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Hwang and Jang: Factors Influencing the Depression Level of Couples Participating in the National Supporting Program for Infertile Couples
Original Article

Journal of Korean Academy of Community Health Nursing 2015; 26(3): 179-189.

Published online: 30 September 2015

DOI: https://doi.org/10.12799/jkachn.2015.26.3.179

Factors Influencing the Depression Level of Couples Participating in the National Supporting Program for Infertile Couples

Nami Hwang1, Insun Jang2

1Korea Institute for Health and Social Affairs, Sejong, Korea.

2Department of Nursing, Korea Bible University, Seoul, Korea.

Corresponding author: Jang, Insun. Department of Nursing, Korea Bible University, 32 Dongil-ro(st), 214-gil, Nowon-gu, Seoul 139-791, Korea. Tel: +82-2-950-5485, Fax: +82-2-950-5484, agape90@korea.com

Received 3 February 2015       Revised 19 March 2015       Accepted 9 September 2015

© 2015 Korean Academy of Community Health Nursing

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to identify factors influencing depression of participants in the National Supporting Program for Infertile Couples (NSPI) who received a treatment of IVF (in vitro fertilization) or IUI (intra-uterine insemination).

Methods

Using the 2013 NSPI Satisfaction On-line Survey data, secondary data analyses were conducted on 830 cases of IVF and 706 cases of IUI. Descriptive statistics, independent t-test, χ2 test, and logistic regression were performed using SPSS/WIN 21.0.

Results

Logistic regression analysis showed that non-pregnancy status (OR=3.05), unexplained infertility (OR=4.29), relationship trouble with spouse (OR=3.57), and relationship trouble with the in-law family (OR=2.78) were significant factors predicting the depression level in the IUI treatment group. Non-pregnancy status (OR=5.28), childlessness (OR=1.92), financial support helpful hardly or not at all (OR=2.63), relationship trouble with spouse (OR=3.28), relationship trouble with the in-law family (OR=2.83), and unemployment (OR=1.60) were significant factors in the IVF treatment group.

Conclusion

To reduce infertile women's depression, adequate attention and care need to be paid to these psychological symptoms. It is suggested to develop counseling and couple-therapy along with methods to enhance social support (including that from the in-law's family).

Keywords: Infertility, Depression, Insemination, In vitro fertilization

Figures and Tables

Table 1

Comparison of Socio-demographic Characteristics of Respondents

jkachn-26-179-i001
Characteristics Categories IUI (n=706) IVF (n=830) χ2 or t p
n (%) n (%)
Wife age (year) 25~29 43 (6.9) 32 (4.3) 48.05 <.001
30~34 324 (52.3) 286 (38.6)
35~39 209 (33.7) 298 (40.2)
40~45 44 (7.1) 125 (16.9)
M±SD 34.2±3.47 35.6±3.91 -7.14 <.001
Husband age (year) 25~29 15 (2.4) 16 (2.2) 40.68 <.001
30~34 218 (35.1) 156 (21.2)
35~39 284 (45.7) 364 (49.5)
40~45 104 (16.7) 199 (27.1)
M±SD 36.0±3.59 37.2±3.93 -5.99 <.001
Employment status Unemployed 239 (38.5) 303 (41.0) 1.02 .599
Employed 329 (53.1) 372 (50.3)
Part-time 52 (8.4) 64 (8.7)
Education ≤High school 89 (14.2) 140 (18.9) 5.29 .071
University 432 (69.1) 482 (65.0)
≥Graduate school 104 (16.6) 119 (16.1)
Pregnancy status (now) Yes 145 (23.3) 98 (13.4) 22.60 <.001
No 477 (76.7) 635 (86.6)
Child (number) 0 417 (67.1) 435 (58.7) 11.43 .003
1 180 (29.0) 279 (37.7)
≥2 24 (3.9) 27 (3.6)

Note. Missing data excluded; IUI=intrauterine insemination; IVF=in vitro fertilization.

