불임 남성의 삶의 질 예측 모형

Abstract

ABSTRACT

Predictive Model for the Quality of Life of Infertile Men

Park, Jum Mi Department of Nursing The Graduate School of Hanyang University Directed by Professor Yoo, Eun Kwang, R.N., Ph.D.

This study explores influencing factors on the quality of life of infertile men, and attempts to construct a structural model to predict their quality of life. The influencing factors and broader structural model of infertile men’s quality of life were developed based on precedent studies and literature reviews on general and social perspectives on infertility. The resulting exogenous variables were infertility related stress, and social support; mediating variables were depression, marital adjustment, and spirituality; resulting variables were measured through 6 theoretical variables, including quality of life, and 23 measurement variables. Each of the assessment tool’s validity and reliability were confirmed prior to its usage in the study. Data was collected via questionnaires from 242 infertile, male outpatients from ‘C’ Hospital Urologist Department’s 3 Infertile Clinics, with the subjects’ confidentiality ensured. The self-reported questionnaires were collected for 7 months from February to August 2016 in the outpatient centers. The collected data was analyzed using SPSS/WIN 21.0 Program and Mplus 6.0 Program.

The results of the study are as follows.

1. The average age of the subjects was 35 (±4.11), with maximum age of 49, and minimum age of 26; 62.4% was below 35. The occupation of the subjects were as follows: office worker 63.6%, professionals 15.7%, and self-employed 19%. Most of the subjects belonged to nuclear families 90.1%, were the eldest son 39.7%, and were married for around 1-3 years 47.1%. The smoking profiles were as follows: do not smoke at all 48.8%, currently smoke 32.2%, quit smoking 19%. Most participants 41.3%, drank around 1-2 times a week, and did not exercise for more than 30 minutes a week 61.6%. 67.8% of the participants reported having staff dinners less than twice a week. Participants’ stress levels were as follows: low 48.8%, high 27.3%, average 24%. Working hours were as follows: 9-12 hours 80.2%, less than 8 hours 13.6%, more than 13 hours 6.2%. Levels of economic pressure perceived were as follows: average 34.3%, no pressure 33.5%, high 32.2%. Most participants were diagnosed as infertile for less than 1 year 67.4%, and attempted to conceive for 2-3 years 45%. 51.2% reported that there were no people pressuring them due to their infertility, and 63.6% reported their spouse as their source of support. 93.4% were hopeful on the hospital treatment. The participants identified following parties as the cause of infertility: unknown 50.8%, men 24%, others 13.6%, both parties 11.6%.

2. Infertility related stress score range was 46-276 points, with an average score of 99.57±19.13 out of 276 points. Under infertility related stress, ‘parental presssure’ domain score was the highest, at 28.51±5.20, and ‘spiritual’ domain score was the lowest, at 14.72±4.91. Smoking males had statistically significantly higher infertility related stress scores (F=3.43, p=.034). Average social support score was 4.07±0.65 out of 5 points. Under social support, ‘esteem support’ domain score was the highest, at 4.14±0.69, and ‘information support’ domain score was the lowest, at 4.01±0.73. Social support score was statistically significantly higher amongst males who exercised more than 30 minutes a week (t=-2.35, p=.019), had prior experience of infertility treatment (t=-2.36, p=.019), and were currently undergoing infertility treatment (F=4.55, p=.001). Average depression score was 1.24±0.29 out of 3 points indicating not being depressive. Under depression, ‘performance difficulties’ domain score was the highest, at 2.06±2.55, and ‘physical changes’ domain score was the lowest, at 0.87±1.26. No characteristics had statistically significant effect on depression. Average martial adjustment score was 4.84±0.59 out of 6 points. Under marital adjustment, ‘satisfaction’ domain score was the highest, at 5.13±0.59, and ‘intimacy’ domain score was the loweset, at 4.57±0.96. Marital adjustment scores were statistically significantly higher amongst subjects who did not smoke (F=5.47, p=.005), and were employed (F=6.63, p=.001). Spirituality score range was 28-168 points, with an average score of 114.40±20.69 out of 168 points which was medium level. Under spirituality, ‘internal resources’ domain score was the highest, at 35.49±6.39, and ‘purpose of life’ domain score was the lowest, at 17.94±3.6. Spirituality scores were statistically significantly higher amongst infertile men who were residing in Seoul (t=2.31, p=.022), did not smoke (F=3.24, p=.041), and exercised (t=-2.26 p=.025). Average quality of life score was 4.10±0.51 out of 5 points. Under quality of life, ‘sex life’ domain score was the highest, at 4.23±0.61, and ‘psychological health’ domain score was the lowest, at 3.85±0.56. Quality of life score was statistically significantly higher amongst infertile men who did not smoke (F=4.95, p=.008).

3. The hypothetical model’s goodness of fit exceeded the recommended level. The variable that directly affected quality of life was infertility related stress. Depression acted as a mediating variable to indirectly affect quality of life. In other words, lower the levels of infertility related stress and depression, higher the standard of living for infertile men. Hypothesis test with quality of life as the endogenous variable identified infertility related stress (β=-0.79, t=-9.41), depression (β=-0.20, t=-2.58), and spirituality (β=0.21, t=2.90) as statistically significant variables. Marital adjustment (β=-0.06, t=-0.69) and social support (β=-01.2, t=-1.79) were not statistically significant. The variables accounted for 84.1% of the variation.

Study results show that infertility related stress and depression have negative correlation, and spirituality has positive correlation with infertile men’s quality of life. As such, there needs to be a development of practical and multi-faceted Nursing intermediation programs to control infertility related stress and depression levels so as to sustain infertile men’s quality of life. In conclusion, creation of specialized counseling centers for infertile men who are starting their infertility treatments, so as to provide infertility-related information and mediate their anxiety and fears related to the treatment, is essential to increase their quality of life. Furthermore, developments of infertility treatments that not only encompass physical treatments, but also mental and psychological treatments, are crucial. There is especially a need for personal counseling to cater to each man’s personal characteristics, as well as development of Nursing intermediation programs and suitable environment for the infertile men to express themselves. This study is meaningful for its development of prediction model for infertile men’s quality of life, and identification of infertility related stress, depression, and spirituality as factors that influence the quality of life. The model could serve as basic data for future development of Nursing intermediation programs to improve quality of life of infertile men.

Key words : infertile men, infertility related stress, social support, quality of life