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American Journal of  Physical Education 
and Health Science (AJPEHS)

Depression, Coping Strategies and Social Support among Infertile Women Attending 
Gynecology Clinics of  a Tertiary Care Hospital in South-West Nigeria: Prevalence, Patterns, 

Peculiarities and Associated Factors
Joy Oluwabosede Esan1, Margaret Inemesit Akpan2, Aloysius Obinna Ikwuka3*, Babatunde Ayodeji Esan4

Volume 3 Issue 1, Year 2025
ISSN: 2992-9679 (Online) 

DOI: https://doi.org/10.54536/ajpehs.v3i1.4893
https://journals.e-palli.com/home/index.php/ajpehs

Article Information ABSTRACT

Received: March 20, 2025

Accepted: May 05, 2025

Published: May 26, 2025

Infertility is one of  the fastest growing concerns when it comes to reproductive health 
and most often, women get the blame. Consequently, females suffer from major psycho-
social and emotional problems that may lead to serious mental health concerns. The aim 
of  this research was to study depression, coping strategies, and social support among 
infertile women attending gynecology clinics of  a tertiary care hospital in South-West 
Nigeria, paying attention to their prevalence, patterns, peculiarities, and associated factors. 
A descriptive cross-sectional design was used involving 372 respondents. Simple random 
sampling technique was used to select the study population and sample size. Data collection 
was done using a semi-structured standardized questionnaire. Applied statistical tests of  
significance were stated and were tested using chi-square test, with p-value <0.05 considered 
statistically significant. 38.7% of  the respondents were within the age range of  31-36 years 
and only 1.0% of  the respondents were within the age range of  19-24 years. Majority of  
the infertile women in this study (39.2%) had a normal level of  depression according to 
Beck Depression Inventory. Socio-demographic characteristics such as age, income, level of  
education, type of  family, and duration of  marriage were significantly related to occurrence 
of  depression among the respondents. Most of  the respondents (57.5%) had first degree 
(bachelor’s degree) from the university. More than half  (67.7%) had income >N100,000 
monthly. Majority of  the respondents (76.9%) came from a monogamous family and the 
duration of  marriage in 34.4% of  the respondents was 6-10 years (p<0.001). Majority of  the 
respondents (55.9%) accepted sympathy and understanding from someone – Seeking Social 
Support coping strategy; 68.3% of  the respondents do not think they brought the problem 
on themselves - Accepting Responsibility coping strategy; 50.0% of  the respondents hoped 
a miracle would happen, and 43.0% of  the respondents avoided being with people in 
general - Escape Avoidance coping strategy; 51.1% of  the respondents concentrated on the 
next step to be done - Painful Problem-solving coping strategy; 71.0% of  the respondents 
prayed - Positive Re-appraisal coping strategy; 45.2% of  the respondents did not express 
their anger to the person(s) that caused the problem - Confrontative coping strategy; 31.7% 
of  the respondents somewhat keep their feelings to themselves - Self-controlling coping 
strategy; and 43.0% of  the respondents tried to forget the whole thing - Distance coping 
strategy. The relationships between coping ability and severity of  depression were examined 
and it was discovered that there is statistically significant relationship between the coping 
ability and severity of  depression among the infertile women. There is a need to assess 
infertile women‘s general and psychological health. Care for infertile women should be in a 
contextually and culturally appropriate manner to improve their health status and quality of  
life. Health policy in developing countries needs to recognize the public health burden of  
depression as it affects infertile women. Key health services available in the clinics should 
include integrating psychological care, strengthening social support network, counseling, and 
follow-up services in infertility management.

Keywords

Associated Factors, Coping 
Strategies, Depression, Fertility 
Clinic, Ibadan, Infertile Women, 
Infertility, Oyo State, Patterns, 
Peculiarities, Prevalence, Social 
Support, South-West Nigeria, 
Women, Women’s Health

1 Department of  Nursing, University College Hospital, Ibadan, Nigeria
2 Faculty of  Allied Medical Sciences, University of  Calabar, Calabar, Nigeria
3 College of  Medicine and Health Sciences, American International University West Africa, Banjul, The Gambia
4 Department of  Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria
* Corresponding author’s e-mail: aloysiussweet@yahoo.com

INTRODUCTION
Reproductive health is defined as a state of  complete 
physical, mental, and social well-being, and not merely 
the absence of  disease or infirmity, in all matters relating 
to the reproductive system, its functions and processes 
(WHO, 2021b). Global attention has been drawn to the 
importance of  reproductive health. In fact, the United 
Nation’s popular third Sustainable Development Goal 
(SDG) is “Good Health and Well-being”, which is to 
actualize healthy lives and accelerate well-being for all, at 
all ages. The seventh target states that by 2030, there will 

be universal access to sexual and reproductive healthcare 
services, including family planning, information and 
education, and the integration of  reproductive health into 
national strategies and programs (United Nations, 2020). 
Globally, infertility affects 9-15% of  couples, with higher 
rates reported in the developing countries (Zurlo, 2019). 
Gametes which refer to the male and female reproductive 
cells (sperm and ova) are haploid and contain one set 
of  chromosomes which could be either 1–22 X or 1–22 
Y (Ikwuka, 2023a). Even when fertilization occurs and 
results in pregnancy, the effects of  tobacco consumption 



