‘I felt less alone knowing I could contribute to the forum’: psychological distress and use of an online infertility peer support forum

Figures & data

Table 1. Differences in socio-demographic and fertility-related characteristics between posters, lurkers and non-users of the Connect forum.

	Full sample		Non-users		Lurkers		Posters
	n	Valid %	n	Valid %	n	Valid %	n	Valid %	X^2	p
Sex	220	–	114	–	66	–	40	–	14.682	.001
Male	50	22.73	37	32.46	11	16.67	2	5.00
Female	170	7727	77	67.54	55	83.33	38	95.00
Education	218	–	112	–	66	–	40	–	1.915	.927
High school or less	16	7.34	7	6.25	7	10.61	2	5.00
CEGEP, vocational	39	17.89	21	18.75	11	16.67	7	17.50
University degree	72	33.03	36	32.14	21	31.82	15	37.50
Graduate degree	91	41.74	48	42.86	27	40.91	16	40.00
Missing	2	–	2	–	0	–	0	–
Household income ($)	215	–	110	–	66	–	39	–	1.610	.952
Less than 80,000	62	28.84	31	28.18	21	31.82	10	25.64
80,000–119,999	64	29.77	31	28.18	21	31.82	12	30.77
120,000–159,999	40	18.60	20	18.18	12	18.18	8	20.51
160,000 and over	49	22.79	28	25.45	12	18.18	9	23.08
Missing	5	–	4	–	0	–	1	–
Ethnicity	217	–	111	–	66	–	40	–	.574	.751
White	131	60.37	67	60.36	38	57.58	26	65.00
Non-white	86	39.63	44	39.64	28	42.42	14	35.00
Missing	3	–	3	–	0	–	0	–
Immigration status	215	–	109	–	66	–	40	–	1.754	.416
Immigrant	88	40.93	49	44.95	23	34.85	16	40.00
Born in Canada	127	59.07	60	55.05	43	65.15	24	60.00
Missing	5	–	5	–	0	–	0	–
Parity	217	–	112	–	65	–	40	–	5.493	.064
No children	174	80.18	83	74.11	57	87.69	34	85.00
1 child or more	43	19.82	29	25.89	8	12.31	6	15.00
Missing	3	–	2	–	1	–	0	–
Prior psychological counselling	218	–	112	–	66	–	40	–	9.222	.010
Yes	35	16.06	11	9.82	12	18.18	12	30.00
No	183	83.94	101	90.18	54	81.82	28	70.00
Missing	2	–	2	–	0	–	0
Types of diagnoses	219	–	113	–	66	–	40	–	3.599	.891
Female-factor only	71	32.42	34	30.09	25	37.88	12	31.00
Male-factor only	53	24.20	28	24.78	17	25.76	8	20.00
Mixed (male and female factor)	30	13.70	16	14.16	7	10.61	7	17.50
Unexplained/In testing	65	29.68	35	30.97	17	25.76	13	32.50
Missing	1	–	1	–	0	–	0	–
Time in fertility treatment	212	–	109	–	63	–	40	–	17.353	.008
Less than 5 months	56	26.42	37	33.94	16	25.40	3	7.50
5–12 months	56	26.42	26	23.85	15	23.81	15	37.50
13–30 months	51	24.06	20	18.35	15	23.81	16	40.00
31 months or more	49	23.11	26	23.85	17	26.98	6	15.00
Missing	8	–	5	–	3	–	0	–
Achieved pregnancy during study	172	–	82	–	51	–	39	–	.100	.951
No	129	75.00	61	74.39	38	74.51	30	76.92
Yes	43	25.00	21	25.61	13	25.49	9	23.08
Missing	48	–	32	–	15	–	1	–

Abbreviations: n = number of cases; X² = Chi-square test; p = significance value (2-sided test).

Table 2. Differences in psychological outcomes at intake between posters, lurkers and non-users of the Connect forum.

			Non-user		Lurker		Poster		ANOVA
	n	Missing	M	SD	M	SD	M	SD	F	p
Anxiety symptoms (GAD-7)	210	10	7.31	5.85	5.95	4.55	10.00^a	5.82	6.406	.002
Perceived Stress (PSS-4)	218	2	6.59	2.94	6.59	3.13	8.63^b	3.54	6.778	.001

a = Bonferroni post-hoc shows that posters had significantly higher GAD-7 scores than lurkers (p = 0.001, mean difference = 4.047, SD = 1.132) and non-users (p = 0.032, mean difference = 2.688, SD = 1.043).

b =  Bonferroni post-hoc shows that posters had significantly higher PSS-4 scores than lurkers (p = 0.004, mean difference = 2.041, SD = 633) and non-users (p = 0.002, mean difference = 2.044, SD = .582).

Abbreviations. GAD-7 = Generalized Anxiety Disorder 7-item scale; PSS-4 = Perceived Stress Scale 4; n = number of cases; M = mean; SD = standard deviation; p = significance value (2-sided test).

