Associations between Stigma, Cognitive Appraisals, Coping Strategies and Stress Responses among Japanese Women Undergoing Infertility Treatment

Abstract

The number of infertility treatment cycles in Japan is the highest worldwide. Studies have shown that stigma is a predictor of stress-related symptoms including anxiety and depression in women undergoing infertility treatment. Stress management to prevent stress-related symptoms may be crucial; however, few studies have examined the model of stigma and stress responses. Based on the stress-coping model, we hypothesized that stigma threatens the identity of such women and that coping failure increases stress responses. We aimed to explore the role of cognitive appraisals and coping strategies as mediators of the association between the stigma of infertility and stress responses. In December 2021, we conducted a cross-sectional study in Japan, in which 254 women undergoing infertility treatment completed a web-based survey. Hierarchical multiple regression analysis was conducted to analyze the associations between stigma, cognitive appraisals, coping strategies, and stress responses. The results showed that explanatory power increased with each additional variable in the following order: stigma, cognitive appraisals, and coping. Participants with a high level of stigma evaluated it as threatening, and used self-blame and venting coping strategies, and showed higher stress responses. Conversely, participants who used positive reframing coping strategies exhibited lower stress responses. Based on this, effective strategies to address stigma and stress responses are necessitated.

Irrational parenthood cognition and infertility stigma among infertile women: a cross- sectional study in Changsha, China

“…Similarly, high levels of stigma have also been reported in other studies (19)(20)(21). It has been well established in the literature that infertility stigma was associated with a wide range of negative health outcomes, including low self-esteem, low self-e ciency, failure in coping, and social isolation, which all contributed to high psychological distress such as depression and anxiety, and even suicide ideation (22)(23)(24)(25). In addition, infertile women with high stigma were less likely to seek treatment and more likely to discontinue treatment even if they sought treatment (26,27).…”

Relationships Between Perceived Stigma and Coping Strategies in Patients with Multiple Sclerosis

“…Similarly, Holubova et al (33) demonstrated a direct and significant link between the use of emotion-focused coping strategies and increased internalized stigma in schizophrenia patients. Stigma has been conceptualized by several researchers as a potent stressor that can exacerbate clinical symptoms and potentially trigger illness relapse (34)(35)(36). Consequently, MS patients utilize coping strategies to manage the stress and depression caused by stigma (31).…”

Assisted reproductive technology in Japan: A summary report for 2021 by the Ethics Committee of the Japan Society of Obstetrics and Gynecology

“… 10 , 34 Cultural and social factors include the social stigma associated with infertility. 35 , 36 , 37 Unmarried couples in Japan usually do not have children. 38 Further measures that could help improve Japan's current ART and fertility trends can be summarized under the governmental movements to support infertility patients.…”