Document Type : Original Article
Authors
Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
Abstract
Keywords
It is known well Having children has always been considered
as a major sociocultural value in many societies
(
Rational relationship is the most common problem explained
by dissatisfied couples. Many mental health issues
occur if spouses not to speak about or meet their needs (
Attribution style theory provides a framework for understanding
the causal statements that individuals explain
their own behavior as well as the behavior of others (
Therefore, it is import to know how relationship beliefs and attributionstyles can impact on one’s quality of life. To our knowledge, this represents the first study to exam. ine this relationship in infertile couples. The aim of this study is to investigate the connection between the quality of life based on relationship beliefs and attribution styles in infertile couples.
A cross-sectional study was conducted on infertile couples who referred to the Royan Institute, a specialty infertility clinic in Tehran, the capital of Iran, between January and February 2014. Correlation sample size formula with a 0.4 correlation between variables from same study and was used to find an optimal sample size. The sample size with a confidence interval of 95%, power of 80%, and with a significance level of 0.05, was estimated to be 50 couples (50 males and 50 females). The sampling method was available sampling. The inclusion criteria were being 18 years or older, having a history of infertility, and being able to read and write in Persian.
The study was approved by the Ethics Committee of Royan Institute. Aims of the study and the confidentiality of the data were clearly explained for all participants. Eligible individuals were also assured that acceptance or refusal to participate in the research had no influence on their treatment procedures. Voluntarily filling the questionnaire was considered as consent.
The demographic questionnaire include age (years), educational levels (under diploma,under diploma and academic), type of infertility (male factor, female factor, unknown, both), duration of infertility (year), duration of marriage (year).
The quality of life (the short form health survey) SF-
12 used in our study is a Persian version of the SF-36
instrument. The SF-12 was developed in 1996 by Ware
et al. (
Relationship Belief Inventory (RBI) questionnaire was
published in 1981 by Eidelson and Epstein (
The Attribution Style Questionnaire (ASQ) was built
in 1982 by Peterson et al. (
Statistical analysis were performed using the Statistical Package for the Social Sciences; SPSS V.22.0 for Windows (IBM SPSS V.22.0.0). Continuous variables were expressed as mean ± SD and categorical variables as frequencies (%). Normality of the variables was checked with Kolmogorov-Smirnov Test. Pearson correlation coefficient was used to examine the relationship between study variables, and paired t test was used to evaluate the difference between male and female data (wives and husbands). Finally, multiple linear regression analysis was performed by controlling confounders. P<0.05 was considered statistically significant.
In this study, 50 infertile couples consisting of 50 (50%) men
and 50 (50%) women participated. The mean age was 33.30
± 5.13 for males and 28.94 ± 5.26 for females (P<0.001).
Amongst the participants 35 individuals (35%) had an academic
education. According to the cause of infertility, 49 couples
(49%) involved in male factor infertility, 8 (8%) female
factor, 7 (7%) both and 36 (36%) unknown. The mean duration of infertility was 4.7 ± 3.84 years and the mean duration of marriage was 6.8 ± 3.89 years in the participants (
Demographic characteristics of the infertile couples
| Male Mean ± SD or n (%) | Female Mean ± SD or n (%) | P value | ||
|---|---|---|---|---|
| 33.30 ± 5.13 | 28.94 ± 5.26 | <0.001 | ||
| 0.017 | ||||
| 33 (66) | 33 (66) | |||
| 17 (34) | 13 (34) | |||
| 49 (49) | ||||
| 8 (8) | ||||
| 7 (7) | ||||
| 36 (36) | ||||
| 4.7 ± 3.84 | ||||
| 6.8 ± 3.89 | ||||
The mean score for the quality of life was significantly
different between wives and husbands and it was higher
in husbands than wives (P=0.019,
Between the factors of RBI questionnaire, Mindreading is Expected (M), Partners Cannot Change (C), Sexual Perfectionism (S) and Sexes Are Different (MF) were significantly different between wives and husbands and they were all higher in wives than in their husbands (P=0.008, 0.001, 0.035 and 0.010 respectively). The husbands had a relatively higher score of Disagreement is Destructive (D) compared to their wives, but the difference was not significant (P=0.152). Overall, the wives expressed a higher mean total RBI compared to their husbands and the overall difference was significant (P=0.002). In the attribution style questionnaire, the scores for negative internality and cynical attributions were not significantly different among males and females have a higher mean score in husbands compared to their wives but not significant. Also, there was no significant difference between males and females with regard to casual attribution categories.
