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. Author manuscript; available in PMC: 2015 Oct 19.
Published in final edited form as: Arch Womens Ment Health. 2014 Dec 18;18(2):163–176. doi: 10.1007/s00737-014-0484-x

Table 1.

Articles included in the current review

Study Participants Relevant outcome(s) Assessment time point(s) Measure(s)a Relevant results
Baor et al. (2004) 75 parents of twins conceived via ART (N=37) or NC (N=38) recruited from 2 Israeli hospitals Mental health, parenting stress 8.5 months PP PSI, MHI

  1. Primip ART parents reported more parenting stress than primip NC parents.

  2. Primip ART mothers reported worse mental health than primip NC mothers.
Choi et al. (2009) 8069 mothers of singletons (N=7293) and multiples (N=776) included in a study of a national representative sample of children born in the US in 2001 Depression 9 months PP Abbreviated CESD Mothers of multiples (versus singletons) had a 43 % greater chance of having moderate/severe depressive symptoms.
Clarke et al. (2014) 9078 mothers in rural Nepal who were participating in a cluster randomized controlled trial Psychiatric distress 6 weeks PP GHQ-12 Having a multiple (versus single) birth contributed significantly to distress.
Colpin et al. (1999) 103 families w/ NC twins (N=54), or twins conceived via hormonal treatment (N=25), or AI or IVF (N=24) recruited from Belgian maternity hospitals or via Flemish governmental organizations Parenting stress and psychosocial well-being 10–13 months PP (1 assessment/participant) PSI, GHQ-30

  1. More parenting stress re: parental competence, health, and partner relationship in primip (versus multip) mothers.

  2. More stress re: parental competence, health and psychosocial well-being in primip mothers in AC groups (versus NC mothers or multip AC mothers).
Cook et al. (1998) 26 families of NC (N=14) or IVF (N=12) twins recruited from British infertility clinics Parenting stress 5 years PP PSI Parents of IVF twins reported more stress than parents of NC twins.
Damato (2004) 139 mothers of twins recruited from a national (US) mothers of twins support group Depression 9.8 weeks PP EPDS Rate of PPD was no higher than rates reported in studies of general population.
Eisengart et al. (2003) 199 mothers of high-risk VLBW infants (N=77), low-risk VLBW infants (N=43), and healthy, term infants (N=79) prospectively and sequentially recruited from newborn nurseries and neonatal intensive care units at 3 Midwestern (US) hospitals Psychiatric distress 24 months PP BSI Multiple birth did not predict maternal psychiatric distress.
Ellison et al. (2005) 249 mothers of singletons (N=128), twins (N=111), and triplets (N=10) identified through medical records at a US infertility clinic and an obstetric study Depression, perceived stress 1–4 years PP (1 assessment/participant) CESD, PSS Each increase in birth multiplicity was associated with increases in maternal depression, but not stress.
Feldman et al. (2004) Mothers and fathers of 138 triplets (N=69 [23 sets]), twins (N=46 [23 sets]), and singletons (N=23) recruited from an Israeli hospital Parenting stress 3 months PP Abbreviated PSI Parents of triplets reported more stress than parents of twins, who in turn reported more stress than parents of singletons (similar for mothers and fathers).
Forman et al. (2000) 6790 mothers attending a Danish antenatal care clinic Depression 4 months PP EPDS Multiples did not contribute to higher risk for PPD.
Freeman et al. (2007) 55 mothers of triplets (N=10), twins (N=15), and singletons (N=30) conceived via IVF/ICSI recruited from the database of a French organization that studies children conceived via ART Depression, parenting stress 3 years PP EDS, PSI

  1. Mothers of multiples reported more parenting stress than mothers of singletons.

  2. No difference in parenting stress between mothers of triplets versus twins.

  3. No between-group differences in depression.
Garel et al. (1997) 11 mothers of triplets recruited consecutively from a French maternity hospital Depression 4 years PP CESD Four mothers had “high” levels of depression.
Glazebrook et al. (2001) 184 women (65 w/ twins [N=59] or triplets [N=6]) and 167 men who conceived via IVF; 146 women and 134 men w/ NC singletons; recruited via a research and treatment unit (IVF couples) or a hospital-based antenatal clinic (NC couples) at a British hospital Anxiety, depression, parenting stress 18 and 28 weeks GA and 6 weeks PP (anxiety, depression); 1 year PP (parenting stress [mothers]) HADS, EPDS, PSI

  1. At 18 weeks GA, the multiple IVF group (IVFM) was more anxious than the single IVF group (IVFS) and the NC group.

  2. At 28 weeks GA, the IVFM group was more anxious than the IVFS or NC groups. IVFM women were more depressed than IVFS or NC women.

