Perinatal female depression seriously endangers the health of mothers and infants, and effective intervention is the key to prevention and treatment. As a psychological intervention method that focuses on client-led treatment and emphasises emotional support, the role of non-directive counselling in depression intervention in perinatal women deserves in-depth discussion. To explore the application methods and mechanisms of non-directive counselling intervention in alleviating depression in perinatal women, and to construct its key elements and practical logic models. The key elements and logical models of non-directive counselling intervention are refined and constructed using the grounded theoretical research method to carry out open coding, axial coding and selective coding of data. Selective coding-based results show that building a sense of security, attachment, and self-worth is the foundation of the intervention and helps promote trust and engagement. The counselling process promotes emotional expression and regulation by enhancing communication skills and creating a free and supportive emotional space. Through emotional support and structured companionship, women gradually shift from external dependence to self-regulation, forming autonomy and internal control. Continuous feedback mechanisms can further enhance self-awareness and regulation efficacy, ensuring that interventions are tailored to individual needs. This study proposes the key elements and practical logic model of non-directive counselling intervention for perinatal female depression, which provides clear operational guidelines for relevant professionals. These findings may facilitate the scientific and effective application of non-directive counselling strategies, thereby improving the specificity and effectiveness of interventions.
Pregnancy loss may trigger complicated grief. Self-judgment and pressure to abort contrary to one's preferences may increase the risk and severity of complicated grief reactions. A topic-blind survey was offered to a random panel of 41- to 45-year-old American females. Of 2361 eligible respondents, 1925 (82%) usable surveys were collected. The highest levels of grief were associated women whose abortions were self-reported as inconsistent with their values and preferences. The grief scores of women who had natural pregnancy losses were most similar to those of the women who had unwanted abortions. Higher levels of grief were associated with self-judgement, intrusion, pressure to abort, immediate or persistent negative reactions, and reactions that interfered more with work, relationships and other activities. Nearly 40% reported that the worst of their negative feelings attributed to their pregnancy losses continue and persist today. Compared to a natural pregnancy loss, persistent and complicated grief following an induced abortion may be more or less common depending on the degree that the abortion was consistent, or inconsistent, with a woman's own values and preferences. With 40% reporting persistent negative emotions, even 20 years later, more interventions and resources are warranted. There are similarities in the degrees of grief and prolonged grief following natural pregnancy losses and induced abortions.Perceptions of self-judgment and more pregnancy wantedness are risk factors for more intense and prolonged grief.Abortion decisions that are inconsistent with a woman’s own values or preferences are strongly associated with prolonged and/or disenfranchised grief.
Fear of childbirth (FOC) is associated with adverse outcomes, for the expecting woman as well as for her baby. In order to prevent and treat FOC, it is important to understand the psychological processes involved. Two potential key processes are intolerance of uncertainty and pain catastrophizing. The aim of this cross-sectional study was to explore intolerance of uncertainty and pain catastrophizing in pregnant individuals with severe vs. low/moderate FOC, and potential differences between nulliparas and multiparas. The sample of 332 individuals filled out a range of questionnaires, and were categorized as severe (n = 66) and low/moderate (n = 266) FOC. The results showed that participants with severe FOC (Wijma Delivery Expectancy Questionnaire, W-DEQ ≥85) reported higher levels of intolerance of uncertainty and pain catastrophizing than participants with low/moderate FOC. We did not find any significant differences between nulliparas and multiparas. Noteworthy, levels of pain catastrophizing in the severe FOC group were similar to those reported in chronic pain samples. Although we cannot draw any conclusions about causality or direction of proposed links, these findings warrant a need for identifying and developing treatment strategies to target intolerance of uncertainty and pain catastrophizing, in both nulliparas and multiparas with high levels of FOC.
