P-505 Mapping acceptance and commitment therapy (ACT) outcomes in the context of infertility: A systematic review
Authors: Barbosa C , Santos S , Pedro J 
Published: June 2022

Abstract

Study question
How ACT variables are associated or may impact mental health outcomes (i.e., anxiety, stress, and depression symptoms) in patients with an infertility diagnosis?

Summary answer
ACT variables seem to be associated with better mental health outcomes in patients with an infertility diagnosis.

What is known already
Evidence indicates that people with infertility face psychosocial challenges, with a significant number of studies finding that mental health seems to be negatively affected. ACT is part of the family of behavioral and cognitive therapies and was already established as having a beneficial effect on psychological issues in other health conditions. Since infertility is a relevant stressor, we expected that ACT had also a protective role on mental health. To date, no study tried to summarize this evidence, which might help to develop the intervention with ACT components for this population.

Study design, size, duration
A systematic review of the literature was conducted to identify studies assessing Infertility and ACT. A literature search was conducted from inception to October 2021 in the following electronic databases: Web of Science, Pubmed, and B-On. The PRISMA guidelines were followed.

Participants/materials, setting, methods
A search was conducted using combinations of keywords and MeSH (“infertility” AND “Acceptance and Commitment Therapy” AND “depression”; “anxiety”; “stress”). No limitation regarding the type of publication, date, or language was created during the searches. Empirical and quantitative studies were considered if they assessed mental health variables and ACT hexagon model components in patients with infertility.

Main results and the role of chance
Out of 137 studies initially identified, six of them met eligibility criteria and were included in the review. The studies were carried out between 2012 and 2020 and originated from two countries: four from Portugal and two from Iran. The samples were composed by women (three) and couples (three). The results revealed that couples dealing with infertility present higher psychological inflexibility and experiential avoidance scores, and lower scores of acceptance when compared with fertile couples and couples who pursued adoption. Psychological inflexibility seems to be positively correlated with depressive, anxiety, and stress symptoms. Gender differences were also found, i.e., women tend to show higher scores of depression symptoms, psychological inflexibility, and experiential avoidance than men. Women dealing with infertility have the tendency to avoid thoughts, emotions, and situations somehow associated with pregnancy and parenthood as a way of trying to escape from infertility’s painful experience. In general, studies suggest that ACT may be an adequate approach for patients dealing with infertility.

Limitations, reasons for caution
The number of studies was small and they were predominantly from Portugal, increasing the likelihood of a risk of bias of the findings. Cultural variables must be considered and conclusions need to be interpreted with caution.

Wider implications of the findings
Since ACT variables seem to be associated with better mental health outcomes, these results indicated that couples with infertility would benefit from intervention addressing ACT components. Future studies should explore the effectiveness of these interventions in this population.

Trial registration number
not applicable