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on pregnancy have been reported (Udeh, 2023a; Udeh, 
2023b; Udeh, 2023c). The effects of  hormonal imbalance 
on fertility (Aliu-Ayo, 2023a; Aliu-Ayo, 2023b), and 
anemia on pregnancy (Inya, 2023a; Inya, 2023b) have also 
been reported.
According to the WHO, the clinical description of  the 
reproductive system disease known as infertility – is 
defined as a failure to conceive naturally after 365 days or 
more of  uninterrupted sexual intercourse (Zurlo, 2019; 
Bakhtiyar, 2019). In Sub-Saharan Africa where Nigeria 
is located, infertility affects 25% of  couples (Fehintola, 
2017).
In addition, there are ongoing studies dwelling on 
the links between metabolic disorders and infertility. 
Metabolic Syndrome Diseases (MSDs) which include 
hypertension, obesity, diabetes mellitus, and dyslipidemia, 
are interlinked diseases and often occur concurrently. 
MSDs are associated with very high economic costs, 
morbidity and mortality rates (Ikwuka, 2015; Ikwuka, 
2017a; Ikwuka, 2017c; Ikwuka, 2023c; Ikwuka, 2023f; 
Ikwuka, 2024; Virstyuk, 2016). Numerous studies have 
also reported associations between MSDs and increased 
levels of  blood pressure, glucose and lipid metabolic 
disorders, asymptomatic hyperuricemia, systemic 
immune inflammation, and fibrogenesis – factors that 
may eventually lead to kidney damage (Ikwuka, 2017d; 
Ikwuka, 2017e; Ikwuka, 2018c; Ikwuka, 2018d; Ikwuka, 
2019a; Ikwuka, 2019c; Ikwuka, 2022; Ikwuka, 2023d; 
Virstyuk, 2017a; Virstyuk, 2018a; Virstyuk, 2019; 
Virstyuk, 2021a; Virstyuk, 2021b).
Nonetheless, remaining involuntarily without issue, due 
to inability to conceive is one of  life’s highest misfortunes. 
Besides being a medical condition in itself, involuntary 
childlessness can have a significant impact on well-being 
and quality of  life (Mol, 2018). Abnormal immune 
responses e.g. formation of  anti-sperm antibodies in 
women against their partner’s sperm cells have been 
identified as contributing factors to female infertility.
Additional immune-related mechanisms include 
antibodies to clotting factors, which may result in both 
thrombosis and hemorrhage; as well as hemolytic 
reactions which can occur in the process of  transfusion 
of  blood products (Ikwuka, 2023e). Oxidative stress has 
also been linked to infertility. The major contributors 
to oxidative stress are free radicals such as superoxide 
anions, hydroxyl radicals, and hydroperoxyl radicals 
and all are significant physiologically. A non-radical 
which is significant physiologically is hydrogen peroxide 
(Ama, 2023; Baysah, 2023; Ikwuka, 2023b; Uche, 2023). 
Infertility has been ranked as one of  the high stressors in 
life with psychological, social, and cultural consequences 
(Maroufizadeh, 2018). One of  the most common 
mental health problems among women with infertility is 
depression (Aflakseir, 2016).
Depression is defined as a disposition or expressive state 
that is marked by moods of  low self-respect or guilt and 
a reduced ability to enjoy life (Britannica, 2021). Globally, 
depression affects up to 300 million persons of  all ages 

(Alimohamadi, 2020) and approximately 40% of  infertile 
women are reported to have symptoms of  depression 
and anxiety (Crawford, 2017; Cusatis, 2019). Many studies 
have revealed that couples with infertility are twice likely 
to suffer from anxiety and depression than couples who 
are fertile (Maroufizadeh, 2018; Cusatis, 2019). 
The resultant psychosocial issues affect the female gender 
more adversely than her spouse, especially in societies 
where there are prejudices against women (Bakhtiyar, 
2019). This is so, due to the association of  infertility and 
the women’s social role (Cusatis, 2019). Attitudes toward 
women’s infertility are often influenced by ethnic and 
cultural groups with some cultures vindicating the male 
spouse from the issue of  infertility thus making infertility 
solely the woman’s challenge (Bakhtiyar, 2019). Men can 
easily cope with childlessness, more than women (Amini, 
2020). 
Moreover, treatments of  infertility are quite expensive, 
emotionally draining, and time-consuming. Therefore, it 
is necessary for the clinicians to know the state of  well-
being of  the infertile women before engaging them in the 
treatment. Findings from a study conducted by (Crawford, 
2017) revealed that failure in infertility treatment leads 
to higher rates of  depression and anxiety. Implications 
of  infertility on the well-being of  women are becoming 
alarming in the world, Nigeria inclusive. 
On the other hand, metabolic syndrome diseases (MSDs) 
are interrelated diseases that contribute significantly 
to healthcare costs, morbidity, and mortality rates, thus 
requiring the search for new, effective, and innovative 
treatment options (Ikwuka, 2024). Innovative treatment 
options such as combining HMG-CoA reductase 
inhibitors, SGLT-2 inhibitors, and angiotensin II receptor 
blockers (type 1) i.e. A2RB (AT1), have shown clinical 
effectiveness indicated by marked improvements in 
the metabolic functions of  the heart, liver, pancreas, 
and kidney (Ikwuka, 2017b; Ikwuka, 2018a; Ikwuka, 
2018b; Ikwuka, 2021; Virstyuk, 2017b; Virstyuk, 2018b; 
Virstyuk, 2018c; Ikwuka, 2024). Additionally, Glucagon-
like Peptide 1 Receptor Agonists (GLP-1 RAs) such 
as liraglutide have been shown to improve the clinical 
outcomes in patients with type 2 diabetes mellitus and 
hypertension (Ikwuka, 2019b).
Meanwhile, studying depression, coping strategies, and 
social support among infertile women will contribute to 
existing literature – which will in turn assist members of  
the healthcare team to understand how best to address 
the needs of  these women and care for them holistically. 
In addition, findings from this study will serve as a 
reference source for policymaking on the healthcare 
needs of  infertile women in Oyo State, and Nigeria, at 
large. Lastly, this study will broaden the knowledge of  the 
researchers on the topic. Therefore, this research aimed 
to study depression, coping strategies, and social support 
among infertile women attending gynecology clinics of  
a tertiary care hospital in South-West Nigeria, paying 
attention to their prevalence, patterns, peculiarities, and 
associated factors.