  3. At 6 weeks PP, IVFM men were more depressed than IVFS or NC men. No between-group differences in depression or in anxiety for women.

  4. No between-group differences in parenting stress 1-year PP.
Glazebrook et al. (2004) 260 mothers of IVF twins or triplets (N=36) or singletons (N=95), or NC singletons (N=129) recruited via a research and treatment unit (IVF couples) or a hospital-based antenatal clinic (NC couples) at a British hospital Mental health, parenting stress 1 year PP GHQ, PSI

  1. 22 % of mothers of multiples reported severe parenting stress versus 5 % of mothers of IVF singletons and 9 % of mothers of NC singletons.

  2. Mothers of multiples did not have worse mental health than mothers of singletons.
Haigh and Wilkinson (1989) Parents of 84 sets of twins and 84 random (N=42) and matched (N=42) singleton controls, participating in a larger child development study in the UK Anxiety, depression 3 weeks, 3 months, and 6 months PP Leeds scalesb

  1. 3 weeks PP 20 % of twin mothers, 25 % of matched controls, and 11 % of random controls had elevated anxiety and depression.

  2. 3 months PP 16 % of twin mothers, 13 % of matched controls, and 6 % of random controls had elevated anxiety and depression.

  3. 3 months PP 10.5 % of twin mothers, 2.5 % of matched mothers, and 1.2 % of random controls were depressed.

  4. 6 months PP 23 % of twin mothers, 16 % of matched controls, and 6 % of random controls were depressed.
Hay et al. (1990)

  1. 40 Australian women expecting twins (N=10) or singletons (N=10) or w/ twins (N=10) or singletons (N=10)

  2. 40 Australian mothers of twins (N=20) and singletons (N=20)

 Anxiety, depression (a) antenatal to 3 months PP (1 assessment/ participant) (b) 6–12 weeks PP (1 assessment/participant) (a) MHQ (b) GHQ, EPDS

  1. Mothers of twins had the highest anxiety and depression scale scores.

  2. Mothers of twins:
    1. had higher GHQ scores and
    2. experienced high anxiety at 3 times the rate of mothers of singletons and extreme depression at 5 times the rate.
Jahangiri et al. (2011) 61 women who conceived via IVF and were pregnant with singletons (N=48) or twins (N=13) recruited from a US university-affiliated reproductive medicine clinic Depression, anxiety 5–8, 10–12, and 20–22 weeks GA (3 assessments/participant) CESD, STAI

  1. Women expecting twins were marginally more anxious at 10–12 weeks GA and significantly more anxious at 20–22 weeks GA.

  2. Women expecting twins did not report higher depressive symptoms.
Munro et al. (1990) 158 parents of twins conceived via IVF (N=79), after infertility workup w/o IVF (N=30), or NC (N=49) recruited from an Australian University IVF program Psychiatric symptoms 6 months to 5 years 8 months PP (1 assessment/participant) GHQ

  1. IVF and NC parents had similarly elevated scores.

  2. Both groups had higher scores than the group that had conceived after infertility workup only.

  3. No differences in mothers’ and fathers’ scores.
Olivennes et al. (2005) 1325 mothers of twins (N=367) and singletons (N=958) conceived via IVF/ICSI recruited from the database of a French organization that studies children conceived via ART Depression, parenting stress 2–5 years PP (1 assessment/participant) EDS, PSI Mothers of twins:

  1. had more parenting stress and depression and

  2. were less likely to experience pleasure in parenting.
Roca-de Bes et al. (2011) 636 parents 265 ART (125 parents of singletons, 140 parents of multiples) and 371 non-ART (209 parents of singletons, 162 parents of multiples) recruited from fertility units at a university hospital and a private hospital in Spain Depression, perceived stress 6 months–4 years PP (1 assessment/participant) CESD, PSS Parents of multiples reported more depression but not more stress.
Sheard et al. (2007) 175 first-time mothers who conceived singletons (N=119), twins (N=49), or triplets (N=7) via IVF recruited from a research and treatment unit at a British hospital Depression 6 weeks PP EPDS

