Investigating the Relationships among Stressors, Stress Level, and Mental Symptoms for Infertile Patients: A Structural Equation Modeling Approach.
OBJECTIVE
Patients with infertility are a high risk group in depression and anxiety. However, an existing theoretically and empirically validated model of stressors, stress, and mental symptoms specific for infertile patients is still a void. This study aimed to determine the related factors and their relational structures that affect the level of depressive and anxiety symptoms among infertile patients.


METHODS
A cross-sectional sample of 400 infertility outpatients seeking reproduction treatments in three teaching hospitals across Taiwan participated in the structured questionnaire survey in 2011. The hypothesized model comprising 10 latent variables was tested by Structural Equation Modeling using AMOS 17.


RESULTS
Goodness-of-fit indexes, including χ2/DF = 1.871, PGFI = 0.746, PNFI = 0.764, and others, confirmed the modified model fit the data well. Marital stressor, importance of children, guilt-and-blame, and social stressor showed a direct effect on perceived stress. Instead of being a factor of stress, social support was directly and positively related to self-esteem. Perceived stress and self-esteem were the two major mediators for the relationships between stressors and mental symptoms. Increase in social support and self-esteem led to decrease in mental symptoms among the infertile patients.


CONCLUSIONS
The relational structures were identified and named as the Stressors Stress Symptoms Model, clinically applied to predict anxiety and depression from various stressors. Assessing sources and level of infertility-related stress and implementing culturally-sensitive counseling with an emphasis on positive personal value may assist in preventing the severity of depression and anxiety.
Department of Health Services Administration, China Medical University, Taichung, Taiwan.
Jong-Yi
JY
Wang
Department of Business, Chungyo Department Store, Taichung, Taiwan.
Yi-Shan
YS
Li
Office of the President, National Changhua University of Education, Changhua, Taiwan.
Jen-De
JD
Chen
Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan.
Wen-Miin
WM
Liang
Reproductive Medicine Center, Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan.
Tung-Chuan
TC
Yang
Reproductive Medicine Center, Yuan's General Hospital, Kaohsiung, Taiwan.
Young-Chang
YC
Lee
Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan.
Chia-Woei
CW
Wang
D000328:Adult; D001007:Anxiety / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D007246:Infertility / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D011594:Psychometrics; D012649:Self Concept; D012944:Social Support; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D013624:Taiwan