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L. Schmidt, U. Christensen, B.E. Holstein, The social epidemiology of coping with infertility, Human Reproduction, Volume 20, Issue 4, April 2005, Pages 1044–1052, https://doi.org/10.1093/humrep/deh687
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Abstract
BACKGROUND: To analyse the cross-sectional association between coping responses with infertility and occupational social class. Infertility is evenly distributed across social classes in Denmark, and there is free access to high-quality assisted reproduction technology. METHODS: Data were based on a questionnaire in a consecutive sample of 1169 women and 1081 Danish men who were about to begin assisted reproduction treatment. The coping measure was developed from an adaptation of Lazarus and Folkman's Ways of Coping Questionnaire and based on results from interviews with infertile people. The measure was developed in four categories: active-avoidance coping; active-confronting coping; passive-avoidance coping; meaning-based coping. These subscales were later confirmed by factor analysis. Occupational social class was measured in a standardized way. RESULTS: Contrary to expectations, the logistic regression analyses showed that women from lower social classes V+VI and men from social classes III+IV used significantly more active-confronting coping. Women from lower social classes V+VI used significantly more meaning-based coping. Both men and women from social classes III–VI used significantly more passive-avoidance coping and significantly less active-avoidance coping. CONCLUSION: Due to the significant social differences in coping with infertility, the study suggested that elements of coping may be learned from one's social network and reference group.
Introduction
Fertility clinic staff often need to advise and support patients in their coping with infertility- and treatment-related stress. It is therefore important to gain insight into the mechanisms which influence the patients' coping response. Some scholars consider coping to be anchored in the personality as a personality trait (Kobasa, 1979) or in the individual's actions and perceptions as a specific coping style (Aldwin, 2000). Other scholars interpret coping as a psychosocial resource. Important elements of coping may be learned from one's membership and reference groups, in the same way as other behaviours are learned and internalized (Pearlin, 1989). Lazarus and Folkman (1984) emphasized the contextual nature of the coping process, observing that coping must change over time, and across different stressful situations, to be effective. According to Aneshensel (1996), the personal component of stress and coping has dominated in previous research and needs to be balanced by studies of environmental components, such as supportive social environment or high social class.
This paper examines how coping with infertility was related to occupational social class in a study population of couples in Denmark who were about to begin assisted reproduction treatment. Infertility in this paper is defined as a failure to achieve a pregnancy after a woman has attempted to become pregnant for >12 months. Although stressors are often unevenly distributed across social classes, this was not the case in this study. Population-based studies from Denmark have shown that infertility is unrelated to social class (Rachootin and Olsen, 1982; Schmidt et al., 1995).
Infertility is a chronically stressful situation, a non-event transition (Koropatnick et al., 1993). Chronic stressors develop slowly as continuous and problematic conditions in our social conditions or social roles (Wheaton, 1999). The attempts to achieve a childbirth will often last for years, with repeated attempts at conceiving, with or without the use of assisted reproduction technologies. For many couples, infertility and its treatment cause a serious strain on their interpersonal relationship, disturbed relationships with other people, personal distress, reduced self-esteem, and periods of existential crisis (Abbey et al., 1992; Wirtberg, 1992; Schmidt, 1996; Greil, 1997; Tjørnhøj-Thomsen, 1999).
In the transactional coping model, coping is considered to be a process that starts with an event that is primarily appraised by the individual as either threatening, harmful or challenging. We suggest that chronic stressors and non-events could be equally harmful as an event. If the problem is seen as stressful, the person will try to manage it (problem-focused coping) and/or to regulate the distress (emotion-focused coping). Folkman (1997) has revised this model and added meaning-based coping, which includes positive reappraisal of the situation, goal-directed problem-focused coping, spiritual beliefs and practices, and the infusion of ordinary events with positive meaning.
Very few studies have focused on the relationship between social and economic circumstances and coping (Thoits, 1995; Taylor and Seeman, 1999). Taylor and Seeman (1999) referred to a personal communication from Carver reporting preliminary evidence that avoidant coping was more prevalent when socio-economic status decreased. Ross and Mirowsky (1989) found that highly educated people were more likely to use active problem-solving, which included three elements: (i) not simply ignoring the problem; (ii) figuring out the cause; and (iii) doing something about it. Also, people with high levels of education were more likely to talk with others when faced with a problem. Billings and Moos (1984) found only moderate associations between coping and socio-demographic characteristics among persons entering treatment for depression. Appraisal-focused coping aiming at defining and redefining the personal meaning of the situation, and, among men, problem-focused coping responses seeking to modify or eliminate the source of stress were more likely in more educated respondents. Emotional discharge included letting feelings out, and trying to reduce tension by drinking, eating or smoking more was more common among men with lower occupational status. Westbrook (1979) investigated 200 women who were completing a childbearing year. She reported that working-class mothers used less instrumental coping such as attending prenatal classes and seeking information, they were less likely to choose strategies of confrontation such as taking positive action based on their understanding of a problem, and more likely to select fatalistic mechanisms, e.g. being prepared to expect the worst. Also Grossi (1999) reported that problem-focused coping such as an active, control-oriented attitude towards unemployment was less frequent among participants with a low education coupled with low financial strain.
Based on previous research, we hypothesized that people from higher social classes used more active problem-solving strategies (Westbrook, 1979; Billings and Moos, 1984; Ross and Mirowsky, 1989; Grossi, 1999) and less avoidant coping (Taylor and Seeman, 1999). Higher social classes I+II included professionals, executives and medium level, white collar employees. Active problem-solving strategies included, e.g. asking other people for advice, talking to other people about emotions related to infertility, and to let feelings out. Avoidant coping included strategies such as hoping for a miracle, feeling that the only thing to do was to wait (passive-avoidance), avoid being with pregnant women or children, and trying to keep feelings to themselves (active-avoidance coping). Furthermore, we suggested that the association between social class and coping with infertility could be mediated by how disrupted their life was because of the infertility and the association could further be influenced by the duration of infertility; whether the couple had been in assisted reproduction treatment previously; and whether they already had a child together.
Materials and methods
Setting
Denmark provides a tax-financed, comprehensive health system with equal, free and easy access to high quality assisted reproduction treatment. Among Western European countries, Denmark has the largest proportion of use of assisted reproduction treatment compared to the population (Nyboe Andersen et al., 2004). Data in this study were collected consecutively from Danish-speaking infertile couples beginning a new period of treatment at four public and one private fertility clinic. Three of the four public clinics included were university clinics. The four public clinics covered 62.8% of all IVF, ICSI and oocyte donation cycles conducted at public fertility clinics in Denmark in the years 2000–2001. The study included only 47 respondents from the private clinic. The study is part of an ongoing, prospective cohort study, The Copenhagen Multi-centre Psychosocial Infertility (COMPI) Research Programme (Schmidt et al., 2003a,b).
Procedure
In the period from January 2000 to August 2001, all new couples received a questionnaire, a form for declaration of non-participation in the study, and a stamped, pre-addressed, return envelope for each spouse, immediately before their first treatment attempt at the clinic. The questionnaires were returned to the first author (L.S.), who was not employed at any of the fertility clinics. The clinic staff did not know whether or not a patient was participating in the study. For a more detailed description, see Schmidt et al. (2003a).
The study was assessed by the Scientific Ethical Committee of Copenhagen and Frederiksberg Municipalities and no objections were noted. The study was approved by the Danish Data Protection Agency.
Study population
In total, 2812 people (1406 couples) received a questionnaire, and 2250 (80.0%) participated. Slightly more women (1169, 83.1%) than men (1081, 76.9%) responded after two reminder letters. In 1069 couples, both partners participated in the study. In 100 couples, only the woman responded; and in 12 couples, only the man responded.
Questionnaire
The participants completed the COMPI questionnaire booklet, which contained questions about reproductive history (women only), psychosocial aspects of infertility including fertility problem stress, ways of coping, social relations, sense of coherence, health, and well-being. The following section describes only those materials used for the analyses presented here. A more comprehensive account of the entire project battery is available from the first author (L.S.).
