Infertility, social pressure, and mental health: An empirical study based on a reproductive sociology framework

doi:10.5498/wjp.116396

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Jul 19, 2026; 16(7): 116396
Published online Jul 19, 2026. doi: 10.5498/wjp.116396

Table 1 Demographic and clinical characteristics of study participants (n = 1200), n (%)

Characteristics	Total	Women (n = 749)	Men (n = 451)	P value
Age, mean ± SD	32.8 ± 5.2	32.3 ± 5.0	33.6 ± 5.4	< 0.001
Education level ≥ college	940 (78.4)	595 (79.6)	345 (76.5)	0.116
Employed full-time	984 (82.0)	587 (78.4)	397 (87.9)	< 0.001
Primary infertility	772 (64.3)	492 (65.8)	280 (61.9)	0.087
Infertility duration, years	2.7 (1.8)	2.8 (1.8)	2.5 (1.7)	< 0.001
Active treatment	878 (73.2)	568 (76.0)	310 (68.7)	< 0.001

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Table 2 Psychometric properties of Infertility Social Pressure and Mental Health Scale subscales

Subscale	Items	mean ± SD	Range	Cronbach’s α	Test-retest r	Factor loading range
Family pressure	8	3.45 ± 0.92	1-5	0.88	0.82	0.64-0.82
Social pressure	7	3.15 ± 0.89	1-5	0.91	0.85	0.68-0.85
Cultural pressure	6	3.28 ± 1.04	1-5	0.85	0.79	0.61-0.78
Media/societal pressure	7	2.87 ± 0.95	1-5	0.89	0.83	0.65-0.81
Self-imposed pressure	6	4.12 ± 0.78	1-5	0.87	0.86	0.70-0.84
Total scale	34	3.37 ± 0.75	1-5	0.92	0.84	-

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Table 3 Social pressure scores by demographic characteristics, mean ± SD

Characteristics	n	Family pressure	Social pressure	Cultural pressure	Media pressure	Self-imposed	Total score
Gender
Women	749	3.68 ± 0.89^a	3.32 ± 0.84^a	3.45 ± 1.01^a	3.02 ± 0.91^a	4.28 ± 0.73^a	3.78 ± 0.64^a
Men	451	3.07 ± 0.87^b	2.89 ± 0.89^b	2.98 ± 1.03^b	2.63 ± 0.94^b	3.87 ± 0.81^b	2.94 ± 0.71^b
Infertility type
Primary	772	3.52 ± 0.91^a	3.21 ± 0.87^a	3.34 ± 1.02	2.91 ± 0.93^a	4.21 ± 0.76^a	3.48 ± 0.72^a
Secondary	428	3.31 ± 0.92^b	3.03 ± 0.92^b	3.17 ± 1.08	2.79 ± 0.98^b	3.96 ± 0.81^b	3.22 ± 0.79^b
Duration (years)
1-2	535	3.21 ± 0.88^a	2.98 ± 0.85^a	3.11 ± 1.01^a	2.73 ± 0.92^a	3.98 ± 0.78^a	3.20 ± 0.71^a
3-4	418	3.58 ± 0.91^b	3.24 ± 0.87^b	3.38 ± 1.03^b	2.94 ± 0.94^b	4.19 ± 0.76^b	3.54 ± 0.73^b
> 5	247	3.79 ± 0.94^c	3.47 ± 0.93^c	3.52 ± 1.09^c	3.08 ± 0.99^c	4.32 ± 0.79^c	3.72 ± 0.77^c

^aP < 0.05.

^bP < 0.01.

^cP < 0.001.

Values with different superscript letters within each column indicate statistically significant differences (P < 0.05) based on one-way analysis of variance followed by Tukey’s post-hoc test. Values sharing the same letter are not significantly different from each other.

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Table 4 Mental health outcomes by gender and infertility characteristics, mean ± SD

Variable	Depression score	Anxiety score	Psychological distress
Total sample	3.42 ± 0.98	3.56 ± 0.92	3.49 ± 0.87
Gender
Women	3.68 ± 0.94^a	3.82 ± 0.88^a	3.75 ± 0.82^a
Men	2.99 ± 0.92^b	3.13 ± 0.87^b	3.06 ± 0.81^b
Infertility type
Primary	3.51 ± 0.96^a	3.65 ± 0.91^a	3.58 ± 0.86^a
Secondary	3.26 ± 0.99^b	3.40 ± 0.92^b	3.33 ± 0.87^b
Duration
1-2 years	3.18 ± 0.93^a	3.32 ± 0.89^a	3.25 ± 0.83^a
3-4 years	3.48 ± 0.97^b	3.62 ± 0.91^b	3.55 ± 0.86^b
5+ years	3.74 ± 0.99^c	3.88 ± 0.93^c	3.81 ± 0.88^c
Treatment status
Active treatment	3.51 ± 0.97^a	3.65 ± 0.91^a	3.58 ± 0.86^a
No treatment	3.19 ± 0.95^b	3.33 ± 0.90^b	3.26 ± 0.85^b

^aP < 0.05.

^bP < 0.01.

^cP < 0.001.

