Whose fault is it? Blame predicting psychological adjustment and couple satisfaction in couples seeking fertility treatment

Infertility bears psychological and relational consequences for couples who face this problem. Few studies have examined the role of self- and partner blaming to explain psychological and relationship adjustment in couple presenting with a fertility problem. This study used a dyadic approach to explore the links between blaming oneself and one's partner and both partners' symptoms of depression and anxiety, and couple satisfaction in 279 couples enrolled in fertility treatments. Partners were questioned about the extent to which they blamed themselves and their partner for the fertility problem. They also completed the Dyadic Adjustment Scale and the Index of Psychological Symptoms. Path analyses based on the Actor-Partner Interdependence Model showed that self-blame predicted anxiety and depression symptoms in both men and women. Men's self-blame also predicted their own lower relationship satisfaction, whereas women's self-blame predicted more depression and anxiety in their partner. Partner blame in women predicted their own and their partner lower relationship satisfaction. Women's tendency to blame their partner also predicted their own depression symptoms. Clinical implications of these findings are discussed.

When Bad Things Turn Good and Good Things Turn Bad: Sequences of Redemption and Contamination in Life Narrative and their Relation to Psychosocial Adaptation in Midlife Adults and in Students

Midlife adults (age 35 to 65) and college undergraduates provided lengthy, open-ended narrative accounts of personally meaningful episodes from the past, such as life-story high points, low points, turning points, and earliest memories. The oral (adult) and written (student) narratives were coded for redemption and contamination imagery. In the midlife sample, adults scoring high on self-report measures of generativity showed significantly higher levels of redemption and lower levels of contamination sequences. In both samples, redemption sequences in life narrative accounts were positively associated with self-report measures of psychological well-being, whereas contamination sequences predicted low levels of well-being among midlife adults. In addition, redemption sequence scores were a stronger predictor of well-being than were ratings of the overall affective quality of life-narrative accounts. The results are discussed with respect to the empirical literature of benefit-finding in the face of adversity and in the context of the recent upsurge of interest in the collection and interpretation of life narratives.

Managing multiple goals during fertility treatment: An interpretative phenomenological analysis

This study investigated how men and women made sense of multiple goals during fertility treatment. Both members of three heterosexual couples participated in two or three semi-structured interviews over 6 months, producing 14 accounts, which were analysed using interpretative phenomenological analysis. The goal of biological parenthood dominates assumptions in infertility research, but its importance varied between participants, who balanced that goal with retaining emotional well-being, avoiding financial difficulties and maintaining their relationship. These themes are discussed in the context of the self-regulation model, which allows fertility treatment experiences to be conceptualised more broadly than do other models.

Investigation of the benefits of HIV/AIDS caregiving and relations among caregiving adjustment, benefit finding, and stress and coping variables

The present study explored the nature of benefit finding in HIV/AIDS caregiving, and examined relations among caregiver adjustment, benefit finding, and stress and coping variables. A total of 64 HIV/AIDS caregivers and 46 care recipients completed interviews and questionnaires. First, the study aimed to explore the types of benefits associated with HIV/AIDS caregiving. Content analyses of caregiver responses to an interview question inquiring about gains from caregiving revealed eight benefit themes. Second, the study aimed to examine relations between caregiver adjustment and both benefit finding and stress and coping variables. We hypothesized that number of caregiver reported benefits, social support, challenge and control appraisals, and problem focused coping would be inversely related to poorer adjustment, whereas care recipient reported global distress and illness, caregiver threat appraisal and passive-avoidant emotion-focused coping would be positively associated with poorer adjustment. Correlations indicated that poorer adjustment (measured by global distress, depression, caregiving impact, social adjustment and health status) was positively correlated with care-recipient distress, threat appraisals and passive avoidant coping and inversely correlated with social support, and number of reported benefits. Unexpectedly, problem-focused coping, controllability and challenge appraisals, and care recipient illness were unrelated to adjustment. Third, the study aimed to examine relations between benefit finding and stress and coping variables. Correlations indicated that benefit finding was related to social support use, seeking social support coping and problem-solving coping. Findings indicate that the benefit finding and stress/coping frameworks have utility in guiding research into adaptation to HIV/AIDS caregiving. Results also indicate targets for intervention in the provision of services for HIV/AIDS caregivers.

