The role of Infertility-related psychological inflexibility in the relationship between infertility-related stress and depressive symptoms in women with infertility
DOI:
https://doi.org/10.31211/rpics.2021.7.2.220Keywords:
Depressive Symptoms, Infertility, Psychological inflexibility, Stress, Descriptive cross-sectional studyAbstract
Background and Aim: Introduction: Infertility is a medical and social condition that impacts people’s lives at the marital, family, social and financial levels. Several studies point to comorbidity between psychopathology and infertility, and people facing the demands of infertility may use maladaptive mechanisms of emotion regulation translated into psychological inflexibility. Objectives: This current study aimed to explore the mediating role of infertility-related psychological inflexibility in the relationship between infertility-related stress and depressive symptoms in women presenting an infertility diagnosis and pursuing infertility medical treatment. In addition, as a secondary aim, the associations between the time since diagnosis and the study variables were examined. Methods: A cross-sectional study was conducted on a sample of 96 women recruited with the support of the Portuguese Fertility Association. Participants filled in online a set of self-report instruments. Sociodemographic and clinical data were collected, and standardized measures of infertility-related stress, depressive symptoms, and infertility-related psychological inflexibility were used. Results: The results demonstrated that the effect of infertility-related stress on depressive symptoms was .46, being totally mediated by infertility-related psychological inflexibility. Discussion: Difficulty in achieving a pregnancy is a painful life event that interferes with the goals and plans for building a family, which can lead to stress and depressive symptoms. The relationship between these symptoms seems to be influenced by the mechanism of infertility-related psychological inflexibility. Therefore, interventions such as Acceptance and Commitment Therapy and the Mindfulness-Based Program for Infertility may be particularly suitable for this population by integrating psychological inflexibility as a therapeutic target.
Downloads
References
Awtani, M., Mathur, K., Shah, S., & Banker, M. (2017). Infertility stress in couples undergoing intrauterine insemination and in vitro fertilization treatments. Journal of Human Reproductive Sciences, 10(3), 221–225. https://doi.org/g53b
Boivin, J., Bunting, L., Collins, A. J., & Nygren, G. A. (2007). International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Human Reproduction, 22(6), 1506–1512. https://doi.org/c27zhm
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676–688. https://doi.org/ftbs23
Chawla, N., & Ostafin, B. (2007). Experiential avoidance as a function dimensional approach to psychopathology: An empirical review. Journal of Clinical Psychology, 63(9), 871–890. https://doi.org/d69c2j
Costa, J., & Pinto-Gouveia, J. (2011). The mediation effect of experiential avoidance between coping and psychopathology in chronic pain. Clinical Psychology and psychotherapy, 18(1), 34–37. https://doi.org/dz6tbx
Cousineau, T. M., & Domar, A. D. (2007). Psychological impact of infertility. Best Practice & Research Clinical Obstetrics and Gynaecology, 21(2), 293–308. https://doi.org/bcd664
Dancey, C. P., & Reidy, J. (2017). Statistics without maths for psychology (7a ed.). Pearson Education Inc.
Datta, J., Palmer, M. J., Tanton, C., Gibson, L. J., Jones, K. G., Macdowall, W., Glasier, A., Sonnenberg, P., Field, N., Mercer, C. H., Johnson, A. M., & Wellings, K. (2016). Prevalence of infertility and help seeking among 15 000 women and men. Human Reproduction, 31(9), 2108–2118. https://doi.org/gjpzcv
Deka, P. K., & Sarma, S. (2010). Psychological aspects of infertility. British Journal of Medical Practitioners, 3(3), 32–34. https://bit.ly/3wPKZpD
Domar, A. D., Broome, A., Zuttermeister, P. C., Seibel, M., & Friedman, R. (1992). The prevalence and predictability of depression in infertile women. Fertility and Sterility, 58(6), 1158–1163. https://doi.org/g53r
Ferreira, C., Trindade, I. A., & Martinho, A. (2016). Explaining rigid dieting in normal-weight women: The key role of body image inflexibility. Eating and Weight Disorders, 21(1), 49–56. https://doi.org/f8tvzb