Table 3. Regression analysis summary of whether anxiety symptoms at intake predict use of the Connect forum.

Model 1	B	SE	Wald	df	Exp(B)	95% CI	p
Non-user vs. Poster
Anxiety symptoms (GAD-7)	−.062	.036	2.927	1	.940	[.875, 1.009]	.087
Time in treatment	−.236	.201	1.373	1	.790	[.532, 1.172]	.241
Being male	2.044	.779	6.893	1	7.724	[1.679, 35.531]	.009
No children	−1.502	.614	5.978	1	.223	[.067, .742]	.014
No prior psychological counselling	1.065	.521	4.170	1	2.900	[1.044, 8.056]	.041
Lurker vs. Poster
Anxiety symptoms (GAD-7)	−.126	.041	9.380	1	.882	[.814, .956]	.002
Time in treatment	.017	.212	.007	1	1.017	[.671, 1.543]	.935
Being male	.894	.831	1.157	1	2.444	[.480, 12.452]	.282
No children	−.086	.703	.015	1	.918	[.232, 3.639]	.903
No prior psychological counselling	.402	.511	.620	1	1.495	[.549, 4.072]	.431

Note: Posters were used as the reference group.

Abbreviations: GAD-7 = Generalized Anxiety Disorder 7-item scale; SE = standard error; df = degrees of freedom; CI  =  Confidence interval for Exp(B); p = significance value (2-sided test).

Table 4. Regression analysis summary of whether perceived stress levels at intake predict use of the Connect forum.

Model 2	B	SE	Wald	df	Exp(B)	95% CI	p
Non-user vs. Poster
Stress (PSS-4)	−.159	.069	5.275	1	.853	[.745, .977]	.022
Time in treatment	−.171	.197	.748	1	.843	[.573, 1.241]	.387
Being male	2.047	.779	6.901	1	7.743	[1.681, 35.659]	.009
No children	−.889	.543	2.684	1	.411	[.142, 1.191]	.101
No prior psychological counselling	1.106	.518	4.569	1	3.023	[1.096, 8.337]	.033
Lurker vs. Poster
Stress (PSS-4)	−.203	.073	7.772	1	.816	[.707, .941]	.005
Time in treatment	.081	.208	.151	1	1.084	[.721, 1.631]	.697
Being male	.924	.826	1.253	1	1.906	[.345, 10.539]	.460
No children	.361	.640	.319	1	1.435	[.410, 5.029]	.572
No prior psychological counselling	.830	.578	2.063	1	2.294	[.739, 7.122]	.151

Note: Posters were used as the reference group.

Abbreviations: PSS-4 = Perceived Stress Scale 4; SE = standard error; df = degrees of freedom; CI  =  Confidence interval for Exp(B); p = significance value (2-sided test).

Table 5. Changes in perceived stress and anxiety symptoms from intake to follow-up based on Connect use.

	Posters				Lurkers				Non-users
	M	SD	df	p	M	SD	df	p	M	SD	df	p
Perceived stress (PSS-4)
Intake	8.49	3.48	36	.059	6.33	3.28	50	.279	6.63	2.85	79	.901
Follow-up	7.51	3.12			5.98	2.76			6.59	3.08
Anxiety symptoms (GAD-7)
Intake	9.51	5.57	34	.004	5.46	4.43	47	.721	6.79	5.49	74	.289
Follow-up	6.89	5.18			5.29	4.79			6.20	5.09

Note. Significant p indicates a significant score change between time-points (2-sided test). Direction of change is observable with the mean.

Abbreviations: GAD-7 = Generalized Anxiety Disorder 7-item scale; PSS-4 = Perceived Stress Scale 4; M = mean; SD = standard deviation; df = degrees of freedom.

Table 6. Comparing participants’ changes in mean scores from intake to follow-up (repeated-measures ANCOVAs).

Effect	MS	df	F	p	Partial Eta Square
Anxiety symptoms (GAD-7)
Time (Intake to follow-up)	19.531	1	2.026	.157	.014
Time x Connect use	24.383	2	2.529	.083	.034
Time x Successful pregnancy	18.017	1	1.869	.174	.013
Error	9.641	143
Perceived stress (PSS-4)
Time (Intake to follow-up)	1.068	1	.297	.587	.002
Time x Connect use	6.935	2	1.929	.149	.025
Time x Successful pregnancy	12.315	1	3.426	.066	.022
Error	3.595	153

Note: The repeated-measures ANCOVAs controlled for covariates that were significant in bivariate analyses: sex, parity, previous psychological counselling, and time in treatment.

Abbreviations: GAD-7 = Generalized Anxiety Disorder 7-item scale; PSS-4 = Perceived Stress Scale 4; MS = mean square; df = degrees of freedom; F = F-statistic from repeated-measures ANCOVAs; p = significance value.

Data availability

The data that support the findings of this study are available upon reasonable request from the corresponding author, P.Z. The data are not publicly available to protect the privacy of individuals who participated in the study.