Association between depression and infertility based on the PHQ-9 score: Analyses of NHANES 2013-2018

Abstract

Background Over the past decade, nationally representative research elucidating the association between depression and infertility has been notably lacking. Our study aimed to investigate the association between depression and infertility among women of childbearing age. Methods Our study encompassed 3,654 women aged 18 to 45 years from the National Health and Nutrition Examination Survey (NHANES) 2013-2018. Infertility was defined as a positive response to the query: "Have you attempted to conceive for a minimum of one year without achieving pregnancy?"Depression was evaluated by the Patient Health Questionnaire (PHQ-9) score (range, 0-27). Multiple logistic regression analyses and subgroup analyses stratified by age and race/ethnicity were conducted to investigate the association between depression and infertility. Furthermore, fitted smoothing curves and threshold effect analysis were utilized to depict the nonlinear relationship. Results Total PHQ-9 score was associated with infertility in the fully adjusted model (OR 1.04, 95% CI 1.01-1.07, P = 0.010), and this relationship exhibited a non-linear pattern, reaching a saturation point at 13, as substantiated by the fitting of smoothed curves. Additionally, the association remained robust when stratified by age but not by race/ethnicity. Limitations Cross-sectional design and recall biases. Conclusions In this cross-sectional study, depression was associated with infertility among women of childbearing age in the fully adjusted models. This observed association holds potential relevance for clinicians tasked with enhancing psychological well-being during infertility management strategies.