  1. Trend for mothers of multiples to have higher depression scores.

  2. Trend for each additional baby to increase risk of clinically significant depressive symptoms.

  3. Having a multiple birth and a baby w/ a difficult temperament resulted in a three-fold increase in risk of PPD.
Singer et al. (1999) Mothers of 206 very low birth weight infants recruited from neonatal intensive care units at a Midwestern (US) hospital Mental health, parenting stress 1, 8, 12, 24, and 36 months PP BSI, PSI Mothers of multiples had similar levels of mental health concerns and stress as mothers of singletons.
Thorpe et al. (1991) 139 mothers of twins and 12,573 mothers of singletons born during 1 week in 1970 in the UK Depression 5 years PP MI

  1. Mothers of twins more likely to be depressed than mothers of singletons.

  2. Trend for risk of depression in mothers of twins to be higher than in women w/ closely spaced singletons.
Thorpe et al. (1995) 11,208 women expecting twins (N=147) and singletons (N=11,061) in Avon (UK) over a 21-month period from 1991–1992 Depression 18 and 32 weeks GA EPDS No differences in rates of depression.
Tully et al. (2003) 121 mothers w/ ART twins and 121 mothers w/ NC twins, who were part of a probability sample from consecutive birth cohorts (1994 and 1995) in the UK and Wales Depression 5 years PP DIS No differences in rates of depression.
Vilska et al. (2009) 458 couples who conceived twins (N=91 pairs) or singletons (N=367) via ART, and 399 couples w/NC twins (N=20 pairs) or singletons (N=379) recruited from 5 Finnish infertility clinics Anxiety, depression 2nd trimester (T1), 2 (T2) and 24 (T3) months PP GHQ

  1. ART mothers of twins had lower depression than NC mothers of twins at T1.

  2. All mothers of twins had higher depression at T2 and T3, and more anxiety at T2 than all mothers of singletons.

  3. NC mothers of twins had more anxiety than NC mothers of singletons at T3.

  4. No differences in depression or anxiety in any fathers at T1.

  5. All fathers of twins had more symptoms of depression at T2 and T3 than all fathers of singletons, and more symptoms of anxiety at T3.
Zanardo et al. (1998) 15 mothers and 11 fathers of 30 high-risk premature twins, and parents of 15 high-risk premature singletons recruited from a neonatal intensive care unit at an Italian hospital Anxiety Discharge of 1st twin and 1 month later STAI

  1. Trend for more anxiety in parents of multiples.

  2. Trend for more anxiety in mothers versus fathers in both groups.
a

All measures except the DIS were administered in self-report format

AC assisted conception, ART assisted reproductive technology, AI artificial insemination, GA gestational age, ICSI intracytoplasmic sperm injection, IVF in vitro fertilization, multip multiparous, NC naturally conceiving/conceived, PP postpartum, PPD postpartum depression, primip primiparous; measure abbreviations and references: BSI Brief Symptom Inventory (Derogatis 1992), CESD Center for Epidemiological Studies Depression scale (Radloff 1977), DIS Diagnostic Interview Schedule (Robins, Cottler, Bucholz, and Compton 1995), EDS Edinburgh Depression Scale (Thorpe 1993), EPDS Edinburgh Postnatal Depression Scale (Cox 1986), GHQ General Health Questionnaire (Goldberg 1992), GHQ-30 General Health Questionnaire-30 (Goldberg and Williams 1988), HADS Hospital Anxiety and Depression Scale (Zigmond and Snaith 1983), MHI Mental Health Inventory (Veit and Ware 1983), MI Malaise Inventory (Rutter, Tizard, and Whitmore 1980), MHQ Middlesex Hospital Questionnaire (Crisp et al. 1978), PSI Parenting Stress Index (Abidin 1990), PSS Perceived Stress Scale (Cohen and Williamson 1988), STAI State-Trait Anxiety Inventory (Spielberger 1983)