Predicting emotional response to unsuccessful fertility treatment: a prospective study

The predictive value of a comprehensive model with personality characteristics, stressor related cognitions, coping and social support was tested in a sample of 187 nonpregnant women. The emotional response to the unsuccessful treatment was predicted out of vulnerability factors assessed before the start of the treatment. The results indicated the importance of neuroticism as a vulnerability factor in emotional response to a severe stressor. They also underlined the importance of helplessness and marital dissatisfaction as additional risk factors, and acceptance and perceived social support as additional protective factors, in the development of anxiety and depression after a failed fertility treatment. From clinical point of view, these results suggest fertility-related cognitions and social support should receive attention when counselling women undergoing IVF or ICSI treatment.

Gender differences and dynamics shaping the adoption life cycle: review of the literature and recommendations

The role of gender in the experiences of adoptive family members has received little systematic attention. Gender differences in response to different tasks and phases of the adoption life cycle are described. Gendered dynamics within the adoptive family, for birth parents, and in the field of adoption are highlighted. Birth fathers and adoptive fathers are typically marginalized, which leaves women to address emotion, connection, and communication, and family dialogues about adoption may engage daughters more successfully than sons. The article reviews reasons why differential rates of problem behavior for adopted boys and girls may result from gender differences in emotional expressiveness, social support seeking, and identity formation. Implications of the feminization of adoption are explored, and recommendations for practice and research are proposed.

Correlates of Levels and Patterns of Positive Life Changes Following Sexual Assault

This study builds on previous work suggesting that many survivors report positive life changes soon after a sexual assault and that those who retain those changes over time report the least distress 1 year post-assault (P. Frazier, A. Conlon, & T. Glaser, 2001). The purposes of this study were to assess correlates of early reports of positive life changes and individual trajectories of self-reported positive changes over time among female sexual assault survivors (n = 171) using hierarchical linear modeling. The factors most related to reporting positive life change soon after the assault were social support, approach and religious coping, and perceived control over the recovery process. Increases in these factors also were associated with increases in self-reported positive life changes over time. The relations between social support and positive change also were mediated by coping strategies and control appraisals, particularly perceived control over the recovery process.

Distress of infertile males after fertility workup: a longitudinal study

OBJECTIVE

Former research has revealed that distress declines after fertility workup. It was the aim of the present study to explore whether this decline depends on such aspects as the diagnosis or the former usage of fertility services.

METHODS

Patients attending an andrological clinic filled out questionnaires on distress and coping behaviour at clinic attendance as well as 4 months later.

RESULTS

For distress scores there was an interaction between time and former usage of infertility services, indicating that only first-time consulters show a decline in distress after fertility workup. No impact of diagnosis on distress scores could be detected. Generally, patients showed a decrease of active coping behaviour after fertility workup, along with a greater tendency to accept infertility as one's fate.

CONCLUSION

The findings indicate that there are different processes working in first-time and repeat consulters with respect to the course of distress.

Psychosocial aspects of selected issues in women's reproductive health: current status and future directions

Emphasizing research published in the past decade, this article presents a summary and evaluation of psychosocial investigations of women's reproductive health, with a focus on selected aspects of menstruation, pregnancy and birth, infertility, and menopause. In some areas, studies have focused on negative physical and psychological concomitants of these health issues. However, research reveals substantial individual variability, with most women adapting well to reproductive health changes. Although methodological and conceptual shortcomings have limited firm conclusions, research has advanced our understanding of the multivariate biological, psychological, and social influences on women's reproductive health and associated outcomes. Understanding and promoting women's reproductive health across the lifespan requires biopsychosocial approaches to research.

The interrelationship between coping strategies and sexual functioning in in vitro fertilization patients

This study examined the correlation between various coping strategies and sexual functioning and the likelihood of conception from in vitro fertilization (IVF). Self-reported questionnaires were distributed randomly among the 102 women enrolled in an IVF program, 96 of whom were recruited. Of the studied parameters, positive reinterpretation, and growth, and active coping strategies were found to be positively associated with sexual functioning, while there was a significantly (p < .05) adverse influence of planning and self-restraint. Being sexually active during the IVF-treatment period was found to be positively associated (p < .05) with the likelihood of conception and with adaptive coping strategies.