Measurements
Medical background information included the following variables: years infertile; past fertility treatment; and diagnosis. Diagnosis was recoded into female infertility (no, yes) and male infertility (no, yes).
Socio-demographic background information included the following variables: age; years of cohabitation; having a child together; and social position. A standardized measure of social position included seven items about school education, vocational training, and occupation. Based on this measure, social position was categorized into a descending scale of occupational social class: from social class I (high) to social class V (low) and social class VI which compromised individuals who received social welfare (Hansen, 1984). Social position was recoded into three levels: high (social classes I+II including professionals, executives and medium level white collar employees), medium (social classes III+IV including low level white collar employees and skilled workers) and low (social classes V+VI including unskilled and semi-skilled workers and participants receiving social benefits).
Ways of coping
As recommended by Folkman and Lazarus (1988) and Costa et al. (1996), we developed a coping questionnaire specifically aimed at measuring coping strategies in relation to a specific stressor: infertility. This 29-item questionnaire was developed from three sources: (i) items were adapted from the 66-item Ways of Coping Questionnaire (WOCQ), a process-oriented measure of coping derived from Lazarus and Folkman's (1984)Folkman and Lazarus' (1988) and transactional model of stress; (ii) Folkman's (1997) later revision of the coping model with the inclusion of the new concept, meaning-based coping; and (iii) items developed from qualitative interviews with 32 infertile Danish men and women about infertility-related distress and coping (Schmidt, 1996) (see Table I). An item was selected from WOCQ if this specific way of coping was clearly manifested in the qualitative interview transcripts. In total, 18 items were selected from WOCQ; and seven of these were re-formulated to focus on the specific stressor infertility. Further, we developed 11 items based on the results from the interview study. These 29 items covered a wide range of responses that the participants may have engaged in dealing with the fertility problem. The items were categorized into four subscales based on their conceptual content: (1) active-avoidance strategies (e.g. avoid pregnant women or children); (2) active-confronting strategies (e.g. show feelings, ask others for advice); (3) passive-avoidance strategies (e.g. hope for a miracle); and (4) meaning-based coping (e.g. pray, find other goals in life). The response key was (1) not used, (2) used somewhat, (3) used quite a bit and (4) used a great deal.
The subscales comprised items that were significantly intercorrelated (marked with an asterisk in Table I). Ten items did not fit the scales, and these items were excluded from the analyses. The spouses' scores were intercorrelated for each scale: active-avoidance scale, r=0.35; active-confronting scale, r=0.35; passive-avoidance scale, r=0.37; and meaning-based coping, r=0.36. A confirmatory factor analysis showed goodness-of-fit-index (GFI)=0.88 for the entire model. When subscales were removed from the model one at a time the GFI were >0.91. The factor analyses were calculated in SAS, version 8.02, using proc calis and the macro polychor.sas (htpp://ftp.sas.com/techsup/download/stat/polychor.html). Each subscale was dichotomized into high and low. The threshold point was chosen in such a way that approximately one-third of the respondents were categorized as high. The choice of threshold points was confirmed by sensitivity analyses in order to make sure that the dichotomization did not hide important information about the studied statistical associations. The number of items, range, mean, Cronbach's coefficient alpha, and threshold point for the dichotomy are reported in Table II. We included responses for each subscale only for those participants who had answered at least half of the items in that subscale.
Fertility problem stress
The psychosocial impact of infertility was measured using 16 items concerned with the benefits and strains related to infertility in the personal, social and marital domains. Seven of these items were taken from The Fertility Problem Stress Inventory (Abbey et al., 1991). In this study, we included three subscales in the analyses: marital benefit; stress in the marital domain; and stress in the social domain. Marital benefit (two items) measured the extent to which infertility had strengthened the marital relationship. Infertility-related stress in the marital domain (four items) assessed the extent to which infertility had produced strain on the marital and sexual relationship. Infertility-related stress in the social domain (four items) assessed the stress that infertility had produced on social relations with family, friends and workmates. The response categories from the marital benefit subscale and two items from the marital stress subscale comprised a 5-point Likert response key from (1) strongly disagree to (5) strongly agree. The response key for the remaining two items of the marital stress subscale and for the social stress subscale was a 4-point scale from (1) none at all to (4) a great deal. Further details about these subscales are reported in Table II.
Disruption of life
The participants' assessment of how infertility had disrupted their life was measured by the item: ‘My life has been disrupted because of this fertility problem'. The response key was a 5-point Likert scale from (1) strongly agree, to (5) strongly disagree (Abbey et al., 1991). This measure was used as a proxy measure for the appraisal of how the stressor infertility was experienced.
Questionnaire pilot test and translation
The questionnaire was pilot-tested among 122 infertile people. The pilot-test showed appropriate distribution of scores across the different response categories, and few items had to be reformulated. Items originally written in English were translated into Danish by two people independently, back-translated into English by two other people, and finally compared for conceptual correspondence. Most of the items were nearly identically translated and back-translated.
Non-respondents
In total, 562 subjects (20.0%) did not participate. It was possible to obtain ages for 305 (54.2%) of these non-respondents. When separated into three age groups (≤30, 31–35, >35 years) the female non-respondents were significantly older (23.0, 44.8, 32.2%) than the women who participated (25.9, 56.0, 18.1%, χ2=18.72, df=2, P<0.001). The same was true for the men who did not participate (13.0, 34.4, 52.7%) compared to men who participated (15.0, 50.6, 34.4%, χ2=16.59, df=2, P<0.001). We did not have information about social position for non-respondents.
Data analyses
The four coping scales were coded as ‘one’ or ‘zero’ with ‘one’ signifying approximately the third with highest scale values. We used similar threshold points for women and men, despite the differences in distribution of scale values (Table II). The association between social class and the four different coping subscales was calculated by odds ratios separately for women and men. We hypothesized that the variables age, a child together, years of cohabitation, years of infertility, previous fertility treatment, fertility diagnosis, infertility-related marital benefit, infertility-related stress in the marital domain and in the social domain, and disruption of life could influence the relationship between social class and coping. The variables previous fertility treatment, fertility diagnosis, and infertility-related stress in the social domain were found not to be associated with the determinant social position and, consequently, were deleted from the multivariate models. The analyses regarding the use of the four different coping strategies were carried out using logistic regression. All analyses were performed separately for women and men, because the correlation between spouse scores would mean that the independence assumption in regression would be violated. For each of the regression analyses, the following list of covariates was included: age; the couple having a child together; years of cohabitation; years infertile; infertility-related marital stress; infertility-related marital benefit; and disruption of life. The exact number of years was used for age. We calculated (i) the age-adjusted crude odds ratios and (ii) the adjusted odds ratios where all covariates were included in the model at the same time. Finally, we included two alternative measures of social position in the model, one by one: educational level and family social class (i.e. the occupational social class of the highest ranking spouse). Analyses were performed in SAS, version 6.12.
Results
Table II shows key data about the participants and the variables included in the analyses. Women had a non-significantly higher mean value than men on the four coping scales. The distribution of occupational social class was significantly different among men and women (χ2=59.10, df=3, P<0.001). The mean age was 31.8 years among women and 34.1 years among men; and the mean duration of cohabitation was ∼7.7 years. Only 4.6% had a child together and the mean duration of infertility was 4.1 years. The majority of participants had prior experience with fertility treatment. Approximately 35% reported a diagnosis that indicated female infertility (e.g. blocked tubes and/or irregular ovulation or anovulation); and ∼40% reported a diagnosis that indicated male infertility (e.g. decreased semen quality).
The mean values for the marital benefit scale, and for the marital stress scale, were similar for women and men, whereas women had an insignificantly higher mean value on the infertility-related social stress scale than men. Finally, more women than men reported that their lives had been disrupted because of infertility.
