Is coping strategies predictor of anxiety and depression in couple infertile?


Background: Infertility is a complex crisis of life and increases psychological difficulties such as anxiety and depression. Identification of copy strategies for stressful events like infertility is important. The aim of our study was to investigate the relationship between coping strategies with anxiety and depression symptoms in men and women’s infertile. Methods: This descriptive-analytic study was conducted from 2011-2012 on 168 Iranian infertile couples referred to the Fatemeh Zahra infertility and reproductive health research center of Babol university of medical science to initiate assistant reproductive technologies and completed the Ways of Coping Questionnaire (WCQ), The State-Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI).The results were analyzed using t-test, the Pearson correlation and the stepwise model of multiple regression analysis. P < 0.05 was considered for level of significant. Results: Escape/ avoidance contributed the greatest amount of unique variance to the model for anxiety/de-pression of infertile women (P < 0.0001, P < 0.001) and followed by distancing (P < 0.0001, P < 0.01), accepting responsibility(P < 0.0001, P < 0.01). Seeking social support was the negative significantly predictor for both anxiety and depression in infertile women (P < 0.01, P < 0.01), but planful problem solving was the inversely predictor for only depression in infertile women (P < 0.01). Escape/avoidance was the only predictor factor of the model anxiety for infertile men (P < 0.01). Escape/avoidance and self controlling were the positive predictor (P < 0.001) and planful problem solving was the negative predictor for men depression (P < 0.05). Conclusion: men and women infertile who use disproportionally maladaptive coping strategies such as escape/avoidance are predisposed to anxiety and depression symptoms. How using the coping strategies is very important in expressing anxiety and depression in infertile couples and training the adaptive coping strategies suggested by counseling centers.

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Faramarzi, M. , Pasha, H. , Esmaelzadeh, S. , Jorsarai, G. , Mir, M. and Abedi, S. (2013) Is coping strategies predictor of anxiety and depression in couple infertile?. Health, 5, 643-649. doi: 10.4236/health.2013.53A085.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Jedrzejczak, P., Luczak-Wawrzyniak, J., Szyfter, J., Prze-wozna, J., Taszarek-Hauke, G. and Pawelczyk, L. (2004) Feelings and emotions in women treated for infertility. Przeglad Lekarski, 61,1334-1337.
[2] Cousineau, T.M. and Domar, A.D. (2007) Psychological impact of infertility. Best Practice & Research Clinical Obstetrics and Gynaecology, 21, 293-308. doi:10.1016/j.bpobgyn.2006.12.003
[3] Bayley, T.M., Slade, P. and Lashen, H. (2009) Relationships between attachment, appraisal, coping and adjustment in men and women experiencing infertility concerns. Human Reproduction, 24, 2827-2837. doi:10.1093/humrep/dep235
[4] Pasha, H. (2011) Evaluation of depression in infertile women using Beck and Hamilton. International Journal of Fertility and Sterility, 5, 99.
[5] Faramarzi, M., Alipor, A., Esmaelzadeh, S., Kheirkhah, F., Poladi, K. and Pasha, H. (2008) Treatment of depression and anxiety in infertile women: Cognitive behavioral therapy versus fluoxetine. Journal of Affective Disorders, 10, 159-164. doi:10.1016/j.jad.2007.09.002
[6] Faramarzi, M., Kheirkhah, F., Esmaelzadeh, S., Alipour, A., Hjiahmadi, M. and Rahnama, J. (2008) Is psychotherapy a reliable alternative to pharmacotherapy to promote the mental health of infertile women? A randomized clinical trial. European Journal of Obstetrics & Gynecology and Reproductive Biology, 141, 49-53. doi:10.1016/j.ejogrb.2008.07.012
[7] Ahmadi, H., Montaser-Kouhsari, L., Nowroozi, M.R. and Bazargan-Hejazi, S. (2011) Male infertility and depression: A neglected problem in the Middle East. Journal of Sexual Medicine, 8, 824-830. doi:10.1111/j.1743-6109.2010.02155.x
[8] Nelson, A. and Gellar, P.A. (2011) Coping with fertility treatment: Infertility-related stress and social support among women receiving in vitro fertilization. Gender Medicine, 9, S100. doi:10.1016/j.genm.2011.09.023
[9] Mendola, R., Tennen, H., Affleck, G., McCann, L. and Fitzgerald, T. (1990) Appraisal and adaptation among women with impaired fertility. Cognitive Therapy and Research, 14, 79-93. doi:10.1007/BF01173526
[10] Stanton, A.L., Tennen, H., Affleck, G. and Mendola, R. (1991) Cognitive appraisal and adjustment to infertility. Women Health, 17, 1-15. doi:10.1300/J013v17n03_01
[11] Stanton, A.L., Tennen, H., Affleck, G. and Mendola, R. (1992) Coping and adjustment to infertility. Journal of Social and Clinical Psychology, 11, 1-13. doi:10.1521/jscp.1992.11.1.1
[12] Lazarus, R.S. and Folkman, S. (1984). Stress, appraisal and coping. Springer Publishing Company Inc., New York, 1984.