Table 2

Comparison of Infertility related Characteristics and Family Support of Respondents

jkachn-26-179-i002
Characteristics Categories IUI (n=706) IVF (n=830) χ2 or t p
n (%) n (%)
Causes of infertility Unexplained 488 (70.7) 401 (49.3) 86.13 <.001
Female 100 (14.5) 273 (33.6)
Male 68 (9.9) 83 (10.2)
Both 34 (4.9) 56 (6.9)
Infertility duration (month) <12 13 (2.3) 20 (3.0) 69.79 <.001
12~23 71 (12.6) 57 (8.5)
24~35 143 (25.3) 113 (16.9)
36~47 175 (31.0) 143 (21.4)
48~59 83 (14.7) 121 (18.1)
≥60 80 (14.2) 214 (32.0)
M±SD 38.2±18.10 50.2±43.36 -6.53 <.001
Treatment result Fail 489 (75.8) 448 (58.6) 47.12 <.001
Sucess only pregnancy 48 (7.4) 84 (11.0)
Sucess delivery 108 (16.7) 232 (30.4)
Distance to hospital (hour) <1 491 (79.1) 498 (67.1) 28.88 <.001
1~2 106 (17.1) 173 (23.3)
≥2 24 (3.9) 71 (9.6)
Financial support Very helpful 378 (60.6) 365 (49.3) 19.05 <.001
Moderate helpful 240 (38.5) 358 (48.4)
Not helpful 6 (1.0) 17 (2.3)
Attendance of health program Wife No 290 (41.1) 324 (39.0) 0.70 .403
Yes 415 (58.9) 506 (61.0)
Husband No 345 (48.9) 405 (48.8) 0.00 .956
Yes 360 (51.1) 425 (51.2)
Depression Yes (≥4) 125 (20.5) 177 (24.3) 2.83 .093
No (≤3) 486 (79.5) 551 (75.7)
Total number of IVF before 1.55±1.12 2.54±1.18 -13.27 <.001
Total number of IUI before 2.42±2.93 2.05±1.22 2.52 .012
Relationship with spouse Get better 143 (23.2) 165 (22.5) 5.85 .054
Not change 452 (73.4) 521 (71.2)
Get worse 21 (3.4) 46 (6.3)
Relationship with in-laws' house Get better 71 (11.6) 86 (12.0) 7.22 .027
Not change 505 (82.4) 561 (78.0)
Get worse 37 (6.0) 72 (10.0)

Note. Missing data excluded; IUI=intrauterine insemination; IVF=in vitro fertilization.

Table 3

Depression according to Socio-demographic Characteristics of Respondents

jkachn-26-179-i003
Characteristics Categories IUI (n=706) χ2 (p) IVF (n=830) χ2 (p)
Yes No Yes No
n (%) n (%) n (%) n (%)
Wife age (year) 25~29 16 (13.1) 24 (5.0) 10.66 (.014) 6 (3.4) 24 (4.4) 5.83 (.120)
30~34 62 (50.8) 256 (53.1) 80 (45.2) 200 (36.6)
35~39 36 (29.5) 167 (34.6) 69 (39.0) 221 (40.5)
40~45 8 (6.6) 35 (7.3) 22 (12.4) 101 (18.5)
Husband age (year) 25~29 5 (4.0) 10 (2.1) 2.15 (.542) 5 (2.9) 10 (1.8) 3.09 (.377)
30~34 45 (36.0) 167 (34.7) 36 (20.6) 118 (21.8)
35~39 57 (45.6) 219 (45.5) 93 (53.1) 257 (47.4)
40~45 18 (14.4) 85 (17.7) 41 (23.4) 157 (29.0)
Employment status Unemployed 55 (44.4) 177 (36.9) 4.08 (.130) 88 (50.3) 209 (38.3) 8.00 (.018)
Employed 56 (45.2) 265 (55.2) 73 (41.7) 288 (52.7)
Part-time 13 (10.5) 38 (7.9) 14 (8.0) 49 (9.0)
Education ≤High school 21 (16.9) 66 (13.6) 0.99 (.610) 40 (23.0) 94 (17.1) 3.87 (.144)
University 84 (67.7) 336 (69.3) 111 (63.8) 360 (65.6)
≥Graduate school 19 (15.3) 83 (17.1) 23 (13.2) 95 (17.3)
Pregnancy status (now) Yes 13 (10.5) 126 (26.1) 13.68 (<.001) 9 (5.2) 89 (16.4) 13.70 (<.001)
No 111 (89.5) 356 (73.9) 163 (94.8) 455 (83.6)
Child (number) 0 95 (76.0) 314 (65.4) 6.64 (.036) 135 (76.3) 293 (53.6) 28.68 (<.001)
1 24 (19.2) 148 (30.8) 39 (22.0) 230 (42.0)
≥2 6 (4.8) 18 (3.8) 3 (1.7) 24 (4.4)

