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Journal of Sex & Marital Therapy Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/usmt20
Stress, Sexual Satisfaction, and Marital Adjustment in Infertile Couples Nili Benazon , John Wright & StÉPhane Sabourin Version of record first published: 14 Jan 2008.
To cite this article: Nili Benazon , John Wright & StÉPhane Sabourin (1992): Stress, Sexual Satisfaction, and Marital Adjustment in Infertile Couples, Journal of Sex & Marital Therapy, 18:4, 273-284 To link to this article: http://dx.doi.org/10.1080/00926239208412852
PLEASE SCROLL DOWN FOR ARTICLE Full terms and conditions of use: http://www.tandfonline.com/page/terms-and-conditions This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.
Stress, Sexual Satisfaction, and Marital Adjustment in Infertile Couples
Downloaded by [University of Hong Kong Libraries] at 01:53 20 March 2013
N I L I B E N A Z O N , J O H N W R I G H T , and S T E P H A N E SABOURIN
A longitudinal study was designed to assess the effects of infertility as well as the influence of the subsequent medical investigation on marital functioning. During their initial visit at a fertility clinic, I65 couples underwent psychological assessment. Questionnaires were completed to assess stress, sexual satisfaction, and marital adjustment. Participants were categorized into those who became pregnant during the I 2 months of the study (n = 48 couples) and those for whmn treatment was not successful (n = I I 7 couples). Sipijicant increases in stress and decreases in marital functioning were experienced 4 subjects as the treatment investigation progressed. Furthermore, greater levels of marital distress were obserued in couples that did not conceive. Signijicant gender differences were obserued.
A recent review of the literature has concluded that infertile patients are on the average more psychosocially distressed during their evaluation or treatment for infertility than control subjects. More specifically, the psychological distress level of infertile subjects was found to fall midway between normal and clinical While infertility investigations d o not generally result in extreme or incapacitating distress for either the men or women studied, it has been shown that the participants do experience a certain degree of symptomatic s chological difficulty as they progress through the treatment process!-' None of these studies, however, have definitively delineated how the couple, as a unit, is affected by the investigation process. Furthermore, the studies that do deal with this question appear to have reached contradictory conclusions. Some This study was based on a dissertation conducted by the first author undcr the direction of the second author. T h e research was supported in part by grants from Health and Welfare Canada, the Fonds d e la recherche en sante d u Quebec and by the Conseil quCbecois d e la recherche socialc. This research was also supported in part by the Social Sciences and Humanities Research Council of Canada through a Canada Research Fellowship to Stephane Sabourin. We acknowledge the thoughtful comments of Robert Lencki and Michael Benazon and the collaboration of Lise Lachance and France VCronneau. Correspondence concerning this article should be addressed to John Wright, Ph.D.. Department d e psychologie. Universite d e Montreal. C.P. 6128. Succ. "A", Montreal, Quebec, Canada H3C 357.
Journal of Sex & Marital Therapy, Vol. 18, No. 4, Winter 1992 0 Brunner/Mazel,Inc. 273
Downloaded by [University of Hong Kong Libraries] at 01:53 20 March 2013
274
Journal of Sex k? Marital Therapy, Vol. 18, N o . 4 , Winter 1992
researchers have reported deterioration in marital functioning8V9; whereas, others have claimed that subjects who undergo treatment for infertility experience improved communication a n d greater intimacy; consequently, they feel closer to each Still others have observed that some aspects of the marital relationship, such as sexual functioning, are perturbed but the marital dyad remains intact.'* One explanation could be that this lack of agreement is d u e to methodological shortcomings. Few studies have examined the fluctuations in marital satisfaction over an extended period of time, employed standardized measurements, or included sufficient sample sizes to verify the prevalence, extent, and duration of relationship difficulties experienced by the infertile couple. Contradictions could also be partly attributed to differences between men a n d women with regard to their response to the infertility investigation, since most of these studies have focused primarily o n the female partner and have neglected to include their husbands in the sample population. This is important since studies that evaluated the differential responses to infertility o n measures of stress, depression, and self-esteem have been consistent, with women showing greater distress levels than their partner^.'.'^ However, with respect to measures of marital functioning, the differential responses between men and women have been far less conclusive. Some studies report a gender effect: women show greater increases in marital distress than their spouse^.