Abstract
Background:
Infertility is a psychological crisis for a couple, spouse, and their families. Due to the positive effects of spiritual intelligence on the positive adaptation and growth of the individual under difficult circumstances, this study was conducted to determine the relationship between spiritual intelligence and resilience in infertile couples in Isfahan.
Materials and Methods:
This cross-sectional study was performed in 2020 on 162 infertile couples. Data were collected by the convenience sampling method from infertile couples referring to Infertility Centers in Isfahan through two standard questionnaires. Data analysis was performed using descriptive statistical methods for quantitative variables. The relationship between spiritual intelligence and resilience score was investigated using inferential statistical methods of Pearson's correlation coefficient and multiple linear regression. A p value of less than 0.05 was considered significant.
Results:
The results showed that the mean age Standard Deviation (SD) of women and their spouses was 32.01 (5.86) and 36.30 (5.82) years, respectively. Pearson's correlation coefficient showed that there was a significant positive direct relationship between resilience score with total spiritual intelligence score (r = 0.36, p < 0.001) and its dimensions Critical Existential Thinking (CET) (r = 0.60, p < 0.001), personal meaning production (PMP) (r = 0.38, p < 0.001), Transcendental Awareness (TA) (r = 0.43, p < 0.001), and Conscious State Expansion (CSE) (r = 0.53, p < 0.001). The PMP (t = 6.38, p < 0.001) and the CSE (t = 2.15, p = 0.03) were significant predictors of resilience scores.
Conclusions:
The result of our study showed that couples with a higher level of spiritual intelligence had a better understanding of the problems and harms of primary infertility and would cope with it more efficiently.
Keywords: Infertility, intelligence, Isfahan, psychological resilience, spirituality
Introduction
Infertility is a global problem. A total of 15% of couples are infertile. This will be approximately 48.5 million couples.[1] Various studies estimated that the prevalence of infertility in Iran in recent years is between 14 and 20%.[2] Thus, one-fifth of Iranian families experience primary infertility.[3] In Iranian culture, childbearing is precious. However, infertility is a tragic psychological accident for the individual, the spouses, and the couple's families.[4] Studies have shown that having children in Iran, as in other developing countries, has a significant effect on the mental health of infertile people.[5] Infertility creates a sense of inability for women to get their desired social role, so it can lead to mental distress.[6] In addition, treatment of infertility is associated with exorbitant costs, low self-esteem, guilt, loneliness, insecurity and fear of the future, and a sense of failure and regret. These negative emotions are observed even in people under treatment and are not limited to developing areas.[7] Infertility for a couple is a complex problem that threatens the mental and social health of infertile couple, especially woman. Couples experience some psychological problems due to both infertility and medical interventions such as psychological disorder, fear, anxiety, worry, and depression. Sometimes, these side effects are so severe. For example, the results of a systematic review revealed that, in 21,453 infertile individuals from eight countries, the mental burden from the treatment had been one of the main reasons for stopping the infertility treatment.[8] There are several ways to help infertile couples to improve their health. Paying attention to spirituality is one of these strategies that can be considered to help couples.
Spirituality seems to be one of the factors that affects health; however, attention to the spiritual dimension of health has been neglected in health promotion issues and programs around the world (especially in the field of infertility). Spirituality allows individuals to identify a single concept in life and feel that there is a greater force than all the problems. Spiritual health can have a positive effect on physical and mental health.[9]
Researchers expressed that creating personal meaning in life could be associated with pain and stress.[10] Religious beliefs could allow people to gain more mental ability and patience to endure the pains of life.[11,12] Resilience reflects physical endurance, self-motivated improvement, and the ability to create emotional balance in stressful situations.[13] Infertility problems, such as the cost of treatment, depression, the effects of medications, and surgical procedures, may make it difficult for a couple to cope and in some cases even lead to irreparable damage to the couple's life. In some cases, the couple's incompatibility with the existing conditions leads to the abandonment of treatment methods. So, considering the positive effects of spiritual intelligence on the positive adaptation and growth in difficult situations and the failure to investigate the relationship between spiritual intelligence and resilience among infertile couples in Iran, the purpose of this study was to determine the relationship between spiritual intelligence and resilience in infertile couples in Isfahan.
