Somatising the desire toward a child among Hong Kong Chinese women undergoing IVF: The mediating role of anxiety

Abstract

Study question: Does anxiety mediate the effect of importance of childbearing on physical symptoms among Hong Kong Chinese women undergoing IVF? Summary answer: Anxiety fully mediates the effect of importance of childbearing on physical symptoms among women undergoing IVF after controlling for demographic and clinical factors. What is known already: Anxiety is a common emotional reaction among women undergoing IVF. The unpredictable and uncontrollable nature of IVF fuels anxiety toward its process and outcome. Anxiety could be somatised and manifested in physical symptoms such as fatigue, headache, insomnia, and muscle pain. The stake and therefore the anxiety toward the IVF treatment could be heightened if the couple regards having a child as essential to themselves, their relationship and the family. Hence, this study examined whether perceived importance of childbearing escalates physical symptoms of somatization, and whether anxiety mediates the relationship between such attitude and physical distress. Study design, size, duration: This analysis utilized the baseline data of a randomized controlled trial that compared the effectiveness of a body-mind-spirit intervention in reducing the anxiety of women during the two-week wait before pregnancy test against two control conditions (health education and spiritual intervention). 225 participants who provided complete response to the items required in this analysis was included. The baseline data was collected in between 2015 and 2017 from the Queen Mary Hospital, Hong Kong. Participants/materials, setting, methods: Women who were going to undergo IVF were recruited. The importance of childbearing was measured by a 4-item scale; anxiety was assessed by the State-Trait Anxiety Inventory (State scale); physical symptoms were evaluated by the 14-item physical distress scale of Body-Mind-Spirit Well-Being Inventory. The mediation analysis was conducted with PROCESS macro in SPSS with 5000 bootstrapped samples, and with women’s and husbands’ age, previous ART treatment, subfertility years, subfertility type, and causes of subfertility controlled. Main results and the role of chance: Perceived importance of childbearing was positively correlated with state anxiety (r=.31; p<.001) and physical distress (r=.20, p<.001), and physical distress was positively correlated with state anxiety (r=.35, p<.001). After controlling for demographic and clinical characteristics, childbearing importance was significantly associated with physical distress in the total effect model, B = 0.69, SE = 0.23, [95%CI of B = 0.22-1.15], p=.0038. However, when state anxiety was added to the model, state anxiety was significantly related to physical distress, B = 0.70, SE = 0.14, [95%CI of B = 0.42-0.98], p<.001, and the association between childbearing importance and physical distress was no longer significant (p>.05). The indirect effect was statistically significant, B = 0.36, SE = 0.10, [95%CI of B = 0.20-0.59]. In other words, full mediation by state anxiety was found in the effect of childbearing importance on physical distress. The analysis was repeated by interchanging the role of physical distress and state anxiety, such that physical distress became the mediator. However, although the indirect effect was statistically significant, the mediation was partial as the direct effect from childbearing importance to state anxiety continued to be significant too. Hence, the former model was regarded as a more parsimonious representation of the relationship among childbearing importance, state anxiety and physical distress. Statistical significance was indicated by a p-value below 0.05. Limitations, reasons for caution: Physical distress was evaluated by selfreport of the participants. Recall bias and self-selection bias may reduce the generalizability of the findings. Wider implications of the findings: Interventions that aim at reducing anxiety during IVF treatment should take into account personal value and expectations attached to childbearing and the somatization of such concerns. Our findings also highlight the interaction among values, emotions and physical distress, and provide empirical foundation for multi-component interventions that address these aspects. Trial registration number: HKUCTR-1984