Fieldsend, M. (2018). What is it like being involuntarily childless? Searching for ways of understanding from a psychological perspective. Em N. Sappleton (Ed.), Voluntary and involuntary childlessness (pp. 49–70). Emerald Publishing Limited. https://doi.org/g53q
Fieldsend, M., & Smith, J. A. (2020). “Either stay grieving or deal with it”: The psychological impact of involuntary childlessness for women living in midlife. Human Reproduction, 35(4), 876–885. https://doi.org/g53p
Galhardo, A., Alves, J., Moura-Ramos, M., & Cunha, M. (2019). Infertility-related stress and depressive symptoms–the role of experiential avoidance: A cross-sectional study. Journal of Reproductive and Infant Psychology, 38(2), 139–150. https://doi.org/g53n
Galhardo, A., Cunha, M., Monteiro, B., & Pinto-Gouveia, J. (2020). Assessing psychological inflexibility in infertility: The development and validation study of the Psychological Inflexibility Scale – Infertility (PIS-I). Journal of Contextual Behavioral Science, 18, 239–246. https://doi.org/g53m
Galhardo, A., Cunha, M., & Pinto-Gouveia, J. (2013). Mindfulness-Based Program for Infertility: Efficacy study. Fertility and Sterility, 100(4), 1059–1067. https://doi.org/f2m74g
Galhardo, A., Moura-Ramos, M., Cunha, M., & Pinto-Gouveia, J. (2018). How does the Mindfulness-Based Program for Infertility (MBPI) work in reducing depressive symptoms?. Mindfulness, 9, 629–635. https://doi.org/gc98b8
Galhardo, A., Pinto-Gouveia, J., Cunha, M., & Matos, M. (2011). The impact of shame and self-judgment on psychopathology in infertile patients. Human Reproduction, 26(9), 2408–2414. https://doi.org/dk5fmv
González-Fernández, S., Fernández-Rodríguez, C., Mota-Alonso, M. J., García-Teijido, P., Pedrosa, I., & Pérez-Álvarez, M. (2017). Emotional state and psychological flexibility in breast cancer survivors. European Journal of Oncology Nursing, 30, 75–83. https://doi.org/gckwhf
Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2010). Multivariante data analysis (7a ed.). Pearson Education.
Harris, R. (2009). ACT made simple. New Harbinger Publications.
Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new acceptance and commitment therapy. New Harbinger Publications, Inc.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. Guilford Press.
Hayes, S. C., Wilson, K. W., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152–1168. https://doi.org/cgw8mg
Holley, S. R., Pasch, L. A., Bleil, M. E., Gregorich, S., Katz, P. K., & Adler, N. E. (2015). Prevalence and predictors of major depressive disorder for fertility treatment patients and their partners. Fertility and Sterility, 103(5), 1332–1339. https://doi.org/f27tk7
Joelsson, L. S., Tydén, T., Wanggren, K., Georgakis, M. K., Stern, J., Berglund, A., & Skalkidou, A. (2017). Anxiety and depression symptoms among sub-fertile women, women pregnant after infertility treatment, and naturally pregnant women. European Psychiatry, 45, 212–219. https://doi.org/gb2ff6
Kashdan, T. B., Barrios, V., Forsyth, J. P., & Steger, M. F. (2006). Experiential avoidance as a generalized psychological vulnerability: Comparisons with coping and emotion regulation strategies. Behaviour Research and Therapy, 44(9), 1301–1320. https://doi.org/ftqdk2
Klock, S. C. (2015). Reproductive psychology and fertility counseling. Em S. N. Covington (Ed.) Fertility counseling clinical guide and case studies (pp. 33–45). Cambridge University Press. https://bit.ly/3kMVCEF
Lawson, A. K., Klock, S. C., Pavone, M. E., Hirshfeld-Cytron, J., Smith, K. N., & Kazer, R. R. (2014). Prospective study of depression and anxiety in female fertility preservation and infertility patients. Fertility and Sterility, 102(5), 1377–1384. https://doi.org/f2vzsc
Levin, M. E., MacLane, C., Daflos, S., Seeley, J. R., Hayes, S.C., Biglan, A., & Pistorello, J. (2014). Examining psychological inflexibility as a transdiagnostic process across psychological disorders. Journal of Contextual Behavioral Science, 3(3), 155–163. https://doi.org/ggjs6c
Lilly, M. M., & Allen, C. E. (2015). Psychological inflexibility and psychopathology in 9-1-1 telecommunicators. Journal of Traumatic Stress, 28(3), 262–266. https://doi.org/10.1002/jts.22004
Lindsay, T. J., & Vitrikas, K. R. (2015). Evaluation and treatment of infertility. American Family Physician, 91(5), 308–314. https://www.aafp.org/afp/2015/0301/p308.html
Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335–343. https://doi.org/fwhsp7
Marôco, J. (2010). Análise de equações estruturais: Fundamentos teóricos, software & aplicações. ReportNumber.