^^'^-'^ Other researchers have observed n o such effect and maintain that men's and women's marital distress scores a r e not differentiated o n the basis of g e n d e ~ - . ~ *Hence, ' ~ * ' ~ it would appear that the factors responsible for fluctuations in marital functioning should be examined in greater detail to aid in the clarification o f these apparent contradictions. T w o constructs that w e wish to examine in greater detail are levels of experienced stress a n d sexual satisfaction. T h e notion that stress is induced by the state of infertility as well as by the accompanying medical investigation, sometimes referred to as treatment intrusiveness, is now well established in the l i t e r a t ~ r e . ~ Physicians, ,'~ sociologists, a n d psychologists have each taken a different perspective when examining this stressful life event. Physicians allude to the stress generated by medical treatment (surgery, hormonal d r u g therapy, and keeping daily records of body temperature).la-" Sociologists advance that infertility is a social phenomenon and hold society responsible for perpetuating the notion that the marital relationship is incomplete without the addition of children, with childlessness being a form of deviant behavior to be discredited and stigrnati~ed.''-'~ T h e principal framework adopted by psychologists in examining the psychosocial reactions to the state of infertility have been grief a n d crisis theory, where infertility is considered to be analagous t o the experience of losing a child; therefore, the usual stages of grief must be o v e r ~ o m e . ~ ~ - ~ ~ 'These three groups of researchers interested in assessing the effect of stress on marital functioning have focused primarily o n the couple's sexual relationship and have made reference to the intrusive nature of the investigative procedures. With regard to the stress induced by the intrusive nature of the investigation procedures, results have shown that these
275
Downloaded by [University of Hong Kong Libraries] at 01:53 20 March 2013
Infertile Couples
interventions may produce a variety of sexual dysfunctions: loss of libido, premature ejaculation, impotence and the inability to achieve orgasm, and decrease in sexual a c t i ~ i t y .Those ~ ~ ~ ~couples *~ who d o not experience sexual dysfunctions may, nonetheless, suffer from increased levels of anxiety, reduced spontaneity in sexual interactions, and diminished interest in sexual a~tivity.~' Thus, increases in stress could result in persistent sexual difficulties, which may in turn upset the balance of a couples' marital relationship, culminating in decreases in marital satisfaction. Deterioration of marital satisfaction as a result of a dysfunctional sexual relationship may not, however, be inevitable. A study by Lalos et a1.'* observed difficulties in the couples' sexual relationship while marital satisfaction remained intact. Kaval et al.3' found that couples did experience difficulties in their sexual relationship initially, but that any negative influences brought on by the investigation were quickly outweighed by the optimism generated from having taken steps toward resolving their infertility problem. The main purpose of the present study was to determine whether infertile couples who consult at a fertility clinic experience a deterioration in marital functioning over time. We postulated that women, as compared to men, would report a more significant time-related decrease in marital satisfaction. In an effort to contribute to our understanding of the mechanisms responsible for fluctuations in marital functioning, we also examined the effects of stress and sexual satisfaction on changes in marital satisfaction. More specifically, we hypothesized that the level of stress experienced would be related to sexual satisfaction, which, in turn, would affect marital satisfaction.
METHOD Subjects Participants were Francophone couples who consulted, for the first time, a fertility clinic of a large metropolitan hospital. T h e aim of this contact was to establish a diagnosis and to seek medical treatment for their problem of infertility. Each couple was subject to a number of criteria for selection in this study: 1) having never received a complete diagnostic evaluation in a specialized clinic; 2) having never been treated for a problem of infertility; 3) being accompanied by one's partner; and 4) agreeing to take part in a two-year longitudinal study aimed at assessing the psychosocial impact of infertility. In total, 461 out of 680 couples agreed to participate. Since this research is part of an ongoing longitudinal investigation, which includes five moments of assessment at six-month intervals, only part of the results were available for analysis at the time of this study: the first three moments of assessment with a total of 165 couples. All 461 couples could not be included in the sample population for one of the following reasons: 1) they were not yet due for their third moment of assessment; 2) they had withdrawn from the psychosocial study; and 3) they had ceased medical treatment at the fertility clinic. In
Downloaded by [University of Hong Kong Libraries] at 01:53 20 March 2013
276
Jounal of Sex &? Marital Therapy, Vol. 18, No. 4 , Winter 1992
order to control for contaminatory effects due to pregnancy, subjects were divided into two groups. One group comprises 1 1 7 couples who neither became pregnant during the treatment process nor had any children together prior to undertaking fertility treatment. T h e second group includes 47 couples who become pregnant during the first 18 months of the investigation. All subjects had attempted, without success, to conceive a child by natural means, for a period of at least one year (M = 38 months, S.D. = 26 months). T h e average age of the men and women was 31 and 30 years, respectively. T h e income of the subjects fluctuated from 20,000 to 140,000 Canadian dollars per year. T h e infertility problem was attributed to the female partner in 50% of the cases, and to the male partner in 25% of the cases. In 13% of the cases, physicians attributed the problem to both partners, and in 12%of the cases infertility was unexplained. To ensure high partici ation rates in this longitudinal study, couples were reimbursed a sum of 30 for each psychosocial assessment completed at the clinic to compensate for travel, parking, and child care expenses.
