Document Type : Original Article
Authors
1 Department of Psychology, Payame Noor University, Tehran, Iran
2 Department of Psychology, Research Institute of Hawzeh and University, Qom, Iran
3 Department of Obstetrics and Gynaecologic Nursing, Nursing School, Gulhane Military Medical Academy, Ankara, Turkey
Abstract
Keywords
Infertility is defined as a failure to achieve pregnancy
after one year of regular intercourse without
preventive methods (
Problems in sleep, work, relations (especially
marital relations), and painful sensitivity to any
natural motives related to reproduction are observed
in infertile people (
Although at the first stage infertility is a clinical
condition, diagnosis can have many effects on the
psychological performance of couples. Moreover,
the psychological dimension of infertility affects
other aspects of couple’s personal lives including
social and economic ones (
Previous studies show that stress, anxiety and
depression scales were significantly higher in infertile
couples than in fertile couples (
Investigations show that after the first year of marriage there is a lot of pressure on couples to have a child. This pressure increases during the third and fourth years (
In previous studies, different scales have been used to measure stress and depression in infertile women (
However, there is no tool to show all the problems and concerns of infertile women. Especially there is no admissible and valid scale in Iran and there are no proper tools to do efficient research in this field. Moreover due to a lack of technical tools, most of infertility investigations consider personal features, anxiety and depression using various standard tools. So an infertility depression questionnaire is a vital tool to do research in this field. The present article aims to evaluate valid and admissible tools which measure distress scale in Iranian women during infertility and treatment.
In this cross-sectional project, the study population included all infertile women referring to Yazd infertility centre and all fertile women in Yazd. 155 infertile women within the age range of 22 to 41 years (mean age 29.1 years) and 145 fertile women with mean age of 30.2 years were chosen as a sample. From 2010, all women referring to Yazd infertility centre who had been married for at least two years, had no children, had been diagnosed as infertile by a physician and did not have any treatment experiences filled in the Infertility Distress Scale questionnaire and Fertility Problem Inventory. Prior to questionnaire completion, first they signed the consent form, the aim of the research was explained and they filled it with their own consent. Participants were informed that this research did not have any impact on the treatment process and they could give it back. Cluster sampling was used for fertile women. One region was chosen from three regions in Yazd and then 145 mothers were selected as a fertile sample from one of the schools.
This questionnaire includes 21 multiple choice items which are scaled from 1 to 4, except 5 questions with opposite scaling from 4 to 1. The total scale of 21 items made the overall scale range from 21 to 84. To apply the questionnaire on Iranian participants, first it was received from Akyuz et al. (
This questionnaire consists of 46 questions and considers infertility in 5 dimensions: social, sexual, relations, life style without a child and the need
to be a parent (
Data was analysed using exploratory factor analysis, Bartlett test of sphericity and Varimax rotation.
This study was approved by the Ethics Committee of the Institutional Review Board of Payam-e-Noor University of Southern khorasan province.
Cronbach’s alpha value, re-test and parallel forms were used for the validation and reliability measurement of this questionnaire.
It presents statistical features for 21 items, overall scale, every item’s correlation to overall scale and the effects of deleting every item on Cronbach’s alpha value on participants. The average of 21 items was 3.153 (item 18) -1.086 (item 12) (
As is shown in
Average, standard deviation and correlation of items to overall scale and Cronbach’s alpha value in case of deleting an item (n=300)
Item | M | SD | Correlationwith totalscore | Cronbach ’salpha if itemdeleted |
---|---|---|---|---|
2.063 | 0.740 | 0.809 | 0.901 | |
2.330 | 0.842 | 0.531 | 0.905 | |
3.146 | 1.237 | 0.188 | 0.614 | |
2.070 | 0.856 | 0.463 | 0.907 | |
2.163 | 1.160 | 0.646 | 0.902 | |
2.163 | 1.160 | 0.646 | 0.902 | |
2.586 | 1.131 | 0.465 | 0.907 | |
2.430 | 0.766 | 0.755 | 0.902 | |
2.246 | 0.977 | 0.258 | 0.911 | |
2.953 | 1.120 | 0.387 | 0.909 | |
1.773 | 1.194 | 0.741 | 0.900 | |
1.086 | 0.431 | 0.197 | 0.910 | |
2.000 | 1.416 | 0.833 | 0.869 | |
3.980 | 0.244 | 0.072 | 0.912 | |
2.020 | 1.423 | 0.839 | 0.869 | |
3.026 | 1.229 | 0.526 | 0.905 | |
2.513 | 1.045 | 0.646 | 0.902 | |
3.153 | 1.270 | 0.413 | 0.903 | |
2.563 | 0.924 | 0.773 | 0.900 | |
2.513 | 1.045 | 0.646 | 0.902 | |
2.463 | 1.371 | 0.366 | 0.911 | |
M; Mean.
SD; Standard deviation.
