The family is the smallest union in society that is based on marriage and blood relation and involves relationships between wife, husband, children and siblings (
The World Health Organization (WHO) defines "infertility" as the failure of getting pregnant in spite of the couple having unprotected regular sexual intercourse for at least one year (
The effects of infertility on individuals’ emotions are complicated and these effects vary based on the duration of infertility, individuals’ capacities for adaptation, reasons and prognosis of infertility, and emotional and social supports (
Social support, which is a source of coping, is of great importance for the infertile woman to help preserve her physical and mental health. Social support is a valuable coping method that contributes to love, affection, confidence, self-expression, self-knowledge and sense of belonging. Even if it cannot eliminate the stressful situation, it enables individuals to be more optimistic by decreasing their levels of anxiety. It helps individuals in coping with challenging situations and generating new solutions, and decreasing their desperation (
Infertility is a condition adversely affecting the woman in terms of biologic, psychological and social aspects. Thus, midwives/nurses who are assigned to support couples in the infertility diagnosis and treatment process have great responsibilities. Infertility nursing is a process that starts in the polyclinic and extends to the operating room; it prioritises psychological and social conditions of couples and includes care during all kinds of medical and surgical treatments (
Based on these important benefits, this study was conducted to determine the relationship between perceived social support and depression in infertile women.
This descriptive and sectional study was conducted in the IVF Centre of a university hospital in the city centre of Elazig (Turkey) between 16 April 2012 and 31 October 2012. The centre where study data were collected was selected because it is the largest unit in the province of Elazýg and renders services to women from surrounding cities and with diverse socio-cultural features.
The population of the study consisted of women who applied to the IVF Centre of Firat University Research Hospital for infertility treatment. The study sample group comprised 238 women who applied to the relevant centre for infertility treatment between the specified dates.
The number of infertile women who accessed the relevant centre for
n=Necessary sample size
p=Standard of deviation
q=1- Standard of deviation
d=Margin of error (Confidence interval)
The number of participants calculated as representing the population was at least 196 individuals. Those women who met the sample criteria and accepted to participate in the study within the period when the researcher was present in the centre were included in the study until the minimum number (196) was attained. This number was reached within 4.5 months. Considering that data loss may occur during the data collection process, the sample size was extended to a total of 238 individuals. The inclusion criteria of the sample group were that women were literate, had been diagnosed with infertility and in the process of having treatment, and they had no serious medical history that threatened life and did not receive treatment because of this reason. The exclusion criteria of the sample group were being not literate, and having a serious medical history.
The study data were collected between 16 April 2012 and 31 August 2012. During the data collection process, the following forms were used: "Questionnaire Form" prepared by researchers, "Beck Depression Inventory" (BDI) for evaluation of depression, and the "Multidimensional Scale of Perceived Social Support" (MSPSS) for determination of the perceived social support. The questionnaire and scales were administered by researchers during face-to-face interviews with women who applied to the IVF Centre. Each woman was interviewed in a separate room in the related centre to enable them to answer the questions comfortably. The questionnaire and scales took about 10-15 minutes in total to complete.
The questionnaire form, which was prepared by researchers based on a literature review, has 26 questions (
The 21-item BDI was developed by Beck et al. in 1961 for the purpose of evaluating the physical, emotional, and cognitive symptoms observed during depression. The purpose of the scale is to objectively determine the symptom levels of depression, rather than diagnosing the depression (
The 12-item MSPSS developed by Zimet et al. in 1988 to subjectively assess the social support was used in this study (
The validity and reliability study of the scale was conducted by Eker and Arkar in 1995 (
The Statistical Package for the Social Sciences (SPSS; SPSS Inc., Chicago, IL, USA) version 15.0 was used to assess the study data. Percentage distributions, mean, t test, one-way analysis of variance (One-Way ANOVA), and Pearson correlation analysis were used to analyse the data.
Before commencing the study, approval was obtained from the Ethics Committee of Ataturk University Faculty of Health Sciences and then written permission was received from the hospital where the study would be conducted. Before starting the data collection process, in order to protect the rights of women included in the study, they were informed about the purpose of the study and that the data would be kept confidential. Any questions from the women were answered and they were given relevant information after the completion of the questionnaire.
Results of the study could be generalised to infertile women in the study group.
