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BMC Women's Health
Published in: BMC Women's Health 1/2024

Open Access 01-12-2024 | Infertility | Research

The mediating and moderating effects of resilience on the relationship between sleep quality and psychological distress in Chinese women with infertility

Published in: BMC Women's Health | Issue 1/2024

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Abstract

Background

Research has widely indicated that the psychological distress experienced by infertile patients during fertility treatments may have a negative effect on the results of assisted reproduction. Although numerous studies have shown that psychological resilience and sleep quality are important influencing factors for psychological distress, the mediating mechanisms of psychological resilience in the relationship between sleep quality and psychological distress for Chinese women in particular remain unclear. Therefore, the current study investigates the association between sleep quality, resilience, and psychological distress in Chinese women with infertility and examines the mediating and moderating roles of resilience on the relationship between sleep quality and psychological distress.

Methods

In this cross-sectional study, a total of 595 women with infertility who were undergoing IVF-ET were recruited at the Reproductive Medicine, Shandong University, from April to November 2019. Participants were instructed to complete four questionnaires, including a questionnaire about socio-demographic and clinical-related information, the Pittsburgh Sleep Quality Index (PSQI), the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), and the Kessler-10 (K10). Pearson’s correlation analysis was conducted preliminarily to describe the relationships between sleep quality, resilience, and psychological distress. A mediation model and a moderated model were constructed and analyzed using the PROCESS macro for SPSS. The Johnson-Neyman (J-N) technique was then used to identify the regions of significance across the levels of moderator values.

Results

Patients in the sample had a high prevalence of psychological distress (48.6%, K10 scores > 22), and mediation analysis indicated that resilience played a partially mediating role in the relationship between sleep quality and psychological distress (indict effect = 0.072, P < 0.001). Moderation analysis indicated that resilience also moderated the association between sleep quality and psychological distress.