sp
Measures
The Dyadic Adjustment Scale (DAS)32is a self-assessment questionnaire composed of 32 items which measure dyadic adjustment. This instrument, translated by Baillargeon, Dubois, and M a r r i n e a ~ permits ,~~ the evaluation of four aspects of marital functioning: dyadic satisfaction, dyadic cohesion, dyadic consensus, and affectional expression. Global scores of the DAS range from 0 to 151 ; the higher the score obtained by the subject, the greater the degree of marital satisfaction. Reliability and validity estimates for the DAS are a d e q ~ a t e . ~ * - ~ ~ The Index ofsexual Satisfaction ( ISS)35translated into French by Comeau and B o i ~ v e r tis, ~a~self-assessment questionnaire composed of 25 statements that measure the degree (or importance) of disagreement and dissatisfaction experienced by each partner with respect to hidher sexual relationship. Each statement is rated on a scale of 5 points, which ranges from 1 “rarely or never” to 5 “most of the time or always.” T h e final score is obtained by adding the 25 items, which results in a maximum score of 125. A sum of 25 is then subtracted from the final score in order that the global score ranges between 0 (maximum satisfaction) and 100 (maximum dissatisfaction). Global scores of 30 or more are indicative of a perturbed sexual relationship while scores of 30 or less fall within the normal range. T h e reliability of the instrument appears satisfactory; Cronbach’s alpha coefficient is Convergent and discriminant validity scores have proven a d e q ~ a t e . ~ ~ . ~ ~ The Ysvchologtcal State of Stress (PSS)” evaluates the intensity of an individual’s subjective feeling of stress. This self-assessment questionnaire is composed of 53 statements. There exist two short forms of the instrument (A and B), each one consisting of 27 statements. T h e short form A version of the questionnaire was adopted in the present study. Global scores vary from 27 to 216; the higher the score obtained by the subject, the greater is hidher level of experienced stress. T h e internal
277
Infertile Couples
consistency coefficient reaches .96 and the test-retest correlation over a 12-month period is satisfactory (.69). Stress scores are positively associated with physiological indices of stress.40
Downloaded by [University of Hong Kong Libraries] at 01:53 20 March 2013
Procedure
When subjects made their initial telephone contact with the fertility clinic, they were informed by the receptionist of the following two conditions stipulated by the medical team. Each patient and hidher partner must be present for the first evaluation at the clinic, and a three-hour session was to be foreseen which would involve an interview with a physician and a battery of tests on the couple’s psychosocial functioning. Patients would be required to return to the clinic on a number of occasions for further medical procedures. Every six months, for the next 24 months, couples would be approached by the research team studying the psychosocial impact of infertility and its treatment and asked to again complete the psychosocial test battery, which would require a further 60-80 minutes of their time. Subjects were assured that the results of the test battery would remain strictly confidential and would be used only to improve the care offered by the medical team, and would under no circumstances be used to identify patients ineligible for medical treatment. While couples were strongly urged to participate in the first evaluation, they were informed that subsequent recalls were on a strictly voluntary basis. Upon arrival at the fertility clinic, couples met with a senior gynecologist for a period of 45-90 minutes. They were then met by one of the four psychosocial evaluators (all females) who explained to them the objectives of the research study. If both members of the couple agreed to participate, they then proceeded to complete, independently, the aforementioned paper-and-pencil questionnaires after having both signed a prepared conscnt form. RE S ULTS
Mean and standard deviation scores obtained on the DAS, ISS, and PSS, for both sexes at each moment of assessment, are presented in Table 1. Scores on each measure were analyzed by three-way ANOVAs (gender of subject by success or failure to become pregnant, over three assessment periods). An interaction effect between gender and time of assessment was found on the variable stress. An examination of simple effects demonstrates that at the first time of assessment, women reported higher scores on the PSS than, men which indicates that they experienced significantly greater levels of stress than their spouses (F( 1,159)= 9.66, P
Journal of Sex & Marital Therapy Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/usmt20
Stress, Sexual Satisfaction, and Marital Adjustment in Infertile Couples Nili Benazon , John Wright & StÉPhane Sabourin Version of record first published: 14 Jan 2008.