Table III shows the age-adjusted odds ratios and the fully adjusted odds ratios for use of the four coping scales by social class. Among both women and men, the use of active-avoidance coping decreased significantly with decreasing social class. The odds ratios of ∼0.50 illustrate that this coping response was used only half as often in the lowest social classes V+VI as in the higher social classes.
Among women, the use of active-confronting coping increased significantly when occupational social classes V+VI were compared with social classes I+II. There was a significantly elevated level of active-confronting coping among male participants from social classes III+IV but not among male participants from social classes V+VI. Passive-avoidance coping increased significantly with decreasing social class among both women and men. The association was particularly strong among men, where the odds ratio (95% CI) in social classes V+VI was 2.85 (1.93–4.24). Meaning-based coping was more common among women from the lowest social classes V+VI (multivariate OR; 95% CI, 1.49; 0.99–2.25), but a similar association was not observed among men.
In all the analyses, the odds ratios attenuated from the univariate model to the multivariate model. Because we were curious to see if this attenuation was related to any particular covariate we repeated all analyses, with exclusion of each covariate, one at a time. It appeared that the attenuation was not related to any covariate in particular, but all covariates contributed a little (analyses not shown). The analyses which included education together with family social class did not change the pattern of associations between social position and coping response (data not shown).
Discussion
We expected that people from higher social classes used a broader coping repertoire and that they would use more active problem-solving coping strategies. Contrary to this, we found that women from higher classes I+II used significantly less active-confronting coping and less meaning-based coping when compared with women from the lowest social classes V+VI. Among men, there was a significant identical relationship for active-confronting coping when the highest social classes I+II were compared with the medium social classes III+IV. A possible explanation of these social differences in active-confrontive coping could be that our measure of this coping strategy included items about seeking infertility-related information. People from higher social classes might be more informed before starting fertility treatment. In our study, however, all participants had done something about the problem by seeking assisted reproduction treatment at highly specialized fertility clinics. In Denmark, as mentioned, assisted reproduction treatment is free of charge, offered in a tax-financed health system with equal and easy access. Other studies have indicated that highly educated people are more likely to use problem-focused strategies as doing something about a problem, figuring out the cause, thinking through the situation and seeking information (Westbrook, 1979; Billings and Moos, 1984; Ross and Mirowsky, 1989; Grossi, 1999).
We also expected that people from higher social classes would use less avoidant coping strategies. We measured avoidance coping in two different scales: active-avoidance (e.g. leaving when people talk about pregnancies and children); and passive-avoidance (e.g. hoping for a miracle). Both women and men from occupational social classes III–VI used passive-avoidance coping strategies significantly more than people from higher social classes. This is in accordance with a preliminary finding by Carver reported in Taylor and Seeman (1999). On the other hand, both women and men from social classes III–VI used the active-avoidance coping strategies less frequently than people from higher social classes. The active-avoidance coping scale included an item about turning to work, or other substitute activity, to take the mind off things. It could be that it is more appealing for people from higher social classes to turn to work activities, as many highly educated people perceive their jobs as more stimulating and flexible.
These remarkable social differences in coping strategies could be interpreted as a contextual effect: an exposure to children in one's social network. As well-educated people in Denmark postpone having children (Knudsen, 1993), we assume that couples from lower social classes have more friends, family members and colleagues with children than couples from higher social classes. Data from Denmark in the year 2000, when the COMPI data collection started, showed that only 20.6% of women from lower social classes, aged 30–39 years, were childless compared to 29.1% of women from higher social classes. Ten years earlier, in 1990, 66.1% of women from lower social classes, aged 20–29 years, were childless compared to 81.9% of women from higher social classes (L.B.Knudsen, personal communication). The COMPI participants have tried to become parents during this 10 year period.
In this paper, we applied Folkman and Lazarus' transactional approach to coping, i.e. coping was not seen as a personality trait but as reactions adopted through experience and learned from one's social environment and reference groups. Based on the above-mentioned population data about childlessness, we suggest that COMPI participants from lower social classes experienced greater exposure to other people's children. Infertile people from lower social classes, therefore from a younger age, have had a longer time to learn to manage situations in which pregnancies and children are being discussed, which may explain why these participants do not feel compelled to avoid such conversations. In a prospective, qualitative interview study among infertile couples, Wirtberg (1992) showed how social context influenced the experience of infertility. Infertility and childlessness affected ‘women in all areas of life. There is no context where relief can be obtained.’ (p. 70). For women, there were no ‘pain-free zones’. In contrast, work and spare-time activities were, for most men ‘pain-free zones’ (p. 71) where they were not confronted with their infertility.
The study was well-suited to the research question raised. First of all, the Danish setting, with free and easy access to high quality assisted reproduction treatment, makes selection bias due to health system factors less likely. Our study included participants from clinics in urban and more rural areas and the public clinics involved covered >60% of all the public assisted reproduction treatment in Denmark. Second, the study dealt with a stressor that is probably independent of social class. We were thus able to avoid the problem of uneven exposure to the stressor. Third, the study population was homogeneous with respect to the stressor; all participants were infertile and seeking assisted reproduction treatment, which made the study appropriate for the investigation of coping responses. Fourth, the study population was large, it covered all new patients in four large public fertility clinics, and it had a high response rate. Thus selection bias was low. Finally, coping strategies were studied with an instrument developed specifically to measure coping in relation to infertility. Less than four per cent of the participants were non-responsive to these items.
An important limitation in this study is the highly selected study population which only comprises participants who have decided to seek assisted reproduction treatment. We were thus unable to observe coping processes and their social gradient among infertile people not seeking assisted reproduction treatment. Population-based studies about infertility in Denmark have shown that, around 1990, >50–60% of infertile people sought assisted reproduction treatment (Schmidt et al., 1995; Olsen et al., 1996). Today, with the development of new technologies such as ICSI, we assume that a higher proportion of infertile people in Denmark seek medical help. It is possible that both infertile people not seeking assisted reproduction treatment and the 20% non-responders might use coping strategies different from those used by the participants we have studied. We included the participants at a very stressful period in their infertility process, namely at the beginning of a new treatment period. In a follow-up study among former female fertility patients having their intensive treatment period ≥6 years earlier, the mean scores of the psychological tests were not different from the reference values of the tests (Sundby, 1992). In a longitudinal study among IVF couples, Verhaak et al. (2003) showed that among women anxiety and depression increased during unsuccessful cycles and at the 6 month follow-up after the final cycle only limited signs of psychological recovery was identified. Among the men there were no significant changes in depression and anxiety. We suggest that infertility-related adaptation and coping change over time and that these changes could affect the associations between occupational social class and coping strategies studied. We have not measured personality traits and are hence unable to study whether previous psychological problems aggravate infertility-related stress and whether this affects the coping strategies used. A further limitation in the findings was the exclusion of immigrant minorities.
The Ways of Coping Questionnaire (WOCQ) has been used previously to study coping responses among infertile people. Some studies have included the total 66-item version of WOCQ (Litt et al., 1992; Slade et al., 1992; Stanton et al., 1992; Prattke and Gass-Sternas, 1993; Pook et al., 1999; Dhillon et al., 2000) while other researchers have selected two or three subscales from WOCQ (Dray et al., 1988; Abbey et al., 1991; Morrow et al., 1995; Lukse and Vacc, 1999). Jordan and Revenson (1999) conducted a meta-analysis of six of those studies (Dray et al., 1988; Abbey et al., 1991; Slade et al., 1992; Stanton et al., 1992; Prattke and Gass-Sternas, 1993; Morrow et al., 1995). The WOCQ subscales used in previous infertility studies are subscales based on factor analysis of coping responses from: (i) a sample of 85 middle-aged, married couples with at least one child at home (Folkman et al., 1986); and (ii) a sample of 291 randomly-selected women and men aged 18–74 years (Aldwin and Revenson, 1987). In contrast, as recommended (Folkman and Lazarus, 1988; Costa et al., 1996), we studied coping strategies with an instrument especially developed for the measurement of coping in relation to the specific stressor infertility. This measurement was based on the WOCQ developed by Folkman and Lazarus (1988) as well as on qualitative interviews about coping responses among infertile couples (Schmidt, 1996). The conceptually derived substantial four coping subscales were confirmed by factor analysis. Although the coping measure was carefully developed, it still needs to be validated and tested for reliability in other study populations.