[13] Lechner, L., Bolman, C. and van Dalen, A. (2007) Definite involuntary childness: Associations between coping, social support and psychological distress. Human Reproduction, 22, 288-294. doi:10.1093/humrep/del327
[14] Litt, M.D., Tennen, H., Affleck, G. and Klock, S. (1992) Coping and cognitive factors in adaptation to in vitro fertilization failure. Journal of Behavioral Medicine, 15, 171- 187. doi:10.1007/BF00848324
[15] Thorn, P. and Wischmann, T. (2009) German guidelines for psychosocial counselling in thearea of gamete donation. Human Fertility, 12, 73-80. doi:10.1080/14647270802712728
[16] Benyamini, Y., Gozlan, M. and Kokia, E. (2009) Women’s and men’s perceptions of infertility and their associations with psychological adjustment: A dyadic approach. British Journal of Health Psychology, 14, 1-16. doi:10.1348/135910708X279288
[17] Podolska, M.Z. and Bidzan, M. (2011) Infertility as a psychological problem. Ginekologia Polska, 82, 44-49.
[18] Martins, M.V., Peterson, B.D., Almeida, V.M. and Costal, M.E. (2011) Direct and indirect effects of perceived social support on women’s infertility-related stress. Human Reproduction, 26, 2113-2121. doi:10.1093/humrep/der157
[19] Kraaij, V., Garnefski, N. and Vlietstra, A. (2008) Cognitive coping and depressive symptoms in definitive infertility: A prospective study. Journal of Psychosomatic OBstetrics & Gynecology, 29, 9-16. doi:10.1080/01674820701505889
[20] Thoits, P.A. (1995) Stress, coping, and social support processes: Where are we? What next? Journal of Health and Social Behavior, 36, 53-59. doi:10.2307/2626957
[21] Folkman, S., Lazarus, R.S., Dunkelschetter, C., Delongis, A. and Gruen, R.J. (1986) Dynamics of stressful encounter: Cognitive appraisal, coping, and encounter outcomes. Journal of Personality and Social Psychology, 50, 992- 1003. doi:10.1037/0022-3514.50.5.992
[22] Folkman, S. and Laza-rus, R.S. (1988) Coping as a mediator of emotion. Journal of Personality and Social Psychology, 54, 466-475. doi:10.1037/0022-3514.54.3.466
[23] Vahedi, H. (2000) Investigating of being practical, validity, reliability and assessment of coping styles test among adolescence in high school of Tehran. MS. Thesis, Azad University, College of Educational Sciences and Psychology, Tehran, 40-45.
[24] Spielberger, C.D., Gorssuch, R.L., Lushene, P.R., Vagg, P.R. and Jacobs, G.A. (1983) Manual for the state-trait anxiety inventory. Consulting Psychologists Press, Inc.
[25] Panahi-shahri, M. (2002) The primary study in validity, reliability and norms of the state-trait anxiety inventory (STAI). MS. Thesis, Tarbiat Modares University, College of Psychology, Tehran, 41-45.