Materials and Methods
This study was a descriptive cross-sectional study, which was performed in one step in 2020 (from January to April) on infertile couples in Isfahan. The sample size was estimated to be 162 couples based on similar studies[14] and using the formula (p = 0.12, q = 0.88, z = 1.96, d = 0.05). The inclusion criteria of the research included having a history of primary infertility and completing an informed consent form. Lack of willingness to participate in the study was considered as the exclusion criterion of the study. Isfahan has two main infertility treatment centers, one of which is privately run and the other is publicly run. Samples were collected using a convenience sampling method, and information was collected from infertile couples who were referred to the Isfahan Fertility and Infertility Center (private center) and Maryam Clinic (public center), in Isfahan, Iran. The researcher visited infertility centers and identified couples with inclusion criteria. One of the researchers then stated the research objectives for the couple. After obtaining informed consent, the questionnaire was completed by infertile couples as self-reported.
King's Spiritual Intelligence Self-Report Inventory (SISRI) was used to collect research data. The questionnaire has 24 items that measure spiritual intelligence on a 5-point Likert scale (0–4), and its scores vary between 0 and 96. The scale has four subsets of Critical Existential Thinking (CET), Personal Meaning Production (PMP), Transcendental Awareness (TA), and Conscious State Expansion (CSE). In Iran, Raghibi et al.[15] obtained Cronbach's alpha coefficient of 0.89 and a validity coefficient of 0.67 through retesting. In a study conducted by Khodabakhshi Koolaee et al. (2013),[10] Cronbach's alpha for the total questionnaire was 0.91, that for CET was 0.75, that for PMP was 0.79, that for TA was 0.66, and that for CSE was 0.80.
The Connor–Davidson Resilience Scale (CD-RISC) was used to measure the level of infertility-related resilience. This scale has 25 items that measure the resilience structure based on a 5-point Likert scale. Based on this scale, a score of 1 is considered “completely incorrect” and a score of 5 is considered “always correct.” The scoring range is between 25 and 125. Mohammadi translated it and obtained its reliability as 0.89 by Cronbach's alpha internal consistency, and its validity was 0.87 by the factor analysis method.[16] Also, demographic and fertility characteristics were collected using a checklist including questions about women and spouse's age, education level of wife and spouse, housing and income level, duration of marriage, duration of treatment, and cause of infertility.
Data analysis was conducted using Statistical Package for the Social Sciences (SPSS) version 18 (Chicago, IL, USA). To analyze the data for quantitative continuous variables, descriptive statistical analysis was used. Also, Pearson's correlation coefficient, independent-samples t-test, and multiple linear regression were used to investigate the relationship between spiritual intelligence and resilience score. A p value of less than 0.05 was considered significant.
Ethical considerations
Patient information was kept confidential by the researcher, and all patients completed informed consent. The ethics committee of Isfahan University of Medical Sciences approved this study, and the committee's reference number was “IR.MUI.RESEARCH.REC.1397.486.”
Results
The results showed that the mean (SD) of women's age was 32.01 (5.86) years and the mean (SD) of men's age was 36.30 (5.82). Also, it was shown that the duration of marriage was 8.48 (5.49) in the range of 1 to 27 years and their mean treatment's period was 50.72 (51.41) days between 1 and 216 days. Approximately 58.6% of participants had referred to the public center, and the others had gone to the private center.
The average score of the couple's total spiritual intelligence was 53.41 (12.19). Also, the average resilience score of the subjects was 86.03 (15.86) in the range of 47–125. Pearson's correlation coefficient showed that there was a direct relationship between resilience score and total spiritual intelligence score and all its dimensions. There was a direct relationship between resilience score with CET (r = 0.60) and medium direct relationship with TA (r = 0.43) and CSE (r = 0.53), while there was a weak direct relationship between resilience score with total spiritual intelligence score (r = 0.36) and PMP (r = 0.38, p < 0.001) [Table 1].
Table 1.
Pearson's correlation coefficients between resilience score and total spiritual intelligence score and its dimensions
| Dimensions of spiritual intelligence | Resilience score |
|||
|---|---|---|---|---|
| r | p | Mean (SD) | Min–Max | |
| Total spiritual intelligence | 0.36 | <0.001 | 53.41 (12.19) | 12-91 |
| Critical existential thinking | 0.60 | <0.001 | 16.17 (4.45) | 4-28 |
| Personal meaning production | 0.38 | <0.001 | 11.97 (3.29) | 1-20 |
| Transcendental awareness | 0.43 | <0.001 | 15.54 (3.78) | 6-27 |
| Conscious state expansion | 0.53 | <0.001 | 9.73 (3.29) | 0-20 |
Multiple linear regression analysis showed that scores of PMP and TA were significant predictors of resilience score, respectively, but in the presence of these two, other dimensions of spiritual intelligence were not significant predictors of resilience score, respectively [Table 2].