Note. Missing data excluded; IUI=intrauterine insemination; IVF=in vitro fertilization.

Table 4

Depression according to Infertility related Characteristics and Family Support of Respondents

jkachn-26-179-i004
Characteristics Categories IUI (n=706) χ2 or t (p) IVF (n=830) χ2 or t (p)
Yes No Yes No
n (%) n (%) n (%) n (%)
Causes of infertility Unexplained 79 (64.8) 353 (72.8) 11.18 (.011) 75 (43.1) 275 (50.3) 13.76 (.003)
Female 25 (20.5) 65 (13.4) 76 (43.7) 169 (30.9)
Male 7 (5.7) 48 (9.9) 9 (5.2) 65 (11.9)
Both 11 (9.0) 19 (3.9) 14 (8.0) 38 (6.9)
Infertility duration (month) <12 3 (2.6) 9 (2.0) 6.27 (.281) 3 (1.9) 17 (3.4) 15.73 (.008)
12~23 9 (7.7) 60 (13.6) 9 (5.6) 47 (9.4)
24~35 26 (22.2) 115 (26.1) 19 (11.8) 91 (18.2)
36~47 42 (35.9) 132 (29.9) 29 (18.0) 113 (22.6)
48~59 22 (18.8) 60 (13.6) 31 (19.3) 89 (17.8)
≥60 15 (12.8) 65 (14.7) 70 (43.5) 143 (28.6)
Treatment result Fail 100 (82.0) 356 (74.2) 3.25 (.197) 130 (75.1) 291 (53.4) 31.52 (<.001)
Sucess only pregnancy 7 (5.7) 37 (7.7) 19 (11.0) 58 (10.6)
Sucess delivery 15 (12.3) 87 (18.1) 24 (13.9) 196 (36.0)
Distance to hospital (hour) <1 90 (72.6) 389 (80.9) 4.20 (.123) 97 (55.7) 385 (70.0) 12.40 (.002)
1~2 27 (21.8) 75 (15.6) 53 (30.5) 119 (21.6)
≥2 7 (5.6) 17 (3.5) 24 (13.8) 46 (8.4)
Financial support Very helpful 62 (50.4) 307 (63.4) 7.21 (.027) 55 (31.1) 302 (55.4) 33.46 (<.001)
Moderate helpful 59 (48.0) 173 (35.7) 114 (64.4) 234 (42.9)
Not helpful 2 (1.6) 4 (0.8) 8 (4.5) 9 (1.7)
Attendance of health program Wife No 39 (31.2) 168 (34.6) 0.52 (.469) 43 (24.3) 192 (34.8) 6.82 (.009)
Yes 86 (68.8) 317 (65.4) 134 (75.7) 359 (65.2)
Husband No 53 (42.4) 206 (42.5) 0.00 (.988) 68 (38.4) 247 (44.8) 2.24 (.134)
Yes 72 (57.6) 279 (57.5) 109 (61.6) 304 (55.2)
Total number of IVF before 1.53±1.16 1.63±0.98 -0.71 (.476) 2.46±1.15 2.85±1.23 -3.80 (<.001)
Total number of IUI before 2.33±2.41 2.76±4.49 -1.40 (.164) 2.05±1.21 2.06±1.24 -0.07 (.942)
Relationship with spouse Get better 21 (16.8) 121 (25.0) 30.31 (<.001) 30 (17.0) 135 (24.7) 50.58 (<.001)
Not change 90 (72.0) 356 (73.6) 115 (65.3) 396 (72.5)
Get worse 14 (11.2) 7 (1.4) 31 (17.6) 15 (2.7)
Relationship with in-laws' house Get better 5 (4.0) 66 (13.7) 42.36 (<.001) 11 (6.4) 75 (14.0) 60.80 (<.001)
Not change 98 (78.4) 400 (83.2) 119 (68.8) 434 (81.0)
Get worse 22 (17.6) 15 (3.1) 43 (24.9) 27 (5.0)

