Effects of Self-Esteem on the Associations Between Infertility-Related Stress and Psychological Distress Among Infertile Chinese Women: A Cross-Sectional Study

Figures & data

Table 1 Distribution of Characteristics and Univariate Analyses of Depression and Anxiety

Variables	N (%)	Depression	P	Anxiety	P
		Mean ± SD		Mean ± SD
Age			0.931		0.177
20–29	128(23.9)	5.41±3.41		7.42±3.96
30–39	365(68.1)	5.35±3.43		7.00±3.75
>40	43(8.0)	5.19±3.30		6.21±3.76
Residence			0.419		0.536
Rural area	111(20.7)	5.59±3.21		7.23±3.59
Urban area	425(79.3)	5.29±3.46		6.99±3.80
Education level			0.008		0.395
Senior high school or lower	224(41.8)	5.86±3.38		7.18±3.72
Junior college	114(21.3)	5.25±3.35		6.61±3.86
Bachelor degree or above	198(36.9)	4.83±3.41		7.12±3.74
Income (RMB, yuan)			0.001		0.413
<4000	144(26.9)	6.19±3.29		7.26±3.62
≥4000	392(73.1)	5.04±3.40		6.96±3.81
History of pregnancy			0.616		0.588
No	283(52.8)	5.28±3.48		6.95±3.81
Yes	253(47.2)	5.43±3.33		7.13±3.70
Cause of infertility			0.116		0.227
Female factor	331(61.8)	5.51±3.20		7.26±3.71
Male factor	93(17.4)	4.69±3.86		6.65±4.10
Unexplained	112(20.9)	5.45±3.58		6.71±3.60
History of infection			0.535		0.878
No	496(92.5)	5.33±3.44		7.03±3.75
Yes	40(7.5)	5.68±3.03		7.13±3.96
History of operation			0.126		0.141
No	316(59.0)	5.17±3.44		6.85±3.75
Yes	220(41.0)	5.60±3.36		7.30±3.77
History of infertility treatment			0.019		0.007
No	221(41.2)	4.94±3.28		6.52±3.52
Yes	315(58.8)	5.64±3.47		7.40±3.88
Negative life event			0.403		0.087
No	404	5.28±3.39		6.88±3.65
Yes	132	5.57±3.47		7.52±4.05
Sleep disorders			<0.001		<0.001
No	275(51.3)	4.50±3.23		5.86±3.46
Yes	261(48.7)	6.25±3.37		8.28±3.67
Times of exercise weekly			0.006		0.083
0	249(46.5)	5.86±3.44		7.42±3.82
1–2	188(35.1)	4.95±3.41		6.76±3.66
3–4	99(18.5)	4.85±3.18		6.61±3.72
Sources of stress			0.764		0.095
The family	166(31.0)	5.25±3.48		7.17±3.66
Oneself	293(54.7)	5.34±3.37		6.77±3.81
Others (friend or colleague)	77(14.4)	5.60±3.43		7.78±69

Abbreviation: SD, standard deviation.

Table 2 Description Statistics for Continuous Variables

Variables	Mean	SD	Range	n (%)
Age	32.77	4.42	22–47
Depression	5.35	3.41	0–16
8 ≤ Scores ≤ 10				109(20.3)
11 ≤ Scores ≤ 21				41(7.6)
Anxiety	7.04	3.76	0–18
8 ≤ Scores ≤ 10				126(23.5)
11 ≤ Scores ≤ 21				100(18.7)
Infertility-related stress	140.41	30.29	61–226
Self-esteem	29.08	3.94	17–40

Abbreviation: SD, standard deviation.

Table 3 Correlations Among Continuous Variables

Variables	1	2	3	4	5
1.Age	1
2.Depression	−0.11	1
3.Anxiety	−0.103*	0.661**	1
4.Infertility-related stress	−0.059	0.456**	0.451**	1
5. Self-esteem	0.163**	−0.444**	−0.406**	−0.445**	1

Notes: *p < 0.05, **p < 0.01.

Table 4 Hierarchical Linear Regression Analyses of the Factors Associated with Depression

Variables	Depression
	Model 1(β)	Model 2(β)	Model 3(β)	Model 4(β)
Age	0.023	0.036	0.068	0.064
Education level	−0.082	−0.051	−0.006	−0.003
Income	−0.134***	−0.093*	−0.073*	−0.068
History of infertility treatment	0.088*	0.057	0.056	0.053
Sleep disorders	0.245***	0.188***	0.167***	0.167***
Times of exercise weekly	−0.106*	−0.076*	−0.068	−0.069
Infertility-related stress		0.399***	0.288***	0.297***
Self-esteem			−0.280***	−0.294***
Interaction				−0.099**
F	11.574	27.275	31.547	29.203
Adjusted R^2	0.106	0.256	0.314	0.322

Notes: *p < 0.05, **p < 0.01, ***p<0.001.

Table 5 Hierarchical Linear Regression Analyses of the Factors Associated with Anxiety

Variables	Anxiety
	Model 1(β)	Model 2(β)	Model 3(β)	Model 4(β)
Age	−0.084*	−0.064	−0.034	−0.039
History of infertility treatment	0.102*	0.069	0.069	0.066
Sleep disorders	0.312***	0.251***	0.234***	0.233***
Infertility-related stress		0.401***	0.306***	0.315***
Self-esteem			−0.225***	−0.240***
Interaction				−0.133**
F	24.411	50.783	49.011	43.105
Adjusted R^2	0.116	0.271	0.310	0.321

Notes: *p < 0.05, **p < 0.01, ***p<0.001.

Table 6 Test of Mediation Model

X	M	Y	c	a	b	c’	a*b (BCa 95% CI)
Infertility-related stress	Self-esteem	Depression	0.3990***	−0.3962***	−0.2799***	0.2881***	0.1109(0.0770,0.1495)
		Anxiety	0.4014***	−0.4242***	−0.2253***	0.3058***	0.0956(0.0622,0.1327)

Notes: ***p<0.001. ^aAssozciations of infertility-related stress with self-esteem. ^bAssociations of self-esteem with depression or anxiety. ^cDirect associations of infertility-related stress with depression or anxiety. ^c’Indirect associations of infertility-related stress with depression or anxiety. BCa 95% CI: Bias-corrected and accelerated 95% Confidence Interval. Age, education level, income, history of infertility treatment, sleep disorders and times of exercise weekly are covariates for depression. Age, history of infertility treatment, sleep disorders are covariates for anxiety.