To cite this article: Nili Benazon , John Wright & StÉPhane Sabourin (1992): Stress, Sexual Satisfaction, and Marital Adjustment in Infertile Couples, Journal of Sex & Marital Therapy, 18:4, 273-284 To link to this article: http://dx.doi.org/10.1080/00926239208412852
PLEASE SCROLL DOWN FOR ARTICLE Full terms and conditions of use: http://www.tandfonline.com/page/terms-and-conditions This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.
Stress, Sexual Satisfaction, and Marital Adjustment in Infertile Couples
Downloaded by [University of Hong Kong Libraries] at 01:53 20 March 2013
N I L I B E N A Z O N , J O H N W R I G H T , and S T E P H A N E SABOURIN
A longitudinal study was designed to assess the effects of infertility as well as the influence of the subsequent medical investigation on marital functioning. During their initial visit at a fertility clinic, I65 couples underwent psychological assessment. Questionnaires were completed to assess stress, sexual satisfaction, and marital adjustment. Participants were categorized into those who became pregnant during the I 2 months of the study (n = 48 couples) and those for whmn treatment was not successful (n = I I 7 couples). Sipijicant increases in stress and decreases in marital functioning were experienced 4 subjects as the treatment investigation progressed. Furthermore, greater levels of marital distress were obserued in couples that did not conceive. Signijicant gender differences were obserued.
A recent review of the literature has concluded that infertile patients are on the average more psychosocially distressed during their evaluation or treatment for infertility than control subjects. More specifically, the psychological distress level of infertile subjects was found to fall midway between normal and clinical While infertility investigations d o not generally result in extreme or incapacitating distress for either the men or women studied, it has been shown that the participants do experience a certain degree of symptomatic s chological difficulty as they progress through the treatment process!-' None of these studies, however, have definitively delineated how the couple, as a unit, is affected by the investigation process. Furthermore, the studies that do deal with this question appear to have reached contradictory conclusions. Some This study was based on a dissertation conducted by the first author undcr the direction of the second author. T h e research was supported in part by grants from Health and Welfare Canada, the Fonds d e la recherche en sante d u Quebec and by the Conseil quCbecois d e la recherche socialc. This research was also supported in part by the Social Sciences and Humanities Research Council of Canada through a Canada Research Fellowship to Stephane Sabourin. We acknowledge the thoughtful comments of Robert Lencki and Michael Benazon and the collaboration of Lise Lachance and France VCronneau. Correspondence concerning this article should be addressed to John Wright, Ph.D.. Department d e psychologie. Universite d e Montreal. C.P. 6128. Succ. "A", Montreal, Quebec, Canada H3C 357.
Journal of Sex & Marital Therapy, Vol. 18, No. 4, Winter 1992 0 Brunner/Mazel,Inc. 273
Downloaded by [University of Hong Kong Libraries] at 01:53 20 March 2013
274
Journal of Sex k? Marital Therapy, Vol. 18, N o . 4 , Winter 1992
researchers have reported deterioration in marital functioning8V9; whereas, others have claimed that subjects who undergo treatment for infertility experience improved communication a n d greater intimacy; consequently, they feel closer to each Still others have observed that some aspects of the marital relationship, such as sexual functioning, are perturbed but the marital dyad remains intact.'* One explanation could be that this lack of agreement is d u e to methodological shortcomings. Few studies have examined the fluctuations in marital satisfaction over an extended period of time, employed standardized measurements, or included sufficient sample sizes to verify the prevalence, extent, and duration of relationship difficulties experienced by the infertile couple. Contradictions could also be partly attributed to differences between men a n d women with regard to their response to the infertility investigation, since most of these studies have focused primarily o n the female partner and have neglected to include their husbands in the sample population. This is important since studies that evaluated the differential responses to infertility o n measures of stress, depression, and self-esteem have been consistent, with women showing greater distress levels than their partner^.'.'^ However, with respect to measures of marital functioning, the differential responses between men and women have been far less conclusive. Some studies report a gender effect: women show greater increases in marital distress than their spouse^.^^'^-'^ Other researchers have observed n o such effect and maintain that men's and women's marital distress scores a r e not differentiated o n the basis of g e n d e ~ - . ~ *Hence, ' ~ * ' ~ it would appear that the factors responsible for fluctuations in marital functioning should be examined in greater detail to aid in the clarification o f these apparent contradictions. T w o constructs that w e wish to examine in greater detail are levels of experienced stress a n d sexual satisfaction. T h e notion that stress is induced by the state of infertility as well as by the accompanying medical investigation, sometimes referred to as treatment intrusiveness, is now well established in the l i t e r a t ~ r e . ~ Physicians, ,'~ sociologists, a n d psychologists have each taken a different perspective when examining this stressful life event. Physicians allude to the stress generated by medical treatment (surgery, hormonal d r u g therapy, and keeping daily records of body temperature).la-" Sociologists advance that infertility is a social phenomenon and hold society responsible for perpetuating the notion that the marital relationship is incomplete without the addition of children, with childlessness being a form of deviant behavior to be discredited and stigrnati~ed.''