P-567 The role of self-criticism in the relationship between infertility-related stress and anxiety and depression symptoms in women facing infertility
Authors: Pedro J , Alves M , Santos S 
Published: June 2023

Abstract

Study question
Can self-criticism help to explain the relationship between infertility-related stress and anxiety and depression symptoms in women facing infertility?

Summary answer
Women with higher infertility-related stress presented also with higher anxiety and depression symptoms and their self-criticism attitudes help to explain this relationship.

What is known already
Infertility is a demanding and potentially stress-inducing medical condition, which can trigger anxiety and depression symptoms in women. Feelings of being inadequate, failing to achieve a major life goal, and experiences of shame might develop dysfunctional strategies such as self-criticism attitudes. Self-criticism has been associated with poor mental health outcomes. However, in the field of infertility, the role of self-criticism in the relationship between infertility-related stress and anxiety and depression symptoms has never been explored.

Study design, size, duration
This cross-sectional study was conducted between December 2021 and March 2022. Women (in a heterosexual relationship), having an infertility diagnosis and/or trying to conceive for more than 12 months and aged between 18 and 45 years were invited to participate in the study. Data were collected through an online platform, after the dissemination of the study on social media created specifically for this purpose, through a snowball strategy.

Participants/materials, setting, methods
The sample was composed of 130 women.Participants completed a self-reported questionnaire including demographic, health data, and measures of infertility-related stress (COMPI), self-criticism (FSCRS), and anxiety and depression symptoms (DASS-21). A mediation model using PROCESS was used to test whether the relationship between infertility-related stress and anxiety and depression symptoms is mediated by self-criticism. Psychological support was used as a control variable since preliminary analyses revealed that this variable has a multivariate effect on the outcomes.

Main results and the role of chance
Women were on average 34 years old and the majority were married. Seventy-three percent had already undergone fertility treatments and the most frequent diagnosis was unexplained infertility and female factor. About 30% were having psychological support. The results obtained through the mediation models showed significant direct effects on the relationship between infertility-related stress and anxiety (b = .13, SE = .05, p &lt; .01) and depression symptoms (b = .30, SE = .05, p &lt; .001), indicating that higher levels of infertility-related stress are associated with higher levels of anxiety and depression symptoms. Significant indirect effects were also identified between infertility-related stress and depression symptoms (SE = .02; IC de 95 % [.0167, .1124]) and between infertility-related stress and anxiety symptoms (SE = .05; IC de 95 % [.0100, .0906]), through self-criticism showing that this relationship can be explained by self-critical attitudes.

Limitations, reasons for caution
Due to the nature of our sample, the results need to be interpreted with caution. The cross-sectional design does not allow to draw causal directions; further longitudinal studies exploring the role of these variables are needed and exploring the role of possible confounders. Studies including men are needed as well.

Wider implications of the findings
This work highlighted the role of self-criticism as explaining the relationship between infertility-related stress and anxiety and depression symptoms. Psychological support aiming to promote self-compassion (in contrast with self-criticism) attitudes might help to develop more functional strategies and contribute to better mental health outcomes in women facing infertility.

Trial registration number
NA