Within each variable category, means with different superscript letters are significantly different (P < 0.05) based on one-way analysis of variance followed by Tukey’s post-hoc test. For example, in the Duration category, the 1-2 years (a) and 3-4 years (b) groups did not differ significantly from each other but were both significantly lower than the 5+ years (c) group, indicating a significant progressive increase.

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Table 5 Correlation matrix of social pressure domains and mental health outcomes

Variable	Family pressure	Social pressure	Cultural pressure	Media pressure	Self-imposed	Depression	Anxiety	Psychological distress
Family pressure	-	-	-	-	-	-	-	-
Social pressure	0.68^a	-	-	-	-	-	-	-
Cultural pressure	0.61^a	0.59^a	-	-	-	-	-	-
Media pressure	0.54^a	0.62^a	0.57^a	-	-	-	-	-
Self-imposed	0.71^a	0.66^a	0.63^a	.58^a	-	-	-	-
Depression	0.65^a	0.58^a	0.54^a	0.49^a	0.72^a	-	-	-
Anxiety	0.62^a	0.56^a	0.52^a	0.47^a	0.69^a	0.78^a	-	-
Psychological distress	0.64^a	0.57^a	0.53^a	0.48^a	0.71^a	0.91^a	0.89^a	-

^aP < 0.001.

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Table 6 Multiple regression analysis predicting psychological distress

Predictor	B	SE	β	t	P value	95%CI
Constant	0.82	0.09	-	9.11	< 0.001	0.64-1.00
Family pressure	0.27	0.03	0.28	9.00	< 0.001	0.21-0.33
Social pressure	0.14	0.03	0.14	4.67	< 0.001	0.08-0.20
Cultural pressure	0.18	0.02	0.21	9.00	< 0.001	0.14-0.22
Media pressure	0.09	0.02	0.10	4.50	< 0.001	0.05-0.13
Self-imposed pressure	0.38	0.03	0.34	12.67	< 0.001	0.32-0.44

R² = 0.42, Adjusted R² = 0.42, F (5, 1194) = 296.8, P < 0.001. CI: Confidence interval.

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Table 7 Social pressure mediation analysis

Path	Direct effect	Indirect effect	Total effect	95%CI (indirect)
Women
Infertility characteristics → depression	0.18^a	0.34^c	0.52^c	0.29-0.39
Infertility characteristics → anxiety	0.16^a	0.33^c	0.49^c	0.28-0.38
Men
Infertility characteristics → depression	0.15^a	0.23^c	0.38^c	0.18-0.28
Infertility characteristics → anxiety	0.14	0.21^c	0.35^c	0.16-0.26
Urban residents
Family pressure → depression	0.24^c	0.11^a	0.35^c	0.05-0.17
Family pressure → anxiety	0.22^b	0.10^a	0.32^c	0.04-0.16
Rural residents
Family pressure → depression	0.36^c	0.19^b	0.55^c	0.13-0.25
Family pressure → anxiety	0.34^c	0.22^c	0.56^c	0.16-0.28
Higher education (≥ college)
Social pressure → depression	0.26^c	0.12^a	0.38^c	0.06-0.18
Social pressure → anxiety	0.24^c	0.11^a	0.35^c	0.05-0.17
Lower education (< college)
Social pressure → depression	0.32^c	0.20^b	0.52^c	0.14-0.26
Social pressure → anxiety	0.30^c	0.18^b	0.48^c	0.12-0.24

^aP < 0.05.

^bP < 0.01.

^cP < 0.001.

CI: Confidence interval.

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Table 8 Risk profile analysis for groups at high risk for psychological distress

Risk profile	n (%)	ISPMHS score, mean ± SD	Distress prevalence	OR (95%CI)
Lowest risk
Men, secondary, < 2 years, low family pressure	85 (7.1)	2.43 ± 0.52	18.3%	1.00 (reference)
Moderate risk
Men, primary, 2-4 years, moderate pressure	161 (13.4)	3.12 ± 0.61	42.5%	3.31 (2.14-5.12)
Women, secondary, < 3 years, moderate pressure	214 (17.8)	3.28 ± 0.68	48.9%	4.26 (2.82-6.44)
High risk
Women, primary, 3-5 years, high family pressure	293 (24.4)	3.89 ± 0.73	71.3%	10.84 (7.26-16.18)
Highest risk
Women, primary, 5+ years, high family pressure, low support	107 (8.9)	4.32 ± 0.65	89.3%	38.26 (23.47-62.37)

Odds ratio for clinically significant psychological distress (score ≥ 3.5). CI: Confidence interval; OR: Odds ratio; ISPMHS: Infertility Social Pressure and Mental Health Scale.

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Citation: Huang SH, Ji HP, Tang XH, Li M, Jiang SC, Yin M. Infertility, social pressure, and mental health: An empirical study based on a reproductive sociology framework. World J Psychiatry 2026; 16(7): 116396
URL: https://www.wjgnet.com/2220-3206/full/v16/i7/116396.htm
DOI: https://dx.doi.org/10.5498/wjp.116396

Huang SH, Ji HP, Tang XH, Li M, Jiang SC, Yin M. Infertility, social pressure, and mental health: An empirical study based on a reproductive sociology framework. World J Psychiatry 2026; 16(7): 116396 [DOI: 10.5498/wjp.116396]

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