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Psychosoziale Interventionen bei Kinderwunsch*

Ein Review

A review of psychosocial interventions in infertility

A review

  • Übersicht
  • Published:
Gynäkologische Endokrinologie Aims and scope

Zusammenfassung

Viele staatliche, medizinische und kommunale Stellen empfehlen nachdrücklich psychologische Beratung für Kinderwunschpatienten. Zweck dieser Arbeit war es festzustellen, ob psychosoziale Interventionen das Befinden und die Schwangerschaftsraten verbessern, sowie zu bestimmen, welches die effektivsten Interventionen sind. Es wurde eine systematische Recherche aller Artikel durchgeführt, die 1. eine psychosoziale Intervention beschreiben und 2. ihre Wirkung auf mindestens 1 Ergebnismaß in einer Kinderwunschpopulation evaluieren. Das erste Kriterium erfüllen insgesamt 380 Studien, von denen aber nur 6,6% (n=25) unabhängige Evaluierungsstudien sind. Eine Analyse zeigte, dass psychosoziale Interventionen eher einen Abbau des negativen Affekts bewirkten als eine Veränderung des interpersonalen Funktionierens. Eine Auswirkung der psychosozialen Interventionen auf die Schwangerschaftsrate war nicht wahrscheinlich. Weiter wurde festgestellt, dass Gruppeninterventionen mit Schwerpunkt Wissensvermittlung und Trainieren von Fähigkeiten eine signifikant stärkere positive Veränderung herbeiführten als Beratungen, die sich auf emotionalen Ausdruck und Unterstützung oder die Diskussion von Gedanken und Gefühlen zum Thema Kinderwunsch konzentrierten. Männer und Frauen profitierten gleichermaßen von psychosozialen Interventionen. Die künftige Ausrichtung der Forschung im Bereich der Evaluierung psychosozialer Interventionen wird diskutiert.

Abstract

Counselling has been strongly recommended by numerous governmental, medical and community associations to help infertile people. The purpose of this review was to determine whether psychosocial interventions improved wellbeing and pregnancy rates, and to identify the kinds of interventions that were most effective. A systematic search identified all published and unpublished papers in any language and any source that (1) described a psychosocial intervention and (2) evaluated its effect on at least one outcome measure in an infertile population. A total of 380 studies met the first criteria but only 6.6% (n = 25) of these were independent evaluation studies. Analysis of these studies showed that psychosocial interventions were more effective in reducing negative affect than in changing interpersonal functioning (e.g., marital and social functioning). Pregnancy rates were unlikely to be affected by psychosocial interventions. It was also found that group interventions which had emphasised education and skills training (e.g., relaxation training) were significantly more effective in producing positive change across a range of outcomes than counselling interventions which emphasised emotional expression and support and/or discussion about thoughts and feelings related to infertility. Men and women were found to benefit equally from psychosocial interventions. Directions for future research on the evaluation of psychosocial interventions are discussed.

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Notes

  1. Von den 25 Studien enthielten 68% keinerlei Angaben, die zur Berechnung der Effektstärke für eine oder mehrere Ergebnisvariablen verwendet werden konnten. Selbst bei den Studien, die solche Angaben machten, hätte man immer noch bestimmte Annahmen zur Berechnung der Effektstärke treffen müssen (z. B. Annahme eines p-Wertes für die als „nicht signifikant“ eingestuften Ergebnisse). Aus diesen Gründen wäre die Effektstärkenberechnung nach unserer Auffassung unzuverlässig gewesen. Die einzige Ausnahme waren die Schwangerschaftsraten, bei den sich die Analysen leicht aus den von den Autoren gelieferten Daten rückberechnen ließen.

  2. Drei der 11 Studien zogen Schwangerschaftsraten nicht in Betracht.

  3. Die Ergebnisse waren gleich, unabhängig davon, ob die edukativen Kategorien zusammen oder getrennt betrachtet wurden.

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Danksagung

Ich bedanke mich herzlich bei Tewes Wischmann und Bernhard Strauß für die Suche und Übersetzung deutschsprachiger Studien und bei Ulrike Hahn, die einen ersten Entwurf dieses Artikels kommentiert hat. Dank gebührt auch Deborah Lancastle für die Hilfe bei der Suche nach relevanten Studien sowie Janet Takefman, die ebenfalls meinen ersten Entwurf kritisch gelesen hat.

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  1. School of Psychology, Cardiff University, Cardiff CF10 3YG, UK

    J. Boivin

  2. School of Psychology, Cardiff University, PO Box 901, Cardiff, Wales, UK

    J. Boivin

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*Übersetzung der Originalarbeit J Boivin (2003) A review of psychosocial interventions in infertility. Social Science & Medicine 57:2325–2341. Übersetzung: Tewes Wischmann, Heidelberg. Mit freundlicher Genehmigung von Elsevier Science Ltd.

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Boivin, J. Psychosoziale Interventionen bei Kinderwunsch*. Gynäkologische Endokrinologie 2, 94–109 (2004). https://doi.org/10.1007/s10304-004-0062-9

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