Grief and Loss Content Stream - mhpn.org.au · – Psycho-biological effects of hormone treatments....
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Grief and Loss Content Stream
Transcript of Grief and Loss Content Stream - mhpn.org.au · – Psycho-biological effects of hormone treatments....
Grief and Loss Content Stream
Supported by The Royal Australian College of General Practitioners, the Australian Psychological Society,the Australian College of Mental Health Nurses and The Royal Australian and New Zealand College of Psychiatrists
DATE:
November 12, 2008
Webinar
Wednesday 5th June 2019
Disenfranchised Grief: Exploring the impact of infertility on mental health
Ms Denise DonatiFertility Nurse
Professor Jane FisherPsychologist
Dr Carolyn BreadonPsychiatrist
PAGE 1
Tonight’s panel
Audience tip:Click the ‘Open Chat’ tab
at the bottom right of your screen to chat with
other participants. NB: chat will open in a new
browser window.Facilitator: Dr Ebonney van der Meer
General Practitioner
Learning outcomes
Through a discussion about Erin and Adam, at the completion of the webinar participants will be able to:
• Describe the complex relationship between grief and loss, mental health and infertility as well as the risk factors for and warning signs of mental illness in persons experiencing grief and loss by way of infertility
• Describe the challenges, merits and opportunities in evidence-based approaches deemed most effective in treating and supporting people experiencing mental health issues related to infertility
• Better target referrals for people experiencing mental health issues related to infertility as a result of an improved understanding of the role of different disciplines
PAGE 2
Supporting resources are in the library tab at the bottom right of your
screen.
Fertility Nurse’s perspective
PAGE 3
Ms Denise Donati
Parenthood is a major transition in life and many people’s lifelong dream and wishThe stress of not fulfilling this wish has been associated with:
• Anger• Depression• Anxiety• Relationship issues• Worthlessness
Fertility Nurse’s perspective
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Ms Denise Donati
Constant daily triggers
• Even the clinic nurse/doctor are pregnant – and I’m not
• An office colleague is having a termination
• Avoiding intercourse
Fertility Nurse’s perspective
PAGE 5
Ms Denise Donati
Fertility Nurse’s perspective
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Ms Denise Donati
Silent messages sent to patients
• Flowers and thank you cards in the clinic
• Be careful of what we say and how we say it
• When discussing results – set realistic expectations by choice of words i.e. perfect endometrium - text book embryo?
• When discussing outcome – refer to the treatment not the patient i.e. cycle was not successful rather than ‘you failed’
Fertility Nurse’s perspective
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Ms Denise Donati
Men and women differences
• Woman want & need to talk again & again
• Men just want to ‘fix’ it
Fertility Nurse’s perspective
PAGE 8
Ms Denise Donati
Heading
Points of conversation
• Point one• Two• Three
Fertility Nurse’s perspective
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Ms Denise Donati
Heading
Points of conversation
• Point one• Two• Three
Fertility Nurse’s perspective
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Ms Denise Donati
Heading
Points of conversation
• Point one• Two• Three
Psychologist’s perspective
PAGE 11
Professor Jane Fisher
Fertility difficulties
• …failure to achieve a clinical pregnancy after at least 12 months of unprotected sexual intercourse...
• … worldwide about one in ten couples experience fertility difficulties...- primary infertility (the inability to conceive at all)- secondary infertility (have at least one living child but unable
to conceive again)- sub-fecundity (the capacity to conceive but not to sustain a
pregnancy to term) • in Australia 15% of couples have fertility difficulties• all have access to assisted reproductive technologies
Psychologist’s perspective
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Professor Jane Fisher
Assisted reproductive technologies
In Australia and New Zealand in 2015:– 39,006 women experienced 73,481 treatment cycles– 5.6% more than in 2014– Women aged on average 35.8 years– Women using donated gametes 40.5 years– 5,773 embryos had Pre-implantation Genetic Testing– Among initiated cycles:
- 22.8% led to a clinical pregnancy - 18.1% to a live birth
– 14,791 babies born after ART conception– 4.3% of births in Australia follow ART
Harris K, Fitzgerald O, Paul RC, Macaldowie A, Lee E & Chambers GM 2016. Assisted reproductive technology in Australia and New Zealand 2014.
Psychologist’s perspective
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Professor Jane Fisher
Psychological consequences of infertility
• Psychiatric illness or intense psychological reaction to abnormal circumstances?
