title: Definite involuntary childlessness: associations between coping, social support and psychological distress.
abstract: BACKGROUND
  Around 4% of all couples remain involuntarily childless. These people often experience insufficient social support, which further aggravates the distress symptoms such as physical health problems, anxiety, depression and complicated grief. This study investigates the association of coping style and the degree of satisfaction regarding social support from primary support groups with distress symptoms of involuntarily childless individuals.
  
  
  METHODS
  Subjects in this cross-sectional study were people who wanted to have children with their partner but were unable to conceive and had acknowledged their involuntary childlessness. The sample consisted of 116 persons (response 88%) with an average age of 39 years (SD = 6.0), with 75% women. The sample group completed a questionnaire consisting of passive and active coping styles from the Utrecht Coping List (UCL), the discrepancy variant of the Social Support List (SSL-D), the short version of the Questionnaire on Experienced Health Complaints (VOEG-21), the Hospital Anxiety and Depression Scale (HADS) and the Inventory of Complicated Grief-Revised (ICG-R), adapted for this study.
  
  
  RESULTS
  Women especially experienced more health complaints, more anxiety and depression symptoms and more complicated grief than the general population. Regression analysis shows that when controlled for sex and the duration of involuntary childlessness, the concepts passive coping style and dissatisfaction with social support were positively associated with health complaints, depression, anxiety and complicated grief. The concept active coping style was negatively associated with depression, anxiety and complicated grief. Explained variance of the different distress symptoms varied from 30 to 65%. A moderating association of perceived social support is only found between a passive coping style and health complaints.
  
  
  CONCLUSIONS
  Psychosocial interventions should be continued after the childlessness has become definite. By teaching couples how to cope actively with their childlessness and how to ask for support, the negative consequences of their childlessness may be decreased.
authors.affiliation: Faculty of Psychology, Netherlands Open University, Heerlen, The Netherlands. lilian.lechner@ou.nl
authors.forename: L
authors.initials: L
authors.lastname: Lechner
authors.forename: C
authors.initials: C
authors.lastname: Bolman
authors.forename: A
authors.initials: A
authors.lastname: van Dalen
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety / Q000209:etiology; D003863:Depression / Q000209:etiology; D005260:Female; D006117:Grief; D006801:Humans; D007246:Infertility / Q000150:complications / Q000523:psychology*; D008297:Male; D012044:Regression Analysis; D012737:Sex Factors; D012944:Social Support; D013315:Stress, Psychological