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MATERIALS AND METHODS
Study Area
This study was carried out at University College Hospital 
(UCH), Ibadan, Ibadan North Local Government Area 
(LGA), Oyo State, South-West Nigeria. The University 
College Hospital, Ibadan started with 500 bed spaces 
but has expanded overtime to 1,000 bed spaces and 163 
examination couches with occupancy rates ranging from 
55-60%. It has about 65 departments among which is 
the Department of  Obstetrics and Gynecology which 
has five units namely Assisted Conception Unit (ACU), 
Fertility Research and Endocrinology Unit (FREU), Feto-
Maternal Medicine Unit (FMMU), Genito-Urinary Unit 
(GUU), and Gyne-Oncology Unit (GOU). University 
College Hospital, Ibadan was chosen for this study 
because it is the only government (public) hospital that 
has a well-structured gynecology clinic and in-vitro 
fertility center within the Ibadan North LGA which 
caters for infertility cases.

Study Design
This study adopted a descriptive cross–sectional design.

Study Population
The study population consisted of  infertile women (who 

presented with a history of  inability to conceive after a 
period of  one year) attending gynecology clinics at UCH, 
Ibadan, irrespective of  age, tribe or religious affiliation.

Sample Size
The Cochran equation for descriptive, cross-sectional 
studies with a study population >10,000 was used to 
determine the sample size (Singh, 2014). 
n0, sample size for large population >10,000 = (Z2 PQ)/d2 
Where: 
Z is the abscissa of  the normal curve that cuts off  an area 
α at the tail set at a 95% confidence interval (1.96); 
P is 32% (0.32) as derived from a comparative study of  
depression among fertile and infertile women in a South–
western Nigerian city (Oladeji, 2018);
Q is (1 - P) = (1 – 0.32) = 0.68; and
d is the precision set at 5% (p<0.05).
n0= ((1.962×0.32×0.68)/0.052 ) = 334.4 
The minimum sample size (n0) of  334 respondents was 
generated. Meanwhile, after adjusting for non-response 
(attrition) rate of  10%; then, 1 – 0.1 = 0.9. Thus, 334 ÷ 
0.9 = 372 which is the sample size.

Sample Size Distribution

Table 1: Sample Size Distribution
Unit Clinic Days Population Proportion
GUU Tuesdays 152 73
FMMU Mondays 140 68
GOU Thursdays 156 75
FREU Mondays 129 63
ACU Tuesdays 193 93

Inclusion Criteria
• Infertile women attending Gynecology Clinics at 

UCH, Ibadan within the period of  this study for reasons 
connected with infertility

• Infertile women attending Gynecology Clinics at 
UCH, Ibadan within the period of  this study, who have 
psychological problems such as depression, anxiety 
disorders linked to infertility

Exclusion Criteria
• All women attending Gynecology Clinics at UCH, 

Ibadan within the period of  this study for other reasons 
which are not infertility

• Infertile women attending Gynecology Clinics at 
UCH, Ibadan within the period of  this study, who have 
other existing psychological problems such as depression, 
anxiety disorders not linked to infertility

Sampling Technique
This study used the simple random sampling technique 
to recruit respondents on each clinic day. Each eligible 
respondent was asked to pick a ballot paper which was 
prepared by the one of  the researchers before the clinic 

starts. In this way, every eligible patient had equal chances 
of  being selected to join the study.

Study Instruments
An adapted questionnaire was distributed to the study 
respondents. The questionnaire consisted of  three parts. 
The first part included socio-demographic characteristics 
of  the respondents such as age, tribe, marital status, 
type of  marriage, duration of  marriage, husband’s and 
wife’s educational qualifications, husband’s occupation, 
monthly income, number of  children, etc. The second 
part consisted of  Beck’s Depression Inventory which the 
validity and reliability has been tested by many researchers, 
the internal consistency ranged from 0.73 to 0.92 with 
a mean of  0.86 (Bowen, 2017; Park, 2020). The Beck’s 
Depression Inventory (BDI) is a self-reporting catalogue 
that measures attitudes and symptoms of  depression. 
It was developed into different forms. It was used in 
screening the infertile women for depression (American 
Psychological Association, 2021). In clinical practice, 
the Beck’s Depression Inventory and ways of  coping 
questionnaire assist clinicians in making judgments 
about the areas in which a patient is mostly affected 