Estrogen fluctuations during menopause are linked to increased psychiatric symptoms like depression and anxiety. Depression rates in menopausal women are 2-3 times higher than in premenopausal women, primarily due to rapid estrogen changes. Estrogen affects emotional stability by regulating neurotransmitters, adjusting HPA axis sensitivity, and influencing neuroinflammatory and epigenetic pathways. Menopausal hormone therapy (MHT) is a key treatment, stabilizing neurotransmitter systems and HPA axis activity, but requires personalized and evidence-based approaches. This paper aims to systematically summarize the association between estrogen fluctuations and menopausal psychiatric symptoms, elucidate the underlying physiological and molecular mechanisms driving these symptoms, and evaluate the therapeutic potential of MHT, so as to provide a robust theoretical basis for clinical decision-making in menopausal mental health management. We performed a thorough review of peer-reviewed studies from medical and psychiatric databases, examining the connections between menopausal estrogen changes, neurotransmitter regulation, HPA axis function, neuroinflammation, epigenetic changes, and the effectiveness and safety of MHT for managing psychiatric symptoms. We prioritized high-quality clinical trials, epidemiological studies, and mechanistic research to ensure reliable evidence. The review highlights that sudden estrogen changes during menopause disrupt serotonin and norepinephrine signaling, alter HPA axis activity, and trigger neuroinflammation and epigenetic changes, increasing the risk of depression and anxiety. Menopausal hormone therapy (MHT) can alleviate these symptoms by restoring neurotransmitter balance and normalizing HPA axis function. However, its effectiveness depends on factors like treatment timing, hormone type, and individual patient characteristics, including medical history and symptom severity. Estrogen fluctuation is a significant modifiable risk factor for psychiatric symptoms during menopause, affecting neurotransmitter, endocrine, inflammatory, and epigenetic pathways. Menopausal hormone therapy (MHT) is effective for symptom management when personalized and administered within recommended timeframes. This underscores the importance of assessing estrogen levels and psychiatric symptoms in menopausal women to optimize MHT and enhance mental health outcomes.
Infertility is a global health challenge with profound psychosocial consequences. Couples navigate this journey within social media and online communities. These digital spaces offer opportunities for support, coping and information exchange, but also expose users to comparison culture, misinformation, and inequities. This scoping review aims to synthesize the available evidence on how social-media and online communities shape the psychosocial experience of infertility, identifying both supportive and harmful dimensions. Following Joanna-Briggs Institute methodology PRISMA-ScR guidelines, a comprehensive search was conducted. Eligible studies included qualitative, quantitative and mixed-methods designs. Data were charted using a standardized extraction tool and synthesized thematically. Of 6,935 records screened, 19 studies were included. A qualitative content analysis was undertaken to identify four domains: (1) Psychosocial impact of infertility in online spaces, (2) Coping strategies and peer support, (3) Information sharing and misinformation, and (4) Gender, equity and global perspectives. Through studies, supportive functions coexisted with significant risks particularly misinformation, commercial exploitation and exacerbation of stigma. Social media functions both as a lifeline and a liability in the infertility journey. Harnessing its supportive potential while mitigating risks requires clinician engagement, digital literacy initiatives, culturally sensitive research and ethical oversight.
Endometriosis (EMS) is associated with a markedly increased incidence of depression and anxiety, primarily due to cyclic pain, concerns about infertility from impaired ovarian function, and fear of disease recurrence. Surgery and its associated pain may trigger both emotional and physiological stress responses. Young, nulliparous patients with fertility intentions often experience additional psychological burdens related to surgical safety, postoperative recovery, and the potential impact on future fertility. Music has been shown to promote relaxation, reduce tension and anxiety, and alleviate pain. However, no studies have evaluated the postoperative effects of music therapy in this specific patient population. To investigate whether music therapy can effectively reduce postoperative pain and alleviate perioperative anxiety in young patients with fertility desires undergoing laparoscopic cystectomy for endometriotic ovarian cysts, and to explore its potential as a simple, non-pharmacological intervention. A single-center, two-arm, single-masked randomized controlled trial (RCT). The Third Affiliated Hospital of Sun Yat-sen University (a teaching hospital). A total of 149 patients were included for analysis, with 75 assigned to the music group and 74 to the control group. Perioperative music therapy administered to young, nulliparous patients with fertility intentions undergoing laparoscopic cystectomy for EMS. One participant withdrew during follow-up, and 149 patients were included in the final analysis. Baseline characteristics-including age, BMI, marital status, preoperative VAS scores, and GAD-7 scores and anxiety levels-showed no significant differences between groups. Postoperative VAS scores at 6 h (p = 0.20), Day 1 (p = 0.438), Day 3 (p = 0.714), and Day 7 (p = 0.899) revealed no significant differences. Similarly, GAD-7 scores and anxiety severity levels on postoperative Day 1 (p = 0.541; p = 0.984), Day 3 (p = 0.287; p = 0.436), and Day 7 (p = 0.468; p = 0.703) showed no statistical significance between groups. Music therapy may serve as an adjunctive intervention for young, nulliparous patients with fertility intentions undergoing laparoscopic cystectomy for endometriosis; however, no significant effects were observed in reducing perioperative anxiety or postoperative pain in this population.