Table 2.
Multiple linear regression analysis to predict resilience score based on spiritual intelligence dimension scores
| Dimensions of spiritual intelligence | β | S.E | p | CI (95%) for β |
|---|---|---|---|---|
| Critical existential thinking | −0.16 | 0.30 | 0.61 | −0.75-0.44 |
| Personal meaning production | 2.64 | 0.41 | <0.001 | 1.83-3.46 |
| Transcendental awareness | −0.09 | 0.37 | 0.81 | −0.82-0.65 |
| Conscious state expansion | 0.85 | 0.40 | 0.03 | 0.70-1.64 |
Independent-samples t-test showed that the mean score of resilience and the total score of spiritual intelligence and its dimensions were not significantly different between couples treated in public and private centers (p > 0.05) [Table 3].
Table 3.
Mean resilience score and total spiritual intelligence score and its dimensions by type of infertility treatment site
| Public center Mean (SD) | Private center Mean (SD) | Independent- samples t-test |
||
|---|---|---|---|---|
| t | p | |||
| Total spiritual intelligence | 54.33 (13.48) | 52.11 (10.04) | 1.20 | 0.23 |
| Critical existential thinking | 16.45 (4.96) | 15.76 (3.59) | 1.03 | 0.31 |
| Personal meaning production | 12.20 (3.58) | 11.64 (2.83) | 1.06 | 0.29 |
| Transcendental awareness | 15.90 (4.13) | 15.03 (3.18) | 1.50 | 0.13 |
| Conscious state expansion | 9.77 (3.35) | 9.67 (3.22) | 0.19 | 0.85 |
| Resilience score | 85.32 (16.98) | 87.05 (14.19) | 0.68 | 0.49 |
Discussion
The results showed a positive and significant relationship between spiritual intelligence and resilience. The results of our study showed that there was a strong direct relationship between resilience score with CET and medium direct relationship with TA and CSE, while there was a weak direct relationship between resilience score with total spiritual intelligence score and PMP. Therefore, the results indicated that couples who had a higher level of spiritual intelligence would have a better understanding of their infertility problems. Spiritual intelligence was related to emotional and behavioral stability and resilience to stress.[17]
The results showed that the mean score of resilience and the total score of spiritual intelligence and its dimensions were not significantly different between couples treated in public and private centers. Therefore, it seems that the economic and social status of couples was not among the factors affecting spiritual intelligence and resilience in infertile couples.
The results of the present study showed that there was a positive and significant relationship between all four dimensions of spiritual intelligence with resilience in infertile couples. Therefore, the development of spiritual intelligence seems to be effective in achieving better and more efficient adaptation to the consequences of infertility. In other words, it seems that the development of spiritual intelligence can reduce the negative psychological and social results of infertility and may be effective for continuing treatment methods. Similarly, the results of a study showed that spirituality could reduce the psychological problems of infertile women and help them during infertility treatments.[14] Furthermore, spirituality increases the resistance of individuals to face problem in any case.[18]
The results of this study indicated a strong relationship between resilience with CET and medium relationship with TA and CSE. Like the results of the present study, Nik Amal and Shademanfar's study and some other studies[19,20,21] showed that spiritual intelligence had a positive and significant relationship with resilience. In our study, among the dimensions of spiritual intelligence, CET had the most relationship with resilience, but in Nik Amal and Shademanfar's study, transcendent self-awareness had the greatest share in explaining resilience changes.[22] It seems that the significant difference between the results of these two studies can be attributed to the difference in the studied communities.