Average, standard deviation and correlation of items to overall scale and Cronbach’s alpha in case of deleting an item (n=155)
Item | M | SD | Correlationwith totalscore | Cronbach ’salpha if itemdeleted |
---|---|---|---|---|
2.395 | 0.801 | 0.715 | 0.898 | |
2.535 | 0.808 | 0.499 | 0.902 | |
3.535 | 0.982 | 0.360 | 0.905 | |
2.303 | 0.767 | 0.469 | 0.902 | |
2.612 | 1.186 | 0.578 | 0.900 | |
2.612 | 1.186 | 0.578 | 0.900 | |
2.768 | 1.086 | 0.341 | 0.906 | |
2.858 | 0.784 | 0.785 | 0.898 | |
2.329 | 1.195 | 0.135 | 0.912 | |
3.458 | 0.961 | 0.583 | 0.900 | |
2.496 | 1.926 | 0.700 | 0.897 | |
1.148 | 0.544 | 0.145 | 0.908 | |
2.935 | 1.440 | 0.875 | 0.890 | |
3.961 | 0.339 | 0.350 | 0.909 | |
2.974 | 1.427 | 0.887 | 0.890 | |
3.180 | 0.942 | 0.454 | 0.903 | |
2.767 | 1.049 | 0.526 | 0.901 | |
3.425 | 0.993 | 0.538 | 0.901 | |
2.864 | 0.765 | 0.744 | 0.898 | |
2.767 | 1.049 | 0.526 | 0.901 | |
3.167 | 1.027 | 0.587 | 0.900 | |
M; Mean.
SD; Standard deviation.
Correlation coefficient between IDS and special variables is presented in
T-test to consider IDS difference in fertile and infertile groups
Group | N | SD | M | T- test | P value |
---|---|---|---|---|---|
155 | 12.738 | -13.205 | 0.001 | ||
145 | 7.812 | 42.855 | |||
M; Mean.
SD; Standard deviation.
Conceptual admissibility of the questionnaire was confirmed by 10 experts (psychologist, psychiatrist, women’s expert). With respect to the factor analysis method, main component analysis and Varimax rotation were used. Moreover because the basic goal of factor analysis is to limit a lot of variables to a limited number of factors with the least rate of data lost, exploration of factor analysis was considered useful here. This method is used when a researcher does not have enough evidence to make an assumption about the number of fundamental elements. In fact this method uses data to justify the relation between variables (
According to data analysis, the results for Kaiser-Meyer-Olkin (KMO) were higher than 0.5 and the level of meaningfulness in the Bartlett Test of Sphericity was less than 0.05, so present data can be used as factors (
The horizontal axis shows the items and the vertical axis represents special scales. According to
Moreover variance maximizes the square of factor loads in each column and minimizes the number of variables with a strong load in each factor.
Because factor loads between 0.2-0.5 are proper for a question in every factor (
Rock diagram for identifying infertility depression scale.
Variance percentage, variance accumulative percentage and special scales for 5 factors
Component | Total | Of variance (%) | Cumulative (%) |
---|---|---|---|
8.391 | 39.955 | 39.955 | |
4.689 | 22.327 | 62.282 | |
2.811 | 13.387 | 75.670 | |
1.627 | 7.748 | 83.418 | |
1.060 | 5.046 | 88.464 | |
Infertility depression test, rotated factor matrix in Varimax method
Item | Component | ||||
---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | |
0.843 | |||||
0.589 | |||||
0.729 | |||||
0.729 | |||||
0.750 | |||||
0.730 | |||||
0.809 | |||||
0.736 | |||||
0.730 | |||||
0.844 | |||||
0.736 | |||||
0.565 | |||||
0.762 | |||||
0.542 | |||||
0.645 | |||||
0.858 | |||||
0.703 | |||||
0.797 | |||||
0.650 | |||||
0.569 | |||||
0.777 | |||||
Validity investigation by Cronbach’s alpha value confirmed the same role of all items in overall scale, and item deletion did not increase alpha. Therefore, it was not necessary to delete or change items. Cronbach’s alpha values were 0.76 and 0.091 for fertile and infertile women, respectively. Moreover with respect to the t test there was a meaningful difference in IDS scale for these two groups. This is due to internal pressures and the need to be a mother and also social pressures because of not having a child which increases stress in infertile women. In other words, one can mention cultural elements, i.e; the role of mother is considered an important part of women’s existence in different societies. Different researches show that this is the most important and satisfying role for women (
On the other hand, infertility is related to women at first and failure to achieve pregnancy results in pressures from the husband’s family. Finally there is a concern that non-pregnancy is sufficient reason for divorce or husband’s re-marriage. Besides, infertile men are more depressed but women show the same levels depression regardless of whether they or their husbands are infertile. All the evidence shows that infertile women have more stress and depression than fertile women.
According to the results, higher educational level decreases the effects of infertility pressures and leads to lower scales in questionnaires. In this article, factor analysis method and correlation coefficient higher than 0.46 resulted in 5 factors with special value higher than 1, which identified 0.88% of overall variance. Cronbach’s alpha value 0.89 was also found by re-experimentation of 30 samples (15 fertile, 15 infertile). Therefore, this tool can be used to measure infertility depression scale in Iranian women and proper confrontation with this problem. The limited scale volume is one of the problems which needs careful generalisation to all society. It is hoped that using IDS in other research can help to achieve valuable results and decrease infertility depression. Moreover, proper education to confront infertility is the best way to reduce stress in this group.
According to the results, the Infertility Distress Scale questionnaire has enough admissibility and validity in the measurement of the infertility distress scale in Iranian infertile women.