Conclusions

Resilience may play a key role in the relationship between sleep quality and psychological distress. Our findings imply that resilience training may therefore be an effective component of psychological distress intervention in women with infertility.
Literature
1.
Zegers-Hochschild F, Adamson GD, Dyer S, Racowsky C, de Mouzon J, Sokol R, et al. The International Glossary on Infertility and Fertility Care, 2017. Hum Reprod. 2017;32(9):1786–801.PubMedPubMedCentralCrossRef
2.
Li X, Wang K, Huo Y, Zhou M. The effect of infertility-related stress on Chinese infertile females’ mental health: the moderating role of marital adjustment. Psych J. 2019;8(2):232–9.PubMedCrossRef
3.
Gdańska P, Drozdowicz-Jastrzębska E, Grzechocińska B, Radziwon-Zaleska M, Węgrzyn P, Wielgoś M. Anxiety and depression in women undergoing infertility treatment. Ginekol Pol. 2017;88(2):109–12.PubMedCrossRef
4.
Dadhwal V, Choudhary V, Perumal V, Bhattacharya D. Depression, anxiety, quality of life and coping in women with infertility: a cross-sectional study from India. Int J Gynaecol Obstet. 2022;158(3):671–8.PubMedCrossRef
5.
Li G, Jiang Z, Kang X, Ma L, Han X, Fang M. Trajectories and predictors of anxiety and depression amongst infertile women during their first IVF/ICSI treatment cycle. J Psychosom Res. 2021;142:110357.PubMedCrossRef
6.
Gameiro S, van den Belt-Dusebout AW, Smeenk JM, Braat DD, van Leeuwen FE, Verhaak CM. Women’s adjustment trajectories during IVF and impact on mental health 11–17 years later. Hum Reprod. 2016;31(8):1788–98.PubMedCrossRef
7.
Lin JL, Lin YH, Chueh KH. Somatic symptoms, psychological distress and sleep disturbance among infertile women with intrauterine insemination treatment. J Clin Nurs. 2014;23(11–12):1677–84.PubMedCrossRef
8.
Ohayon MM, Sagales T. Prevalence of insomnia and sleep characteristics in the general population of Spain. Sleep Med. 2010;11(10):1010–8.PubMedCrossRef
9.
Maglione JE, Ancoli-Israel S, Peters KW, Paudel ML, Yaffe K, Ensrud KE, et al. Depressive symptoms and subjective and objective sleep in community-dwelling older women. J Am Geriatr Soc. 2012;60(4):635–43.PubMedPubMedCentralCrossRef
10.
Rezaei M, Khormali M, Akbarpour S, Sadeghniiat-Hagighi K, Shamsipour M. Sleep quality and its association with psychological distress and sleep hygiene: a cross-sectional study among pre-clinical medical students. Sleep Sci. 2018;11(4):274–80.PubMedPubMedCentralCrossRef
11.
Fernandez-Mendoza J, Shea S, Vgontzas AN, Calhoun SL, Liao D, Bixler EO. Insomnia and incident depression: role of objective sleep duration and natural history. J Sleep Res. 2015;24(4):390–8.PubMedPubMedCentralCrossRef
12.
Spaggiari G, Romeo M, Casarini L, Granata ARM, Simoni M, Santi D. Human fertility and sleep disturbances: a narrative review. Sleep Med. 2022;98:13–25.PubMedCrossRef
13.
Lin Y-H, Chueh K-H, Lin J-L. Somatic symptoms, sleep disturbance and psychological distress among women undergoing oocyte pick-up and in vitro fertilisation-embryo transfer. J Clin Nurs. 2016;25(11–12):1748–56.PubMedCrossRef
14.
Kloss JD, Perlis ML, Zamzow JA, Culnan EJ, Gracia CR. Sleep, sleep disturbance, and fertility in women. Sleep Med Rev. 2015;22:78–87.PubMedCrossRef
15.
Willis SK, Hatch EE, Wise LA. Sleep and female reproduction. Curr Opin Obstet Gynecol. 2019;31(4):222–7.PubMedCrossRef
16.
Bonanno GA, Westphal M, Mancini AD. Resilience to loss and potential trauma. Annu Rev Clin Psychol. 2011;7:511–35.PubMedCrossRef
17.
Arbinaga F. Self-reported perceptions of Sleep Quality and Resilience among Dance Students. Percept Mot Skills. 2018;125(2):351–68.PubMedCrossRef
18.
Tian X, Gao Q, Li G, Zou G, Liu C, Kong L, et al. Resilience is associated with low psychological distress in renal transplant recipients. Gen Hosp Psychiatry. 2016;39:86–90.PubMedCrossRef
19.
Doi S, Fujiwara T, Ochi M, Isumi A, Kato T. Association of sleep habits with behavior problems and resilience of 6- to 7-year-old children: results from the A-CHILD study. Sleep Med. 2018;45:62–8.PubMedCrossRef
20.
Wong MM, Puttler LI, Nigg JT, Zucker RA. Sleep and behavioral control in earlier life predicted resilience in young adulthood: a prospective study of children of alcoholics and controls. Addict Behav. 2018;82:65–71.PubMedPubMedCentralCrossRef
21.
Anyan F, Hjemdal O. Adolescent stress and symptoms of anxiety and depression: Resilience explains and differentiates the relationships. J Affect Disord. 2016;203:213–20.PubMedCrossRef
22.
Wang L, Xu B, Gu Y, Zhu J, Liang Y. The mediating and moderating effects of resilience on the relationship between perceived stress and depression in heroin addicts. J Community Psychol. 2019;47(3):495–503.PubMedCrossRef
23.
Ding H, Han J, Zhang M, Wang K, Gong J, Yang S. Moderating and mediating effects of resilience between childhood trauma and depressive symptoms in Chinese children. J Affect Disord. 2017;211:130–5.PubMedCrossRef
24.
Kishore MT, Satyanarayana V, Ananthanpillai ST, Desai G, Bhaskarapillai B, Thippeswamy H, et al. Life events and depressive symptoms among pregnant women in India: moderating role of resilience and social support. Int J Soc Psychiatry. 2018;64(6):570–7.PubMedCrossRef
25.
Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.PubMedCrossRef
26.
Tsai P, Wang S, Wang M, Su C, Yang T, Huang C, Fang S. Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects. Qual Life Res. 2005;14(8):1943–52.PubMedCrossRef
27.
