Document Type : Original Article
Authors
1 Department of Psychology, University of Isfahan, Isfahan, Iran
2 Department of Reproductive Biotechnology at Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran;Isfahan Fertility and Infertility Center, Isfahan, Iran
Abstract
Keywords
Infertility is defined as 1 year unprotected intercourse
without pregnancy (
Stresses of infertility and its treatment procedure
can damage the quality of relationships in infertile couples. If the couples cannot appropriately cope with these stresses, those may lead to several psychological problems for each partner that can considerably affect their marital relationship with each other. Such stressful relationships per se can intensify stresses and distresses related to infertility. Thus, in this position a vicious circle develops that can negatively affect couple’s mental health mutually. Moreover, it has been argued that the diagnosis of infertility may magnify and intensify the disappointments and conflicts that have been previously existed in couple’s relationships with each other (
Although mental health of couples may be damaged by the diagnosis of infertility and couples are usually confused about the ways of handling this condition, infertility per se does not necessarily damage couple’s mental health or quality of their relationship with each other (
Happiness, which is as essential dimension of life and related to functioning and success (
Based on several studies and theoretical discussion, it is clear that there are significant relationships between marital relationship status with mental health (
Based on several studies, that mentioned, it seems that infertile individuals may be more at risk for mental health problems, compared with fertile individuals, because they experience many social, cultural, and psychological stresses related to infertility (
According to our knowledge, so far no study investigated the mediator role of happiness in relationship between marital relationship status and mental health in infertile individuals through a causal model. Thus, the purpose of this study was to investigate the causal model of relation between marital relationship status, happiness, and mental health in infertile individuals. The theoretical path model for the relation between marital relationship status, happiness, and mental health is presented in the figure 1.
Theoretical path model for the relation between marital relationship status, happiness, and mental health.
The research method of this study was descriptive. The study population included all infertile men and women visited in the Isfahan Fertility and Infertility Center between August and September 2012. The sample of this study were 155 subjects (men: 52 and women: 78) whom had been visited in the Fertility and Infertility Center and selected by convenience sampling [a type of sampling in which members of the population are chosen based on their relative ease of access. This kind of sampling is common to use when applying other sampling methods accompanied by some difficulties. But in this kind of sampling there are limitations to generalization of data (
The Oxford Happiness Questionnaire (OHQ) is a self-report instrument with 29 items designed to measure intensity of happiness (
The General Health Questionnaire (GHQ-28) is a self-report instrument with 28 items designed to measure mental health (
In this study, Cranach’s alpha values for the three instruments were computed. In the GRIMS, Cranach’s alpha was assessed as 0.935, in OHQ, as 0.934, and in GHQ-28, Cranach’s alpha as 0.563.
Data was analyzed by SPSS17 and Amos 5 software using descriptive statistics and path analysis.
Ethical considerations in this study concluded:
each of subjects who not volunteer to participate in the research was disregarded for this study.
The information related to each participant was secret and no organization or person with the exception of the authors reaches to these data.
Mean, standard deviation, and independent sample t test of all participants' scores in variables of the study are presented in the table 1.
According to table 1, there were no significant gender differences in marital relationship status and happiness but in mental health scores, a difference between men and women was significant. Accordingly, the levels of mental health of infertile women are significantly lower than infertile men.
To analysis of the causal model of relation between marital relationship status, happiness, and mental health, path analysis was used. The result of path analysis for all participants (including men and women) is presented in the table 2.
Based on the table 2, a direct path of marital relationship status to happiness and a direct path of happiness to mental health were significant. Marital relationship status had relatively the low direct effect on happiness but happiness had almost the high direct effect on mental health. Fitness of the theoretical presented model for all participants (including men and women) was investigated by fitness indexes (
Based on the results of table 3, fitness of the theoretical causal model of the study was confirmed for all participants including men and women. The model with path coefficients is presented in the figure 2. Based on this model, marital relationship status had indirectly effect on mental health through happiness (indirect effect=0.119).
Also, the model of the study separately investigated men and women. The result of path analysis for women is presented in the table 4.
Based on the table 4, in women participants, the direct path of marital relationship status to happiness and the direct path of happiness to mental health were significant. Marital relationship status had relatively the low direct effect on happiness but happiness had almost the high direct effect on mental health. Fitness of the theoretical presented model for women participants was investigated by fitness indexes. These results are presented in the table 5.
Mean and standard deviation of participants' scores in marital relationship status, happiness, and mental health in men and women
Variables | Mean | SD | t | ||||
---|---|---|---|---|---|---|---|
Men | Women | Total | Men | Women | Total | ||
39.192 | 38.307 | 38.689 | 6.048 | 7.014 | 7.046 | 2.077* | |
41.788 | 38.243 | 39.712 | 17.200 | 16.081 | 16.560 | -0.500 | |
25.038 | 30.995 | 28.386 | 14.982 | 15.125 | 15.273 | -0.849 | |
*; P=0.040.
Standard regression weights of paths between variables in men and women
Paths | Estimate | Standard error | |
---|---|---|---|
Happiness | 0.193* | 0.197 | |
Mental health | - 0.621 **1 | 0.059 | |
1; Minus in this table were used because of differences between scoring the instruments, it is not indicate the negative relation between the two concepts, *; P=0.028 and **; P=0.001.
Fitness indexes for the theoretical path model for the relation between marital relationship status, happiness, and mental health in all participants (including men and women).
