STUDY QUESTION: Are there any gender differences and dyadic interactions in the associations between infertility-related stress and resilience and posttraumatic growth in infertile couples? SUMMARY ANSWER: Husbands’ posttraumatic growth was only impacted by their own infertility-related stress and resilience, whereas wives’ posttraumatic growth was influenced by their own resilience and their spouses’ resilience. WHAT IS KNOWN ALREADY: Posttraumatic growth may play a significant role in protecting the infertile couples’ psychological well-being and contribute to positive pregnancy outcomes. The reciprocal influence on each other within the infertile couple in terms of relationships between infertility-related stress and resilience and posttraumatic growth has been largely overlooked. STUDY DESIGN, SIZE, DURATION: This cross-sectional study included 170 couples who were recruited from the First Affiliated Hospital of Soochow University between September 2019 and January 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS: The Fertility Problem Inventory, Connor–Davidson Resilience Scale-10, and Post-traumatic Growth Inventory were used to measure infertility-related stress, resilience, and posttraumatic growth. The Actor-Partner Interdependence Model was used to analyze the effects of infertility-related stress and resilience on the couple’s own posttraumatic growth (actor effect) as well as on their partner’s posttraumatic growth (partner effect). MAIN RESULTS AND THE ROLE OF CHANCE: Husbands had higher levels of resilience than wives, while no significant gender differences were found in the levels of infertility-related stress and posttraumatic growth. Posttraumatic growth correlated with each other among infertile couples. Husbands’ infertility-related stress had actor effects on their own posttraumatic growth, while wives’ infertility-related stress had no effect on their own or their spouses’ posttraumatic growth. Husbands’ resilience had actor and partner effects on their own and their wives’ posttraumatic growth, while wives’ resilience only had an actor effect on their own posttraumatic growth. LIMITATIONS, REASONS FOR CAUTION: First, our sample was limited to infertile Chinese couples seeking clinical treatment. Second, sociodemographic and psychological measures were self-reported. Third, as the current study is a cross-sectional study, the dynamic process of posttraumatic growth is unknown. WIDER IMPLICATIONS OF THE FINDINGS: Infertile couples should be considered as a whole in studies on infertility. Couple-based psychological interventions are critical and more effective in improving mental health among individuals with infertility. Elevating the level of resilience may contribute to improving posttraumatic growth for both husbands and wives. Moreover, enhancing the ability to cope with infertility-related stress might be useful for husbands and indirectly contribute to wives’ posttraumatic growth. STUDY FUNDING/COMPETING INTEREST(S): This research was supported by the National Natural Science Foundation of China (Grant No. 31900783) and the College Natural Science Research Project of Jiangsu Province (Grant No.19KJD320004). The authors declare no conflict of interest. TRIAL REGISTRATION NUMBER: N/A.

Background: Concerns about insufficient milk are a common reason for supplementation and breastfeeding cessation. The H&H Lactation Scale (HHLS) captures a broad maternal appraisal of lactation that includes confidence, perceived infant satiety, and satisfaction. We examined the cross-sectional association of sense of coherence with HHLS total and domain scores and estimated the indirect association through breastfeeding self-efficacy. Methods: This single-center cross-sectional study included 255 women attending a routine one-month postpartum follow-up. Sense of coherence, breastfeeding self-efficacy, and perception of milk supply were measured using the SOC-13, BSES-SF, and Chinese-language HHLS, respectively. Analyses included hierarchical regression, domain-specific path models, and 5,000-resample bootstrap estimates under parsimonious and expanded adjustment specifications. Sensitivity analyses excluded women currently formula feeding. Results: SOC was positively associated with BSES-SF and HHLS total scores. Adding BSES-SF increased explained variance in HHLS total score from 10.4 to 36.1%. The parsimonious indirect estimate was 0.187 (bootstrap 95% CI 0.097 to 0.299), and the expanded estimate was 0.044 (−0.002 to 0.108). Indirect associations were evident for HHLS Maternal confidence/commitment (0.086, 0.036 to 0.152) and satisfaction (0.102, 0.057 to 0.155), but not infant satiety (−0.001, −0.021 to 0.019). After excluding 48 women currently formula feeding, the corresponding estimates remained positive in both the parsimonious (0.199, 0.102 to 0.323) and expanded (0.061, 0.004 to 0.147) models. Conclusion: Breastfeeding self-efficacy was related to mothers’ broader appraisal of lactation, particularly confidence and satisfaction, and the principal pattern remained among women who were currently breastfeeding. The findings did not extend to perceived infant satiety and do not establish temporal mediation. BSES-SF may complement, but should not replace, clinical assessment of lactation and infant intake.

Purpose: This study was designed to explore separate and cumulative effects of fertility-related pressure, anxiety, depression, resilience and marital quality on suicidal ideation in Chinese infertile couples.Methods: A cross-sectional study was conducted among infertile couples at the reproductive medicine center. Suicidal ideation was evaluated using item 9 of PHQ-9. A score of 1 or above indicated the presence of suicidal ideation. The Fertility Problem Inventory, Generalized Anxiety Disorder-7, Patient Health Questionnaire-8, the 10-item Connor-Davidson Resilience Scale and Quality of Marriage Index were used to measure the risk and protective factors. Risk factor index is used to represent the number of risk factors, and protective factor index is used to represent the number of protective factors.Results: A total of 674 infertile couples participated this study. 65 infertile men and 76 infertile women reported suicidal ideation. Univariate analysis revealed that infertility-related pressure, anxiety, depression, resilience and marital quality were associated with suicidal ideation in both genders. Binary logistic regression revealed positive associations of risk factor index with suicidal ideation in couples (males: OR = 1.966, 95%CI: 1.636–2.363; females: OR = 2.484, 95%CI: 1.992–3.098). The protective factor index was significantly associated with reduced suicidal ideation odds in females (OR = 0.530, 95%CI: 0.316–0.888), but no significant association was found in males (p = 0.159).Conclusion: Our findings indicate that infertility-related pressure, anxiety, depression, resilience and marital quality are associated with suicidal ideation among infertile couples. Specifically, higher risk factor index is linked to increased odds of SI in both genders, with females showing a stronger association. And higher protective factor index is associated with reduced odds of SI in females, though this effect is not significant in males. Therefore, interventions targeting the reduction of infertility-related pressure, anxiety, and depression, coupled with the enhancement of resilience and marital quality, may effectively mitigate the risk of suicidal ideation in this population.