http://doi.org/10.33698/NRF0332-Anshuka, V. Venkadalakshmi, Karobi Das, Aashima Arora
Abstract:
Background: Infertility is dened as a failure to conceive within one or more years of regular unprotected coitus. It is a medical condition that can cause considerable social, emotional and psychological distress. Objective-To assess the psychosocial problems in the couples with primary infertility attending the infertility clinic, PGIMER, Chandigarh. Material and methods- A descriptive study was conducted at infertility clinic of PGIMER, Chandigarh. 96 couples were enrolled through convenient sampling technique. Data collection was done by interviewing participants using interview schedule consisting of (a) sociodemographic prole, (b) Dyadic Adjustment Scale (DAS) and (c) Depression, Anxiety and stress scale (DASS-21). Results- Most of the couples (90%) were happily married. More than half (58%) of husbands did not experience depression at all, but (40%) of women experienced moderate depression. Two third (68%) of husbands had normal anxiety range but 40% of women experienced extremely severe anxiety. More than half (60%) of couples did not experience any stress. Conclusion- Most of couples were happily married but women experienced more anxiety and depression as compared to men.
Key Words: Infertility, Depression, Anxiety.
Correspondence at:
Mrs. V. Venkadalakshmi Lecturer,
National Institute of Nursing Education, PGIMER, Chandigarh, India
Ph. No. 985552533
email-Venkadalakshami_v@rediffmail.com
Introduction:
Infertility is an embarrassing and debilitating condition that represents public and social health problems. It is the medical condition that can cause considerable social, emotional and psychological distress. It had been recognized that infertility affects a couple physically, emotionally, nancially and socially1. When a couple starts seeking treatment regarding infertility, there is added suffering because of invasive medical inquiries and procedures2. Infertile couples experience various psychosocial concerns such as high cost of treatment, constant anxiety about infertility treatment outcomes, exhaustion from visiting various clinics regarding infertility, societal repercussions, confronting many questions about a childless marriage, potential distress during process and treatment and fear of losing the spouse due to infertility or destruction of family. It results into frustration, personal conict, and sharp decline in self esteem, isolation, identity crisis and loss of marital adjustment. Marital adjustment is a process mainly composed of marital satisfaction, dyadic cohesion, consensus by both partners on matters of importance to marital functioning, showing affection and warmth toward the spouse, sharing intimacies in day to day life3.
Infertility affects men and women differentially. The process of diagnosis and treatment of infertility and perspectives on course of action vary with age, gender and role identity4. It is considered a multifaceted stressor, which effects high depression level in men and high level of anxiety in women. 5 Hence, the need was felt to investigate the prevalence of psychosocial aspects among infertile couples.
Objective:
To assess the psychosocial problems among couples with primary infertility attending t h e I n f e r t i l i t y C l i n i c , P G I M E R , Chandigarh.
Material and methods:
A descriptive study on psychosocial aspects among couples with primary infertility was undertaken at Infertility Clinic of PGIMER, Chandigarh. Total 96 couples diagnosed with primary infertility willing to participate in the study and visiting the clinic from Aug to Oct 2019 were enrolled by convenient sampling technique.
Tool used for data collection was an interview schedule consisting of 4 parts a) Sociodemographic prole b) clinical prole
- c) Dyadic Adjustment Scale (DAS) and d) Depression Anxiety, Stress scale (DASS- 21). Dyadic Adjustment Scale (DAS) is structured questionnaire was given by Spanier, 1985 available in open domain for 6 It consists of 32 items. Scoring is done on 5 point Likert scale for 1-15 items which includes 5-Always Agree, 4- Almost Always agree, 3- Occassionally Disagree, 2-Frequently Disagree, 1- Almost Always agree, 0- Always Disagree. For item number 16,17, and from 20 to 22 scoring is done on 5 point Likert scale which includes 0- All the time, 1-Most of the time, 2- More often than not, 3- Occasionally, 4- Rarely, 5- Never. Scoring for item number 23 includes 4- Almost, 3- Occasionally every day, 2-Everyday 1- Rarely, 0- Never. Item number 24 was rated on 4 point rating scale which included 4-All of them, 3-Most of them, 2-Some of them, 1-Very few of them, 0-None of them. Scoring of Item number 25-28 includes 5 point rating scale includes 0-Never, 1- Less than once a month, 2- Once or twice a month, 3- Once or twice a week, 4- Once a day, 5-More often. Item number 29, 30 is a dichotomous scale. Scoring of item number 31is a 6 point rating scale which includes 0- Extremely unhappy, 1- Fairly unhappy, 2- A little unhappy, 3- Happy, 4- Vey happy, 5- Extremely happy, 6- Perfect. Item number 32 included 5- I want desperately for my relationship to succeed, and would go to almost any length to see that it does.4- I want very much for my relationship to succeed, and will do all I can to see that it does. 3 – I want very much for my relationship to succeed, and will do my fair share to see that it does.2- It would be nice if my relationship succeeded, but I can’t do much more than I am doing now to help it succeed.1- It would be nice if it succeeded, but I refuse to do any more than I am doing now to keep the relationship going.0- My relationship can never succeed, and there is no more that I can do to keep the relationship going.
