title: The infertility trap: how defeat and entrapment affect depressive symptoms.
abstract: OBJECTIVE
  Does the perception of failure without a solution or way forward of infertile couples have a mediator role between the importance couples attribute to parenthood and depressive symptoms?
  
  
  CONCLUSIONS
  The perception of failure without a solution or way forward, assessed by feelings of entrapment and defeat, mediates the effect of the importance of parenthood on depressive symptoms of infertile men and women.
  
  
  BACKGROUND
  Research has documented that the heightened importance of parenthood affects infertile couples' adjustment to infertility and medical treatments. However, it remains unclear which psychological mechanisms and perceptions may underlie the association between having parenthood as a nuclear aspect of life and presenting depressive symptoms related to difficulties in accomplishing that important life goal. Although these links have been scantly addressed in infertility, previous studies have pointed to the role that perceptions of defeat and entrapment have in several psychopathological conditions.
  
  
  METHODS
  The study was cross-sectional. Couples pursuing medical treatment for their fertility problems were invited to participate by their doctors in several public and private clinics. Data collection took place between July 2009 and 2011.
  
  
  METHODS
  One hundred forty-seven infertile couples consented to participate in the study. Both couple members (147 women and 147 men) completed a set of self-report instruments for the assessment of depressive symptoms, perceptions of defeat and entrapment, importance of parenthood and rejection of a childfree lifestyle. Analyses were conducted through Structural Equation Modeling and followed a dyadic analysis strategy, allowing for controlling the interdependence of the data.
  
  
  RESULTS
  The hypothesized tested model showed a very good fit to the data [(χ(2) = 68.45, P = 0.014, comparative fit index = 0.98, standardized root-mean-square residual = 0.06 and root mean square error of approximation = 0.06] and explained 67 and 58% of the variability in depressive symptoms in women and men, respectively. Results revealed that the importance of parenthood does not have a direct effect on depressive symptoms of infertile men and women, but an indirect effect, by affecting the perception of having failed and not being able to solve it or move forward [women: estimate for indirect effect: 0.38 (bias corrected (BC) 95% confidence interval (CI) = 0.25; 0.56; P < 0.001); men: estimate for indirect effect: 0.23 (BC 95% CI = 0.06; 0.40; P = 0.013)].
  
  
  CONCLUSIONS
  The study was cross-sectional, which does not allow for the establishment of causality. Another limitation is the heterogeneity of the sample, as participants were recruited at various stages of their fertility care. In addition, due to the specific nature of the variables, further studies are needed to establish exactly how the relationship between defeat and entrapment and depression operates, as the mechanism may be bidirectional.
  
  
  CONCLUSIONS
  This study emphasizes the role of perceptions of defeat and entrapment on the psychological adjustment to infertility and assisted reproduction. These emotional processes should be taken into consideration and targeted in psychological interventions of couples undergoing medical treatments for infertility. In fact, although parenthood may be perceived as a core purpose for many couples dealing with difficulties in conceiving, it is only when these difficulties are experienced as failures without a resolution and as inescapable, that couples are prone to develop depressive symptoms.
  
  
  BACKGROUND
  This research has been supported by the first author Ph.D. Grant (SFRH/BD/68392/2010), sponsored by the Portuguese Foundation for Science and Technology (FCT). The authors have no conflict of interests.
  
  
  BACKGROUND
  N/A.
authors.affiliation: Instituto Superior Miguel Torga, Largo da Cruz de Celas, n°1, Coimbra 3000-132, Portugal CINEICC - Faculty of Psychology and Educational Sciences of the University of Coimbra, Rua do Colégio Novo, Coimbra 3001-802, Portugal anagalhardo@ismt.pt.
authors.forename: A
authors.initials: A
authors.lastname: Galhardo
authors.affiliation: CINEICC - Faculty of Psychology and Educational Sciences of the University of Coimbra, Rua do Colégio Novo, Coimbra 3001-802, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Moura-Ramos
authors.affiliation: Instituto Superior Miguel Torga, Largo da Cruz de Celas, n°1, Coimbra 3000-132, Portugal CINEICC - Faculty of Psychology and Educational Sciences of the University of Coimbra, Rua do Colégio Novo, Coimbra 3001-802, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Cunha
authors.affiliation: CINEICC - Faculty of Psychology and Educational Sciences of the University of Coimbra, Rua do Colégio Novo, Coimbra 3001-802, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Pinto-Gouveia
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression; D004644:Emotions; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000523:psychology* / Q000628:therapy; D008297:Male; D016487:Parenting / Q000523:psychology*; D010465:Perception; D011788:Quality of Life; D013315:Stress, Psychological
keywords: defeat; depressive symptoms; entrapment; infertility; mediator role; need for parenthood; rejection of childfree lifestyle; representations about the importance of parenthood