A meta-analytic review of coping with illness: do causal attributions matter?

OBJECTIVE

The present meta-analytic review assessed the relations between causal attributions, coping, and psychological adjustment in individuals with physical illnesses or undergoing medical procedures. A theoretical model predicting psychological adjustment was proposed. It was hypothesized that causal attributions would be both directly related to psychological adjustment and indirectly related to psychology adjustment via coping strategies.

METHODS

Relevant methodological and statistical information was extracted from 27 target studies. Weighted correlations from 27 studies were used as the unit of analysis to test the theoretical model.

RESULTS

Overall, internal, unstable, and controllable attributions were indirectly associated with positive psychological adjustment through the use of Approach and Emotion-Focused coping (P<.01). In addition, stable and uncontrollable attributions were indirectly associated with negative psychological adjustment through the use of Avoidance coping (P<.01).

CONCLUSION

These results suggest that attributions guide some motivated cognitions and behaviors within the context of illness, and are related to specific coping strategies. The discussion focuses on the predictive validity of these findings using the proposed theoretical model.

Why do infertile males use psychological couple counselling?

The purpose of the present study was to identify characteristics of male patients that could be relevant for the uptake of psychological couple counselling for infertility. Therefore, 94 male patients who participated in psychological couple counselling were compared to 134 unselected infertility patients who attended an andrological clinic. Counselling users showed higher scores for depression and anxiety as well as a higher number of impaired sperm parameters. Multivariate analysis revealed that beyond the level of depression the number of impaired sperm parameters delivered additional information about the probability of a patient using counselling. For interpretation of these results the former research was broadly reviewed. It is suggested that an increased level of distress, the feeling of being responsible for infertility and few marital difficulties are relevant for the usage of couple counselling by male infertility patients. Practical consequences are discussed.

Positive by-products of the struggle with chemical dependency

Focus groups were conducted to identify ways persons in recovery from chemical dependence think they have benefited from their struggles with addiction. Categories of positive by-products were identified independently by two sets of readers. Several of the positive by-products discussed by the focus group participants are commonly reported from other kinds of challenging life experiences. These include increases in self-efficacy, family closeness, closeness with others, compassion and spirituality, and changes in life priorities. Additional positive by-products were discussed by the focus group participants that may be more unique to substance abuse and other similar stressors, including increased self-knowledge, enhanced ability to help offspring with substance abuse-related issues, and decreased naïveté. Ways to incorporate knowledge about these positive by-products into substance abuse treatment programs are introduced.

Langfristige psychische Folgen von Kinderlosigkeit: Eine Übersicht

Zusammenfassung. Die Situation ungewollt kinderloser Frauen und Männer gerät in den letzten Jahren zunehmend ins Blickfeld der Öffentlichkeit. Zu den kurzfristigen Folgen von Kinderlosigkeit liegen Ergebnisse zu infertilen Paaren mit reproduktionsmedizinischer Behandlung vor. Diese belegen Belastungen in den Bereichen Lebenszufriedenheit, Gesundheit und Partnerschaftszufriedenheit. Als Risikofaktoren des kurzfristigen Bewältigungsprozesses werden die Mehrdeutigkeit der Diagnosen, Partnerschaftsprobleme, Konfession, soziale Isolation, externale Attribuierungsprozesse und medizinische Behandlungsmaßnahmen diskutiert. Erst wenige Studien beschäftigen sich mit den langfristigen Folgen von Kinderlosigkeit und kommen zu dem Ergebnis, daß sich infertile Paare im Hinblick auf ihren allgemeinen Gesundheitszustand nicht von Eltern unterscheiden. Empirische Studien weisen jedoch auch darauf hin, daß sich die ungewollte Kinderlosigkeit langfristig negativ auf die Beziehung kinderloser Paare auswirkt. Nach den Studienergebnissen haben kinderlose Frauen und Männer weniger umfassende soziale Netze, sie erleben aber keine größere Einsamkeit oder Beeinträchtigungen in der Lebenszufriedenheit aufgrund der geringeren sozialen Unterstützung. Studien zu kurz- und langfristigen Bewältigungsstrategien belegen, daß Kontrollüberzeugungen eine wichtige Rolle spielen. Auch die Fähigkeit zur Umstrukturierung der eigenen Lebenspläne und soziale Unterstützung (auch Beziehungen zu Kindern) erweisen sich als bedeutsam für den langfristigen Umgang mit der Kinderlosigkeit.