Table 1 and table 2 illustrate descriptive characteristics of women included in the study. Table 2 illustrates the distribution of women’s infertility features and the women’s opinions on infertility.
Table 3 illustrates the distribution of lowest and highest scores obtained from the BDI and MSPSS, along with the women’s mean scores. The women’s total mean score on the BDI was 12.55 ± 8.07. Scores obtained by women on the MSPSS was 15.75 ± 8.53 for the subscale of friend, 21.52 ± 8.20 for the subscale of family, and 15.62 ± 8.45 for the subscale of significant others. The women’s total MSPSS score was 52.89 ± 21.75.
Table 4 illustrates the relationship between BDI with subscale mean scores and total mean scores of the MSPSS. A statistically negative significant relationship is determined between the score of the subscale "friend" in MSPSS and the total score of BDI at the level of p<0.01. There is a statistically negative significant relationship between the score of the subscale "family" in the MSPSS and the total score of BDI at the level of p<0.01. A statistically negative significant relationship was found between the score of the subscale "significant other" in the MSPSS and the total score of the BDI at the level of p<0.01.
According to these results, a statistically negative significant relationship was determined between the scales (r:-0.596, p<0.01). In other words, it was observed that as the women’s perceived social support increases, the symptoms of depression decrease.
Table 5 illustrates some of the women’s socio-demographic characteristics and the comparison of mean scores of the scales of the BDI and MSPSS. No statistically significant difference was determined between the women’s remaining features, except for the mean scores of the BDI according to the women’s educational and income status. The difference between women’s working condition, marriage duration and elapsed time following the diagnosis of infertility and their total mean scores of MSPSS was found to be statistically significant (p<0.05).
Distribution of women’s socio-demographic and medical characteristics
|Characteristics (n = 238)||Mean||Standard deviation|
|Low education level||202||84.9|
|High education level||36||15.1|
|Low education level||167||70.2|
|High education level||71||29.8|
Distribution of women’s infertility features
|Features (n = 238)||Number||%|
|Those who had received no treatment before||70||29.4|
|Friend, relative, environment||12||7.1|
|Internet – TV||21||12.4|
IVF; In vitro fertilisation and *; Following special phases when the ovary is stimulated by drugs and ovulation occurs, sperm are prepared in the laboratory and are inserted into the female genital tracts by means of a catheter
Lowest and highest scores of BDI and MSPSS and mean scores of women
|Scales||Lowest and highest scores of scales||Minimum scores of scales||Maximum scores of scales||Mean scores of scales X̅± SD|
|Total||0–63||0||42||12.55 ± 8.07|
|Friend||4–28||4||28||15.75 ± 8.53|
|Family||4–28||4||28||21.52 ± 8.20|
|Significant Other||4–28||4||28||15.62 ± 8.45|
Determination of the relationship between the mean scores of MSPSS and BDI
*; P<0.01, BDI; Beck Depression Inventory and MSPSS; Multidimensional Scale of Perceived Social Support.
Some characteristics of women and comparison of mean scores of BDI and MSPSS
|31 and older||12.80±8.18||14.80±8.64||21.21±8.25||14.73±8.45||50.75±21.72|
|t: 0.53, df: 236, p ˃ 0.05||t: 1.92, df: 236, p ˃ 0.05||t: 064, df: 236, p ˃ 0.05||t: 1.81, df: 236, p ˃0 .05||t: 1.70, df: 236, p˃ 0.05|
|High education level||9.69±7.16||17.86±8.32||23.97±6.81||16.61±9.61||58.44±20.63|
|t: 2.32, df: 236, p<0.05||t: 1.61, df: 236, p˃ 0.05||t: 1.95, df: 236, p˃ 0.05||t: 0.76, df: 236, p ˃ 0.05||t: 1.66, df: 236, p ˃ 0.05|
|t: 1.93, df: 236 p< 0.05||t: 0.53, df: 236, p˃ 0.05||t: 1.35, df: 236, p˃ 0.05||t: 0.92, df: 236, p˃ 0.05||t: 1.02, df: 236, p ˃ 0.05|
|t: 1.85, df: 236, p ˃ 0.05||t: 1.65, df: 236, p> 0.05||t: 2.77, df: 236, p< 0.05||t: 1.10, df: 236, p˃ 0.05||t: 3.12, df:236, p˂ 0.05|
|t: 0.15, df: 236, p ˃ 0.05||t: 0.35, df: 236, p˃0.05||t: 0.06, df: 236, p ˃ 0.05||t: 0.18, df: 236, p ˃ 0.05||t: 004, df: 236, p˃ 0.05|
|12 and above||14.06±7.80||13.12±8.82||19.58±9.04||13.70±7.82||46.41±22.65|
|F: 1.72, df: 2, p˃ 0.05||F: 3.93, df: 2, p˂ 0.05||F: 2.90, df: 2, p ˂ 0.05||F: 2.32, df: 2, p ˂ 0.05||F: 3.48, df: 2, p ˂ 0.05|
|t: 1.59, df: 236, p˃ 0.05||t:1.50, df: 236, p ˃ 0.05||t: 0.76, df: 236, p˃ 0.05||t: 0.13, df: 236, p˃ 0.05||t: 0.35, df: 236, p˃ 0.05|
