Strategie di coping, qualità di vita, adattamento diadico e salute psicologica nelle coppie infertili: un approccio multidimensionale

Dall’analisi della letteratura sull’infertilità è emerso che il momento in cui una donna e il suo partner apprendono di non poter avere figli può essere definito come una vera e propria "crisi di vita", che coinvolge diversi piani esistenziali dando luogo a senso di inadeguatezza, vissuti di frustrazione, stress, e perdita (Wischmann, Stammer, Scherg, Gerhard, and Verres, 2001). La diagnosi di infertilità, infatti, incide sia dal punto di vista individuale, generando riduzione dell’autostima, senso di colpa, paura, ostilità, tristezza, sia dal punto di vista dei vissuti di coppia. Infine, ricerche recenti si sono focalizzate sulla percezione della qualità della vita in relazione all’esperienza di infertilità, facendo riferimento alla definizione di qualità della vita proposta dall’Organizzazione Mondiale della Sanità, secondo cui essa è costituita dalla percezione individuale della propria posizione in relazione al contesto culturale, al sistema dei valori e ai propri obiettivi, aspettative, ideali e interessi. La qualità della vita comprende dimensioni quali il benessere emozionale, le attività sociali, la salute fisica, il contesto di appartenenza e le credenze personali (Skevington et al., 2004) . L’infertilità ed i trattamenti ad essa connessi hanno un impatto molto significativo quindi sulla qualità di vita percepita dalla persona (Schmidt, 2006; Verhaak et al., 2007; Chachamovich et al., 2010). Per esempio, l’infertilità risulta essere negativamente associata al benessere relazionale, sessuale e psicosociale (Phipps, 1993; Drosdzol and Skrzypulec, 2008). I pazienti infertili sperimentano maggiori livelli di stress e di tensione nella relazione con il proprio partner. A causa di questo forte impatto, la miglior pratica nel trattamento dell’infertilità dovrebbe prevedere un approccio olistico ed integrare la qualità della vita nella clinica pratica (Boivin et al., 2008). La diagnosi di infertilità influenza anche la percezione di adattamento e la soddisfazione di coppia (Peterson et al., 2008; Chachamovich et al., 2009). Molto significative, pur essendo meno numerose, sono le ricerche che esplorano l’impatto dell’infertilità sulla percezione di adattamento diadico, che, secondo Spanier, deriva dall’interazione di quattro dimensioni: la soddisfazione; la coesione; il consenso e l’espressione affettiva (Spanier, 1976). Ricerche effettuate hanno evidenziato, infatti, effetti negativi dell’infertilità sull’adattamento di coppia percepito in quanto le coppie infertili sperimentano più frequentemente difficoltà relazionali, nella vita sessuale, e riduzione dell’impegno coniugale e del dialogo (Wirtberg, et al. 2007)

Paths towards parenthood after repeated treatment failures: a comparative study on predictors of psychological health outcomes in infertile couples persisting in treatments or opting for adoption

Introduction: Infertility literature suggests widespread recourse to long-term medical treatments despite evidence of high stress, costs, and adverse effects of repeated treatment failures. However, there is a lack of research comparing predictors of stress and psychological health outcomes between members of infertile couples who – after repeated failures – persist in pursuing medical treatments (PT) with those who opted for quitting treatments and adopting (QTA). Basing on a transactional and multidimensional approach to infertility-related stress and health, the present study aims at exploring individual (socio-demographics; coping strategies) and situational (infertility-related parameters; infertility-related stressors; couple’s dyadic adjustment dimensions) predictors of state-anxiety and depression in male and female partners of PT-infertile couples and of QTA-infertile couples. Methods: Participants were both members of 176 couples with duration of infertility and a history of medical treatments for at least 3 years (76 PT-infertile couples, 100 QTA-infertile couples). The study variables were compared by study group across genders. Structural equation models (SEM) were used to test main and moderating effects of study variables on state-anxiety and depression by study group and across genders. Results: Members of infertile couples quitting treatments and adopting (QTA) reported significantly lower levels of state-anxiety and depression, higher stress related to need for parenthood and rejection of childfree-lifestyle and lower stress related to social and couple’s relationship concerns than those who persist in pursuing medical treatments (PT). Members of infertile couples quitting treatments and adopting (QTA) recurred to a greater extent to active coping strategies (problem-solving/social-support) and to a lower extent to passive coping strategies (avoiding/turning-to-religion), and they reported higher levels of dyadic adjustment. Specificities in main and moderating factors related to state-anxiety and depression by study group and across genders were found. Conclusion: Findings should be addressed to provide a comprehensive assessment of both members of infertile couples facing repeated treatment failures to identify risks and resources and develop tailored evidence-based interventions