Perceived personal control (PPC): a new concept in measuring outcome of genetic counseling

Many researchers have tried to establish criteria for the evaluation of genetic counseling and the assessment of its success. Most studies focused on counseling outcomes mainly educational and reproductive variables. In the present study we introduced the concept of "perceived personal control" (PPC), which captures a wider and more meaningful range of effects of genetic counseling. It was found to be central to coping with health threats and to adapting to a broad spectrum of health problems. This study investigated 154 counseling cases. Counselees were requested to complete pre- and post-counseling questionnaires consisting of a knowledge test, measures of PPC, expectations/evaluations of counseling, and satisfaction with the procedure. Comparisons of mean PPC scores before and after counseling showed significant increases. Higher post-counseling PPC was found among counselees who had been given a definite diagnosis, a specific recurrence risk, and been offered prenatal diagnosis. Post-counseling PPC also correlated with knowledge, satisfaction, counseling evaluations, and expectation fulfillment. The findings suggest that PPC is a valid measure for the evaluation of genetic counseling outcomes. The psychometrically reliable scales developed in this study can become helpful tools for assessing genetic counseling both in research and in clinical practice, helping the counselor evaluate the counseling session and focus on the counselees' needs.

Infertility and psychological distress: a critical review of the literature

This essay reviews the literature on the social psychological impact of infertility, paying special attention to the relationship between gender and the infertility experience. It is convenient to divide the literature into articles which explore the possibility that infertility may have psychological causes (Psychogenic Hypothesis) and those which examine the psychological consequences of infertility (Psychological Consequences Hypothesis). The psychogenic hypothesis is now rejected by most researchers, but a related hypothesis, which states that stress may be a causal factor in infertility, is worthy of exploration. The descriptive literature on the psychological consequences of infertility presents infertility as a devastating experience, especially for women. Attempts to test the psychological consequences hypothesis have produced more equivocal results. In general, studies which look for psychopathology have not found significant differences between the infertile and others. Studies which employ measures of stress and self-esteem have found significant differences. The psychological consequences literature is characterized by a number of flaws, including over sampling of women, small sample size, non-representative samples, failure to study those who have not sought treatment, primitive statistical techniques, and an over-reliance on self-reports. Studies on infertility and psychological distress need to take into consideration both the duration of infertility and the duration of treatment. Finding an appropriate set of "controls" is a particularly intractable problem for this area of research. In general, the psychological distress literature shows little regard for the social construction of infertility. By taking what should be understood as a characteristic of a social situation and transforming it into an individual trait, the literature presents what is essentially a medical model of the psycho-social impact of infertility. Most researchers conclude that infertility is a more stressful experience for women than it is for men. Most studies have found that the relationship between gender and infertility distress is not affected by which partner has the reproductive impairment. Future research needs to be better informed by theoretical considerations. Scholars need to pay more attention to the way the experience of infertility is conditioned by social structural realities. New ways need to be developed for better taking into account the processual nature of the infertility experience. Efforts need to be make to include under-studied portions of the infertile population. Finally, more effort needs to be made to better integrate the empirical study of the experience of infertility with important social policy questions.

Construing benefits from adversity: adaptational significance and dispositional underpinnings

The discovery of benefits from living with adversity has been implicated in psychological well-being in numerous investigations, is pivotal to several prominent theories of cognitive adaptation to threat, and can be predicted by personality differences. This article summarizes the prevalence and adaptive significance of finding benefits from major medical problems, locates the place of benefit-finding in stress and coping theories, and examines how it may be shaped by specific psychological dispositions such as optimism and hope and by broader personality traits such as Extraversion and Openness to Experience. The distinction between beliefs about benefits from adversity (benefit-finding) and the use of such knowledge as a deliberate strategy of coping with the problem (benefit-reminding) is underscored and illustrated by daily process research on coping with chronic pain.