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by the disease psychologically and in making treatment 
decisions. The third part consisted of  revised ways of  
coping (Folkman, 1985), the validity and reliability of  
which was tested by (Soares, 2018). In order to ascertain 
the suitability of  these standardized instruments locally, 
(Awoyinka, 2014) tested their reliability using a test-retest 
method, and 0.8 (Cronbach’s Alpha) was the reliability 
coefficient gotten.
The adapted questionnaire has three sections with 62 
items as follows:
Section A contains the socio-demographic characteristics 
of  the respondents with 11 items that were developed by 
the researchers.
Section B contains causes of  depression among the 
respondents with 21 items that were adapted from the 
Beck’s Depression Inventory.
Section C contains coping strategies among the 
respondents with 30 items that were adapted from 
Folkman’s ways of  coping (revised).

Data Collection
A consent letter was written and attached to the 
questionnaire explaining the purpose of  the study and 
period that the study will elapse. Consent was obtained 
and the respondents’ pressing issues concerning the study 
(if  there are) were answered. The data collection spanned 
through six weeks and it was ensured that all selected 
respondents participated in the study because they met 
the inclusive criteria and gave their consent voluntarily 
without any financial inducement.

Data Analysis
Data collected was analyzed using Statistical Package for 
Social Sciences (SPSS) version 22.0. Descriptive analysis 
was done using frequencies, tables, and percentages. 
Inferential analysis was done using Pearson correlation 
coefficient (r) and Chi–square, with statistical significance 
set at p<0.05. The adjusted odds ratio (OR) was 
determined at 95% confidence interval (CI).

Ethical Considerations
The respondents were included in the study only after 
they gave their voluntary consent and were free to opt 
out of  the study if  they so wished without any prejudice. 
None of  them opted out. Confidentiality of  all data 
gathered was maintained. For ethical reasons, awareness 
on depression, and coping strategies among infertile 
women were created for the infertile women, and other 
health workers. All infertile women with depression and 
poor coping strategies were referred to psychotherapists 
while undergoing infertility treatment.
The research was registered by the University of  
Ibadan (UI) and University College Hospital (UCH), 
Ibadan Ethical Committee (EC) with the UI/UCH EC 
Registration Number: NHREC/05/01/2008a dated 
23/07/2021. Notice of  full approval after full committee 
review dated 21/10/2021 was given with the UI/UCH 
Ethics Committee Assigned Number: UI/EC/21/0365.

RESULTS AND DISCUSSION

Table 2: Socio-demographic characteristics of  the respondents
Age 19-24 years 25-30 years 31-36 years 37-42 years >42 years

2(1.1%) 140(37.6%) 144(38.7%) 70(18.3%) 16(4.3%)
Tribe Yoruba Hausa Igbo Fulani Others

200(53.8%) 66(17.7%) 106(28.5%) 0(0%) 0(0%)
Marital 
status

Married Divorced Separated Widowed

360(96.8%) 4(1.1%) 2(0.5) 6(1.6%)
Type of  
marriage

Monogamy Polygamy

286(76.9%) 86(23.1%)
Duration of  
marriage

1-5 years 6-10 years 11-15 years >15 years

100(26.9%) 128(34.4%) 74(19.9%) 70(18.8%)
Husband’s
educational 
qualification

PhD MSc BSc HND OND NCE SSCE

62(16.7%) 86(23.1%) 180(48.4%) 40(10.8%) 2(0.5%) 0(0%) 2(0.2%)
Wife’s 
educational 
qualification 

PhD MSc BSc HND OND NCE SSCE

14(3.8%) 46(12.3%) 214(57.5%) 72(19.4) 14(3.8%) 10(2.7%) 2(0.5%)



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Husband’s 
occupation

Farmer Artisan Trading/
Business

Public 
servant

Private 
sector 
worker

20(5.4%) 6(1.6%) 52(14.0%) 172(46.2%) 122(32.8%)
Monthly 
family 
income

<N10,000 N10,000-
N50,000

N50,001-
N100,000

>N100,000

0(0%) 18(4.8%) 102(27.4%) 252(67.7%)
No. of  
children

None One Two Three > Three

86(23.1%) 210(56.5%) 64(17.2%) 12(3.2%) 0(0%)

2(1.1%) of  the respondents were within the age range of  
19-24 years, 140 (37.6%) were within the age range of  25-
30 years, 144(38.7%) were within the age range of  31-36 

years, 70(18.3%) were within the age range of  37-42 years, 
and 16(4.3%) were within the age range of  >42 years.