Predictors of psychological health in couples diagnosed with Male infertility: A dyadic approach.

Background: Research underlined that infertile men may experience sense of guilt and failure, loss of self-esteem, high psychosocial and marital stress, and psychological suffering, but little attention was given to individual and dyadic dynamics featuring both partners diagnosed with male infertility. Objective: The study aimed to apply the Actor-Partner-Interdependence Model (APIM) to investigate actor and partner effects of infertility-related stressors (Social Concern, Need for Parenthood, Rejection of Childfree Lifestyle, Couple’s Relationship Concern), coping strategies (Social Support, Avoiding, Positive Attitude, Problem-Solving, Turning to Religion) and dyadic adjustment dimensions (Consensus, Satisfaction, Cohesion, Affectional Expression) on perceived levels of state-anxiety and depression among both members of couples diagnosed with male infertility. Method: Both members of 80 couples with male infertility diagnosis completed self-administered questionnaires. Results: Perception of Social and Couple’s Relationship Concerns and adoption of Avoiding and Turning to Religion coping emerged as risk factors for both partners. Adoption of Social Support and Problem-Solving coping and partners’ perception of Rejection of Childfree Lifestyle emerged as risk factors, while the perception of dyadic adjustment and partners’ adoption of Social Support coping, emerged as protective factors for men's psychological health. Perception of Need for Parenthood and partners’ perception of Rejection of Childfree Lifestyle emerged as risk factors, while the perception of Cohesion, and partners’ perception of Social and Couple’s Relationship Concerns and adoption of Positive Attitude coping, emerged as protective factors for women's psychological health. Conclusions: The study suggested specific individual and dyadic dynamics to be addressed for developing tailored interventions to promote psychological health in couples diagnosed with male infertility

Paths towards parenthood after repeated treatment failures: a comparative study on predictors of psychological health outcomes in infertile couples persisting in treatments or opting for adoption

IntroductionInfertility literature suggests widespread recourse to long-term medical treatments despite evidence of high stress, costs, and adverse effects of repeated treatment failures. However, there is a lack of research comparing predictors of stress and psychological health outcomes between members of infertile couples who – after repeated failures – persist in pursuing medical treatments (PT) with those who opted for quitting treatments and adopting (QTA). Basing on a transactional and multidimensional approach to infertility-related stress and health, the present study aims at exploring individual (socio-demographics; coping strategies) and situational (infertility-related parameters; infertility-related stressors; couple’s dyadic adjustment dimensions) predictors of state-anxiety and depression in male and female partners of PT-infertile couples and of QTA-infertile couples.MethodsParticipants were both members of 176 couples with duration of infertility and a history of medical treatments for at least 3 years (76 PT-infertile couples, 100 QTA-infertile couples). The study variables were compared by study group across genders. Structural equation models (SEM) were used to test main and moderating effects of study variables on state-anxiety and depression by study group and across genders.ResultsMembers of infertile couples quitting treatments and adopting (QTA) reported significantly lower levels of state-anxiety and depression, higher stress related to need for parenthood and rejection of childfree-lifestyle and lower stress related to social and couple’s relationship concerns than those who persist in pursuing medical treatments (PT). Members of infertile couples quitting treatments and adopting (QTA) recurred to a greater extent to active coping strategies (problem-solving/social-support) and to a lower extent to passive coping strategies (avoiding/turning-to-religion), and they reported higher levels of dyadic adjustment. Specificities in main and moderating factors related to state-anxiety and depression by study group and across genders were found.ConclusionFindings should be addressed to provide a comprehensive assessment of both members of infertile couples facing repeated treatment failures to identify risks and resources and develop tailored evidence-based interventions