[26] Beck, A., Steer, R. and Garbin, M. (1988) Psychometric properties of the Beck Depression Inventory: Twen-ty-five years of evalution. Clinical Psychology Review, 8, 122- 132. doi:10.1016/0272-7358(88)90050-5
[27] Gorgi, E. (1990) Validity and reliability of Beck depression inventory. MS. Thesis, Education Sciences Faculty, Isfehan.
[28] Greil, A.L. (1997) Infertility and psychological distress: A critical review of the literature. Social Science & Medicine, 45, 1679-1704. doi:10.1016/S0277-9536(97)00102-0
[29] Peterson, B.D., Newton, C.R., Rosen, K.H. and Skaggs, G.E. (2006) The relationship between coping and depression in men and women referred for in vitro fertilization. Fertility Sterility, 85, 802-804. doi:10.1016/j.fertnstert.2005.09.020
[30] Litt, M.D., Tennen, H., Affleck, G. and Klock, S. (1992) Coping and cognitive factors in adaptation to in vitro fertilization failure. Journal of Behavioral Medicine, 15, 171-187. doi:10.1007/BF00848324
[31] Morrow, K.A., Thoreson, R.W. and Penney, L.L. (1995) Predictors of psychological distress among infertility clinical patients. Journal of Consulting and Clinical Psychology, 63, 163-167. doi:10.1037/0022-006X.63.1.163
[32] Golchin, N., Janbozorgi, M., Alipour, M. and Agah-Heris M. (2011) The efficacy of cognitive behavioral therapy on using coping strategies and decreasing pain among females with chronic back pain. Journal of Fundamentals of Mental Health, 13, 160-169.
[33] Cousineau, T.M., Green, T.C., Corsini, E., Seibring, A., Showstack, M.T., Applegarth, L., Davidson, M. and Perloe, M. (2008) Online psychoeducational support for infertile women: A randomized controlled trial. Human Reproduction, 23, 554-566. doi:10.1093/humrep/dem306
[34] Maillet, M.H.I. (2002) Infertility and marital adjustment: The influence of perception of social support, privacy preference and level of depression. Ph.D. Thesis, School of Social Work.
[35] Rashidi, B., Hosseini, S., Beigi, P., Ghazizadeh, M. and Naghi Farahani, M. (2011) Infertility stress: The role of coping strategies, personality trait, and social support. Journal of Family and Reproductive Health, 4, 101-108.
[36] Jordan, C. and Revenson, T.A. (1999) Gender differences in coping with infertility: A meta analysis. Journal of Behavioral Medicine, 22, 341e358. doi:10.1023/A:1018774019232
[37] Berghuis, J. and Stanton, A. (2002) Adjusted to a dyadic stressor: A longititudinal study of coping and depressive symptoms in infertile couples over an insemination attempt. Journal of Consulting and Clinical Psychology, 70, 433-438. doi:10.1037/0022-006X.70.2.433
[38] Morrow, K.A. Thoreason, R.W. and Penney, L.L. (1995) Predictors of psy-chological distress among infertility clinic patients. Journal of Consulting and Clinical Psychology, 63, 163-167. doi:10.1037/0022-006X.63.1.163
[39] Peterson, B.D. (2002) Examining the individual and dyadic coping processes of men and women in infertile couples and their relationship to infer-tility stress, marital adjustment, and depression. Blacks-burg.
[40] Sarafino, E.P. (2002) Health psychology: Biopsychosocial interactions. 4th Edition, Wiley & Sons, New York.
[41] Calvete, E. and Connor-Smith, J.K. (2005) Auto-matic thoughts and psychological symptoms: A cross-cultural comparison of American and Spanish students. Cognitive Therapy and Research, 29, 201-217. doi:10.1007/s10608-005-3165-2
[42] Luo, Y. and Wang, H. (2009) Correlation research on psychological health impact on nursing students against stress, coping way and social support. Nurse Education Today, 29, 5-8. doi:10.1016/j.nedt.2008.05.019
[43] Berg, B.J. and Wilson, J.F. (1991) Psychological functioning across stages of treatment for infertility. Journal of Behavioral Medicine, 14, 11e26. doi:10.1007/BF00844765

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