Cao Danfeng, Bai Caifeng, Zhang Guoxiang
Department of Obstetrics, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China.
School of Nursing, Ningxia Medical University, Yinchuan, China.
Front Psychol. 2022 Jun 28;13:906226. doi: 10.3389/fpsyg.2022.906226. eCollection 2022.
Psychological distress is common among infertility patients. Total scale scores are often used to represent the severity of anxiety, depression, or stress, which ignores important differences between specific symptoms, and relationships between symptoms. This study aimed to identify patterns of psychological distress experienced by infertility patients and to identify the most central symptoms of anxiety, depression, and stress.
From June to September 2016, 740 infertility patients were included in this cross-sectional study. Infertility patients were asked to complete the Generalized Anxiety Disorder-7, Patients Health Questionnaire-9 (PHQ-9), and Fertility Problem Inventory. Network analysis was used to examine the patterns of psychological distress in infertility patients and to test the most central symptoms of anxiety, depression, and stress.
Restlessness was the most central symptom in infertility patients. "Feelings of guilt" had the highest strength among PHQ-9 symptoms. "Relationship concern stress" and "sexual concern stress" had the strongest connections in the network. Stability estimation indicated that the order of node strength centrality was more stable than the order of closeness and betweenness (the CS-coefficients were 0.75, 0.13, and 0.67, respectively). In addition, network structure and global strength were invariant across gender.
The cross-sectional design did not permit identification of causal relationships. Patients in this study were recruited from one reproductive hospital; especially, most patients had low socioeconomic status, which limits generalizability of the findings.
This study reinforces the need to better understand the underlying causes of psychological distress in infertile patients. A more detailed investigation of the relationship between these symptoms could provide information for psychosocial interventions aimed beyond "alleviating psychological distress." We should consider the individual psychological symptom pattern and its potential causes in infertility patients instead of assuming a consistent psychological distress structure.
心理困扰在不孕患者中很常见。总量表得分常被用来表示焦虑、抑郁或压力的严重程度，这忽略了特定症状之间的重要差异以及症状之间的关系。本研究旨在确定不孕患者经历的心理困扰模式，并确定焦虑、抑郁和压力最核心的症状。
2016年6月至9月，740名不孕患者纳入了这项横断面研究。不孕患者被要求完成广泛性焦虑障碍量表-7、患者健康问卷-9（PHQ-9）和生育问题量表。采用网络分析来研究不孕患者的心理困扰模式，并检验焦虑、抑郁和压力最核心的症状。
坐立不安是不孕患者最核心的症状。“内疚感”在PHQ-9症状中强度最高。“关系困扰压力”和“性困扰压力”在网络中联系最强。稳定性估计表明，节点强度中心性的顺序比接近中心性和中介中心性的顺序更稳定（CS系数分别为0.75、0.13和0.67）。此外，网络结构和全局强度在不同性别间是不变的。
横断面设计无法确定因果关系。本研究中的患者是从一家生殖医院招募的；特别是，大多数患者社会经济地位较低，这限制了研究结果的普遍性。
本研究强调了更好地理解不孕患者心理困扰潜在原因的必要性。对这些症状之间关系进行更详细的调查，可以为旨在超越“减轻心理困扰”的心理社会干预提供信息。我们应该考虑不孕患者个体的心理症状模式及其潜在原因，而不是假定存在一致的心理困扰结构。