Jordan and Revenson (1999) studied in their meta-analysis gender differences in coping with infertility. Eight subscales of WOCQ were studied and significant gender differences were identified for four of the strategies: women used the strategies of seeking social support, escape-avoidance, planful problem-solving, and positive reappraisal to a greater degree than their partners. In our study, women used each of the four coping strategies significantly more than the men. However, we identified no gender differences between any of the associations between occupational social class and coping. All the 16 significant and non-significant associations were in the same direction when women were compared with men.
The distribution of participants according to occupational social class was fairly similar to the background population, as demonstrated in a recent survey based on a random sample of 40 year olds in Denmark. The disparities in occupational social class among the participants were large and appropriate for the analyses. We also applied two alternative indicators of social position: education and family social class, but these two measures did not attenuate the associations between occupational social class and coping.
One of the main results was that infertile people from higher social classes I–II used active-avoidance strategies significantly more than infertile patients from the lower social classes. We interpret the active-avoidance strategy studies as a kind of defence strategy protecting the infertile participant from some of the emotional burden of the infertility experience. It seems important for fertility clinic staff to be aware that patients from higher social classes could have a greater need for counselling about how they could manage their infertility, especially when being together with family and friends who are pregnant or who have children.
In conclusion, we showed, contrary to our expectations, that among infertile participants in assisted reproduction treatment, women from the lowest social classes V+VI used more active-confronting coping and more meaning-based coping than women from the highest social classes I+II. Moreover, both men and women from social classes III–VI used more passive-avoidance and less active-avoidance coping compared to people from social classes I+II. The study thus suggested that elements of coping may be learned from one's social network and reference group. There were no gender differences in the associations between occupational social class and the coping strategies studies. Further, our study supported the understanding of the coping process as a contextual response to stressors.
People cope with their fertility problem in different ways. How do you cope? I … . | Origin of the itema . | Included in the subscale . | ||
---|---|---|---|---|
Active-avoidance Coping Scale | ||||
a. avoid being with pregnant women or children | 2 | * | ||
b. leave, when people are talking about pregnancies and children | 3 | * | ||
c. try to keep my feelings to myself | 1 | * | ||
d. turn to work or substitute activity to take my mind off things | 1 | * | ||
e. avoid participating in consultations (men only) | 3 | |||
Active-confronting Coping Scale | ||||
a. let my feelings out somehow | 1 | * | ||
b. accept sympathy and understanding from someone | 1 | * | ||
c. ask other childless people for advice | 2 | * | ||
d. ask a relative or friend for advice | 1 | * | ||
e. read or watch television about childlessness | 3 | * | ||
f. talk to someone about my emotions as childless | 2 | * | ||
g. talk to someone about how tests and treatments affect me emotionally | 2 | * | ||
h. think about the different ways to become parents (e.g. different treatment options, adoption, fostering) | 2 | |||
i. have close relationships with other people's children | 3 | |||
j. take a break from trying to have (another) child | 3 | |||
k. live a healthy life | 3 | |||
l. use humour | 3 | |||
Passive-avoidance Coping Scale | ||||
a. hope a miracle will happen | 1 | * | ||
b. feel that the only thing I can do is to wait | 1 | * | ||
c. have fantasies and wishes about how things might turn out | 1 | * | ||
d. try to forget everything about our childlessness | 2 | |||
e. avoid reading or hearing about childlessness | 3 | |||
Meaning-based Coping Scale | ||||
a. have grown as a person in a good way | 1 | * | ||
b. think about the fertility problem in a positive light | 2 | * | ||
c. find my marriage/partnership even more valuable now | 3 | * | ||
d. find other life goals | 3 | * | ||
e. believe there is a meaning in our difficulties with having children | 3 | * | ||
f. try to analyse the problem to understand it better | 1 | |||
g. pray | 1 |
People cope with their fertility problem in different ways. How do you cope? I … . | Origin of the itema . | Included in the subscale . | ||
---|---|---|---|---|
Active-avoidance Coping Scale | ||||
a. avoid being with pregnant women or children | 2 | * | ||
b. leave, when people are talking about pregnancies and children | 3 | * | ||
c. try to keep my feelings to myself | 1 | * | ||
d. turn to work or substitute activity to take my mind off things | 1 | * | ||
e. avoid participating in consultations (men only) | 3 | |||
Active-confronting Coping Scale | ||||
a. let my feelings out somehow | 1 | * | ||
b. accept sympathy and understanding from someone | 1 | * | ||
c. ask other childless people for advice | 2 | * | ||
d. ask a relative or friend for advice | 1 | * | ||
e. read or watch television about childlessness | 3 | * | ||
f. talk to someone about my emotions as childless | 2 | * | ||
g. talk to someone about how tests and treatments affect me emotionally | 2 | * | ||
h. think about the different ways to become parents (e.g. different treatment options, adoption, fostering) | 2 | |||
i. have close relationships with other people's children | 3 | |||
j. take a break from trying to have (another) child | 3 | |||
k. live a healthy life | 3 | |||
l. use humour | 3 | |||
Passive-avoidance Coping Scale | ||||
a. hope a miracle will happen | 1 | * | ||
b. feel that the only thing I can do is to wait | 1 | * | ||
c. have fantasies and wishes about how things might turn out | 1 | * | ||
d. try to forget everything about our childlessness | 2 | |||
e. avoid reading or hearing about childlessness | 3 | |||
Meaning-based Coping Scale | ||||
a. have grown as a person in a good way | 1 | * | ||
b. think about the fertility problem in a positive light | 2 | * | ||
c. find my marriage/partnership even more valuable now | 3 | * | ||
d. find other life goals | 3 | * | ||
e. believe there is a meaning in our difficulties with having children | 3 | * | ||
f. try to analyse the problem to understand it better | 1 | |||
g. pray | 1 |
1=selected from Ways of Coping Questionnaire (WOCQ) (Folkman and Lazarus, 1988); 2=selected from WOCQ and re-phrased to the specific situation infertility; 3=new item developed on the basis of qualitative interviews with Danish infertile couples (Schmidt, 1996).
The item significantly intercorrelated with other items and was included in the subscale.
