Sielkundige aspekte van infertiliteitspasiënte by die aanvang van infertiliteitsintervensies

Van Waart, Lizanne (2011-03)

Thesis (MA)--University of Stellenbosch, 2011.

Thesis

ENGLISH ABSTRACT: The primary purpose of the present study was to create a profile of the psychological aspects presented by infertility patients of both genders before the commencement of each new phase of clinical intervention. The researched variables were constructed in such a way that negative as well as positive aspects of each patient involved would be reflected. The negative variables, which were classified as risk factors, included depression, anxiety, general mental health and the presence or absence of happiness. The positive variables (protective factors) included variables concerning resilience, namely life-contentment and general psychological well-being. General psychological wellbeing included specific aspects, such as self-acceptance, autonomy, positive relationships with others, purpose in life, environmental mastery and personal growth. The cognitive aspects (thought processes) included variables, such as hope and intrusive thoughts. In the present study intrusive thoughts referred specifically to distraction, social control, worry, punishment, and reappraisal. The secondary purpose was to ascertain whether these variables would be able to indicate to which degree a diagnosis of infertility could have a positive or negative effect on a person, could possibly lead to emotional problems, and how the person should be treated optimally during treatment. The psychological aspects present in men and women were also compared to give the therapist/physician a better understanding of gender differences. A descriptive research design was used. In this cross-sectional study, one-off survey research was executed in order to evaluate the infertility patients before the start of infertility intervention. The measuring instruments were six self-report questionnaires and a demographic questionnaire. The 116 participants, (87 women and 29 men) completed the following self-report questionnaires: “General Health Questionnaire” (GHQ28), “Oxford Happiness Questionnaire” (OHQ), “State of Hope Scale” (SHS), “Thought Control Questionnaire” (TCQ), “Satisfaction With Life Scale” (SWLS), and the “Ryff Psychological Well-Being Scale” (Ryff PWB). The study implies that the diagnosis of infertility can be made using the biopsychosocial model and the psychosocial resilience model to account for medical well-being as framework. Due to the complexity of infertility, specific phases of infertility should not be emphasised and risk factors solely attended to. Infertility should be regarded more globally. The present study reflected that before treatment was started, the home-plan/ovulation-induction group (HP/OI) (1) was more at risk concerning depression and anxiety; (2) uncontrolled thoughts of worry and anxiety were present concomitantly, and (3) there was a risk concerning protective factors. The intracytoplasmic sperm-injection/in vitro-fertilisation group (ICSI/IVF) was at risk regarding anxiety and intrusive thoughts. The artificial-insemination group (AI) possibly had unrealistic expectations before the commencement of the first treatment and risk factors (thought-control processes and protective factors) tested disproportionately high. It could thus be said that the specific cause of infertility well may influence psychological aspects before treatment starts. Infertility should be diagnosed in totality, taking into account the biological as well as the psychological aspects of the infertility patient. To be able to present an optimal diagnosis of infertility and to optimise a prognosis, patients have to be psychologically evaluated before treatment is started. This opens the field to further research with larger samples and particular attention paid to thought-control processes, protective factors and causes of infertility.

AFRIKAANSE OPSOMMING: Die primêre doel van die onderhawige ondersoek was om ’n profiel saam te stel van die sielkundige aspekte teenwoordig by beide geslagte infertiliteitspasiënte voor die aanvang van elke nuwe fase van kliniese intervensie. Die veranderlikes wat ondersoek is, is só saamgestel dat ’n profiel van negatiewe sowel as positiewe aspekte van elke betrokke pasiënt weergegee kon word. Die negatiewe veranderlikes wat as risikofaktore geklassifiseer is, sluit in depressie, angs, algemene geestesgesondheid en die teenwoordigheid, al dan nie, van geluk. Die positiewe veranderlikes (beskermende faktore) sluit in veerkragtigheidsveranderlikes, naamlik lewenstevredenheid en algemene sielkundige welstand. Algemene sielkundige welstand het spesifieke aspekte ingesluit, soos selfaanvaarding, selfstandigheid, positiewe verhoudings met ander, lewensdoel, omgewingsvaardigheid en persoonlike groei. Die kognitiewe aspekte (gedagteprosesse) sluit in veranderlikes soos hoop en indringende gedagtes. Indringende gedagtes verwys in die onderhawige ondersoek spesifiek na afleiding, sosiale beheer, bekommernis, straf en herevaluering. Die sekondêre doelstelling was om te bepaal of hierdie veranderlikes ’n aanduiding sou kon gee in watter mate ’n infertiliteitsdiagnose ’n persoon negatief of positief kan beïnvloed, tot moontlike emosionele probleme kan lei en hoe die persoon optimaal tydens behandeling hanteer behoort te word. Die sielkundige aspekte van mans en vroue is ook vergelyk sodat die sielkundige/geneesheer ’n beter begrip van die behandeling ten opsigte van geslagsverskille kan hê. ’n Beskrywende navorsingsontwerp is gebruik. In hierdie dwarssnitondersoek is van ’n eenmalige opnameondersoek-metode gebruik gemaak om die infertiliteitspasiënte by die aanvang van infertiliteitsintervensie te evalueer. Die meetinstrumente was ses selfbeskrywingsvraelyste en ’n demografiese vraelys. Die 116 deelnemers (87 vroue en 29 mans) het die volgende selfbeskrywingsvraelyste ingevul: General Health Questionnaire (GHQ28), Oxford Happiness Questionnaire (OHQ), State of Hope Scale (SHS), Thought Control Questionnaire (TCQ), Satisfaction With Life Scale (SWLS) en die Ryff Psychological WellBeing Scale (Ryff PWB). Uit die resultate kan afgelei word dat die diagnose van infertiliteit wel vanuit die raamwerk van die biopsigososiale-model en die psigososiale veerkragtigheidsmodel wat mediese welstand verklaar, gemaak kan word. Weens die kompleksiteit van infertiliteit kan daar egter nie net op sekere infertiliteitsfases klem gelê word en net op risikofaktore gelet word nie. Dit is belangrik dat daar meer globaal/holisties na infertiliteit gekyk word. In die onderhawige ondersoek is bevind dat die tuisplan-/ovulasie-induksie-groep (TP/OI) voor die aanvang van behandeling (1) ’n risiko vir depressie en angs geloop het; (2) daar gepaardgaande ongekontroleerde bekommernis- en strafgedagtes aanwesig was en (3) ’n risiko betreffende beskermende faktore. Die intrasitoplasmiese-sperminspuiting-/in-vitrobevrugtingsgroep (ICSI/IVB) was ’n risikogroep vir angs en indringende gedagtes. Die kunsmatige-inseminasie-groep (KI) het moontlik onrealistiese verwagtings voor die aanvang van die eerste behandeling getoon en risikofaktore (gedagtebeheerprosesse en beskermende faktore) was buite verhouding hoog. Daar kan dus gesê word dat die tipe oorsaak van infertiliteit wel sielkundige aspekte by die aanvang van behandeling beïnvloed. Infertiliteit moet omvattend gediagnoseer word, met inagneming van die infertiliteitspasiënt se biologiese én sielkundige aspekte. Om ’n optimale diagnose te kan maak en ’n prognose te optimeer, behoort infertiliteitspasiënte ook sielkundig geëvalueer word voor die aanvang van behandeling. Verdere ondersoeke word aanbeveel met groter steekproewe en besondere aandag aan gedagtebeheerprosesse, beskermende faktore en infertiliteitsoorsake.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/6639
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