Depression and anxiety in sterilised women in Iran

Sterilisation is an effective and convenient means of contraception and has become increasingly popular as a birth control technique throughout the world during the past 40 years. However some women who choose sterilisation may suffer a neurotic syndrome, which is manifested in the form of pain, depression and loss of libido.1We undertook a study designed to investigate depression, anxiety and post-operation regret rate in sterilised women referred to health centres in Tabriz, Iran in 2006. The study design was descriptive-analytical. The study participants comprised 300 women in the age range 25–45 years, of whom 150 women were sterilized between 1 and 10 years ago and 150 were a control group of non-sterilised women who used condoms, withdrawal or safe period methods for contraception. The control group was selected by a cluster random sampling method. Fifteen health centres were selected as a cluster from 96 health centres located in Tabriz. Ten women were selected randomly from each health centre using health documents. Women were eligible for inclusion in the study if they were aged between 25 and 45 years at the time of sampling, and if they had no history of psychological disorders and no recent sorrowful events. There were no differences between the two groups as regards the number of children, income or demographic characteristics. The women were contacted by telephone at their last known address and were asked to complete questionnaires. Data collection was done using Zung’s self-rating depression and anxiety scale in addition to questions about post-sterilisation regret. Data were collected from the subjects anonymously and analysed using SPSS (v. 11.5) statistics software. Analysis employed t-test, Chi-square test and descriptive statistics. The comparison of the means for depression in the two groups was not significantly different (p = 0.96), however the mean of anxiety in the case group was remarkably greater than the control group (p = 0.03). Insufficient poststerilisation rest was a significant risk factor for depression and anxiety (p = 0.008 and p = 0.02, respectively). Requesting information about reversal after tubal sterilisation was 2.7% and the post-sterilisation regret rate was 6%, which was significantly related to women’s conflict with their husbands about the decision-making process prior to sterilisation (p<0.001). The study findings as regards psychological disorders of sterilisation suggested that women undergoing sterilisation should ensure that they have a good rest after their operation in order to reduce the extent of psychological disorders. Unlike studies undertaken in other countries,2–4 women’s age, parity, marriage duration and the timing of sterilisation was unrelated to the women’s regret in our study. The earlier the sterilisation is carried out, the longer the woman’s remaining period of fertile life and the greater the chances of changes in her marital status and/or the loss of a child, both circumstances that may lead to a change in the desired family size and expression of regret. In our study, probably one of the reasons why women’s regret did not appear to be significantly related to young age of sterilisation was the infrequency of divorce or remarriage in our study population. Consistent with our study, Jamieson et al. reported that women who had substantial conflict with their husbands or partners prior to sterilisation were more than three times as likely to regret their decision and more than five times more likely to request a reversal than women who did not report such conflict.5 In our study, pre-sterilisation counseling was reported by 29.3% of subjects. With respect to personality and adaptability differences in facing the changes, pre-sterilisation counseling and post-sterilisation follow-up systems have an important role to play in women’s psychological and psychosexual health promotion

Training in cognitive behavioural interventions on acute psychiatric inpatient wards

There has been a drive towards addressing the types of care and therapeutic interventions available to people with serious mental illness, which is reflected in the latest government mental health policy initiatives. Recent evidence strongly supports the implementation of psychological and social interventions for people with psychosis, and in particular the use of cognitive behavioural techniques. Until now, the main focus has been on people living in the community. This study examines the delivery of psychosocial interventions training to qualified psychiatric nurses and unqualified staff on seven acute psychiatric admission wards in London, UK. The approach had the strength of on-site delivery, follow-up role modelling of the interventions and clinical supervision. Despite this, in some cases the training was less successful, mainly because of staffing and leadership weaknesses. The impact of training in these methods and the implications for mental health education and practice development are discussed