People cope with their fertility problem in different ways. How do you cope? I … . | Origin of the itema . | Included in the subscale . | ||
---|---|---|---|---|
Active-avoidance Coping Scale | ||||
a. avoid being with pregnant women or children | 2 | * | ||
b. leave, when people are talking about pregnancies and children | 3 | * | ||
c. try to keep my feelings to myself | 1 | * | ||
d. turn to work or substitute activity to take my mind off things | 1 | * | ||
e. avoid participating in consultations (men only) | 3 | |||
Active-confronting Coping Scale | ||||
a. let my feelings out somehow | 1 | * | ||
b. accept sympathy and understanding from someone | 1 | * | ||
c. ask other childless people for advice | 2 | * | ||
d. ask a relative or friend for advice | 1 | * | ||
e. read or watch television about childlessness | 3 | * | ||
f. talk to someone about my emotions as childless | 2 | * | ||
g. talk to someone about how tests and treatments affect me emotionally | 2 | * | ||
h. think about the different ways to become parents (e.g. different treatment options, adoption, fostering) | 2 | |||
i. have close relationships with other people's children | 3 | |||
j. take a break from trying to have (another) child | 3 | |||
k. live a healthy life | 3 | |||
l. use humour | 3 | |||
Passive-avoidance Coping Scale | ||||
a. hope a miracle will happen | 1 | * | ||
b. feel that the only thing I can do is to wait | 1 | * | ||
c. have fantasies and wishes about how things might turn out | 1 | * | ||
d. try to forget everything about our childlessness | 2 | |||
e. avoid reading or hearing about childlessness | 3 | |||
Meaning-based Coping Scale | ||||
a. have grown as a person in a good way | 1 | * | ||
b. think about the fertility problem in a positive light | 2 | * | ||
c. find my marriage/partnership even more valuable now | 3 | * | ||
d. find other life goals | 3 | * | ||
e. believe there is a meaning in our difficulties with having children | 3 | * | ||
f. try to analyse the problem to understand it better | 1 | |||
g. pray | 1 |
People cope with their fertility problem in different ways. How do you cope? I … . | Origin of the itema . | Included in the subscale . | ||
---|---|---|---|---|
Active-avoidance Coping Scale | ||||
a. avoid being with pregnant women or children | 2 | * | ||
b. leave, when people are talking about pregnancies and children | 3 | * | ||
c. try to keep my feelings to myself | 1 | * | ||
d. turn to work or substitute activity to take my mind off things | 1 | * | ||
e. avoid participating in consultations (men only) | 3 | |||
Active-confronting Coping Scale | ||||
a. let my feelings out somehow | 1 | * | ||
b. accept sympathy and understanding from someone | 1 | * | ||
c. ask other childless people for advice | 2 | * | ||
d. ask a relative or friend for advice | 1 | * | ||
e. read or watch television about childlessness | 3 | * | ||
f. talk to someone about my emotions as childless | 2 | * | ||
g. talk to someone about how tests and treatments affect me emotionally | 2 | * | ||
h. think about the different ways to become parents (e.g. different treatment options, adoption, fostering) | 2 | |||
i. have close relationships with other people's children | 3 | |||
j. take a break from trying to have (another) child | 3 | |||
k. live a healthy life | 3 | |||
l. use humour | 3 | |||
Passive-avoidance Coping Scale | ||||
a. hope a miracle will happen | 1 | * | ||
b. feel that the only thing I can do is to wait | 1 | * | ||
c. have fantasies and wishes about how things might turn out | 1 | * | ||
d. try to forget everything about our childlessness | 2 | |||
e. avoid reading or hearing about childlessness | 3 | |||
Meaning-based Coping Scale | ||||
a. have grown as a person in a good way | 1 | * | ||
b. think about the fertility problem in a positive light | 2 | * | ||
c. find my marriage/partnership even more valuable now | 3 | * | ||
d. find other life goals | 3 | * | ||
e. believe there is a meaning in our difficulties with having children | 3 | * | ||
f. try to analyse the problem to understand it better | 1 | |||
g. pray | 1 |
1=selected from Ways of Coping Questionnaire (WOCQ) (Folkman and Lazarus, 1988); 2=selected from WOCQ and re-phrased to the specific situation infertility; 3=new item developed on the basis of qualitative interviews with Danish infertile couples (Schmidt, 1996).
The item significantly intercorrelated with other items and was included in the subscale.
Variable . | . | Women (n=1169) . | Men (n=1081) . | P (χ2-test)a . | ||||
---|---|---|---|---|---|---|---|---|
Outcome variables | ||||||||
Active-avoidance Coping Scale (4 items) | Range | 4–16 | 4–16 | <0.001 | ||||
Mean (SD) | 6.98 (2.27) | 6.02 (1.98) | ||||||
Cronbach's alpha | 0.68 | 0.71 | ||||||
Pct >6 points | 50.2 | 29.2 | <0.001 | |||||
Missing (%) | 27 (2.3) | 2 (0.2) | ||||||
Active-confronting Coping Scale (7 items) | Range | 7–26 | 7–26 | <0.001 | ||||
Mean (SD) | 15.67 (4.09) | 13.42 (3.48) | ||||||
Cronbach's alpha | 0.76 | 0.74 | ||||||
Pct >16 points | 42.1 | 17.7 | <0.001 | |||||
Missing (%) | 1 (0.1) | 1 (0.1) | ||||||
Passive-avoidance Coping Scale (3 items) | Range | 3–12 | 3–12 | <0.001 | ||||
Mean (SD) | 9.13 (1.97) | 8.46 (2.15) | ||||||
Cronbach's alpha | 0.46 | 0.55 | ||||||
Pct >9 points | 44.4 | 29.7 | <0.001 | |||||
Missing (%) | 29 (2.5) | 30 (2.8) | ||||||
Meaning-based Coping Scale (5 items) | Range | 5–20 | 5–20 | <0.001 | ||||