Fitness indexes | Value | Appropriate range for fitness | Position of model | |
---|---|---|---|---|
1.996* | Lack of statistical significance | Fitness | ||
0.924 | >0.90 | Fitness | ||
0.976 | >0.90 | Fitness | ||
0.987 | >0.90 | Fitness | ||
0.080 | >0.05-0.08 | Fitness | ||
*; P=0.158, CMIN; Chi-square value, TLI; Tucker lewis index, NFI; Normed fit index, CFI; Comparative fit index and RMSEA; Root mean square error of approximation.
The causal model of relation between marital relationship status, happiness, and mental health in all participants (including men and women).
Standard regression weights of paths between variables in women
Paths | Estimate | Standard error | |
---|---|---|---|
Happiness | 0.254* | 0.241 | |
Mental health | - 0.697** | 0.072 | |
*; P=0.026 and **; P=0.001.
Based on the results of the table 5, fitness of the theoretical causal model of the study in women participants was confirmed. The model with path coefficients is presented in the figure 3. Based on this model, in women participants, marital relationship status had the indirectly effect on mental health through happiness (indirect effect= 0.177). The result of path analysis for men participants is presented in the table 6.
Based on the table 6, in men participants, the direct path of marital relationship status to happiness was not significant but the direct path of happiness to mental health was significant. So, in men participants, marital relationship status had not a significant direct effect on happiness but happiness had almost the high direct effect on mental health. Fitness of the theoretical presented model for men participants was investigated by fitness indexes. These results are presented in the table 7.
Based on the results of table 7, the model of the study for men participants had a poor fitness. The model with path coefficients is presented in the figure 4. Based on this model, in men participants, the direct effect of marital relationship status on happiness and indirect effect of marital relationship status on mental health, through happiness, had not been confirmed.
Fitness indexes for the theoretical path model for the relation between marital relationship status, happiness, and mental health in women
Fitness indexes | Value | Appropriate range for fitness | Position of model |
---|---|---|---|
0.039* | Lack of statistical significance | Fitness | |
1 | >0.90 | Fitness | |
0.999 | >0.90 | Fitness | |
1 | >0.90 | Fitness | |
0.000 | >0.05 - 0.08 | Fitness | |
*; P=0.843,CMIN; Chi-square value, TLI; Tucker Lewis index, NFI; Normed fit index, CFI; Comparative fit index and RMSEA; Root mean square error of approximation.
The causal model of relation between marital relationship status, happiness, and mental health.
Standard regression weights of paths between variables in men
Paths | Estimate | Standard error | |
---|---|---|---|
Happiness | 0.052* | 0.376 | |
Mental health | - 0.559** | 0.098 | |
*; P=0.700 and **; P=0.001.
Fitness indexes for the theoretical path model for the relation between marital relationship status, happiness, and mental health in men
Fitness indexes | Value | Appropriate range for fitness | Position of model | |
---|---|---|---|---|
3.370* | Lack of statistical significance | Fitness | ||
0.243 | >0.90 | Fitness | ||
0.864 | >0.90 | Fitness | ||
0.874 | >0.90 | Fitness | ||
0.197 | >0.05 - 0.08 | Fitness | ||
*; P=0.066, CMIN; Chi-square value, TLI; Tucker lewis index, NFI; Normed fit index, CFI; Comparative fit index and RMSEA; Root mean square error of approximation.
The causal model of relation between marital relationship status, happiness, and mental health in men.
Although the main purpose of this study was not to compare infertile men and women in dependant variables of the study but the results showed significant differences in infertile men’s and women’s mental health. These findings of this study were in the line of studies showed that infertile women demonstrated more health impairment, compared with infertile men (
The findings of this study confirmed the causal model of relationship between marital relationship status, happiness, and mental health in infertile individuals without consideration the gender factor. This model also was confirmed in women participants but not confirmed in men participants. Based on this model in infertile women, marital relationship status directly is effective on mental health with mediation of happiness. Also the results showed that in both infertile men and women, happiness has the direct effect on mental health. The findings are the line of several studies that have showed significant relationships between these three variables (
In psychological theories and studies about close relationships, it has repeatedly reminded that happiness cannot be understood without understanding close relationships. Very studies in the field of well-being have confirmed that happy people have satisfying relationships. Based on these studies, satisfaction of marital relationships is a strong predictor of happiness (
The findings of this study revealed the importance of attention to psychological health of infertile individuals, especially in infertile women. Also, the findings suggest that it is useful to enter some components of marital relationship status that can improve and enhance the experience of happiness in infertile couple’s relationships to mental health in these individuals. So, in the field of psychotherapy and counseling with infertile individuals probably couple therapy or couple counseling is better and more appropriate than individual therapy or counseling. Moreover, the authors suggest that psychological interventions by psychologist or counselors integrate and accompany with medical treatments presented by professional infertility centers.
To generalize these findings to Iranian population, we suggest further researches to assess the model of this study in other population of infertile couples and individuals. One of the most important limitations of this study was disregarding demographic components and personal characteristics such as highest group of age, duration of infertility, type of treatment, main reason of infertility belong to which gender. Most of these limitations were limitation of sufficient number of professional examiner to interview with subjects and invite them to participate in the study. The examiners of this research were only two psychologists, so in spite of considerable time spent for the sampling, the sample size of the study was not completely sufficient.