Coexistence Status And Factors Associated With Posttraumatic Growth And Posttraumatic Stress Disorder In Infertile Patients Treated With IVF-ET

Objectives:To investigate the symptom characteristics and coexistence of posttraumatic growth(PTG)and posttraumatic stress disorder(PTSD)in infertile patients undergoing in vitro fertilization-embryo transfer(IVF-ET).Meanwhile,we explored the effects and pathways of personal factors(fertility stress,attachment style,self-compassion)and environmental factors(family care)on PTG and PTSD in infertile patients based on life crises and personal growth model to provide empirical support for improving the mental health status of this group.Methods:A convenience sampling of 846 infertile patients were recruited from December 2021 to October 2022 at a reproductive hospital in Jinan,Shandong Province.The survey tools included general information questionnaire,Family APGAR Index,COMPI Fertility Problem Stress Form,the Adult Attachment Scale,Self-Compassion Scale,Posttraumatic Growth Inventory and the PTSD Checklist-Civilian Version.SPSS 25.0,R 4.0.2 and AMOS 25.0 were applied for data analysis,and the main methods included univariate analysis,correlation analysis,network analysis,hierarchical linear regression,and structural equation modeling.Results:1.Scores of PTG and PTSD in infertile patients and characteristics of coexistence network structureThe scores of PTG in infertile patients were(57.06±15.10),of which 47.9%showed moderately high levels of growth;and the scores of PTSD in infertile patients were(32.45±12.55),of which 23.6%reached clinically significant levels.Correlation analysis showed a significant negative association between PTG and PTSD in infertile patients(r=-0.153,P<0.01).Network centrality analysis revealed that "ability to handle difficulties","More effort into relationships",and "better understanding of spiritual matters" were the three central entries in the PTG network.And "avoidance of thoughts","difficulty concentrating" and"avoidance of reminders" were the three core symptoms in the PTSD network.The results of bridge centrality analysis showed seven key bridge nodes in the PTG-PTSD network,which were "changed priorities","more compassion for others","intrusive thoughts","detachment","perception of greater personal strength","trauma-related amnesia" and "emotional cue reactivity".This illustrated the phenomenon of coexistence of PTG and PTSD.2.Correlation analysis of PTG,PTSD and family care,fertility stress,attachment style and self-compassion in infertile patientsCorrelation analysis showed that PTG in infertile patients was negatively associated with attachment avoidance,attachment anxiety(r=-0.253,-0.136,Ps<0.01),and positively associated with family care and positive self-compassion(r=0.266,0.431,Ps<0.01).Meanwhile,PTSD in infertile patients was positively associated with fertility stress,attachment avoidance,attachment anxiety and negative self-compassion(r=0.412～0.624,Ps<0.01),and negatively associated with family care and positive self-compassion(r=-0.349,-0.289,Ps<0.01).3.Hierarchical linear regression analysis of PTG,PTSD and related factors in infertile patientsUsing PTG and PTSD of infertile patients as dependent variables,respectively,meaningful general demographic information was included in the first level of the regression equation,family care,fertility stress and attachment style were included in the second level of the regression equation,and self-compassion in the third level of the regression equation.The results of hierarchical linear regression indicated that family care(β=0.135,P<0.001),attachment avoidance(β=-0.136,P=0.001),positive self-compassion(β=0.381,P<0.001)had significant predictive effects on PTG of infertile patients.Fertility stress(β=0.409,P<0.001),attachment anxiety(β=0.135,P<0.001),positive self-compassion(β=-0.107,P<0.001),negative self-compassion(β=0.235,P<0.001)had significant predictive effects on PTSD of infertile patients.4.Structural equation analysis based on PTG and PTSD as parallel dependent variables in infertile patientsBased on the coexistence of PTG and PTSD in the network,this study constructed a structural equation model with PTG and PTSD as parallel dependent variables.The results showed that family care and attachment avoidance can affect PTG not only directly in infertile patients(β=0.129,-0.161,Ps<0.01),but also indirectly through positive self-compassion(β=0.094,-0.066,Ps<0.05).Family care and attachment avoidance can indirectly PTSD through positive self-compassion(β=-0.026,0.018,Ps<0.05).Fertility stress and attachment anxiety can affect PTSD not only directly in infertile patients(β=0.477,0.099,Ps<0.05),but also indirectly through negative self-compassion(β=0.038,0.118,Ps<0.01).Conclusions:1.PTG and PTSD in infertile patients are co-existing non-independent posttraumatic psychological reactions.2.Family care and positive self-compassion are protective factors for PTG in infertile patients,and attachment avoidance is a risk factor for PTG.Positive self-compassion is a protective factor for PTSD in infertile patients,fertility stress,attachment anxiety and negative self-compassion are risk factors for PTSD.3.Positive self-compassion could partially mediate the effects of family care and attachment avoidance on PTG and PTSD in infertile patients,and negative self-compassion could partially mediate the effects of fertility stress and attachment anxiety on PTSD in infertile patients.