Stress Scale And Coping Strategies Adopted By Brazilian Art Patients During Covid-19 Outbreak: Attention Need For Young, Women, First Ivf Attempt And Compromised Income Patients

Abstract Study question What are the stress scale and coping strategies of patients who were unable to start/continue an IVF cycle due to COVID–19 interruption on ART treatments? Summary answer Stress scale was associated to specific coping strategies and was higher for women, patients in first IVF treatment, had compromised income and younger than 38yo. What is known already In March 2020, due to the COVID–19 outbreak caused by the SARS-CoV–2 virus, human reproduction societies, have recommended discontinuation of reproductive care, except for the most urgent cases. After few months, the treatments were resumed following proper safety guidelines. Infertility diagnostic and treatments are severe stressors, causing anxiety, depression and general emotional distress. The disruption of treatments and the pandemic uncertain scenario in all life aspects, certainly have a great impact on mental health of ART patients. There is an urge need to assess the level of stress and coping strategies in this population to offer suitable support and care. Study design, size, duration Prospective, Brazilian multicentric study (6 clinics of ART located in São Paulo, Campinas, Belo Horizonte and Brasilia), with the application of an anonymous online survey of stress scale and 14 coping strategies to 1500 patients (male and female) that had their treatments interrupted or unable to start during the months of March, April and May 2020. The online survey was sent during the months of August/September and responses were collected until early October/2020. Participants/materials, setting, methods The stress scale level was assessed using the Perceived Stress Scale protocol (PSS), and coping strategies using the Brief COPE scale protocol. Social-demographic variables (gender, age, city of residence, marital status, time of infertility, previous IVF treatments and financial impact) were included in the survey. Marginal statistical analyses were performed accordingly (t test, Mann-Whitney, Kruskal-Wallis, chi-square test) and a linear regression model was carried out to calculate the effect of COPE strategies on stress scale. Main results and the role of chance Survey’s response rate was 44.4% (n = 666). The majority were women (83.3%), married (93.2%, mean of 9,41±4,76 years), deal with infertility for 2–5 years (51.5%), had done a previous IVF treatment (61.4%, mean of 2,33 treatments) and had a work activity (83.9%). Almost 40% had their income compromised by the pandemic. Mean age was 38.47±4.99 years (≥38 yo = 59%). Stress scale was higher for women (p < 0.0001), patients that were in their first IVF treatment (p = 0.011), had their income compromised (p = 0.001) and were younger than 38yo (p < 0.0001). The most frequent coping strategies (score 5–8) were planning (87.7%), active coping (83%), positive reframing (72.1%) and religion (71.7%). Women used more emotional support, religion, venting (all p < 0.0001) and self-distraction (p = 0.002) as coping strategies than men. Younger patients (<38yo) reported more use of substances (p = 0.002) and self-distraction (p = 0.001) than older patients. Lower income was associated with denial (p = 0.002) and less use of religion (p < 0.0001) and patients that were about to start their 1st treatment used more venting (p < 0.0001) and denial (p = 0.003) than recurrent patients. The linear regression analysis showed that higher stress was associated to planning, religion, self-blame, venting, self-distraction and behavioral disengagement and lower stress scale to active coping, emotional support, positive reframing and acceptance. Limitations, reasons for caution This study was performed in Brazil, one of the most affected countries by the COVID–19 outbreak, which may limit the generalizability of the findings. Another limitation was the impossibility to compare the stress scale and coping strategies findings in this population prior to the pandemic. Wider implications of the findings: Being a woman and have a compromised income were expected stressor factors. Surprisingly, first IVF attempt and younger patients showed higher stress scale and the use of psychological defense mechanisms, such as the use of substances, denial and self-distraction. Continuous emotional support should be offer for all ART patients. Trial registration number Not applicable