Psychological Resilience as the Mediating Factor Between Stigma and Social Avoidance and Distress of Infertility Patients in China: A Structural Equation Modeling Analysis

Figures & data

Table 1 Univariate Analysis of Social Avoidance and Distress Score of Infertile Women (n = 266)

Variables		Number	Score (Mean±SD)	F/t	P
Age (years)		266	13.36±5.77	1.797	0.018*
Nationality	Han	233	13.42±5.83	0.173	0.678
	Others	33	12.97±5.40
Residence place	Urban areas	152	12.70±5.89	1.588	0.193
	Rural areas	80	14.19±5.43
	Towns	34	14.47±5.81
Education level	Primary school and below	16	13.69±3.30	3.051	0.011*
	Junior school	35	15.09±5.64
	Senior School	25	16.32±6.72
	Junior college	86	13.13±5.75
	Bachelor’s degree	84	11.99±5.38
	Master’s degree	20	13.15±6.44
Occupation	No	40	15.70±5.75	1.631	0.116
	Worker	14	12.86±3.84
	Farmer	29	14.79±5.96
	Staff	55	12.26±5.01
	Public servant or manager	29	12.45±6.47
	Medical worker	23	13.48±4.31
	Teacher	33	12.12±6.47
	Individual merchants	20	13.50±6.69
	Others	23	13.13±5.89
Years of marriage (years)		266	13.36±5.77	0.700	0.793
Presence or absence of biological children	Yes	53	13.51±4.93	0.440	0.835
	No	213	13.32±5.97
Type of infertility	Primary infertility	131	13.36±6.41	0.005	0.945
	Secondary infertility	135	13.39±5.09
Causes of infertility	Female factor	157	13.52±5.94	0.549	0.650
	Male factor	36	12.50±5.33
	Reasons for both parties	45	13.89±6.30
	Unknown reason	28	12.71±4.38
Fertility pressure from others	Very big	67	15.18±5.14	4.913	0.001**
	Big	92	13.22±5.75
	Normal	74	13.12±5.97
	Small	13	13.15±6.26
	Very small	20	8.95±4.41
Per capita monthly income of the family (yuan) Duration of infertility (years)	≤1000	49	15.82±4.67	3.846	0.005**
	1001~3000	59	13.95±5.61
	3001~5000	106	12.55±6.12
	5001~10,000	44	12.43±5.93
	>10,000	8	10.75±4.71
		266	13.36±5.77	0.627	0.644
Have you ever been treated	Yes	186	13.33±5.64	0.014	0.906
	No	80	13.43±6.09

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

Table 2 The Scores of Different Dimensions of Infertile Women (n = 266)

Items	Score (Mean±SD)
Total ISS score	77.84±16.91
Self-devaluation	19.04±5.52
Social withdrawal	16.03±4.00
Public stigma	25.72±7.83
Family stigma	17.06±5.16
Total SADS score	13.36±5.77
Social avoidance	6.80±2.97
Social distress	6.56±3.38
Total CD-RISC score	58.84±12.24
Tenacity dimension	29.73±7.17
Self-strength dimension	19.78±4.31
Optimism dimension	9.32±2.65

Table 3 Correlation Between Stigma and Psychological Resilience and Social Avoidance and Distress

Dimensions	Stigma	Self-Devaluation	Social Withdrawal	Public Stigma	Family Stigma	Social Avoidance and Distress	Social Avoidance	Social Distress	Psychological Resilience	Tenacity Dimension	Self-Strength Dimension	Optimism Dimension
Stigma	1
Self-devaluation	0.732**	1
Social withdrawal	0.690**	0.496**	1
Public stigma	0.853**	0.441**	0.460**	1
Family stigma	0.665**	0.277**	0.258**	0.452**	1
Social avoidance and distress	0.309**	0.280**	0.275**	0.218**	0.171**	1
Social avoidance	0.308**	0.290**	0.316**	0.223**	0.174**	0.894**	1
Social distress	0.257**	0.222**	0.192**	0.175**	0.191**	0.920**	0.646**	1
Psychological Resilience	−0.405**	−0.182**	−0.250**	−0.155*	−0.051	−0.369**	−0.340**	−0.331**	1
Tenacity dimension	−0.160**	−0.125*	−0.217**	−0.123*	−0.036	−0.322**	−0.287**	−0.297**	0.938**	1
Self-strength dimension	−0.243**	−0.206**	−0.210**	−0.209**	−0.098	−0.375**	−0.353**	−0.329**	0.864**	0.696**	1
Optimism dimension	−0.319**	−0.164**	−0.226**	−0.042	0.023	−0.227**	−0.220**	−0.193**	0.678**	0.498**	0.483**	1

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

Figure 1 Correlation analysis between stigma and psychological resilience and SADS. (A) The correlation analysis between stigma and SADS; (B) the correlation analysis between psychological resilience and SADS.

Abbreviation: SADS, social avoidance and distress scale.

Figure 2 Mediating role of psychological resilience between stigma, social avoidance and distress. (A) Hypothesized mediation model (a, b, and c’ = unstandardized regression coefficients): indirect effect = a*b; direct effect = c′; total effect c = sum of indirect and direct effect = a*b + c’; (B) the structural equation model of the mediating role of psychological resilience between stigma, social avoidance and distress (X1: self-devaluation; X2: social withdrawal; X3: public stigma; X4: family stigma; Y1: tenacity dimension; Y2; self-strength dimension; Y3: optimism dimension Y4: social avoidance; Y5: social distress; ellipse: the latent variables; Rectangle: the observed variables; black arrow: the endogenous variable; SAD is the endogenous latent variable; stigma is the exogenous latent variable; resilience is the mediator variable; e1 and e2 are the equation error, and e3-e11 is the measure error).

Abbreviation: SAD, social avoidance and distress.

Table 4 Psychological Resilience in the Mediating Effect Model Between Stigma, Social Avoidance and Distress

Independent Variable	Mediating Variable	Dependent Variable			95% CI		P
				Point estimate	Low	Upper
Stigma	Psychological resilience	Social avoidance and distress	Direct effect	0.338	0.158	0.612	0.000
			Indirect effect	0.116	0.046	0.254	0.001
			Total effect	0.454	0.244	0.777	0.000

Table 5 Fitting Indicators of the Structural Equation Model of Social Avoidance and Distress, Psychological Resilience and Stigma of Infertility Patients

Item	χ^2/dƒ	GFI	AGFI	NFI	IFI	TLI	CFI	RMSEA
Fitting index	2.039	0.958	0.921	0.934	0.965	0.947	0.964	0.063
Fitting standard	<3.00	>0.90	>0.90	>0.90	>0.90	>0.90	>0.90	<0.08