible moderators and mediators were explored with meta-ANOVAs and meta-regression. Results We identified 39 eligible studies (total N = 2746 men and women) assessing the effects of psychological treatment on pregnancy rates and/or adverse psychological outcomes, including depressive symptoms, anxiety, infertility stress, and marital function. Statistically significant and robust overall effects of psychosocial intervention were found for both clinical pregnancy (RR = 2.01; CI: 1.48-2.73; p<0.001) and combined psychological outcomes (Hedges g=0.59; CI: 0.38-0.80; p=0.001,). The pooled effect sizes (ES) for psychological outcomes were generally larger for women (g: 0.51-0.73) than men (0.13-0.34), but the difference only reached statistical significance for depressive symptoms (p=0.004). Meta-regression indicated that larger reductions in anxiety were associated with greater improvement in pregnancy rates (Slope: 0.19; p=0.004). No clear-cut differences were found between effects of cognitive behavioral therapy (CBT) (g=0.84), mind-body interventions (0.61), and other intervention types (0.50). Conclusion The present meta-analysis suggests that psychosocial interventions for couples in treatment for infertility, in particular CBT, could be efficacious, both in reducing psychological distress and in improving clinical pregnancy rates.研究目的：评估心理社会干预（psychosocial interventions）用于辅助生殖技术（Assisted Reproductive Technology, ART）治疗的不孕夫妇，以提升妊娠率并缓解其心理痛苦的相关证据。 研究设计：系统评价与荟萃分析。 数据来源：检索了1978年至2014年4月期间PsycINFO、PubMed、Embase、CINAHL、Web of Science及The Cochrane Library数据库收录的文献。 文献筛选：凡符合以下条件的研究均可纳入：可评估任意心理社会干预对不孕受试者临床妊娠结局和/或心理痛苦的影响、采用定量研究方法且以英文发表。 数据提取：提取研究特征与研究结果，并评估方法学质量。采用随机效应模型合并Hedges g效应量。采用Q统计量与I²统计量评估研究异质性，使用Egger法（Eggers’ method）评价发表偏倚。通过荟萃方差分析（meta-ANOVAs）与荟萃回归（meta-regression）探索潜在调节变量与中介变量。 研究结果：共纳入39项符合标准的研究（总样本量为2746名男女受试者），评估心理治疗对妊娠率和/或不良心理结局（包括抑郁症状、焦虑、不孕应激及婚姻功能）的影响。结果显示，心理社会干预对临床妊娠（相对风险（Relative Risk, RR）=2.01；置信区间（Confidence Interval, CI）: 1.48~2.73；p<0.001）与综合心理结局（Hedges g=0.59；CI: 0.38~0.80；p=0.001）均存在具有统计学意义且稳健的整体效应。心理结局的合并效应量在女性（g: 0.51~0.73）中总体大于男性（0.13~0.34），但该差异仅在抑郁症状维度达到统计学显著性（p=0.004）。荟萃回归分析显示，焦虑症状的缓解程度与妊娠率的提升幅度呈正相关（斜率：0.19；p=0.004）。认知行为疗法（Cognitive Behavioral Therapy, CBT，g=0.84）、心身干预（mind-body interventions，0.61）及其他干预类型（0.50）的干预效应未发现显著差异。 研究结论：本项荟萃分析表明，针对接受不孕治疗夫妇的心理社会干预，尤其是认知行为疗法，可有效缓解心理痛苦并提升临床妊娠率。