Fang Liu: Department of Operation Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450000, China.
Wenju Han: Department of Reproductive Center, Dalian Women and Children's Medical Group, Dalian, Liaoning, 116037, China.
Wei Qiao: Department of Operation Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450000, China.
Zhihan Chen: Department of Social Medicine, College of Health Management, China Medical University, Shenyang, Liaoning, 110122, China.
Yingbo Chen: Department of Operation Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450000, China.
Ruonan Lu: Department of Operation Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450000, China.
Junqiao Qi: Department of Reproductive Center, Dalian Women and Children's Medical Group, Dalian, Liaoning, 116037, China.
Xiuxia Yuan: Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450000, China.
Xueqin Song: Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450000, China. fccsongxq@zzu.edu.cn.
Dongqing Zhang: Department of Operation Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450000, China. zdcwk2007@126.com.
BACKGROUND: This study has employed network analysis while investigating the interrelationships among stress and stigma symptoms and their associations with quality of life among Chinese female infertility patients. METHODS: In this cross-sectional study, 428 female patients who visited the Department of Reproductive Center of Dalian Women and Children's Medical Group with chief complaints of infertility symptoms were recruited using convenience sampling from November 2022 to December 2023. Fertility-related stress and stigma status were examined by the Fertility Problem Inventory (FPI) and Infertility Stigma Scale (ISS), respectively. Quality of life was examined by the Fertility Quality of Life (FertiQoL). Network analysis was conducted to estimate the network of stress and stigma symptoms. The flow network approach was used to identify specific stigma and stress symptoms related to quality of life. Expected influence (EI) and bridge expected influence (bEI) were used to quantify central and bridge symptoms in the network, respectively. The bootstrapping method evaluated the accuracy and robustness of the network estimates. RESULTS: The average predictability of FPI and ISS symptoms was 0.67. The "relationship concern" was the most central symptom across all centrality indices, followed by "public stigma" and "social concern". The main symptoms bridging the FPI and ISS clusters were "self-devaluation", "social concern", and "relationship concern". The network demonstrated robustness in stability and accuracy tests. In the flow network, "social withdrawal" and "self-devaluation" showed strong negative associations with FertiQoL. CONCLUSIONS: "Relationship concern," "public stigma," "social concern," and "self-devaluation" have been identified as the main central and bridge symptoms in the stress and stigma network in this study. Notably, stigma symptoms, particularly "social withdrawal" and "self-devaluation", showed stronger associations with FertiQoL compared to stress symptoms, highlighting their importance in potential treatment strategies.