Mean (SD) | 11.20 (2.99) | 10.47 (2.89) | ||||||
Cronbach's alpha | 0.59 | 0.53 | ||||||
Pct >11 points | 43.6 | 31.8 | <0.001 | |||||
Missing (%) | 29 (2.5) | 29 (2.7) | ||||||
Determinant | ||||||||
Occupational social class | I–II (%) | 16.3 | 28.7 | |||||
III+IV (%) | 60.3 | 47.5 | ||||||
V+VI (%) | 15.1 | 19.9 | ||||||
Outside classification | 8.3 | 3.9 | <0.001 | |||||
Covariates | ||||||||
Age | Mean (SD) | 31.76 (3.67) | 34.12 (5.11) | <0.001 | ||||
Missing (%) | 1 (0.1) | 2 (0.2) | ||||||
Years of cohabitation | Mean (SD) | 7.77 (3.76) | 7.69 (3.69) | 0.750 | ||||
Missing (%) | 35 (3.0) | 13 (1.2) | ||||||
Child together | Yes (%) | 4.5 | 4.8 | 0.754 | ||||
Missing (%) | 30 (2.6) | 4 (0.4) | ||||||
Years of infertility | Mean (SD) | 4.14 (2.32) | 4.10 (2.21) | 0.442 | ||||
Missing (%) | 18 (1.5) | 14 (1.3) | ||||||
Previous fertility treatment | Yes (%) | 59.4 | 56.2 | 0.252 | ||||
Missing (%) | 19 (1.6) | 10 (0.9) | ||||||
Female infertility | Yes (%) | 36.6 | 34.8 | 0.429 | ||||
Missing (%) | 0 (0.0) | 0 (0.0) | ||||||
Male infertility | Yes (%) | 40.0 | 41.1 | 0.579 | ||||
Missing (%) | 0 (0.0) | 0 (0.0) | ||||||
Infertility-related Marital Benefit (2 items) | Range | 0–8 | 0–8 | 0.009 | ||||
Mean (SD) | 5.79 (1.88) | 5.36 (2.06) | ||||||
Pearson's correlation | 0.83 | 0.84 | ||||||
Missing (%) | 38 (3.3) | 35 (3.2) | ||||||
Infertility-related Stress, Marital Domain (4 items) | Range | 0–14 | 0–14 | 0.110 | ||||
Mean (SD) | 3.96 (3.19) | 3.82 (3.14) | ||||||
Cronbach's alpha | 0.73 | 0.72 | ||||||
Missing (%) | 48 (4.1) | 39 (3.6) | ||||||
Infertility-related Stress, Social Domain (4 items) | Range | 0–12 | 0–12 | <0.001 | ||||
Mean (SD) | 2.24 (2.55) | 1.45 (2.19) | ||||||
Cronbach's alpha | 0.79 | 0.84 | ||||||
Missing (%) | 25 (2.1) | 30 (2.8) | ||||||
Infertility-caused disruption of life | Range | 1–5 | 1–5 | <0.001 | ||||
Mean (SD) | 2.76 (1.26) | 3.14 (1.29) | ||||||
Missing (%) | 29 (2.5) | 31 (2.9) |
Variable . | . | Women (n=1169) . | Men (n=1081) . | P (χ2-test)a . | ||||
---|---|---|---|---|---|---|---|---|
Outcome variables | ||||||||
Active-avoidance Coping Scale (4 items) | Range | 4–16 | 4–16 | <0.001 | ||||
Mean (SD) | 6.98 (2.27) | 6.02 (1.98) | ||||||
Cronbach's alpha | 0.68 | 0.71 | ||||||
Pct >6 points | 50.2 | 29.2 | <0.001 | |||||
Missing (%) | 27 (2.3) | 2 (0.2) | ||||||
Active-confronting Coping Scale (7 items) | Range | 7–26 | 7–26 | <0.001 | ||||
Mean (SD) | 15.67 (4.09) | 13.42 (3.48) | ||||||
Cronbach's alpha | 0.76 | 0.74 | ||||||
Pct >16 points | 42.1 | 17.7 | <0.001 | |||||
Missing (%) | 1 (0.1) | 1 (0.1) | ||||||
Passive-avoidance Coping Scale (3 items) | Range | 3–12 | 3–12 | <0.001 | ||||
Mean (SD) | 9.13 (1.97) | 8.46 (2.15) | ||||||
Cronbach's alpha | 0.46 | 0.55 | ||||||
Pct >9 points | 44.4 | 29.7 | <0.001 | |||||
Missing (%) | 29 (2.5) | 30 (2.8) | ||||||
Meaning-based Coping Scale (5 items) | Range | 5–20 | 5–20 | <0.001 | ||||
Mean (SD) | 11.20 (2.99) | 10.47 (2.89) | ||||||
Cronbach's alpha | 0.59 | 0.53 | ||||||
Pct >11 points | 43.6 | 31.8 | <0.001 | |||||
Missing (%) | 29 (2.5) | 29 (2.7) | ||||||
Determinant | ||||||||
Occupational social class | I–II (%) | 16.3 | 28.7 | |||||
III+IV (%) | 60.3 | 47.5 | ||||||
V+VI (%) | 15.1 | 19.9 | ||||||
Outside classification | 8.3 | 3.9 | <0.001 | |||||
Covariates | ||||||||
Age | Mean (SD) | 31.76 (3.67) | 34.12 (5.11) | <0.001 | ||||
Missing (%) | 1 (0.1) | 2 (0.2) | ||||||
Years of cohabitation | Mean (SD) | 7.77 (3.76) | 7.69 (3.69) | 0.750 | ||||
Missing (%) | 35 (3.0) | 13 (1.2) | ||||||
Child together | Yes (%) | 4.5 | 4.8 | 0.754 | ||||
Missing (%) | 30 (2.6) | 4 (0.4) | ||||||
Years of infertility | Mean (SD) | 4.14 (2.32) | 4.10 (2.21) | 0.442 | ||||
Missing (%) | 18 (1.5) | 14 (1.3) | ||||||
Previous fertility treatment | Yes (%) | 59.4 | 56.2 | 0.252 | ||||
Missing (%) | 19 (1.6) | 10 (0.9) | ||||||
Female infertility | Yes (%) | 36.6 | 34.8 | 0.429 | ||||
Missing (%) | 0 (0.0) | 0 (0.0) | ||||||
Male infertility | Yes (%) | 40.0 | 41.1 | 0.579 | ||||
Missing (%) | 0 (0.0) | 0 (0.0) | ||||||
Infertility-related Marital Benefit (2 items) | Range | 0–8 | 0–8 | 0.009 | ||||
Mean (SD) | 5.79 (1.88) | 5.36 (2.06) | ||||||
Pearson's correlation | 0.83 | 0.84 | ||||||
Missing (%) | 38 (3.3) | 35 (3.2) | ||||||
Infertility-related Stress, Marital Domain (4 items) | Range | 0–14 | 0–14 | 0.110 | ||||
Mean (SD) | 3.96 (3.19) | 3.82 (3.14) | ||||||
Cronbach's alpha | 0.73 | 0.72 | ||||||
Missing (%) | 48 (4.1) | 39 (3.6) | ||||||
Infertility-related Stress, Social Domain (4 items) | Range | 0–12 | 0–12 | <0.001 | ||||
Mean (SD) | 2.24 (2.55) | 1.45 (2.19) | ||||||
Cronbach's alpha | 0.79 | 0.84 | ||||||
Missing (%) | 25 (2.1) | 30 (2.8) | ||||||
Infertility-caused disruption of life | Range | 1–5 | 1–5 | <0.001 | ||||
Mean (SD) | 2.76 (1.26) | 3.14 (1.29) | ||||||
Missing (%) | 29 (2.5) | 31 (2.9) |
χ2 is calculated from the contingency tables.
Variable . | . | Women (n=1169) . | Men (n=1081) . | P (χ2-test)a . | ||||
---|---|---|---|---|---|---|---|---|
Outcome variables | ||||||||
Active-avoidance Coping Scale (4 items) | Range | 4–16 | 4–16 | <0.001 | ||||
Mean (SD) | 6.98 (2.27) | 6.02 (1.98) | ||||||
Cronbach's alpha | 0.68 | 0.71 | ||||||
Pct >6 points | 50.2 | 29.2 | <0.001 | |||||
Missing (%) | 27 (2.3) | 2 (0.2) | ||||||
Active-confronting Coping Scale (7 items) | Range | 7–26 | 7–26 | <0.001 | ||||