The COVID-19 Student Stress Questionnaire: Validation in Spanish university students from health sciences

This study aimed to validate the Spanish version of the COVID-19 Student Stress Questionnaire (CSSQ), a 7-item tool assessing COVID-19-related stressors among university students, namely, Relationships and Academic Life, Isolation, and Fear of Contagion. Participants were 331 Spanish university students. Factor analyses sustained the three factor solution of the original tool. Data also revealed satisfactory convergent and discriminant validity, suitable internal consistency, and significant associations with psychological symptoms, as measured by the Symptom Checklist-90-Revised. The Spanish version of the CSSQ represents a valid tool to be used in clinical settings to timely identify students at high psychological risk and to develop evidence-based interventions during/after the pandemic

Technostress and academic motivation: direct and indirect effects on university students' psychological health

Introduction: Research has well demonstrated that the pandemic entailed several implications among university students worldwide in terms of increased use of Information and Communication Technologies (ICTs), technostress, disruptions in academic goals and motivation processes, and growing psychological suffering. Responding to the new research need to go in-depth into the processes linking technostress and motivation dimensions to inform current research/interventions, the present study aimed to explore the direct effects of perceived Technostress dimensions (Techno-Overload, Work-Home Conflict, Pace of Change, Techno-Ease, Techno-Reliability, and Techno-Sociality) and Academic Motivation dimensions (Amotivation, Intrinsic, and Extrinsic Motivation dimensions) on students' perceived levels of Anxiety/Depression and test the potential indirect effect (mediating role) of Academic Motivation dimensions in the associations between Technostress and psychological health conditions. Methods: Overall, 1,541 students from five European countries (Czech Republic, Greece, Italy, Serbia, United Kingdom) completed a survey comprising a Background Information Form, the Technostress Scale, the Academic Motivation Scale-College, and the Hospital Anxiety and Depression Scale. Hayes' PROCESS tool was used to test direct and indirect (mediating) effects. Results: Data revealed that Techno-Overload, Work-Home Conflict, Amotivation, and Extrinsic Motivation-Introjected had a direct negative effect, whereas Techno-Ease, Techno-Reliability, Techno-Sociality, all Intrinsic Motivation dimensions, and Extrinsic Motivation-Identified had a direct protective role for students' psychological health. The significant indirect role of motivation dimensions in the associations between Technostress dimensions and Anxiety/Depression was fully supported. Discussion: Findings allow gaining further insight into the pathways of relationships between technostress, motivation, and psychological health, to be used in the current phase, featured by the complete restoration of face-to-face contacts, to inform the development of tailored research and interventions, which address lights and shadows of the technology use, and which take into account the necessity to enhance its potentials yet without impairing students' motivation and psychological health

IMPROVING SELF-REFLECTIVE PARENTING: EFFECTS OF MENTALIZATION-BASED GROUP WITH MOTHERS OF CHILDREN WITH BEHAVIOURAL PROBLEMS