Moura-Ramos, M. C. B. (2011). Adaptação psicossocial de casais portugueses à infertilidade e à reprodução medicamente assistida. [Tese de Doutoramento, Faculdade de Psicologia e Ciências da Educação da Universidade de Coimbra]. Repositório científico da Universidade de Coimbra. http://hdl.handle.net/10316/18478
Moura-Ramos, M., Gameiro, S., Canavarro, M. C., & Soares, I. (2012). Assessing infertility stress: Re-examining the factor structure of the Fertility Problem Inventory. Human Reproduction, 27(2), 496–505. https://doi.org/bhb6ft
Newbegin, C. (2014). The stress epidemic. InnovAiT, 8(1), 36–40. https://doi.org/g53h
Newton, C. R., Sherrard, W., & Glavac, I. (1999). The Fertility Problem Inventory: Measuring perceived infertility- related stress. Fertility and Sterility, 72(1), 54–62. https://doi.org/bsbw8j
Pais-Ribeiro, J. L., Honrado, A., & Leal, I. (2004). Contribuição para o Estudo da Adaptação Portuguesa das Escalas de Ansiedade, Depressão e Stress (EADS) de 21 itens de Lovibond e Lovibond. Psicologia, Saúde & Doenças, 5(2), 229–239. https://hdl.handle.net/10216/6910
Pedro, J., Sobral, M. P., Mesquita-Guimarães, J., Leal, C., Costa, M. E., & Martins, M. V. (2016). Couples’ discontinuation of fertility treatments: A longitudinal study on demographic, biomedical, and psychosocial risk factors. Journal of Assisted Reproduction and Genetics, 34(2), 217–224. https://doi.org/f9xf4h
Peterson, B. D., & Eifert, G. H. (2011). Using acceptance and commitment therapy to treat infertility stress. Cognitive and Behavioral Practice, 18(4), 577–587. https://doi.org/bqnm7h
Peterson, B. D., Sejbaek, C. S., Pirritano, M., & Schmidt, L. (2014). Are severe depressive symptoms associated with infertility- related distress in individuals and their partners?. Human Reproduction, 29(1), 76–82. https://doi.org/f5jwcs
Pinto, J. C., Martins, P., Pinheiro, T. B., & Oliveira, A. C. (2015). Ansiedade, depressão e stresse: um estudo com jovens adultos e adultos portugueses. Psicologia, Saúde & Doenças, 16(2), 148–163. https://www.redalyc.org/pdf/362/36242128002.pdf
Pozza, A., Dèttore, D., & Coccia, M. E. (2019). Depression and anxiety in pathways of medically assisted reproduction: The role of infertility stress dimensions. Clinical Practice & Epidemiology in Mental Health, 15, 101–109. https://doi.org/g53g
Shapiro, S. A. (1988). Psychological consequences of infertility. Em J. Zuckerberg (Ed.), Critical psychophysical passages in the life of a woman (pp. 269–289). Springer. https://doi.org/g53f
Silva-Carvalho, J. L., & Santos, A. (2009). Estudo Afrodite caracterização da infertilidade em Portugal I- Estudo na comunidade. Universidade do Porto.
Szkodziak, F., Krzyżanowski, J., & Szkodziak, P. (2020). Psychological aspects of infertility: A systematic review. Journal of International Medical Research, 48(6), 1–13. https://doi.org/g53d
Tavakoli, N., Broyles, A., Reid, E., Sandoval, J. R., & Correa-Fernández, V. (2019). Psychological inflexibility as it relates to stress, worry, generalized anxiety, and somatization in an ethnically diverse sample of college students. Journal of contextual Behavioral Science, 11, 1–19. https://doi.org/ggk8sr
Verhaak, C. M., Lintsen, A. M. E., Evers, A. W. M., & Braat, D. D. M. (2010). Who is at risk of emotional problems and how do you know? Screening of women going for IVF treatment. Human Reproduction, 25(5), 1243–1240. https://doi.org/ddfb9t
Volgsten, H., Svanberg, A. S., Ekselius, L., Lundkvist, Ö., & Poromaa, I. S. (2008). Prevalence of psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment. Human Reproduction, 23(9), 2056–2063. https://doi.org/bhpc6q
Wright, K. B. (2005). Researching Internet-based populations: Advantages and disadvantages of online survey research, online questionnaire authoring software packages, and web survey services. Journal of Computer-Mediated Communication, 10(3). https://doi.org/d7z5cr
Zegers-Hochschild, F., Adamson, G. D., Dyer, S., Racowsky, C., De Mouzon, J., Sokol, R., Rienzi, L., Sunde, A., Schmidt, L., Cooke, I. D., Simpsom, J. L., & Van Der Poel, S. (2017). The international glossary on infertility and fertility care, 2917. Human Reproduction, 32(9), 1786–1801. https://doi.org/gh7gqp
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Beatriz Cardoso, Ana Galhardo, Ilda Massano-Cardoso, Marina Cunha
![Creative Commons License](http://i.creativecommons.org/l/by-nc/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The authors retain the copyright and grant the journal right of first publication with the work simultaneously licensed under the Creative Commons Attribution-NonCommercial 4.0 International License that allows the sharing of work and recognition of authorship and initial publication in this journal.