Infertility, affecting one in six individuals worldwide, poses substantial emotional and physical challenges. Its impact on quality of life (QoL), mental health and social relationships is well documented. However, qualitative insights into the lived experiences of those affected remain limited, as do the perspectives of health professionals involved in their care. This study presents qualitative findings from a mixed-method approach. Data were collected through 23 semi-structured interviews with 26 affected individuals and three focus group discussions with 20 healthcare professionals. The results underscore the multifaceted burden of infertility, including emotional distress, relationship strain and a pervasive sense of social exclusion. Participants expressed a clear need for more empathetic and individualized care, while healthcare professionals pointed to structural barriers. The study also identified a lack of societal recognition for infertility and the complex challenges. In some narratives, spirituality emerged as a personal coping resource - though one that is often overlooked or insufficiently addressed in clinical practice. Key recommendations include the expansion of peer support networks, public awareness raising, flexible treatment models and interprofessional collaboration. Future research should evaluate the effectiveness of peer support systems and interdisciplinary care models in addressing the complex and diverse needs of individuals affected by infertility.
This study aims to systematically analyze the disease burden and epidemiological characteristics of depression among women of childbearing age (WCBA) globally and across regions from 1990 to 2021, as well as explore the current research status and hotspots. Data from the 2021 Global Burden of Disease, Injuries, and Risk Factors Study (GBD 2021) were used to examine age-standardized incidence rates (ASIR) and disability-adjusted life years (DALYs) of depression among WCBA by region, age, and socio-demographic index (SDI) level. Relevant literature was retrieved from the Web of Science Core Collection, with bibliometric analyses (temporal-spatial distribution, themes, keywords) performed via VOSviewer and CiteSpace. In 2021, there were ~133 million new global cases of depression among WCBA, with an ASIR of 6,808.01 per 100,000 population. Incidence rose significantly since 1990, accelerating from 2019 to 2021. High SDI regions had higher ASIR, age-standardized DALY rates (ASDR), and average annual percentage change (AAPC). Globally, incidence peaked at 45-49 years with age growth, but younger WCBA (15-29 years) in high SDI regions had higher ASIR. Bibliometric analysis showed rapid research expansion in recent years, covering pregnancy, risk factors, and obesity, with "polycystic ovary syndrome" and "oxidative stress" as emerging hotspots. The study highlights the rising global burden of depression among WCBA and disparities across regions, socioeconomic backgrounds, and age groups, providing scientific evidence for targeted public health interventions.
The endometriosis painful symptoms-4 dimensions ENDOPAIN-4D is a multidimensional questionnaire designed to assess endometriosis-related pain. This study aimed to translate, culturally adapt, and validate ENDOPAIN-4D for European Portuguese. Translation and content validity assessment were assessed in 32 women with endometriosis. For psychometric validation, 386 patients completed an online sociodemographic and clinical questionnaire, the Portuguese ENDOPAIN-4D, and the Endometriosis Health Profile Questionnaire-30 (EHP-30). Statistical analyses included descriptive statistics, exploratory factor analysis, internal consistency, item-total correlation, and concurrent validity. Factor analysis of the "usual pain" dimension supported the original four-factor structure, accounting for 63.7% of variance (Cronbach's α = 0.91). A novel three-factor structure was identified for the "worst pain" dimension, previously psychometrically untested, with good internal consistency (Cronbach's α = 0.83) and acceptable item-total correlations. Concurrent validity with the EHP-30 ranged from weak to strong across domains. The Portuguese ENDOPAIN-4D is a culturally adapted and validated instrument for multidimensional pain assessment in European Portuguese women with endometriosis, with validity likely limited for other Portuguese-speaking communities. The newly identified three-factor structure for worst pain may aid individualized pain management and follow-up in clinical and psychosomatic care. Further studies should evaluate concurrent validity and the stability and responsiveness of the new algorithms. The ENDOPAIN-4D enables multidimensional assessment of pain in women with endometriosis.The Portuguese version was translated, culturally adapted, and validated.The instrument showed excellent internal consistency and preserved factor structure.Further studies are needed to confirm concurrent validity and stability.This validation supports more patient-centered, evidence-based care in Portugal.