Figure 1: Pie chart showing age of  the respondents

200(53.8%) of  the respondents were Yoruba, 66(17.7%) 
were Hausa, and 106(28.5%) were Igbo. 360(96.8%) of  
the respondents were married, 4(1.1%) were divorced, 
and 2(0.5%) were separated, and 6(1.6%) were widows. 
286(76.9%) of  the respondents were in monogamous 
marriages while 86(23.1%) were in polygamous 
marriages. 100(26.9%) of  the respondents were within 
the duration of  marriage of  1-5 years, 128(34.4%) were 
within the duration of  marriage of  6-10 years, 74(19.9%) 
were within the duration of  marriage of  11-15 years, and 
70(18.8%) were within the duration of  marriage of  >15 
years. Concerning husband’s educational qualification, 
62(16.7%) of  the respondents had husbands with 
PhD, 86(23.1%) had husbands with MSc, 180(48.4%) 
had husbands with BSc, 40(10.8%) had husbands with 
HND, 2(0.5%) had husbands with OND, and 2(0.5%) 
had husbands with SSCE. 14(3.8%) of  the respondents 
had PhD, 46(12.4%) had MSc, 214(57.5%) had BSc, 
72(19.4%) had HND, 14(3.8%) had OND, 10(2.7%) had 
NCE, and 2(0.5%) had SSCE.
With regards to the husband’s occupation, 20(5.4%) have 
farmers as husbands, 6(1.6%) have artisans as husbands, 
for 52(14.0%) the husband’s occupation was Trading/
Business, 172(46.2%) have public servants as husbands, and 
for 122(32.8%) the husbands are private sector workers. 
18(4.8%) of  the respondents had monthly family income of  

N10,000-N50,000, 102(27.4%) had monthly family income 
of  N50,001-N100,000; and 252(67.7%) had monthly family 
income of  >N100,000. 86(23.1%) of  the respondents had 
no child, 210(56.5%) had one child, 64(17.2%) had two 
children, and 12(3.2%) had three children.
Using the Beck’s Depression Inventory, Table 3 shows 
the level of  depression among the respondents. The score 
added for each twenty-one question ranges from zero to 
three. The possible highest score is sixty-three and lowest 
score is zero. The total score is the level of  depression. 
0-10 was scored as minimal or normal
11-16 was scored as mild mood disturbance
17-20 was scored as borderline clinical depression
21-30 was scored as moderate depression
31-40 was scored as severe depression
Over 40 was scored as extreme depression
146(39.2%) of  the respondents had a minimal or 
normal level of  depression, 90(24.2%) had a mild 
mood disturbance level of  depression, 36(9.7%) of  
the respondents had a borderline clinical depression, 
68(18.3%) had a moderate depression, 18(4.8%) had 
a severe depression, and 14(3.8%) had an extreme 
depression.
34(9.1%) of  the respondents do not use professional 
help, 104(28.0%) used somewhat, 156(41.9%) used 



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quite a bit, and 78(21.0%) used professional help a 
great deal. However, 8(2.2%) of  the respondents did 
not accept sympathy and understanding from someone, 
80(21.5%) used somewhat, 208(55.9%) used quite a bit, 
and 76(20.4%) accepted sympathy and understanding 
from someone a great deal. In addition, 12(3.2%) of  the 
respondents did not ask a relative or friend for advice, 
74(19.9%) used somewhat, 200(53.8%) used quite a bit, 
and 86(23.1%) asked a relative or friend they respected 

for advice a great deal. Moreover, 22(5.9%) did not talk 
to someone who could do something concrete about the 
problem, 86(23.1%) used somewhat, 194(52.2%) used 
quite a bit, and 70(18.0%) talked to someone who could 
do something concrete about the problem a great deal. 
Nevertheless, 14(3.8%) did not talk to someone to find 
out more about the situation, 76(20.4%) used somewhat, 
160(43.0%) used quite a bit, and 122(32.8%) talked to 
someone to find out more about the situation a great deal. 

Table 3: Level of  depression among the respondents
Level of  Depression Frequency Percentage
Minimal or normal 146 39.2%
Mild mood disturbance 90 24.2%
Borderline clinical depression 36 9.7%
Moderate depression 68 18.3%
Severe depression 18 4.8%
Extreme depression 14 3.8%
Total 372 100.0%

Table 4: The use of  Seeking Social Support coping strategy among the respondents
Seeking Social Support coping strategy Not used, 

n(%)
Used somewhat, 
n(%)

Used quite 
a bit, n(%)

Used a great 
deal, n(%)

I got professional help 34(9.1%) 104(28.0%) 156(41.9%) 78(21.0%)
Accepted sympathy and understanding from 
someone

8(2.2%) 80(21.5%) 208(55.9%) 76(20.4%)

I asked a relative or friend whom I respected for 
advice

12(3.2%) 74(19.9%) 200(53.8%) 86(23.1%)

I talked to someone who could do something 
concrete about the problem

22(5.9%) 86(23.1%) 194(52.2%) 70(18.0%)

I talked to someone to find out more about it 14(3.8%) 76(20.4%) 160(43.0%) 122(32.8%)

Table 5: The use of  Accepting Responsibility coping strategy among the respondents
Accepting Responsibility coping strategy Not used, 

n(%)
Used somewhat, 
n(%)

Used quite 
a bit, n(%)

Used a great 
deal, n(%)

I realized that I brought the problem on myself 254(68.3%) 72(19.4%) 44(11.8%) 2(0.5%)
Criticized or lectured myself 14(3.8%) 70(18.8%) 188(50.5%) 100(26.9%)

Table 6: The use of  Escape Avoidance coping strategy among the respondents
Escape Avoidance coping strategy Not used, 

n(%)
Used somewhat, 
n(%)

Used quite 
a bit, n(%)

Used a great 
deal, n(%)