Also, the result of our study showed that there was a weak direct relationship between resilience score with total spiritual intelligence score and PMP. So, when experiencing stress, PMP allows the individual to create new conditions, even if it is stressful, to find meaning or purpose in it and be able to adapt to new conditions. In this way, it can change the stressors and reduces their negative effects. Similarly, the result of study in Iran showed that when faced with a difficult situation, PMP may lead a person to a meaning-oriented solution and act as an effective problem-solving method.[23]
Some studies, similar to the results of the present study, showed a positive and significant relationship between spirituality, spiritual intelligence, and resilience.[17,13] Therefore, it is expected that those who have higher spiritual intelligence will not only be resistant to facing personal problems caused by infertility, but also strengthen their marital relationships.[24] So, the healthcare providers should be aware of the couple's spiritual beliefs and it is always important to respect and consider them in the process of diagnosis and treatment.[8] The medical team can help the patient organize the spiritual aspects of one's life during the diagnostic and treatment process. It has been proven that having a child plays a pivotal role in couples' happiness in their marital life. When they are deprived of having them, they not only miss the meaning in their life but also develop conflicts in their interpersonal communication, which predisposes them to mental and psychological problems such as anxiety, depression, and mental pressure, consequently which can expose them to domestic violence.[25]
The most important advantages of this project were that for the first time, this study had specifically addressed the relationship between spiritual intelligence and resilience as one of the factors affecting psychological adjustment to the physical and psychological consequences of infertility in Iran. Culture and religion affect spiritual intelligence,[26,27] so conducting a study in Isfahan society limited the generalizability of the study to all infertile couples. Therefore, it was recommended to do the same study in different societies with different cultures and religions.
Conclusion
Based on the findings, there was a positive and significant relationship between spiritual intelligence and resilience. The result of our study showed that couples with a higher level of spiritual intelligence had a better understanding of the problems and harms of primary infertility and would cope with it more efficiently. Developing spiritual intelligence could probably be effective for better and more efficient adaptation to the consequences of infertility and continued treatment.
Financial support and sponsorship
Isfahan University of Medical Sciences
Conflicts of interest
Nothing to declare.
Acknowledgments
The authors would like to thank the women for their willingness to participate in this study (No. 297178).
References
- 1.Agarwal A, Mulgund A, Hamada A, Renee Chyatte M. A unique view on male infertility around the globe. Eprod Biol Endocrinol. 2015;13:37. doi: 10.1186/s12958-015-0032-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Hossein Rashidi B, Malek Afzali H, Haghollahi F, Abedini M, Eslami M. The utilization of infertility services by infertile couples in Iranian Infertility Clinics in 2012-2014. Iran J Obstet Gynecol Infertil. 2017;20:1–12. [Google Scholar]
- 3.Akhondi MM, Ranjbar F, Shirzad M, Ardakani ZB, Kamali K, Mohammad K. Practical difculties in estimating the prevalence of primary infertility in Iran. Int J Fertil Steril. 2019;13:113–7. doi: 10.22074/ijfs.2019.5583. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Wiersema NJ, Drukker AJ, Mai BTD, Giang HN, Nguyen TN, Lambalk CB. Consequences of infertility in developing countries: Results of a questionnaire and interview. Survey in the South of Vietnam. J Transl Med. 2006;4:54. doi: 10.1186/1479-5876-4-54. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Hasanpoor–Azghdy SB. Psychological impact of infertility among infertile women. J Shahid Beheshti Sch Nurs Midwifery. 2014;23:1–8. [Google Scholar]
- 6.Greil AL, Blevins KS, McQuillan J. The experience of infertility: A review of recent literature. Sociol Health Illn. 2010;32:140–62. doi: 10.1111/j.1467-9566.2009.01213.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Klitzman R. Impediments to communication and relationships between infertility care providers and patients. BMC Women's Health. 2018;18:84. doi: 10.1186/s12905-018-0572-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Gameiro S, Boivin J, Peronace L, Verhaak CM. Why do patients discontinue fertility treatment? A systematic review of reasons and predictors of discontinuation in fertility treatment. Human Reprod Update. 2012;18:652–69. doi: 10.1093/humupd/dms031. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Mehrabi T, Alijanpoor Aghamaleki M, Hosseiny RS, Ziraki Dana A, Safaee Z. A study on the relationship between spiritual well-being and quality of life in infertile women referred to infertility centers in Isfahan. Nurs Midwifery J. 2014;12:562–7. [Google Scholar]