The study describes psychological dynamics and investigates the effects of a Mentalization- Based Group Therapy intervention aiming to promote parent reflective functioning in mothers of c hildren with behavioural problems. Methods Group Climate Questionnaire (Mc Kenzie, 1981), Therapeutic Factors Inventory-Short form (TFI-S, Mac Nair-Semands, 2010) and Parent Stress Index-Short Form (PSI-SF, Abidin, 1983) were used to assess perceived Group Climate, Therapeutic Factors and Stress in parenting before and after a 10-week MBT group program with 21 mothers. Significant differences before and after group program were evaluated using Wilcoxon Signed Rank Test; associations of GCQ and TFI with PSI-SF dimensions were evaluated using Pearson correlations and linear regressions. Results Data revealed increased perception of Group Engagement (p<.001) and of all Therapeutic Group Factors, reduced perception of Difficult Child (p<.001), Parent-Child Dysfunctional Interaction (p<.05) and Total Stress in parenting (p<.01), and significant associations of GCQ and TFI with PSI-SF dimensions, highlighting a moderating role of perceived Parent-Child Dysfunctional Interaction on perception of Difficult Child. Conclusions Data highlighted the efficacy of the mentalization-based group intervention to significantly reduce both mothers' perceived difficulties in the interactions with the child and perceived levels of stress in parenting

The association between stressful life events and perceived quality of life among women attending infertility treatments: The moderating role of coping strategies and perceived couple's dyadic adjustment

Background: Research highlighted that Stressful Life Events have high incidence among infertile patients and significant impact on physical and medical parameters related to reproductive functions, but their potential role among factors influencing the infertile patients' perception of fertility-related Quality of Life (QoL) has not been explored. The present study aims to investigate the associations of Stressful Life Events (Stressful events in the family of origin, In family pre-existing pregnancy difficulties, Health problems in childhood) with perceived fertility-related QoL in women attending infertility treatments, examining the potential moderating role of adopted coping strategies and perceived couple's dyadic adjustment. Methods: A questionnaire consisting of Socio-demographics and Infertility-related characteristics, Stress-inducing events in the couples' lives Questionnaire (FLS), Coping Orientations to Problem Experienced (COPE), Dyadic Adjustment Scale (DAS), and Core and Treatment subscales of Fertility Quality of Life (FertiQoL) was administered to 266 women attending infertility treatments. A descriptive correlational design with cross-sectional comparison was used. Results Logistic Regression Analyses after adjusting for socio-demographic and infertility-related characteristics revealed that women who reported Stressful events in the family of origin and In family pre-existing pregnancy difficulties were more likely to report lower levels of perceived Core QoL, while women who reported Health problems in childhood were more likely to report lower levels of perceived Treatment QoL. Couple's dyadic adjustment and specific coping strategies were significantly associated with perceived Core and Treatment QoL and they also significantly moderated the associations between stressful life events and perceived QoL. Conclusions: Data provided original evidence on the strong association between stressful life events and perceived fertility-related QoL also highlighting individual and couples' resources to define counselling interventions with women attending infertility treatments

Infertility-Related Stress and Psychological Health Outcomes in Infertile Couples Undergoing Medical Treatments: Testing a Multi-dimensional Model

The study aims to propose and test a multi-dimensional infertility-related stress model including socio-demographic and fertility-related characteristics, infertility-related stress dimensions, coping strategies and couple’s dyadic adjustment dimensions as predictors of anxiety and depression among partners of couples undergoing infertility treatments. Both members of 250 infertile couples filled out a questionnaire consisting of Socio-demographics (Age; Educational level; Employment status), Fertility-related characteristics (Type of diagnosis; Duration of infertility), Fertility Problem Inventory-Short Form, Coping Orientations to Problem Experienced-New Italian Version, Dyadic Adjustment Scale, State-Trait Anxiety Inventory-Y and Edinburgh Depression Scale. Hierarchical Multiple Linear Regressions indicated that the proposed predictive models for anxiety and depression were significant and had good levels of fit with the data. Gender differences emerged in predictor variables. Findings provide valid predictive models that could be adopted to assess psychological health in infertile patients and to develop evidence-based and tailored counselling interventions at centres for assisted reproduction