Rates of hypertensive disorders affecting pregnancy are increasing, and bipolar disorder is more common in pregnancy than previously thought. The authors investigated differences in the incidence of hypertensive disorders of pregnancy between those with and without bipolar disorder (BPD) and between those receiving and not receiving pharmacotherapy for BPD. Differences in the incidence of hypertensive disorders of pregnancy in those with BPD between those on prophylactic aspirin (ASA) and not, were also examined. EPIC COSMOS was used to examine records from 2019 to 2023. The authors found a meaningful difference in proportions between those with and without BPD when observing development of hypertensive disorders of pregnancy across years. Slightly increased odds of hypertensive disorders were found among those reporting BPD pharmacotherapy compared to those not. Slightly increased odds of hypertensive disorders occurred in those with BPD reporting ASA. The increased odds among those reporting BPD pharmacotherapy could be due to sequelae of disease, medication used, or comorbidities. These findings further corroborate prior evidence of the increasing prevalence of both maternal health complications and mental health disorders int eh United States.
To compare depression prevalence using the Hospital Anxiety and Depression Scale focused on depression (HADS-D), the Patient Health Questionnaire-9 (PHQ-9) and the Patient Health Questionnaire-2 (PHQ-2). It also evaluated the psychometric properties of these instruments and their agreement at different cutoff scores. A cross-sectional study with 119 women with PCOS. Participants completed all three measurements to assess depression. The study compared depression prevalence and analysed psychometric properties using Cohen's Kappa (κ), coefficient (ρ), Spearman's correlation and Cronbach's alpha (α). Depression rate among PCOS women varied significantly by screening tool: 2.52%-26.89%. However, there was poor agreement and correlation between HADS-D and PHQ-9. In contrast, using cutoff scores of HADS-D ≥ 7 and PHQ-9 ≥ 10 yielded strong agreement (κ = 0.731) and correlation (ρ = 0.731). The PHQ-2 ≥ 3 had reasonable correlations with HADS-D ≥ 7 (κ = 0.596, ρ = 0.599) and PHQ-9 ≥ 10 (κ = 0.596, ρ = 0.599). Depression rates in PCOS women vary by evaluation technique. This study recommends a cutoff score of ≥7 for the HADS-D and ≥10 for the PHQ-9 to enhance screening accuracy among Thai PCOS women. The PHQ-2 also represents a convenient alternative tool due to its brevity and user-friendliness. We propose that the PHQ-9, with a score of ≥10, constitutes the most suitable screening instrument for Thai women with PCOS.
This systematic review synthesizes evidence on depressive symptoms and access to mental health care following miscarriage. It examines differences between women in general care settings and those with recurrent pregnancy loss to explore differential psychological vulnerability and care gaps. A search of four databases (inception-June 2025) followed PRISMA guidelines. Studies reporting depressive symptoms or barriers and facilitators to care were included. Given methodological heterogeneity, findings were synthesized narratively using a SWiM framework, stratifying populations by miscarriage history and assessing quality with risk-of-bias tools. Of 1,140 records, 46 were included. Depressive symptoms were common, though prevalence varied by timing, tools, and characteristics. Evidence suggests a possible graded association between recurrent loss and symptoms, although this was inconsistent and often attenuated in acute assessments. Key correlates included childlessness, prior psychiatric history, repeated loss, and low social support. Barriers included insensitive communication, lack of follow-up, and financial constraints. Facilitators included empathetic interactions, clear information, and supportive networks. Miscarriage is frequently associated with significant distress, yet evidence certainty varies regarding recurrence and intervention effectiveness. Findings highlight a persistent gap between women's mental health needs and healthcare responses.
Whilst the negative impact of fear of childbirth (FOC) is well established, there is limited understanding of the factors that reduce it. This study, aimed to explore the relationship between positive mental well-being, childbirth self-efficacy, and FOC during pregnancy through a Salutogenic lens. Using a cross-sectional design, 88 pregnant women recruited from a public hospital in North East Scotland completed an online survey including the Warwick Edinburgh Mental Well-Being Scale (WEMWBS), Childbirth Self-Efficacy Inventory (CBSEI), and Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). The sample scored a mean of 50.36 on WEMWBS, 84.63 for efficacy-expectancy, 127.00 for efficacy-outcome on CBSEI, and 62.19 on W-DEQ. Twelve per cent exhibited a severe FOC. FOC was negatively correlated with mental well-being, childbirth self-efficacy expectancy, and self-efficacy outcome. Multiple regression analysis indicated that higher mental well-being (β = -0.39, p < 0.001) was the strongest predictor of lower FOC. The findings highlights the important role of positive mental well-being and childbirth self-efficacy in reducing FOC, and suggest a need for antenatal education targeted at mastering childbirth techniques and enhancing positive emotions, sense of purpose, and meaning. These findings align with global health priorities by emphasizing the importance of antenatal care that supports and promotes both physical and mental well-being.