Note. Missing data excluded; IUI=intrauterine insemination; IVF=in vitro fertilization.

Table 5

Factors related to Depression

jkachn-26-179-i005
Variables IUI IVF
β p OR 95% CI β p OR 95% CI
(Constant) -0.473 .701 0.623 -4.845 <.001 0.008
Pregnancy status (1=No) 1.117 .001 3.054 1.61~5.81 1.663 <.001 5.277 2.32~12.00
Child (number) (1=0) 0.431 .089 1.539 0.94~2.53 0.652 .039 1.919 1.03~3.57
Causes of infertility
 Unexplained† - .065 - - .026 -
 Female -0.844 .063 0.430 0.18~1.05 -0.725 .085 0.484 0.21~1.11
 Male -0.470 .352 0.625 0.23~1.68 -0.141 .738 0.868 0.38~1.99
Both -1.455 .018 0.233 0.07~0.78 -1.081 .059 0.339 0.11~1.04
Financial support (1=Moderate or not helpful) 0.349 .119 1.418 0.91~2.20 0.969 <.001 2.634 1.67~4.16
Relationship with spouse (1=Get worse) 1.272 .023 3.569 1.20~10.66 1.189 .006 3.284 1.40~7.71
Relationship with in-laws' house (1=Get worse) 1.023 .015 2.783 1.22~6.33 1.038 .004 2.825 1.40~5.71
Wife age -0.048 .140 0.953 0.89~1.02
Employment status (1=Unemployed) 0.469 .036 1.599 1.03~2.48
Infertility duration 0.001 .801 1.001 1.00~1.01
Treatment result (1=Fail) 0.575 .057 1.777 0.98~3.21
Distance to hospital (1=≥1 hours) 0.452 .142 1.571 0.86~2.87
Attendance of health program (Wife) (1=Yes) 0.448 .070 1.565 0.96~2.54
Total number of IVF before 0.184 .700 1.202 0.99~1.47

†Causes of infertility-Unexplained: Reference group; IUI=intrauterine insemination; IVF=in vitro fertilization.