The total DAS score ranged from 0-150. Some of items are worded positively and others are negatively worded. Therefore, some of answers require reversing prior to scoring. The score of 101 or below were classied into distressed in their marital relations but couples with the scores of 102 and higher were non-distressed in their marital relations. Those couples who scored <70 were classied into divorced in relationship (not legally).
Depression Anxiety, Stress scale (DASS- 21)7 is also open domain scale containing 21 items. It has 3 domains and each domain comprised of 7 items. Total DASS-21 ranged from 0-21. Scoring is done by 3 point Likert scale which includes 0-never, 1-sometimes, 2-often, 3- almost always. Each domain has score range of 0-21 which is multiplied by 2 and ranked into different levels. Levels of depression are (0-4) normal depression, (5-6) mild, (7-10) moderate, (11-13) severe and 14+ is extremely severe. Anxiety is categorized into normal(0-3), mild (4-5), moderate(6- 7), severe(8-9) and extreme severe(10+). Similarly category of stress are normal(0- 7), mild(8-9), moderate(10-12), severe(13- 14) and extreme severe(17+).
Ethical clearance was taken from the Institute Ethics Committee, PGIMER, Chandigarh. Permission was taken from HOD Gynaecology and obstetrics, PGIMER, Chandigarh. Informed written consent was taken from participants and they were given fully autonomy to withdraw from the studies at any time. Separate designated room was used to interview the husband and wife separately as per interview schedule. Time taken for an interview was around 40-45 minutes each. After completion of data collection, it was coded and analyzed using SPSS (Version 20.0).
Results:
As per sociodemographic prole, age of husbands ranged from 20-47years with mean age of 33± 2.13 years. Results showed that more than half (60%) of husbands were in the age group of 31-40 years. The age of wives ranged from 20-41years with mean age of 30± 1.34 years and 57% of wives were in the age group of 20-30 years. As per the education status, about half (42%) of couples were graduate and above. Most of husbands (84%) were private job holders and 76% of wives were home makers. Most of couples (70%) were Hindus and from joint family. Majority (73%) were from upper class (Table 1).
As far as marital adjustment is concerned, (according to Dyadic Adjustment Scale), signicantly higher percentage of husbands ( 96 . 9 %) scored 121 – 150 and were categorized as normal and happily married couple, as compared to their wives (90.7%). The signicantly higher mean score was obtained in husbands (123.19±16.14) as compared to wives (111.39±15.38).
Severe (11-13) or Extremely Severe
Table 1: Socio demographic profile of the couples with primary Infertility
N=96
Variables | Husband
n=96 (%) |
Wife
n=96 (%) |
Age (years)
20-30 31-40 >40 |
29(30.2) | 55(57.2) |
59(60.1) | 39(40.6) | |
8( 8.3) | 2( 2.0) | |
Education
<=Matriculation Secondary Graduate and above |
20(20.0)
35(36.4) 41(42.7) |
24(25.0)
30(31.2) 45(43.7) |
Occupation | – 84(87.5)
12(12.5) |
|
Housewife/not employed
Pvt. Job Govt. job |
73(76.0)
10(10.4) 13(13.6) |
|
Religion
Hindu Sikh Other |
68(70.8)
23(23.9) 5( 5.2) |
68(70.8)
23(23.9) 5( 5.2) |
Family type
Nuclear Joint |
25(26.0)
71(73.9) |
25(26.0)
71(73.9) |
Per Capita Income
7008 and above-upper class 3504-7007- Upper middle class 2102-3503- Middle class 1051-2101- lower middle class(<1051- Lower) |
44(45.8)
25(26.0) 18(18.7) 9( 9.3) |
44(45.8)
25(26.0) 18(18.7) 9( 9.3) |
Table 2: Assessment score of couples with Primary Infertility as per Dyadic Adjustment Scale and Depression, Anxiety and stress scale.
|
N=96
depression (14+), (according to DASS-21), was found signicantly higher percent of wives (36.4%) as compared to husbands (11.3%). The mean score of depression among wives (7.62±3.42) was signicantly h i g h e r t h a n t h a t o f h u s b a n d s ‘ (3.6±3.06) (p=<0.05).