• Uniquely stressful because can last for years and might never resolve;
• ‘Infertility strain profile’:
• 20% of women attending an infertility support group –intermittent suicidal ideation
Berg and Wilson, 1990; Kerr, Brown and Balen, 1999; Kee, Jung and Kee, 2000; Fisher, 2007
anxiety self-blame
irritability heightened interpersonal sensitivity
profound sadness social withdrawal
Psychologist’s perspective
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Professor Jane Fisher
Psychological consequences of infertility continued…
• Clinical conceptualisations• Profound life crisis, or existential blow:
- guilt- punishment- intrinsic unworthiness- frustration and anger towards others
• Disenfranchised grief:- pregnancy, childbirth and breastfeeding- state of parenthood- element of adult and gender identity- generation and genetic continuity
Mahlstedt, 1985; Menning, 1982; Becker, 1994, Fisher, 2007, McBain and Reeves, 2019
Psychologist’s perspective
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Professor Jane Fisher
Psychological aspects of diagnosis and treatment
• Psychological symptoms increase at diagnosis, but decrease once treatment is initiated
• Each treatment cycle associated with elevated hope and optimism at embryo transfer
• Menstruation associated with sadness and despondency• Few couples persist for more than six cycles• More than two years of unsuccessful treatment associated with
significant risk of depression• Chronic and unrelieved stress
Berg and Wilson, 1990; Domar, 1992, Fisher 2007, Schmidt 2009
Psychologist’s perspective
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Professor Jane Fisher
Summary
Infertility and assisted conception are always psychologically demanding:
• Existentially challenging• Stressful and anxiety arousing• Not easily resolved• Treatment is intrusive, expensive and counters intimacy• Disenfranchised grief• Lonely and socially isolating
Psychiatrist's perspective
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Dr Carolyn Breadon
Erin’s psychological responses to IVF• Powerlessness
– Waiting months for specialist appointments– Trying to research independently of her GP, organise her
own blood tests prior to appointments – Hurdles to treatment such as waiting for counselling
appointments• “Escalating anxiety” as Erin approaches her 40th birthday• Demoralisation
– Losing hope after repeated unsuccessful cycles, losing faith in her ability to have a baby
– Financial strain of IVF, taking out loans to continue– Relationship strain – “feels like a failure”
Psychiatrist's perspective
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Dr Carolyn Breadon
Effects of hormone treatments
• “..quite often moody”, feeling bloated and sore and bruised from multiple injections, fatigue, low blood pressure, dizziness and fainting…weight gain, draining nature of tests, appointments, scans…running out of annual leave to use for appointments – Biological effects of hormone treatments– Psychological effects of hormone treatments– Psycho-biological effects of hormone treatments
Psychiatrist's perspective
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Dr Carolyn Breadon
Psychological effects of pregnancy loss
• Miscarriage at 7 weeks, miscarriage at 4 weeks, miscarriage at 10 weeks
– Usual rate of miscarriage prior to 10 weeks
– Developing an emotional connection with a baby in utero
• Guilt• Fear• Sadness • Memories of lost babies
crowding out ability to connect with/clearly focus on the current pregnancy (or baby)
• Feeling defeated • Feeling alone • Feeling low • Crying frequently • Husband suggests she focus on work
• Experience of the father/non-biological partner in IVF and subfertility
• Loss of focus on relationship as important in its own right
• Rates of depression in partners of women going through IVF
Psychiatrist's perspective
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Dr Carolyn Breadon
The next step in supporting families with subfertility
• When to refer to a psychiatrist? – Distinguishing between grief, complicated grief, and depression – Biological markers of severe depression
• What can a psychiatrist add to psychological and other supportive therapies? – Positives: additional support/another perspective/someone outside
the IVF cycle to talk to– Negatives: sometimes just another appointment/burden/source of
stigma and judgement• What medications are considered appropriate in this patient
population? – SSRI-based medications are first line (aside from paroxetine)
• Side effects/time to efficacy/risks in pregnancy & breastfeeding
Ms Denise DonatiFertility Nurse
Professor Jane FisherPsychologist
Dr Carolyn BreadonPsychiatrist
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Q&A
Facilitator: Dr Ebonney van der MeerGeneral Practitioner
The following have been identified by the panel as important issues in the field of grief and loss:
• Anxiety after several pregnancy losses
• Normal vs abnormal grief for people with infertility
• Efficacy of medication in responding to grief and/or depression for infertility
• Overlap between grief and depression for infertile couples
A pop up will appear on your screen shortly listing the issues. Choose the one you’d most like the panel to discuss.
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Help guide tonight’s discussion
Ms Denise DonatiFertility Nurse
Professor Jane FisherPsychologist
Dr Carolyn BreadonPsychiatrist
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Q&A
Facilitator: Dr Ebonney van der MeerGeneral Practitioner
• Please ensure you complete the feedback survey before you log out. Click the Feedback Survey at the bottom right of the screen to open the survey.
• Certificates of Attendance for this webinar will be issued as part of MHPN’s conference and will be available within six weeks.
• Each participant will be sent a link to the recording of this webinar and associated resources within four weeks.
• Visit www.mhpn.org.au for details on face-to-face practitioner networks and upcoming webinars.
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Thank you for participating