Mean (SD) | 15.67 (4.09) | 13.42 (3.48) | ||||||
Cronbach's alpha | 0.76 | 0.74 | ||||||
Pct >16 points | 42.1 | 17.7 | <0.001 | |||||
Missing (%) | 1 (0.1) | 1 (0.1) | ||||||
Passive-avoidance Coping Scale (3 items) | Range | 3–12 | 3–12 | <0.001 | ||||
Mean (SD) | 9.13 (1.97) | 8.46 (2.15) | ||||||
Cronbach's alpha | 0.46 | 0.55 | ||||||
Pct >9 points | 44.4 | 29.7 | <0.001 | |||||
Missing (%) | 29 (2.5) | 30 (2.8) | ||||||
Meaning-based Coping Scale (5 items) | Range | 5–20 | 5–20 | <0.001 | ||||
Mean (SD) | 11.20 (2.99) | 10.47 (2.89) | ||||||
Cronbach's alpha | 0.59 | 0.53 | ||||||
Pct >11 points | 43.6 | 31.8 | <0.001 | |||||
Missing (%) | 29 (2.5) | 29 (2.7) | ||||||
Determinant | ||||||||
Occupational social class | I–II (%) | 16.3 | 28.7 | |||||
III+IV (%) | 60.3 | 47.5 | ||||||
V+VI (%) | 15.1 | 19.9 | ||||||
Outside classification | 8.3 | 3.9 | <0.001 | |||||
Covariates | ||||||||
Age | Mean (SD) | 31.76 (3.67) | 34.12 (5.11) | <0.001 | ||||
Missing (%) | 1 (0.1) | 2 (0.2) | ||||||
Years of cohabitation | Mean (SD) | 7.77 (3.76) | 7.69 (3.69) | 0.750 | ||||
Missing (%) | 35 (3.0) | 13 (1.2) | ||||||
Child together | Yes (%) | 4.5 | 4.8 | 0.754 | ||||
Missing (%) | 30 (2.6) | 4 (0.4) | ||||||
Years of infertility | Mean (SD) | 4.14 (2.32) | 4.10 (2.21) | 0.442 | ||||
Missing (%) | 18 (1.5) | 14 (1.3) | ||||||
Previous fertility treatment | Yes (%) | 59.4 | 56.2 | 0.252 | ||||
Missing (%) | 19 (1.6) | 10 (0.9) | ||||||
Female infertility | Yes (%) | 36.6 | 34.8 | 0.429 | ||||
Missing (%) | 0 (0.0) | 0 (0.0) | ||||||
Male infertility | Yes (%) | 40.0 | 41.1 | 0.579 | ||||
Missing (%) | 0 (0.0) | 0 (0.0) | ||||||
Infertility-related Marital Benefit (2 items) | Range | 0–8 | 0–8 | 0.009 | ||||
Mean (SD) | 5.79 (1.88) | 5.36 (2.06) | ||||||
Pearson's correlation | 0.83 | 0.84 | ||||||
Missing (%) | 38 (3.3) | 35 (3.2) | ||||||
Infertility-related Stress, Marital Domain (4 items) | Range | 0–14 | 0–14 | 0.110 | ||||
Mean (SD) | 3.96 (3.19) | 3.82 (3.14) | ||||||
Cronbach's alpha | 0.73 | 0.72 | ||||||
Missing (%) | 48 (4.1) | 39 (3.6) | ||||||
Infertility-related Stress, Social Domain (4 items) | Range | 0–12 | 0–12 | <0.001 | ||||
Mean (SD) | 2.24 (2.55) | 1.45 (2.19) | ||||||
Cronbach's alpha | 0.79 | 0.84 | ||||||
Missing (%) | 25 (2.1) | 30 (2.8) | ||||||
Infertility-caused disruption of life | Range | 1–5 | 1–5 | <0.001 | ||||
Mean (SD) | 2.76 (1.26) | 3.14 (1.29) | ||||||
Missing (%) | 29 (2.5) | 31 (2.9) |
Variable . | . | Women (n=1169) . | Men (n=1081) . | P (χ2-test)a . | ||||
---|---|---|---|---|---|---|---|---|
Outcome variables | ||||||||
Active-avoidance Coping Scale (4 items) | Range | 4–16 | 4–16 | <0.001 | ||||
Mean (SD) | 6.98 (2.27) | 6.02 (1.98) | ||||||
Cronbach's alpha | 0.68 | 0.71 | ||||||
Pct >6 points | 50.2 | 29.2 | <0.001 | |||||
Missing (%) | 27 (2.3) | 2 (0.2) | ||||||
Active-confronting Coping Scale (7 items) | Range | 7–26 | 7–26 | <0.001 | ||||
Mean (SD) | 15.67 (4.09) | 13.42 (3.48) | ||||||
Cronbach's alpha | 0.76 | 0.74 | ||||||
Pct >16 points | 42.1 | 17.7 | <0.001 | |||||
Missing (%) | 1 (0.1) | 1 (0.1) | ||||||
Passive-avoidance Coping Scale (3 items) | Range | 3–12 | 3–12 | <0.001 | ||||
Mean (SD) | 9.13 (1.97) | 8.46 (2.15) | ||||||
Cronbach's alpha | 0.46 | 0.55 | ||||||
Pct >9 points | 44.4 | 29.7 | <0.001 | |||||
Missing (%) | 29 (2.5) | 30 (2.8) | ||||||
Meaning-based Coping Scale (5 items) | Range | 5–20 | 5–20 | <0.001 | ||||
Mean (SD) | 11.20 (2.99) | 10.47 (2.89) | ||||||
Cronbach's alpha | 0.59 | 0.53 | ||||||
Pct >11 points | 43.6 | 31.8 | <0.001 | |||||
Missing (%) | 29 (2.5) | 29 (2.7) | ||||||
Determinant | ||||||||
Occupational social class | I–II (%) | 16.3 | 28.7 | |||||
III+IV (%) | 60.3 | 47.5 | ||||||
V+VI (%) | 15.1 | 19.9 | ||||||
Outside classification | 8.3 | 3.9 | <0.001 | |||||
Covariates | ||||||||
Age | Mean (SD) | 31.76 (3.67) | 34.12 (5.11) | <0.001 | ||||
Missing (%) | 1 (0.1) | 2 (0.2) | ||||||
Years of cohabitation | Mean (SD) | 7.77 (3.76) | 7.69 (3.69) | 0.750 | ||||
Missing (%) | 35 (3.0) | 13 (1.2) | ||||||
Child together | Yes (%) | 4.5 | 4.8 | 0.754 | ||||
Missing (%) | 30 (2.6) | 4 (0.4) | ||||||
Years of infertility | Mean (SD) | 4.14 (2.32) | 4.10 (2.21) | 0.442 | ||||
Missing (%) | 18 (1.5) | 14 (1.3) | ||||||
Previous fertility treatment | Yes (%) | 59.4 | 56.2 | 0.252 | ||||
Missing (%) | 19 (1.6) | 10 (0.9) | ||||||
Female infertility | Yes (%) | 36.6 | 34.8 | 0.429 | ||||
Missing (%) | 0 (0.0) | 0 (0.0) | ||||||
Male infertility | Yes (%) | 40.0 | 41.1 | 0.579 | ||||
Missing (%) | 0 (0.0) | 0 (0.0) | ||||||
Infertility-related Marital Benefit (2 items) | Range | 0–8 | 0–8 | 0.009 | ||||
Mean (SD) | 5.79 (1.88) | 5.36 (2.06) | ||||||
Pearson's correlation | 0.83 | 0.84 | ||||||
Missing (%) | 38 (3.3) | 35 (3.2) | ||||||
Infertility-related Stress, Marital Domain (4 items) | Range | 0–14 | 0–14 | 0.110 | ||||
Mean (SD) | 3.96 (3.19) | 3.82 (3.14) | ||||||
Cronbach's alpha | 0.73 | 0.72 | ||||||
Missing (%) | 48 (4.1) | 39 (3.6) | ||||||
Infertility-related Stress, Social Domain (4 items) | Range | 0–12 | 0–12 | <0.001 | ||||
Mean (SD) | 2.24 (2.55) | 1.45 (2.19) | ||||||
Cronbach's alpha | 0.79 | 0.84 | ||||||
Missing (%) | 25 (2.1) | 30 (2.8) | ||||||
Infertility-caused disruption of life | Range | 1–5 | 1–5 | <0.001 | ||||
Mean (SD) | 2.76 (1.26) | 3.14 (1.29) | ||||||
Missing (%) | 29 (2.5) | 31 (2.9) |
χ2 is calculated from the contingency tables.