References

1. Statistics Korea. 2013 birth statistics [Internet]. Seoul: Statistics Korea;2014. cited 2015 January 20. Available from: http://www.kostat.go.kr/portal/korea/kor_nw/3/index.board?bmode=read&aSeq=329406&pageNo=4&rowNum=10&amSeq=&sTarget=&sTxt=.
2. Centers for Disease Control and Prevention. Infertility FAQ's [Internet]. Atlanta: Centers for Disease Control and Prevention;2013. cited 2013 June 20. Available from: http://www.cdc.gov/reproductivehealth/Infertility/index.htm#1.
3. Hwang NM. The status of infertility and policy direction in Korea. Health Welf Policy Forum. 2003; 82:88–97.
4. Lee SH, Yoon TK, Choi YM, Kim KC, Lee YD, Hwang NM, et al. Report No.: 11-1352000-000833-10. Analysis and evaluation of the results of national supporting program for infertile couples in 2011. NSPI(National Supporting Program for Infertile couples) Evaluation Report. Seoul: Ministry of Health & Welfare, Chung-Ang University Hospital;2012. 12.
5. Boivin J, Griffiths E, Venetis CA. Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies. BMJ. 2011; 342:d223. DOI: 10.1136/bmj.d223.
crossref
6. Ramezanzadeh F, Aghssa MM, Abedinia N, Zayeri F, Khanafshar N, Shariat M, et al. A survey of relationship between anxiety, depression and duration of infertility. BMC Womens Health. 2004; 4(1):9. DOI: 10.1186/1472-6874-4-9.
crossref
7. Ogawa M, Takamatsu K, Horiguchi F. Evaluation of factors associated with the anxiety and depression of female infertility patients. Biopsychosoc Med. 2011; 5(1):15. DOI: 10.1186/1751-0759-5-15.
crossref
8. Lee JH. An analytical study on psychosocial predictors of depression and the effective psychosocial intervention program for reducing depression of infertile women being in infertility treatment [dissertation]. [Seoul]: Korea University;2013. 131.
9. Chang EY. Women's experiences of pregnancy after infertility [master's thesis]. [Seoul]: Ewha Womans University;1998. 86.
10. Lee YJ. An Ethnography on infertile women's grief in Korea [dissertation]. [Seoul]: Kyung Hee University;2008. 123.
11. Domar AD, Zuttermeister PC, Friedman R. The psychological impact of infertility: A comparison with patients with other medical conditions. J Psychosom Obstet Gynaecol. 1993; 14:45–52.
12. Hwang NM. Analysis on factors influencing depression of infertile women. Health Soc Welf Rev. 2013; 33(3):161–187.
13. Kim M. Stress, depression, and fetal attachment in pregnant women having infertility treatments. Korean J Women Health Nurs. 2014; 20(2):163–172.
crossref
14. Min SW, Kim YH, Cho YR. Stress, depression and factors influencing on quality of life of infertile women. J Korean Soc Matern Child Health. 2008; 12(1):19–32.
15. Valsangkar S, Bodhare T, Bele S, Sai S. An evaluation of the effect of infertility on marital, sexual satisfaction indices and health-related quality of life in women. J Hum Reprod Sci. 2011; 4(2):80–85. DOI: 10.4103/0974-1208.86088.
crossref
16. Kim JH, Shin HS. A structural model for quality of life of infertile women. J Korean Acad Nurs. 2013; 43(3):312–320.
crossref
17. Irwin M, Artin KH, Oxman MN. Screening for depression in the older adult: criterion validity of the 10-item center for epidemiological studies depression scale (CES-D). Arch Intern Med. 1999; 159(15):1701–1704. DOI: 10.1001/archinte.159.15.1701.
18. Verberg MF, Eijkemans MJ, Heijnen EM, Broekmans FJ, de Klerk C, Fauser BC, et al. Why do couples drop-out from IVF treatment? A prospective cohort study. Hum Reprod. 2008; 23(9):2050–2055. DOI: 10.1093/humrep/den219.
crossref
19. Domar AD, Rooney KL, Wiegand B, Orav EJ, Alper MM, Berger BM, et al. Impact of a group mind/body intervention on pregnancy rates in IVF patients. Fertil Steril. 2011; 95(7):2269–2273. DOI: 10.1016/j.fertnstert.2011.03.046.
crossref
20. Kim MO. The effect of a mind-body therapeutic program for infertile women repeating IVF treatment on uncertainty, anxiety, and implantation rate [dissertation]. [Seoul]: Yonsei University;2009. 93.
21. Bae KJ, Ro SO, Kim JA. The study of loneliness in infertile women. J Korean Acad Nurs. 1999; 29(6):1379–1391.
crossref
22. Gourounti K, Lykeridou K, Vaslamatzis G. Increased anxiety and depression in greek infertile women results from feelings of marital stress and poor marital communication. Health Sci J. 2012; 6(1):69–81.
23. Verhaak CM, Smeenk JMJ, van Minnen A, Kremer JAM, Kraaimaat FW. A longitudinal, prospective study on emotional adjustment before, during and after consecutive fertility treatment cycles. Hum Reprod. 2005; 20(8):2253–2260. DOI: 10.1093/humrep/dei015.
crossref
24. Mindes E, Ingram K, Kliewer W, James C. Longitudinal analyses of the relationship between unsupportive social interactions and psychological adjustment among women with fertility problems. Soc Sci Med. 2003; 56(10):2165–2180.
crossref
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