Took it out on other people 160(43.0%) 104(28.0%) 54(14.5%) 54(14.5%)
Hoped a miracle would happen 10(2.7%) 42(11.3%) 134(36.0%) 186(50.0%)
Tried to make myself  feel better by eating, 
drinking, smoking, using drugs or medication, etc

34(9.1%) 64(17.2%) 186(50.0%) 88(23.7%)

Avoided being with people in general 16(4.3%) 102(27.4%) 94(25.3%) 160(43.0%)
Talked to someone about how I was feeling 18(4.8%) 60(16.1%) 220(59.1%) 74(19.9%)

254(68.3%) of  the respondents did not realize that they 
brought the problem on themselves, 72(19.4%) used 
somewhat, 44(11.8%) used quite a bit, and 2(0.5%) 
realized that they brought the problem on themselves a 

great deal. 14(3.8%) of  the respondents did not criticize 
or lecture themselves, 70(18.8%) used somewhat, 
188(50.5%) used quite a bit, and 100(26.9%) criticized or 
lectured themselves a great deal.



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160(43.0%) of  the respondents did not take it out on 
other people, 104(28.0%) used somewhat, 54(14.5%) 
used quite a bit, and 54(14.5%) took it out on other 
people a great deal. 10(2.7%) of  the respondents did 
not hope that a miracle would happen, 42(11.3%) used 
somewhat, 134(36.0%) used quite a bit, and 186(50.0%) 
hoped a miracle would happen a great deal. 34(9.1%) of  
the respondents did not try to make themselves feel better 
by eating, drinking, smoking, using drugs or medication, 

etc., 64(17.2%) used somewhat, 186(50.0%) used quite a 
bit, and 88(23.7%) used a great deal.
In addition, 16(4.3%) of  the respondents did not avoid 
being with people in general, 102(27.4%) used somewhat, 
94(25.3%) used quite a bit, and 160(43.0%) avoided 
being with people in general a great deal. 18(4.8%) of  
the respondents did not talk to someone about how they 
were feeling, 60(16.1%) used somewhat, 220(59.1%) used 
quite a bit, and 74(19.9%) used a great deal.

Table 7: The use of  Painful Problem-solving coping strategy among the respondents
Painful problem-solving coping strategy Not used, 

n(%)
Used somewhat, 
n(%)

Used quite 
a bit, n(%)

Used a great 
deal, n(%)

Just concentrated on what I had to do next - the 
next step

6(1.6%) 24(6.5%) 152(40.9%) 190(51.1%)

6(1.6%) of  the respondents did not just concentrate 
on what they had to do next, 24(6.5%) used somewhat, 

152(40.9%) used quite a bit, and 190(51.1%) used a great 
deal.

Table 8: The use of  Positive Re-appraisal coping strategy among the respondents
Positive Re-appraisal coping strategy Not used, 

n(%)
Used somewhat, 
n(%)

Used quite 
a bit, n(%)

Used a great 
deal, n(%)

I prayed 4(1.1%) 14(3.8%) 90(24.2%) 264(71.0%)
I found a new faith 10(2.7%) 48(12.9%) 72(19.4%) 242(65.1%)

Table 10: The use of  Self-controlling coping strategy among the respondents
Self-controlling coping strategy Not used, 

n(%)
Used somewhat, 
n(%)

Used quite 
a bit, n(%)

Used a great 
deal, n(%)

I tried to keep my feelings to myself 58(15.6%) 118(31.7%) 106(24.2%) 90(24.2%)

Table 9: The use of  Confrontative coping strategy among the respondents
Confrontative coping strategy Not used, 

n(%)
Used somewhat, 
n(%)

Used quite 
a bit, n(%)

Used a great 
deal, n(%)

I expressed anger to the person(s) who caused 
the problem

168(45.2%) 94(25.3%) 58(15.6%) 52(14.0%)

4(1.1%) of  the respondents did not pray, 14(3.8%) used 
somewhat, 90(24.2%) used quite a bit, and 264(71.0%) 
prayed a great deal. Moreover, 10(2.7%) of  the 

respondents did not find a new faith, 48(12.9%) used 
somewhat, 72(19.4%) used quite a bit, and 242(65.1%) 
used a great deal.

168(45.2%) of  the respondents did not express anger to 
the person(s) who caused the problem, 94(25.3%) used 

somewhat, 58(15.6%) used quite a bit, and 52(14.0%) 
used a great deal.

58(15.6%) of  the respondents did not try to keep their 
feelings to themselves, 118(31.7%) used somewhat, 

106(24.2%) used quite a bit, and 90(24.2%) used a great 
deal.

Table 11: The use of  Distance coping strategy among the respondents
Distance coping strategy Not used, 

n(%)
Used somewhat, 
n(%)

Used quite 
a bit, n(%)

Used a great 
deal, n(%)

I tried to forget the whole thing 24(6.5%) 78(21.0%) 160(43.0%) 110(29.6%)

24(6.5%) of  the respondents did not try to forget the 
whole thing, 78(21.0%) used somewhat, 160(43.0%) used 
quite a bit, and 110(29.6%) of  the respondents tried to 
forget the whole thing a great deal.

Tests of  Research Hypotheses
Hypothesis 1
There is no statistically significant relationship between 
socio-demographic characteristics (age, type of  marriage, 



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duration of  marriage, husband’s educational qualification, 
wife’s educational qualification, and monthly income) 

and presence of  depression among the infertile women 
(CI=95.0%).