SF-12, RBI and ASQ subscales between couples
| Male Mean ± SD | Female Mean ± SD | P value* | ||
|---|---|---|---|---|
| 38.02 ± 5.12 | 34.64 ± 5.45 | 0.019* | ||
| 19.90 ± 4.19 | 18.74 ± 4.60 | 0.152 | ||
| 21.90 ± 3.89 | 24.16 ± 5.28 | 0.008 | ||
| 18.44 ± 6.24 | 21.90 ± 6.09 | 0.001 | ||
| 22.68 ± 7.79 | 25.48 ± 6.61 | 0.035 | ||
| 17.48 ± 7.55 | 20.44 ± 5.24 | 0.010 | ||
| 100.40 ± 21.94 | 110.72 ± 20.31 | 0.002 | ||
| 4.18 ± 1.15 | 3.79 ± 1.06 | 0.448 | ||
| 4.75 ± 1.17 | 5.08 ± 1.01 | 0.702 | ||
| 3.81 ± 0.81 | 3.89 ± 0.82 | 0.179 | ||
| 4.78 ± 0.99 | 4.87 ± 1.04 | 0.408 | ||
| 3.82 ± 1.26 | 4.04 ± 0.89 | 0.200 | ||
| 4.58 ± 1.34 | 4.79 ± 1.07 | 0.573 | ||
| 11.81 ± 1.92 | 11.72 ± 1.72 | 0.244 | ||
| 14.12 ± 2.98 | 14.75 ± 2.60 | 0.263 | ||
RBI; Relationship Belief Inventory, ASQ: Attribution Style Questionnaire, SF-12: 12-Item Short Form Survey, and *; Paired t test.
The relationship of SF-12 with RBI and ASQ subscales
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |
|---|---|---|---|---|---|---|---|---|---|
| 1. SF-12 | 1 | 0.380* | 0.210* | 0.119 | 0.101 | 0.206* | 0.386** | ||
| 2. Disagreement is destructive | 0.380** | 1 | 0.319** | -0.012 | 0.191 | 0.202* | 0.663** | ||
| 3. Mindreading is expected | 0.210** | 0.319** | 1 | -0.151 | 0.082 | 0.097 | 0.490** | ||
| 4. Partners cannot change | 0.119 | -0.012 | -0.151 | 1 | 0.195 | 0.257* | 0.456** | ||
| 5. Sexual perfectionism | 0.101 | 0.191 | 0.082 | 0.195 | 1 | -0.027 | 0.487** | ||
| 6. Sexes are different | 0.206* | 0.202* | 0.097 | 0.257* | -0.027 | 1 | 0.600** | ||
| 7. Total | 0.386** | 0.663** | 0.490** | 0.456** | 0.487* | 0.600** | 1 | ||
| 1. SF-12 | 1 | 0.061 | 0.213* | -0.166 | 0.110 | -0.029 | 0.118 | -0.054 | 0.175 |
| 2. Negative internal | 0.061 | 1 | 0.100 | 0.144 | -0.127 | -0.031 | -0.135 | 0.661 | -0.065 |
| 3. Positive internal | 0.213* | 0.100 | 1 | -0.226 | 0.561** | 0.265* | 0.644** | 0.120 | 0.876** |
| 4. Negative stability | -0.166 | 0.144 | -0.226* | 1 | -0.017 | 0.010 | -0.099 | 0.540 | -0.138 |
| 5. Positive stability | 0.110 | -0.127 | 0.561** | -0.017 | 1 | 0.125 | 0.466** | -0.009 | 0.786** |
| 6. Negative public | -0.029 | -0.031 | 0.265* | 0.010 | 0.128 | 1 | 0.526 | 0.586** | 0.378* |
| 7. Positive public | 0.118 | -0.135 | 0.644** | -0.099 | 0.466** | 0.526** | 1 | 0.189 | 0.855** |
| 8. Cynical attribution | -0.054 | 0.661** | 0.120 | 0.540** | -0.009 | 0.586** | 0.189 | 1 | 0.126 |
| 9. Optimistically attribution | 0.175 | -0.065 | 0.876** | -0.138 | 0.786** | 0.378** | 0.855** | 0.126 | 1 |
RBI; Relationship Belief Inventory, ASQ; Attribution Style Questionnaire, SF-12; 12-Item Short Form Survey, r; Pearson correlation coefficient, *; P<0.05, and **; P<0.001
Additionally, bivariate correlations were conducted among subscales of two questionnaires (RBI and ASQ) with the score of quality of life (SF-12), as shown in Table 3. In subscales of the RBI questionnaire, D, M, C, S, MF and a total of RBI were positively correlated with the total score of quality of life, but only D, M, S and the total score of RBI had a significant correlation. In addition, positive internality was directly and significantly correlated with total score of SF-12 (P=0.033).