Similarly, in case of anxiety (according to DASS-21), signicantly higher percentage of wives (59.2%) was categorized in severe (8-9) or extremely severe anxiety (10+) as compared to husbands (11.4%). The higher mean score was observed in wives (6.59± 3.76) than that of husbands’ (2.71±2.45) p=<0.05 (Table 2).
Further, 11.3% of wives were having severe (13-16) or extremely severe (17+) stress than husbands (4.1%) according to DASS- The mean score of wives’ stress (5.70±3.73) was signicantly higher than t h a t o f h u s b a n d s ‘ ( 4 . 2 1 + 3 . 1 1 ) p=<0.05(Table 3).
Table 3 : Psychosocial aspects of couples with primary infertility
N=96
S.No. | Items | Psychosocial aspects Score | t(94), p value | |
Husband (Mean±SD) | Wife (Mean±SD) | |||
A | Marital adjustment (DAS Score) | 123.19±16.14 | 111.39±15.38 | 3.7
<0.001 |
B | Depression
(DAS 21 Score) |
3.6±3.06 | 7.62±3.43 | 5.9
<0.001 |
C | Anxiety
(DAS 21 Score) |
2. 71±2. 45 | 6.59±3.76 | 5.19
0.04 |
D | Stress
(DAS 21 Score) |
4.21±3.11 | 5.70±3.73 | 5.2
0.01 |
Discussion:
Infertility is a traumatic experience for a couple as Indian culture emphasizes a lot on fertility. Infertility puts a lot of social, emotional and nancial burden on couples as reproduction is considered very important in Indian social setting. Their desperation to reproduce takes a toll on their mental and physical health which causes psychosocial problems like marital dissatisfaction, discord in relationship, depression, stress and anxiety among them. Thus, this study was conducted to assess the psychosocial aspects among primary infertile couples.
Findings of this study revealed that couples were happily married and were feeling less distress in their relationship because their time period for seeking treatment was less; most of the couples were in 2-5 years of infertility period. As the time passes there is a discord in relationship among infertile couples because bearing a child is the most important yardstick through which worth of a woman is measured after marriage in Indian setting. If couple has some marital disharmony, usually baby connects them together as a family and act as a liaison between both parents. In the absence of child, there is lack of bond between them and they may feel distressed in their marital relationship, sometimes it ends in divorce. The other reason of having low marital distress among the couples was living in nuclear families. Some of the women verbalized that living in nuclear families affected them in positive way as they were living alone away from family and there was little interference from in-laws and relatives. A study conducted by Lee Y et al (2000) showed different results from present study. They revealed that marital distress was less in those infertile couples who were residing with joint family.8
Further, study showed that depression is signicantly (p<0.05) higher in women because most of them were home makers and they used to sit and think about the treatment outcomes, nancial burden, and infertility and moreover the stigma attached to it. Women revealed that they feel worthless and hopeless and does not want to share feelings with anyone about infertility. They feel more anxious (p<0.05) as evidenced by their verbalization of frequent crying episodes without any reason which further leads to increased stress among them. Some of them verbalized that they used to feel agitated and unable to relax even while sleeping. While men felt low level of depression because they were busy in their job and they share their feelings about infertility with their wives and feels less purposeless and hopeless. Similar results were shown in study done by Bach M that women reported higher depression as compared to men and felt lower life purpose9.Another study conducted by Patel et al (2017) supported the ndings of present study. They concluded that wives were more emotionally stressed which further increased the depression and anxiety as compared to men.10
Further, anxiety and stress showed different effects on the basis of gender. In this study, women experienced signicantly more anxiety and stress (p<0.05) because the responsibility of child bearing is expected from women after marriage. Even though she is not single person who contributed to infertility but still she was blamed and harassed. In this study, women revealed that husbands consider that they do not contribute in infertility. They do not come willingly for investigations and need to be persuaded and forced. Wright J et al (1991) supported the ndings of the study. They evaluate the 449 psychosocial responses of couples based on gender differences. The results showed that on comparing with normal population, infertile couples experienced signicant more anxiety, d e p r e s s i o n , h o s t i l i t y, c o g n i t i v e disturbances and low self esteem.11
Conclusion:
It is concluded from ndings that men and women experienced infertility at different levels. Women felt more distressed in terms of anxiety, depression and had low self esteem as compared to men. The level of marital adjustment in men was higher than women. Hence, it is recommended that there were many issues among couples which were untouched during infertility workup and after diagnosing the infertility. Therefore, further qualitative study is recommended to have in-depth insight of problems.
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