-'~ T h e principal framework adopted by psychologists in examining the psychosocial reactions to the state of infertility have been grief a n d crisis theory, where infertility is considered to be analagous t o the experience of losing a child; therefore, the usual stages of grief must be o v e r ~ o m e . ~ ~ - ~ ~ 'These three groups of researchers interested in assessing the effect of stress on marital functioning have focused primarily o n the couple's sexual relationship and have made reference to the intrusive nature of the investigative procedures. With regard to the stress induced by the intrusive nature of the investigation procedures, results have shown that these
275
Downloaded by [University of Hong Kong Libraries] at 01:53 20 March 2013
Infertile Couples
interventions may produce a variety of sexual dysfunctions: loss of libido, premature ejaculation, impotence and the inability to achieve orgasm, and decrease in sexual a c t i ~ i t y .Those ~ ~ ~ ~couples *~ who d o not experience sexual dysfunctions may, nonetheless, suffer from increased levels of anxiety, reduced spontaneity in sexual interactions, and diminished interest in sexual a~tivity.~' Thus, increases in stress could result in persistent sexual difficulties, which may in turn upset the balance of a couples' marital relationship, culminating in decreases in marital satisfaction. Deterioration of marital satisfaction as a result of a dysfunctional sexual relationship may not, however, be inevitable. A study by Lalos et a1.'* observed difficulties in the couples' sexual relationship while marital satisfaction remained intact. Kaval et al.3' found that couples did experience difficulties in their sexual relationship initially, but that any negative influences brought on by the investigation were quickly outweighed by the optimism generated from having taken steps toward resolving their infertility problem. The main purpose of the present study was to determine whether infertile couples who consult at a fertility clinic experience a deterioration in marital functioning over time. We postulated that women, as compared to men, would report a more significant time-related decrease in marital satisfaction. In an effort to contribute to our understanding of the mechanisms responsible for fluctuations in marital functioning, we also examined the effects of stress and sexual satisfaction on changes in marital satisfaction. More specifically, we hypothesized that the level of stress experienced would be related to sexual satisfaction, which, in turn, would affect marital satisfaction.
METHOD Subjects Participants were Francophone couples who consulted, for the first time, a fertility clinic of a large metropolitan hospital. T h e aim of this contact was to establish a diagnosis and to seek medical treatment for their problem of infertility. Each couple was subject to a number of criteria for selection in this study: 1) having never received a complete diagnostic evaluation in a specialized clinic; 2) having never been treated for a problem of infertility; 3) being accompanied by one's partner; and 4) agreeing to take part in a two-year longitudinal study aimed at assessing the psychosocial impact of infertility. In total, 461 out of 680 couples agreed to participate. Since this research is part of an ongoing longitudinal investigation, which includes five moments of assessment at six-month intervals, only part of the results were available for analysis at the time of this study: the first three moments of assessment with a total of 165 couples. All 461 couples could not be included in the sample population for one of the following reasons: 1) they were not yet due for their third moment of assessment; 2) they had withdrawn from the psychosocial study; and 3) they had ceased medical treatment at the fertility clinic. In
Downloaded by [University of Hong Kong Libraries] at 01:53 20 March 2013
276
Jounal of Sex &? Marital Therapy, Vol. 18, No. 4 , Winter 1992
order to control for contaminatory effects due to pregnancy, subjects were divided into two groups. One group comprises 1 1 7 couples who neither became pregnant during the treatment process nor had any children together prior to undertaking fertility treatment. T h e second group includes 47 couples who become pregnant during the first 18 months of the investigation. All subjects had attempted, without success, to conceive a child by natural means, for a period of at least one year (M = 38 months, S.D. = 26 months). T h e average age of the men and women was 31 and 30 years, respectively. T h e income of the subjects fluctuated from 20,000 to 140,000 Canadian dollars per year. T h e infertility problem was attributed to the female partner in 50% of the cases, and to the male partner in 25% of the cases. In 13% of the cases, physicians attributed the problem to both partners, and in 12%of the cases infertility was unexplained. To ensure high partici ation rates in this longitudinal study, couples were reimbursed a sum of 30 for each psychosocial assessment completed at the clinic to compensate for travel, parking, and child care expenses.