This study compared the efficacy of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) and the Childbirth Attitudes Questionnaire (CAQ) in assessing fear of childbirth (FOC) among hospitalized pregnant women, aiming to identify a practical screening tool. A total of 184 pregnant women were recruited from the Northwest Women's and Children's Hospital using convenience sampling. Data were collected through the General Demographic Questionnaire, Fear of Birth Scale (FOBS), W-DEQ, and CAQ. Using the FOBS as a reference, the diagnostic performance of the W-DEQ and CAQ was evaluated via receiver operating characteristic curves and Bayesian discriminant analysis. The area under the curve (AUC) for the W-DEQ (0.888) was significantly higher than that of the CAQ (0.789; Z = -2.189, p < 0.05). Optimal cutoff values were 80.5 for the W-DEQ and 31.5 for the CAQ. Cross-validation revealed accuracy rates of 75.6% and 70.7%, respectively. The incidence of FOC, as assessed by the W-DEQ, CAQ, and FOBS, was 29.9%, 43.9%, and 37.2%. Both tools demonstrated good reliability and validity, but the W-DEQ showed superior performance. It is recommended as the preferred tool for assessing FOC among pregnant women in China due to its comprehensive evaluation capacity.
This randomized controlled trial explored the feasibility and preliminary effectiveness of integrating mindfulness-based body scan (MBBS) interventions into multimodal pelvic floor physiotherapy for vulvodynia treatment. Participants received ten sessions of standardized physiotherapy. The mindfulness intervention group was instructed to additionally perform home-based audio-file guided MBBS five times a week. The primary study endpoint was feasibility. The effect on pain intensity, pain characteristics and sexuality were assessed with Numeric Rating scales (NRS), the McGill-Melzack Pain Questionnaire (MPQ), the Female Sexual Distress Scale (FSDS) and Female Sexual Function Index (FSFI) and digital assessment of pelvic floor. Thirty-three women were randomized and completed the end-of-treatment assessments and 26 (79%) attended the follow-up. 15 of 17 participants of the intervention group (88%) performed the body scans more than ten times and the feasibility criteria were achieved. The intervention group showed significantly better improvements in NRS of average pain, MPQ subscales and FSDS total score. Pelvic floor assessment showed a significant improvement of myofascial pressure points over time with no difference between study groups. Integration of MBBS trainings into multimodal pelvic floor physiotherapy for vulvodynia is feasible and well accepted and may improve pain reduction and sexual function.
To assess the reliability of the 10-item and 4-item Perceived Stress Scale (PSS-10 and PSS-4) in the obstetric population, compared with the original 14-item scale (PSS-14). Data were drawn from two Brazilian multicenter studies: a prospective cohort of pregnant women at 27-29 weeks and a cross-sectional study of postpartum women. Central tendency measures and centiles were compared across versions for overall, pregnant, and postpartum groups. Analyses included concordance, internal consistency, correlation, and reliability. A total of 1,034 women completed the PSS-14. Median scores differed significantly across versions (PSS-10: 47.5; PSS-4: 43.7; PSS-14: 46.4; p < 0.001). Both shortened versions correlated strongly with PSS-14 (PSS-10: r = 0.958; PSS-4: r = 0.814), but agreement was poor (mean difference PSS-14 vs. PSS-10: -0.366 [-8.56 to 7.83], p < 0.001; vs. PSS-4: 5.700 [-14.43 to 25.83], p < 0.001). Reliability was acceptable for PSS-10 (Cronbach's α = 0.704) but low for PSS-4 (α = 0.516). In the obstetric population, PSS-10 may overestimate and PSS-4 underestimate stress levels compared to PSS-14. Further studies are needed to refine the psychometric properties of shorter versions and clarify the clinical implications of score differences. Our findings indicate that the current shortened versions of the Perceived Stress Scale (PSS-10 and PSS-4) might not be a suitable alternative to the original version (PSS-14) in the obstetric population.