For the quality of life, the enter method was used as
a covariate selection method, in step 1, demographics
and subscales of RBI ad ASQ entered to model, sex
and “Disagreement is Destructive” were significantly
related to quality of life (ß=-3.098, P=0.024 and 0.254,
P=0.023 respectively). When gender, education, duration
of marriage, duration of infertility, subscales of RBI and
subscales of ASQ were in the quality of life model, the
model adjusted R2 was equal to 0.134. On the other hand,
variance inflation factor (VIF) and tolerance of variables
showed the model does not have collinearly. In step 2,
sex and “Disagreement is Destructive” entered to model
“Disagreement is Destructive” was positively correlated
with the quality of life (ß=0.319, P=0.001) and gender was
negatively correlated with the quality of life. (ß=-2.499,
P=0.001) When sex and “Disagreement is Destructive”
were in model, there was an improvement in the model
(adjusted R2=0.176, P<0.001,
The results of hierarchical multiple linear regressions, including factors related to the quality of life
| Quality of life | ||||
|---|---|---|---|---|
| P | Beta | SE | B | |
| Step 1: | ||||
| Sex (female vs. male) | -3.098 | 7.986 | -0.282 | 0.024 |
| Education (educated vs. under diploma/diploma) | 1.260 | 1.225 | 1.225 | 0.307 |
| Duration of marriage | -0.101 | 0.303 | -0.071 | 0.739 |
| Duration of infertility | 0.146 | 0.305 | 0.101 | 0.633 |
| Age | -0.133 | 0.152 | -0.135 | 0.385 |
| Disagreement is destructive | 0.254 | 0.110 | 0.257 | 0.023 |
| Mindreading is expected | 0.121 | 0.129 | 0.102 | 0.349 |
| Partners cannot change | 0.048 | 0.130 | 0.041 | 0.714 |
| Sexual perfectionism | 0.055 | 0.133 | 0.044 | 0.680 |
| Sexes are different | 0.055 | 0.113 | 0.054 | 0.631 |
| Negative internal | 0.058 | 0.538 | 0.012 | 0.914 |
| Positive internal | -0.351 | 1.532 | -0.070 | 0.819 |
| Negative stability | 0.125 | 0.751 | 0.018 | 0.869 |
| Positive stability | -0.797 | 1.049 | -0.147 | 0.450 |
| Negative public | -0.402 | 0.627 | -0.079 | 0.523 |
| Positive public | 0.539 | 0.458 | 0.118 | 0.242 |
| Cynical attribution | -0.165 | 0.307 | -0.054 | 0.593 |
Our results revealed that husbands have a higher quality
of life in comparison to their wives and generally males
have a higher quality of life than females. In the Iranian
culture, the paternalistic beliefs for fertility and the lack of
social and economic supports for many women are some
factors that may amplify the psychological problems of
infertile women. Based on cultural conditions, such women
are more likely to be under mental and emotional pressures
(
Our study about factors related to relationship beliefs
showed that the wives expressed a higher mean score in
relationship beliefs than their husbands, meanings that
wives had unreasonable relationship beliefs compared to
their husbands. Also, our results indicated that relationship
beliefs negatively correlate with the quality of life except
for “Disagreement is Destructive” subscale, which is positively
correlated with the quality of life. Many couples believe
that if they oppose to their spouses, it is destructive
and makes them more compatible with marital life, and as
a result, their quality of life goes up. Irrational beliefs were
positively related to different types of distress, such as general
distress, anxiety, depression and anger (
A previous study reported that irrational beliefs relate
to health-related quality of life (
A study reported that attribution style was significantly
associated with psychopathology scores as the patients
that tend to internalize, showed greater overall psychopathology
(
Finally, there is a need to educate infertile couples, so that they have realistic expectations, successful relationships and good quality of life. These could be provided with the help of the couple’s therapists, family life educators, or psychologists. The findings of this study enable us to design and analyze future studies, which will have larger sample sizes from multiple infertility centers, with improvements.
The results of the current study indicate that in infertile couples, men have a higher quality of life in comparison to their wives. Also, all subscales of relationship beliefs have a negative correlation with the quality of life. However, in attribution style only internal attribution style for positive events was associated with the quality of life. In general, there is a correlation between relationship beliefs and the quality of life in infertile couples.
)
