Effects of Self-Esteem on the Associations Between Infertility-Related Stress and Psychological Distress Among Infertile Chinese Women: A Cross-Sectional Study

Background: Anxiety and depression are the most common psychological causes of distress in infertile women. Our study aimed to evaluate the prevalence of depression and anxiety and investigate the effects of self-esteem on the association of infertility-related stress with depression and anxiety among infertile women. Methods: This study was conducted between December 2017 and May 2018. Questionnaires containing Fertility Problem Inventory (FPI), Rosenberg self-esteem scale (RSES) and Hospital Anxiety and Depression Scale (HADS) were distributed among 536 female infertility patients in Shenyang, China. Hierarchical linear regression analyses were used to examine the mediating and moderating role of self-esteem. Baron and Kenny's technique, asymptotic, and resampling strategies were used to confirm the mediating role of self-esteem on the associations between infertility-related stress with depression and anxiety. Results: The prevalence of depression and anxiety was 27.9% and 42.2% among Chinese female infertility patients, respectively. Infertility-related stress was positively associated with depression and anxiety, whereas self-esteem was negatively associated with depression and anxiety. Additionally, the effects of infertility-related stress on depression and anxiety gradually decreased along with an increase in self-esteem. Meanwhile, self-esteem partially mediated the associations between infertility-related stress with depression and anxiety. Conclusion: A high prevalence of psychological distress was found among infertile women. Self-esteem mediated and moderated the effects of infertility-related stress on depression and anxiety. Additionally, infertility-related stress and self-esteem were associated with psycho-logical distress, which explained why infertile women had a higher prevalence of depression and anxiety. Therefore, interventions that focus on self-esteem may be effective and should be used as a resource to combat mental health problems.