Wang L, Shi Z, Zhang Y, Zhang Z. Psychometric properties of the 10-item Connor-Davidson Resilience Scale in Chinese earthquake victims. Psychiatry Clin Neurosci. 2010;64(5):499–504.PubMedCrossRef
28.
Campbell-Sills L, Stein MB. Psychometric analysis and refinement of the Connor-Davidson Resilience Scale (CD-RISC): validation of a 10-item measure of resilience. J Trauma Stress. 2007;20(6):1019–28.PubMedCrossRef
29.
Kessler RC, Barker PR, Colpe LJ, Epstein JF, Gfroerer JC, Hiripi E, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003;60(2):184–9.PubMedCrossRef
30.
Baillie AJ. Predictive gender and education bias in Kessler’s psychological distress scale (k10). Soc Psychiatry Psychiatr Epidemiol. 2005;40(9):743–8.PubMedCrossRef
31.
Zhou C, Chu J, Wang T, Peng Q, He J, Zheng W, Liu D, Wang X, Ma H, Xu LZ. Reliability and validity of 10-item Kessler Scale (K10) Chinese version in evaluation of mental health status of Chinese population. Chin J Clin Psychol. 2008;16(6):627–9.
32.
Chiaffarino F, Baldini MP, Scarduelli C, Bommarito F, Ambrosio S, D’Orsi C, et al. Prevalence and incidence of depressive and anxious symptoms in couples undergoing assisted reproductive treatment in an Italian infertility department. Eur J Obstet Gynecol Reprod Biol. 2011;158(2):235–41.PubMedCrossRef
33.
Chen TH, Chang SP, Tsai CF, Juang KD. Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic. Hum Reprod. 2004;19(10):2313–8.PubMedCrossRef
34.
Haimovici F, Anderson JL, Bates GW, Racowsky C, Ginsburg ES, Simovici D, et al. Stress, anxiety, and depression of both partners in infertile couples are associated with cytokine levels and adverse IVF outcome. Am J Reprod Immunol. 2018;79(4):e12832.PubMedCrossRef
35.
Jackson ML, Sztendur EM, Diamond NT, Byles JE, Bruck D. Sleep difficulties and the development of depression and anxiety: a longitudinal study of young Australian women. Arch Womens Ment Health. 2014;17(3):189–98.PubMedCrossRef
36.
Huang LH, Kuo CP, Lu YC, Lee MS, Lee SH. Association of emotional distress and quality of sleep among women receiving in-vitro fertilization treatment. Taiwan J Obstet Gynecol. 2019;58(1):168–72.PubMedCrossRef
37.
Jansson-Frojmark M, Lindblom K. A bidirectional relationship between anxiety and depression, and insomnia? A prospective study in the general population. J Psychosom Res. 2008;64(4):443–9.PubMedCrossRef
38.
Matthiesen SM, Frederiksen Y, Ingerslev HJ, Zachariae R. Stress, distress and outcome of assisted reproductive technology (ART): a meta-analysis. Hum Reprod. 2011;26(10):2763–76.PubMedCrossRef
39.
Goldstein CA, Lanham MS, Smith YR, O’Brien LM. Sleep in women undergoing in vitro fertilization: a pilot study. Sleep Med. 2017;32:105–13.PubMedCrossRef
40.
Buysse DJ, Angst J, Gamma A, Ajdacic V, Eich D, Rössler W. Prevalence, course, and comorbidity of insomnia and depression in young adults. Sleep. 2008;31(4):473–80.PubMedPubMedCentralCrossRef
41.
Sun X, Dai X, Yang T, Song H, Yang J, Bai J, et al. Effects of mental resilience on neuroendocrine hormones level changes induced by sleep deprivation in servicemen. Endocrine. 2014;47(3):884–8.PubMedCrossRef
42.
van der Zwan JE, de Vente W, Tolvanen M, Karlsson H, Buil JM, Koot HM, et al. Longitudinal associations between sleep and anxiety during pregnancy, and the moderating effect of resilience, using parallel process latent growth curve models. Sleep Med. 2017;40:63–8.PubMedCrossRef
43.
44.
Babić R, Babić M, Rastović P, Ćurlin M, Šimić J, Mandić K, et al. Resil Health Illn Psychiatr Danub. 2020;32(Suppl 2):226–32.
45.
Lehr D, Kunzler A, Helmreich I, Behrendt D, Chmitorz A, Lieb K. [Internet-based resilience training and prevention of mental disorders]. Nervenarzt. 2018;89(7):766–72.PubMedCrossRef
46.
Wang Y, Chen X. Stress and alcohol use in rural Chinese residents: a moderated mediation model examining the roles of resilience and negative emotions. Drug Alcohol Depend. 2015;155:76–82.PubMedPubMedCentralCrossRef
47.
Wang G, Liu X, Lei J. Effects of mindfulness-based intervention for women with infertility: a systematic review and meta-analysis. Arch Womens Ment Health. 2023;26(2):245–58.PubMedCrossRef
48.
Lau J, Khoo AM, Ho AH, Tan KK. Psychological resilience among palliative patients with advanced cancer: a systematic review of definitions and associated factors. Psychooncology. 2021;30(7):1029–40.PubMedCrossRef
49.
Fang M, Li G, Kang X, Hou F, Lv G, Xu X, et al. The role of gender and self-esteem as moderators of the relationship between stigma and psychological distress among infertile couples. Psychol Health Med. 2021;26(10):1181–94.PubMedCrossRef
50.
Kang X, Fang M, Li G, Huang Y, Li Y, Li P, et al. Family resilience is a protective buffer in the relationship between infertility-related stress and psychological distress among females preparing for their first in vitro fertilization-embryo transfer. Psychol Health Med. 2022;27(4):823–37.PubMedCrossRef
51.
Zhao D, Wang H, Feng X, Lv G, Li P. Relationship between neuroticism and sleep quality among asthma patients: the mediation effect of mindfulness. Sleep Breath. 2019;23(3):925–31.PubMedCrossRef
Metadata
Title
The mediating and moderating effects of resilience on the relationship between sleep quality and psychological distress in Chinese women with infertility
Publication date
01-12-2024
Published in
BMC Women's Health / Issue 1/2024
Electronic ISSN: 1472-6874
DOI
https://doi.org/10.1186/s12905-024-03018-x

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