. | Women . | . | Men . | . | ||||
---|---|---|---|---|---|---|---|---|
. | Age-adjusted crude OR . | Fully adjusteda OR . | Age-adjusted crude OR . | Fully adjusteda OR . | ||||
Active-avoidance Coping Scale | ||||||||
Social classes I+II | 1 | 1 | 1 | 1 | ||||
Social classes III+IV | 0.84 (0.64–1.10) | 0.69 (0.51–0.94)* | 0.97 (0.73–1.28) | 0.57 (0.41–0.79)* | ||||
Social classes V+VI | 0.75 (0.52–1.07) | 0.52 (0.34–0.78)* | 0.98 (0.69–1.40) | 0.54 (0.36–0.81)* | ||||
Active-confronting Coping Scale | ||||||||
Social classes I+II | 1 | 1 | 1 | 1 | ||||
Social classes III+IV | 1.30 (0.98–1.72) | 1.14 (0.84–1.53) | 2.04 (1.43–2.89)* | 1.54 (1.06–2.26)* | ||||
Social classes V+VI | 1.78 (1.24–2.57)* | 1.41 (0.95–2.11)* | 1.84 (1.19–2.84)* | 1.27 (0.79–2.04) | ||||
Passive-avoidance Coping Scale | ||||||||
Social classes I+II | 1 | 1 | 1 | 1 | ||||
Social classes III+IV | 1.64 (1.24–2.17)* | 1.47 (1.09–1.99)* | 2.80 (2.06–3.80)* | 2.03 (1.45–2.83)* | ||||
Social classes V+VI | 2.29 (1.59–3.32)* | 1.61 (1.08–2.40)* | 4.05 (2.81–5.83)* | 2.85 (1.93–4.24)* | ||||
Meaning-based Coping Scale | ||||||||
Social classes I+II | 1 | 1 | 1 | 1 | ||||
Social classes III+IV | 1.11 (0.85–1.47) | 0.91 (0.67–1.24) | 1.67 (1.26–2.22)* | 1.10 (0.80–1.51) | ||||
Social classes V+VI | 1.77 (1.23–2.54)* | 1.49 (0.99–2.25)* | 2.24 (1.59–3.16)* | 1.31 (0.89–1.93) |
. | Women . | . | Men . | . | ||||
---|---|---|---|---|---|---|---|---|
. | Age-adjusted crude OR . | Fully adjusteda OR . | Age-adjusted crude OR . | Fully adjusteda OR . | ||||
Active-avoidance Coping Scale | ||||||||
Social classes I+II | 1 | 1 | 1 | 1 | ||||
Social classes III+IV | 0.84 (0.64–1.10) | 0.69 (0.51–0.94)* | 0.97 (0.73–1.28) | 0.57 (0.41–0.79)* | ||||
Social classes V+VI | 0.75 (0.52–1.07) | 0.52 (0.34–0.78)* | 0.98 (0.69–1.40) | 0.54 (0.36–0.81)* | ||||
Active-confronting Coping Scale | ||||||||
Social classes I+II | 1 | 1 | 1 | 1 | ||||
Social classes III+IV | 1.30 (0.98–1.72) | 1.14 (0.84–1.53) | 2.04 (1.43–2.89)* | 1.54 (1.06–2.26)* | ||||
Social classes V+VI | 1.78 (1.24–2.57)* | 1.41 (0.95–2.11)* | 1.84 (1.19–2.84)* | 1.27 (0.79–2.04) | ||||
Passive-avoidance Coping Scale | ||||||||
Social classes I+II | 1 | 1 | 1 | 1 | ||||
Social classes III+IV | 1.64 (1.24–2.17)* | 1.47 (1.09–1.99)* | 2.80 (2.06–3.80)* | 2.03 (1.45–2.83)* | ||||
Social classes V+VI | 2.29 (1.59–3.32)* | 1.61 (1.08–2.40)* | 4.05 (2.81–5.83)* | 2.85 (1.93–4.24)* | ||||
Meaning-based Coping Scale | ||||||||
Social classes I+II | 1 | 1 | 1 | 1 | ||||
Social classes III+IV | 1.11 (0.85–1.47) | 0.91 (0.67–1.24) | 1.67 (1.26–2.22)* | 1.10 (0.80–1.51) | ||||
Social classes V+VI | 1.77 (1.23–2.54)* | 1.49 (0.99–2.25)* | 2.24 (1.59–3.16)* | 1.31 (0.89–1.93) |
P<0.10.
Adjusted for age, having children together, duration of cohabitation, duration of infertility, marital benefit, marital stress and disruption of life.
. | Women . | . | Men . | . | ||||
---|---|---|---|---|---|---|---|---|
. | Age-adjusted crude OR . | Fully adjusteda OR . | Age-adjusted crude OR . | Fully adjusteda OR . | ||||
Active-avoidance Coping Scale | ||||||||
Social classes I+II | 1 | 1 | 1 | 1 | ||||
Social classes III+IV | 0.84 (0.64–1.10) | 0.69 (0.51–0.94)* | 0.97 (0.73–1.28) | 0.57 (0.41–0.79)* | ||||
Social classes V+VI | 0.75 (0.52–1.07) | 0.52 (0.34–0.78)* | 0.98 (0.69–1.40) | 0.54 (0.36–0.81)* | ||||
Active-confronting Coping Scale | ||||||||
Social classes I+II | 1 | 1 | 1 | 1 | ||||
Social classes III+IV | 1.30 (0.98–1.72) | 1.14 (0.84–1.53) | 2.04 (1.43–2.89)* | 1.54 (1.06–2.26)* | ||||
Social classes V+VI | 1.78 (1.24–2.57)* | 1.41 (0.95–2.11)* | 1.84 (1.19–2.84)* | 1.27 (0.79–2.04) | ||||
Passive-avoidance Coping Scale | ||||||||
Social classes I+II | 1 | 1 | 1 | 1 | ||||
Social classes III+IV | 1.64 (1.24–2.17)* | 1.47 (1.09–1.99)* | 2.80 (2.06–3.80)* | 2.03 (1.45–2.83)* | ||||
Social classes V+VI | 2.29 (1.59–3.32)* | 1.61 (1.08–2.40)* | 4.05 (2.81–5.83)* | 2.85 (1.93–4.24)* | ||||
Meaning-based Coping Scale | ||||||||
Social classes I+II | 1 | 1 | 1 | 1 | ||||
Social classes III+IV | 1.11 (0.85–1.47) | 0.91 (0.67–1.24) | 1.67 (1.26–2.22)* | 1.10 (0.80–1.51) | ||||
Social classes V+VI | 1.77 (1.23–2.54)* | 1.49 (0.99–2.25)* | 2.24 (1.59–3.16)* | 1.31 (0.89–1.93) |
. | Women . | . | Men . | . | ||||
---|---|---|---|---|---|---|---|---|
. | Age-adjusted crude OR . | Fully adjusteda OR . | Age-adjusted crude OR . | Fully adjusteda OR . | ||||
Active-avoidance Coping Scale | ||||||||
Social classes I+II | 1 | 1 | 1 | 1 | ||||
Social classes III+IV | 0.84 (0.64–1.10) | 0.69 (0.51–0.94)* | 0.97 (0.73–1.28) | 0.57 (0.41–0.79)* | ||||
Social classes V+VI | 0.75 (0.52–1.07) | 0.52 (0.34–0.78)* | 0.98 (0.69–1.40) | 0.54 (0.36–0.81)* | ||||
Active-confronting Coping Scale | ||||||||
Social classes I+II | 1 | 1 | 1 | 1 | ||||
Social classes III+IV | 1.30 (0.98–1.72) | 1.14 (0.84–1.53) | 2.04 (1.43–2.89)* | 1.54 (1.06–2.26)* | ||||
Social classes V+VI | 1.78 (1.24–2.57)* | 1.41 (0.95–2.11)* | 1.84 (1.19–2.84)* | 1.27 (0.79–2.04) | ||||
Passive-avoidance Coping Scale | ||||||||
Social classes I+II | 1 | 1 | 1 | 1 | ||||
Social classes III+IV | 1.64 (1.24–2.17)* | 1.47 (1.09–1.99)* | 2.80 (2.06–3.80)* | 2.03 (1.45–2.83)* | ||||
Social classes V+VI | 2.29 (1.59–3.32)* | 1.61 (1.08–2.40)* | 4.05 (2.81–5.83)* | 2.85 (1.93–4.24)* | ||||
Meaning-based Coping Scale | ||||||||
Social classes I+II | 1 | 1 | 1 | 1 | ||||
Social classes III+IV | 1.11 (0.85–1.47) | 0.91 (0.67–1.24) | 1.67 (1.26–2.22)* | 1.10 (0.80–1.51) | ||||
Social classes V+VI | 1.77 (1.23–2.54)* | 1.49 (0.99–2.25)* | 2.24 (1.59–3.16)* | 1.31 (0.89–1.93) |
P<0.10.
Adjusted for age, having children together, duration of cohabitation, duration of infertility, marital benefit, marital stress and disruption of life.
The Infertility Cohort is a part of The Copenhagen Multi-centre Psychosocial Infertility (COMPI) Research Programme initiated by Dr L.Schmidt, University of Copenhagen, 2000. The programme is a collaboration between the public Fertility Clinics at Brædstrup Hospital; Herlev University Hospital; The Juliane Marie Centre, Rigshospitalet; Odense University Hospital. We thank Lisbeth B.Knudsen, Associate Professor, mag.scient.soc., Aalborg University who has commented upon the manuscript and provided statistics on childlessness in the Danish population. This study has received support from the Danish Health Insurance Fund (Jnr. 11/097-97), the Else and Mogens Wedell-Wedellsborgs Fund, the manager E.Danielsens and Wife's Fund, the merchant L.F.Foghts Fund, and the Jacob Madsen and Wife Olga Madsens Fund.
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