sp
Measures
The Dyadic Adjustment Scale (DAS)32is a self-assessment questionnaire composed of 32 items which measure dyadic adjustment. This instrument, translated by Baillargeon, Dubois, and M a r r i n e a ~ permits ,~~ the evaluation of four aspects of marital functioning: dyadic satisfaction, dyadic cohesion, dyadic consensus, and affectional expression. Global scores of the DAS range from 0 to 151 ; the higher the score obtained by the subject, the greater the degree of marital satisfaction. Reliability and validity estimates for the DAS are a d e q ~ a t e . ~ * - ~ ~ The Index ofsexual Satisfaction ( ISS)35translated into French by Comeau and B o i ~ v e r tis, ~a~self-assessment questionnaire composed of 25 statements that measure the degree (or importance) of disagreement and dissatisfaction experienced by each partner with respect to hidher sexual relationship. Each statement is rated on a scale of 5 points, which ranges from 1 “rarely or never” to 5 “most of the time or always.” T h e final score is obtained by adding the 25 items, which results in a maximum score of 125. A sum of 25 is then subtracted from the final score in order that the global score ranges between 0 (maximum satisfaction) and 100 (maximum dissatisfaction). Global scores of 30 or more are indicative of a perturbed sexual relationship while scores of 30 or less fall within the normal range. T h e reliability of the instrument appears satisfactory; Cronbach’s alpha coefficient is Convergent and discriminant validity scores have proven a d e q ~ a t e . ~ ~ . ~ ~ The Ysvchologtcal State of Stress (PSS)” evaluates the intensity of an individual’s subjective feeling of stress. This self-assessment questionnaire is composed of 53 statements. There exist two short forms of the instrument (A and B), each one consisting of 27 statements. T h e short form A version of the questionnaire was adopted in the present study. Global scores vary from 27 to 216; the higher the score obtained by the subject, the greater is hidher level of experienced stress. T h e internal
277
Infertile Couples
consistency coefficient reaches .96 and the test-retest correlation over a 12-month period is satisfactory (.69). Stress scores are positively associated with physiological indices of stress.40
Downloaded by [University of Hong Kong Libraries] at 01:53 20 March 2013
Procedure
When subjects made their initial telephone contact with the fertility clinic, they were informed by the receptionist of the following two conditions stipulated by the medical team. Each patient and hidher partner must be present for the first evaluation at the clinic, and a three-hour session was to be foreseen which would involve an interview with a physician and a battery of tests on the couple’s psychosocial functioning. Patients would be required to return to the clinic on a number of occasions for further medical procedures. Every six months, for the next 24 months, couples would be approached by the research team studying the psychosocial impact of infertility and its treatment and asked to again complete the psychosocial test battery, which would require a further 60-80 minutes of their time. Subjects were assured that the results of the test battery would remain strictly confidential and would be used only to improve the care offered by the medical team, and would under no circumstances be used to identify patients ineligible for medical treatment. While couples were strongly urged to participate in the first evaluation, they were informed that subsequent recalls were on a strictly voluntary basis. Upon arrival at the fertility clinic, couples met with a senior gynecologist for a period of 45-90 minutes. They were then met by one of the four psychosocial evaluators (all females) who explained to them the objectives of the research study. If both members of the couple agreed to participate, they then proceeded to complete, independently, the aforementioned paper-and-pencil questionnaires after having both signed a prepared conscnt form. RE S ULTS
Mean and standard deviation scores obtained on the DAS, ISS, and PSS, for both sexes at each moment of assessment, are presented in Table 1. Scores on each measure were analyzed by three-way ANOVAs (gender of subject by success or failure to become pregnant, over three assessment periods). An interaction effect between gender and time of assessment was found on the variable stress. An examination of simple effects demonstrates that at the first time of assessment, women reported higher scores on the PSS than, men which indicates that they experienced significantly greater levels of stress than their spouses (F( 1,159)= 9.66, P