This study aimed to explore the mediating role of marital adjustment between self-efficacy and quality of life in couples undergoing IVF treatment. In this cross-sectional study, 293 infertile Chinese couples completed the General Self-Efficacy Scale, Marital Adjustment Test, and Fertility Quality of Life Scale. Data were analyzed using structural equation modeling based on the actor-partner interdependence mediation model. Both wives and husbands showed positive actor effects - their self-efficacy improved quality of life through their own marital adjustment. For partner effects, husbands' self-efficacy enhanced wives' marital adjustment, while husbands' marital adjustment unexpectedly reduced wives' quality of life. Improving self-efficacy and marital adjustment can enhance quality of life for IVF couples. Healthcare providers should approach couples as an integrated unit and develop dyadic interventions to improve both partners' quality of life.
Polycystic Ovary Syndrome (PCOS) affects 8-13% of females. US population-based research on PCOS limited. We compare PCOS knowledge and describe common PCOS symptoms in those with and without PCOS. An internet panel survey of 382 (200 with PCOS) US females 18-30 years was administered. PCOS knowledge was assessed using 20 items classified as correct or incorrect summed to create a knowledge score. Respondents reported experience of each of 8 common PCOS symptoms. Body image and depression were assessed using the Body Image Measurement Scale and PHQ-9. The sample had a mean age of 26.2 years and was majority White, non-Hispanic (76.0%). Those with PCOS demonstrated better PCOS knowledge (mean score 10.7 vs. 9.8; p = 0.029) and were more likely to identify the cardiometabolic sequelae than those without PCOS. More than 50% of respondents with PCOS reported each of the common symptoms. Those with PCOS reported significantly poorer body image (mean 3.71 vs. 3.31; p < .0001) and higher depression symptoms (mean 14.88 vs. 10.69; p < .0001). This study adds to the relatively small body of research on PCOS conducted among US females and highlights that knowledge about PCOS in US young adult females is low, regardless of PCOS status.
Infertility can lead to significant psychological distress, including depression and anxiety, adversely affecting the quality of life and treatment outcomes for affected women. This study systematically reviews non-pharmacological interventions, particularly cognitive behavioral therapy (CBT), aimed at improving quality of life, mental health, and birth rates among infertile women. A comprehensive literature search was conducted across multiple databases (PUBMED/MEDLINE, Embase, Scopus, Web of Science, and ULAKBİM) up to 22 February 2025, following PRISMA guidelines, with registration in the PROSPERO database (CRD42023457742). The analysis included randomized controlled trials (RCTs) focusing on CBT, with quality of life as the primary outcome. Eight studies involving 687 women met the inclusion criteria. Meta-analysis results revealed significant enhancements in quality of life (SMD: 1.97), alongside notable reductions in depression (SMD: -3.34) and anxiety (MD: -2.09). Additionally, a positive trend in pregnancy rates was observed (MD: 0.48). Despite the promising findings, the overall quality of evidence was deemed low to moderate due to potential biases. This meta-analysis underscores the effectiveness of CBT in improving mental health and quality of life in infertile women, highlighting the need for further high-quality research to validate these outcomes and endorse cognitive interventions in infertility treatment.
Identifying women with secondary tokophobia and offering effective counseling can reduce the psychological burden of their negative experience's childbirth. In light of Iran's population incentive policies, this research will compare the effects of two telemedicine-based counseling methods on secondary tokophobia in single-child women. This study will be conducted in two phases. Phase 1 will identify women with secondary tokophobia through a cross-sectional descriptive study using the Fear of Childbirth Prior to Pregnancy (FOCPP) tool. Phase 2 will be a three-arm randomized controlled trial (RCT), enrolling 102 single-child women with secondary tokophobia, block-randomized in blocks of six to receive either Acceptance and Commitment Therapy (ACT - arm 1), motivational counselling (MC - arm 2), or standard care (control). The study will follow CONSORT-EHEALTH guidelines. Outcomes, including tokophobia, anxiety, depression, and postnatal PTSD, will be assessed at weeks four and eight using standardized questionnaires. Data will be analyzed using statistical tests in SPSS-24. Negative past experiences can lead to secondary tokophobia, where women fear future pregnancies, sometimes avoiding them altogether. Research shows that those with tokophobia may face anxiety, depression, and PTSD, necessitating counseling to encourage future pregnancies. This study will be aim to investigate two counseling interventions for single-child women with secondary tokophobia through a telemedicine approach in the context of Iranian population policies. Current Controlled Trials IRCT20240207060923N1. Registered 18 May 2024.