Table 12: The test of  hypothesis 1
Total Chi-square value Degree of  freedom (df) p-value

Age 372 816.033 172 .000
Type of  marriage 372 231.775 43 .000
Duration of  marriage 372 629.925 129 .000
Husband’s educational qualification 372 1099.784 215 .000
Wife’s educational qualification 372 1122.456 258 .000
Monthly income 372 297.079 86 .000

Table 13: The test of  hypothesis 2
Total Chi-square value Degree of  freedom (df) p-value

Coping strategies 372 6024.374 2623 .000

Consequently, the relationship between the socio-
demographic variables and the presence of  depression 
was examined to look for association. A Chi-square 
test with age (df=172) was performed resulting in a 
test statistics of  816.033, type of  marriage (df=43) was 
performed resulting in a test statistics of  231.775, duration 
of  marriage (df=129) was performed resulting in a test 
statistics of  629.925, husband’s educational qualification 
(df=215) was performed resulting in a test statistics of  
1099.784, wife’s educational qualification (df=258) was 
performed resulting in a test statistics of  1122.456, and 
monthly income (df=86) was performed resulting in a 
test statistics of  297.079. These results all had p-value less 

than 0.001. Hypothesis 1 was rejected.
Therefore, there is a statistically significant relationship 
between socio-demographic characteristics (age, type of  
marriage, duration of  marriage, husband’s educational 
qualification, wife’s educational qualification, and monthly 
income) and presence of  depression among the infertile 
women.

Hypothesis 2
There is no statistically significant relationship between 
coping strategies and level of  depression among the 
infertile women.

The relationship between coping strategies and level of  
depression among the infertile women was examined. A 
Chi-square with (df=2623) was performed resulting in a test 
statistics of  6024.374 (p<0.001). Hypothesis 2 was rejected.
Therefore, there is a statistically significant relationship 

between coping strategies and level of  depression among 
the infertile women.

Hypothesis 3
There is no statistically significant relationship between 

Table 14: The test of  hypothesis 3
Seeking Social 
Support coping 
strategy

Not used, 
n(%)

Used 
somewhat, 
n(%)

Used quite 
a bit, n(%)

Used a 
great deal, 
n(%)

Degree of  
freedom 
(df)

Chi-
square 

p-
value

I got professional help 34(9.1%) 104(28.0%) 156(41.9%) 78(21.0%) 129 548.155 .000
Accepted sympathy 
and understanding 
from someone

8(2.2%) 80(21.5%) 208(55.9%) 76(20.4%) 129 550.896 .000

I asked a relative 
or a friend whom I 
respected for advice

12(3.2%) 74(19.9%) 200(53.8%) 86(23.1%) 129 564.703 .000

I talked to someone 
who could do 
something concrete 
about the problem

22(5.9%) 86(23.1%) 194(52.2%) 70(18.0%) 129 492.142 .000

I talked to someone to 
find out more about it

14(3.8%) 76(20.4%) 160(43.0%) 122(32.8%) 129 536.501 .000

Seeking Social Support coping strategy and level of  
depression among the infertile women. 
With a p-value less than 0.001 in all checked parameters, 

hypothesis 3 was also rejected.
Therefore, there is a statistically significant relationship 
between Seeking Social Support coping strategy and level 



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of  depression among the infertile women.

Prevalence of  Depression among the Respondents
Table 3 revealed that majority (39.2%) of  the infertile 
women in this current study had a minimal or normal 
level of  depression with a Beck’s Depression Inventory 
(BDI) score ranging from 0-10. A few (9.7%) of  the 
infertile women had a borderline clinical depression, while 
18.3% had a moderate depression. Similar findings were 
recorded by (Odunvbun, 2018) where 48.1% prevalence 
of  depression was reported among infertile women in 
Delta State, South-South Nigeria. 
About 24.2% of  the respondents in this current study had 
a mild mood disturbance level of  depression, while 4.8% 
had a severe depression. This is in disagreement with a 
study conducted by (Alimohamadi, 2020) whose findings 
revealed that approximately 40.0% of  the infertile women 
had symptoms of  severe depression and anxiety.
However, it is safe to say that the infertile women in this 
current study were not depressed since majority of  them 
had a good BDI score. This is quite impressive, because 
several studies have reported that infertility comes with its 
own social and psychological challenges such as anxiety, 
depression, and social withdrawal (Rooney, 2018).

Associated Factors of  Depression among the 
Respondents
Table 12 revealed that socio-demographic characteristics 
such as age, type of  marriage, duration of  marriage, 
husband’s educational qualification, wife’s educational 
qualification, and monthly income were significantly 
related to presence of  depression among the respondents. 
This finding is in consonance with the finding of  another 
study (Oladeji, 2018) which identified that some socio-
demographic characteristics associated with depression 
include age and duration of  marriage (≥10 years). Similar 
finding was reported by (Yilmaz, 2020) who stated that 
education, age, socio-economic status, and individual 
characteristics could be great factors causing depression. 
The duration of  infertility can result in depression 
(Szkodziak, 2020). It was further stated that women with 
infertility whose duration of  infertility were between 
4-6 years had the tendency of  depressive symptoms 
(Szkodziak, 2020).
Factors causing depression are often multi-factorial. But 
then, socio-demographic characteristics being associated 
with depression in this current study are quite predictable, 
most especially age, educational qualification, type of  
marriage, and duration of  marriage. Generally, the age of  
an individual determines how long the person has been on 
earth and what he or she has experienced. There is bound 
to be increased level of  anxiety and depressive symptoms 
as infertile women move down the reproductive age as their 
chances of  becoming mothers reduce. In fact, (Aiyenigba, 
2019) noted that psychological distress such as depression 
was higher in infertile women above 35 years. 
Regarding the level of  education, education makes a 
woman feel independent, strong, and less vulnerable to 