- 10.Khodabakhshi Koolaee A, Heidari S, Khoshkonesh A, Heidari M. Relationship between spiritual intelligence and resilience to stress in preference of delivery method in pregnant women. Iran J Obstet Gynecol Infertil. 2013;16:8–15. [Google Scholar]
- 11.Sharma DN, Tiwari GK, Rai PK. Spiritual beliefs add to the perceived health of cancer patients. Int J Indian Psychol. 2017;5:57–69. [Google Scholar]
- 12.Sheikholslamy A, Sadeghi Z, Mohammadi N. The relationship of resiliency and perceived social support with adjustment of mothers with intellectually disable child. Psychol Except Individ. 2015;5:125–39. [Google Scholar]
- 13.Binaiyan L. Tehran: Alzara University; 2011. [The Relationship between spirituality intelligence with resiliency and satisfaction of life among female's students] [Thesis in Persian] [Google Scholar]
- 14.Mosalanejad L, Khodabakshi Koolee A. looking at infertility treatment through the lens of the meaning of life: The effect of group logotherapy on psychological distress in infertile women. Int J Fertil Steril. 2013;6:224–31. [PMC free article] [PubMed] [Google Scholar]
- 15.Raghibi M. Tehran: Shahid Beheshi Unversity Medical Sciences; 2009. [The Reliably and Validity of Spiritual Intelligence Self-reportinventory (SISRI) in Iran] [Thesis in Persian] [Google Scholar]
- 16.Mohammadi M. Tehran: University of Social Welfare and Rehabilitation Sciences; 2005. [The reliably and validity of connor-davidson resilience scale (CDRISC) in Iran] [Thesis in Persian] [Google Scholar]
- 17.Khodabakhshi Koolaee A, Nasiri Z, Mostafaee F. The relationship between resiliency and meaning of life in students. 5th Proceedings Seminar of mental health of students. University of Shahed Medical Science, 15-16 April 2010, Tehran, Iran. [in Persian] [Google Scholar]
- 18.Taebi M, Kariman N, Montazeri A, Majd HA. Development and psychometric evaluation of the female infertility stigma instrument (ISI-F): Protocol for a mixed method study. Reprod Health. 2020;17:70. doi: 10.1186/s12978-020-0904-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Saeidi F, Kimiaei SA, Barzegar Bafrooee K, Rezapoor Y. The Relationship between Early maladaptive schemas and marital adjustment: The spiritual intelligence as a mediator. [Last accessed on 2014 Aug 04];Reef Resources Assessment and Management Technical Paper. 2014 40:434–40. Available form: https://profdoc.um.ac.ir/paper-abstract-1043774.html . [Google Scholar]
- 20.Jafarzadeh-Kenarsari F, Ghahiri A, Zargham-Boroujeni A, Habibi M, Hashemi M. Patient-centered fertility care: From theory to practice. J Midwifery Reprod Health. 2016;4:712–9. [Google Scholar]
- 21.Mohammadi F, Babaee M. Effects of participation in support groups on Alzheimer's family caregivers' strain and spiritual wellbeing. Salmand Iran J Ageing. 2011;6:29–37. [Google Scholar]
- 22.Nik Amal M. and Shademanfar N. The relationship between spiritual intelligence and psychological resilience in students. Qtly J Psychol Res. 2015;6:111–26. [Google Scholar]
- 23.Riahi S, Goudarzi F, Hasanvand S, Abdollahzadeh H, Ebrahimzadeh F, Dadvari Z. Assessing the effect of spiritual intelligence training on spiritual care competency in critical care nurses. J Med Life. 2018;11:346–54. doi: 10.25122/jml-2018-0056. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Mokhtari F, Kamranpour B, Shakiba M. Emotional intelligence and men's sexual performance. J Holist Nurs Midwifery. 2020;30:174–81. [Google Scholar]
- 25.Taebi M, Gandomani SJ, Nilforoushan P, GholamiDehaghi A. Association between infertility factors and non-physical partner abuse in infertile couples. Iran J Nurs Midwifery Res. 2016;21:368–71. doi: 10.4103/1735-9066.185577. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Mokhtari F, Torabi F, Pirhadi M. Relationship between fertility characteristics with spiritual intelligence and resilience in infertile couples. J Edu Health Promot. 2022;11:44. doi: 10.4103/jehp.jehp_97_21. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Panahi S, Bahadoran P, Pirhadi M. Evaluation the relationship between social health and stress of assisted reproductive techniques in infertile women. J Edu Health Promot. 2022;11:96. doi: 10.4103/jehp.jehp_1612_20. [DOI] [PMC free article] [PubMed] [Google Scholar]