The Influencing Factors Of Anxiety And Depression In Infertile Women

Objective:(1)To investigate the demographic characteristics, infertility status, family functions, social support, coping styles, self-esteem, anxiety and depression of the infertile women, and to find the factors that influence anxiety and depresson of the infertile women. (2)To explore the relations among Family APGAR, social support, coping styles, self-esteem and anxiety and depression of the infertile women, and to built a structural equation model of these factors, in order to provide basis for psychological intervention of infertile women.Methods:This was a Cross-section survey. Paticipants were recruited from March to August 2009, in Hunan Maternal and Infant Hospital, the Xiangya Hospital and the Third Xiangya Hospital of the Central South University, in Changsha, Hunan, People's Republic of China, during their visit.230 infertile women and 239 normal pregnant women completed a questionnaire consisting of Self-made Demographic and Infertility Data Recording Form, Family APGAR Scale (APGAR), Social Support Rating Scale (SSRS), Simplified Coping Style Questionnaire (SCQS), the Rosenberg Self-Esteem Scale (SES), Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS). Statistic analysis methods included statistic description, reliability analysis, Chi-square analysis, oneway ANOVA, analysis of covariance, correlation analysis, multiple linear regression analysis and Structural equation analysis.Results:(1) 469 subjects were recruited into this study, and 422 (90.0%) including 211 health pregnant women and 211 infertile women, completed the questionnaies. (2) Chi-square analysis shows anxiety (X2=191.823, P=0.000), depression (X2=56.759,P=0.000) were more frequent in infertile group than those in normal pregnant group. Analysis of covariables shows SAS (F=6.539, P=0.011) and SDS (F=40.509, P=0.000) score of the infertile women are higher than those of pregnant group. (4) In infertile women, One-way ANOVA shows there were significant differences in SAS scores aomong the groups of different educational levels(F=2.684, P=0.048), and the result was also achieved among the groups of different places of residence (F=3.981, P=0.020), the groups of different fertility ideas(F=10.227, P=0.002), the groups of different infertility exposure situations of infertility(F=4.200, P=0.016); there were significant differences in SDS scores aomong the groups of different places of residence (F=3.276, P=0.040), and this result was also achieved among the groups of different family income groups(F=5.148, P=0.024), the groups of different fertility ideas(F=7.057, P=0.009), the groups of different infertility exposure situations of infertility (F=3.043, P=0.050). Correlation analysis reveals SAS score of infertile women was strongly correlated with APGAR score(r=-0.272, P<0.01), SSRS score(r=-0.283, P<0.01), Positive coping score(r=-0.283, P<0.01), Negative coping score(r=0.209, P＜0.01), stigma score(r=0.485, P＜0.01) and SES score(r=-0.486, P＜0.01); SDS score was strongly correlated with APGAR score(r=-0.272, P＜0.01), SSRS score(r=-0.320, P＜0.01), positive coping score(r=-0.320, P＜0.01), negative coping score(r=0.137, P＜0.05), stigma score(r=0.453, P<0.01) and SES score (r=-0.529, P＜0.01). Multiple linear regression shows places of residence, fertility ideas, infertility exposure situations, social support, family APGAR, positive coping, negative coping, feeling of stigma, self-esteem were the predictors of anxiety and depression of the infertile women. (5) According to the structural equation analysis, the pathways included positive coping to support system (social support and family APGAR,β=0.55, P＜0.01), positive coping to self-esteem (β=0.38, P＜0.01), negative coping to support system (β=-0.06, P>0.05), support system to self-esteem (β=0.31, P＜0.01), support system to feeling of stigma (β#=-0.44, P<0.01), feeling of stigma to negative coping (β=0.34, P＜0.01), feeling of stigma to anxiety and depression (β=-0.35, P<0.01), self-esteem to anxiety and depression (β=-0.55, P<0.01). Positive coping (total effects=-0.442) and negative coping (total effects=0.025) indirectly affected anxiety and depression by the mediation of support system, feeling of stigma and self-esteem. Support system (total effects=-0.426) affected anxiety and depression by acting on feeling of stigma and self-esteem. Feeling of stigma influenced anxiety and depression directly, and inderectly by the mediation of self-esteem (direct effects=0.349, indirect effects=0.229, total effects=0.578). Self-esteem had a direct effect on anxiety and depression (total effects=-0.549).Conclusions:(1) The infertile women experienced more anxiety and depression than normal pregnant women. (2) Place of residence, fertility ideas, exposure situations of infertility, social support, satisfaction of family fuction, positive coping, negative coping, feeling of stigma, self-esteem were the influencing factors of anxiety and depression of the infertile women. (3) Coping styles affected anxiety and depression via support system, feeling of stigma and self-esteem. Positive coping had negative effect on anxiety and depression, while negative coping had positive effect. Support system negatively influenced anxiety and depression via feeling of stigma and self-esteem, and it had negative effect. Feeling of stigma had direct positive effect on anxiety and depression, and also via self-esteem. Self-esteem had direct negative effect on anxiety and depression. Besides, the relations among negative coping, support system and feeling of stigma were in a circular manner.