unjustified societal pressures. Indeed, every girl should 
be encouraged to receive higher education throughout 
the world so that she can be prepared to stand up for 
her rights and boldly face the challenges that come later. 
In many traditional societies to date, the main role feel 
of  the females in the family is to bear children and be a 
home maker. So, when a woman fails to fulfil one of  those 
roles, she is deemed useless and worthless by the society. 
On the other hand, professional women contribute 
financially to the family’s well-being and stay productive, 
which automatically increases their value.
Nevertheless, the duration of  marriage clearly reflects 
how long an infertile woman has been battling with 
infertility which in most cases discourages her.

Coping Strategies Adopted by the Respondents 
The findings from this current study established that 
majority used seeking social support coping strategy as 
28.0% got professional help somewhat, and 41.9% used 
it quite a bit. This finding agrees with (Steuber, 2015) 
findings which revealed that the respondents made 
known that social support decreases depression and 
infertile women who received family support were more 
likely to complete infertility treatment. Social support has 
a great impact on both physical and mental health. Social 
support influences people’s choices on health issues and 
behaviors either positively or negatively. Social support 
helps people to cope well with stress and also enhances 
motivation (Cherry, 2020). 
The use of  Accepting Responsibility coping strategy 
was adopted as majority utilized “Criticized or lectured 
myself ”. This finding is in agreement with (Afshani, 
2019)’s study which discovered that self-compassion 
which comprises of  self-kindness, talking to self, common 
humanity, and mindfulness is a good way of  coping with 
infertility.
The use of  Escape Avoidance coping strategy was also 
utilized as infertile women tried to make themselves 
feel better by eating, drinking, smoking, using drugs or 
medication, etc., as 17.2% used it somewhat, 50.0% used 
it quite a bit, and 23.7% used it a great deal. Moreover, 
hoping for a miracle as a coping mechanism was used 
somewhat by 11.3%, whereas 36.0% used it quite a bit, 
and 50.0% used it a great deal.
In discordance with the findings of  (Elyasi, 2020) 
which reported two main styles of  coping strategies: 
emotion-focused style which includes ability to relieve 
negative emotional responses associated with distress, 
and problem-focused style which includes psychological-
based processing of  actions, and information, are majorly 
used for coping mechanism.
The use of  Painful Problem-solving coping strategy was 
used by almost all the respondents (98.4%). However, 
Positive Re-appraisal coping strategy was of  positive use 
as 71.0% of  the respondents prayed a great deal. 65.1% 
of  the respondents found a new faith a great deal. These 
findings are quite similar to (Mohammed-Durosinlorun, 
2019)’s study where it was established that most women 



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with infertility seek spiritual help relating to their faith, 
though some of  the educated ones mixed spiritual help 
with medical treatment. 
The use of  Self-controlling coping strategy was of  positive 
use as 84.4% in total tried to keep their feelings to themselves 
which agrees with the findings of  (Elyasi, 2020).
The use of  Distance coping strategy including trying to 
forget the whole thing was used somewhat by 21.0%, 
43.0% used it quite a bit, and 29.6% used it a great deal. 
This is in agreement with (Jordan, 2015)’s study who 
reported two rationally derived theory of  coping meta-
categories called problem-focused coping and emotion-
focused coping. Problem-focused coping included 
efforts to manage the stressor, and change the person’s 
environment and relationship causing the stress, while 
emotion-focused coping was found to regulate emotional 
distress caused by stressors.
Various coping strategies utilized by the respondents 
in this current study include Seeking Social Support, 
Accepting Responsibility, Escape Avoidance, Painful 
Problem-solving, Positive Re-appraisal, Confrontative, 
Self-controlling, and Distance.
Nonetheless, it is pertinent to point out some of  the 
limitations of  this current study. Several parameters of  
the study were based on self-report and are subject to 
recall bias. Prospects for further research include the fact 
that the sample size was modest to make any wide-scale 
assumptions. Similar studies should be repeated using 
both rural and urban samples with different psychological 
variables to find the similarities and differences between 
various groups of  people with diverse background.

CONCLUSION
There is a low level of  depression among infertile women 
attending gynecology clinics at University College 
Hospital, Ibadan, South-West Nigeria. Infertile women 
seeking treatment for infertility should be screened for 
depression. Healthcare providers need to assess the 
general and psychological health of  infertile women, and 
care for them in a contextually and culturally appropriate 
manner, in order to improve their health status and 
quality of  life.

Acknowledgement
The authors are thankful to the management and staff  
of  the Department of  Obstetrics and Gynecology at 
University College Hospital (UCH), Ibadan, Oyo State, 
South-West Nigeria; to all the infertile women who 
agreed voluntarily and without any financial inducement 
to participate in this research; and to everyone who 
contributed in one way or the other to make this research 
a success.

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