|37 and above||13.38±8.74||15.26±8.36||21.21±8.48||15.15±8.25||51.63±21.77|
|F: 1.91, df: 3, p˃ 0.05||F: 2.08, df: 3, p˃ 0.05||F: 2.41, df: 3, p ˃ 0.05||F: 2.30, df: 3, p˃ 0.05||F: 2.83, df: 3, p˂ 0.05|
Diagnosis and treatment approaches used for infertile couples may hinder their coping skills and social support resources; consume their physical and emotional energy; cause sexual dysfunctions, depression, anxiety, and loneliness; and damage the couple’s relationship (
Examining the women’s mean scores from the MSPSS and BDI (
After examining the relationship between the BDI total score with subscale mean scores and total mean scores of MSPSS shown in table 4, a statistically negative significant relationship was found between the scales at the level of p<0.01. It was determined that as the women’s perceived social support increases, symptoms of depression decrease. Social support is a predictive factor for depression (
On examination of the BDI mean scores and educational status of women according to some of their features shown in table 5, it was observed that those with a high educational level (university graduate) had fewer symptoms of depression. As the educational level increases, it becomes easier for women to have a better economic status, social security and access to knowledge. Women who have access to full information might experience less worry, obscurity, and anxiety. Thus, it is possible to assert that women with higher educational levels have lower BDI scores. In the study conducted by Pinar, women’s mean score of depression was 26.79 ± 10.90 (
Considering the income status of women, it is thought that those with a lower income status have a higher BDI mean score; in other words, those with a poor income status are negatively affected in terms of experiencing depression. In line with result of this study, there are some studies asserting that as the income status increases, the level of depression decreases (
Examining the women’s MSPSS mean scores also showed that the difference between women’s working conditions with total mean score of MSPSS and mean score of its subscale "family" was found to be statistically significant (p<0.05). As the women’s educational level increases, they are enabled to have a regular job and income; access positive information, attitudes and behaviours in terms of health; and also ensure their families attain positive information, attitudes and behaviours on this subject; it could, therefore, be asserted that the women’s perception of social support is also affected positively.
The difference between marriage duration of women with total mean score of the MSPSS and mean score of its subscale "friend" was found to be statistically significant (p<0.05). As the marriage age increases, the perceived social support decreases-similar results were also found in the study conducted by Eren (
The difference between women’s infertility periods and total mean scores of the MSPSS was found to be statistically significant (p<0.05). Similarly, Kus’s study also observed that the difference between the elapsed time following the diagnosis of infertility and total mean scores of MSPSS was statistically significant (
In consequence of this study, it is observed that as the women’s perceived social support decreases, their mean scores of depression increase. The recommendations made in line with results of the study are:
Informing midwives and nurses about the problems experienced by infertile women and interventions aimed at these problems through in-service training programs is important.
Enabling midwives and nurses to examine the social support mechanisms of women diagnosed with infertility, helping them to use the support involved in family and other social support systems positively, as well as making interventions that strengthen the social support systems of individuals with insufficient support, will improve overall care outcomes.
Evaluating the infertile woman both gynaecologically and psychologically, and providing her with contact with a psychologist or psychiatrist when required, can improve psychological health.Infertile women would benefit from close follow up in terms of depression risk.
By conducting comparative studies in groups where pregnancy is achieved or not achieved as a result of the treatment would help to determine the explicit effect of the perceived social support on depression in infertile women.