{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T12:48:45Z","timestamp":1776084525011,"version":"3.50.1"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Infertility affects approximately 48.5 million couples worldwide, with infertile women experiencing significantly higher rates of psychological distress (27\u201340%) compared to the general population. While fertility stress has been identified as a primary contributor to psychological distress, the underlying mechanisms remain poorly understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This cross-sectional study examined the mediating roles of rumination and negative coping styles in the relationship between fertility stress and psychological distress among Chinese infertile women. We hypothesized that fertility stress would influence psychological distress through three indirect pathways: (1) rumination alone, (2) negative coping styles alone, and (3) a sequential chain from rumination to negative coping styles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 608 infertile women (mean age 33.5\u202f\u00b1\u202f4.8\u202fyears) were recruited from three tertiary hospitals in Heilongjiang Province, China. Participants completed standardized measures including the Fertility Problem Inventory (FPI), Event-Related Rumination Inventory (ERRI), Trait Coping Style Questionnaire (TCSQ), and the Chinese version of the Infertility Distress Scale (IDS). Chain mediation analysis was conducted using the PROCESS macro (Model 6) with 5,000 bootstrap samples.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Psychological distress demonstrated strong positive correlations with fertility stress (\n                      <jats:italic>r<\/jats:italic>\n                      \u202f=\u202f0.43,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01), rumination (\n                      <jats:italic>r<\/jats:italic>\n                      \u202f=\u202f0.53,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01), and negative coping styles (\n                      <jats:italic>r<\/jats:italic>\n                      \u202f=\u202f0.49,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01). Chain mediation analysis revealed that the total effect of fertility stress on psychological distress was\n                      <jats:italic>b<\/jats:italic>\n                      \u202f=\u202f0.20 (95% CI [0.16, 0.23]). The direct effect accounted for 45% of this relationship, while indirect effects accounted for 55%. Three significant mediation pathways were identified: through rumination alone (30% of total effect), through negative coping styles alone (20% of total effect), and through the sequential chain from rumination to negative coping styles (5% of total effect).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Fertility stress influences psychological distress in infertile women through direct and indirect pathways. A theoretically-derived sequential chain model suggests a potential vulnerability mechanism, though the cross-sectional design does not permit verification of causal temporal ordering. Longitudinal research is needed to confirm the hypothesized sequence. These findings suggest rumination may represent a key intervention target. However, given the cross-sectional design, further longitudinal and intervention research is needed to establish whether rumination-focused approaches effectively reduce psychological distress. Potential clinical implications should be considered preliminary and warrant testing through randomized controlled trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyg.2026.1784271","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T11:59:31Z","timestamp":1776081571000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Chain mediation of rumination and negative coping styles in the relationship between fertility stress and psychological distress among Chinese infertile women: a cross-sectional study"],"prefix":"10.3389","volume":"17","author":[{"given":"Siyan","family":"Liu","sequence":"first","affiliation":[{"name":"Nursing Department, The Fifth Affiliated Hospital of Harbin Medical University","place":["Daqing, China"]},{"name":"Daqing People\u2019s Hospital","place":["Daqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dongming","family":"Qu","sequence":"additional","affiliation":[{"name":"Department of Reproductive Medicine, The First Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junru","family":"Li","sequence":"additional","affiliation":[{"name":"College of Nursing, Harbin Medical University-Daqing Campus","place":["Daqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongmei","family":"Wu","sequence":"additional","affiliation":[{"name":"College of Nursing, Harbin Medical University-Daqing Campus","place":["Daqing, China"]},{"name":"Laboratory of Basic Research and Health Management on Chronic Diseases in Heilongjiang Province","place":["Daqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Wang","sequence":"additional","affiliation":[{"name":"Daqing People\u2019s Hospital","place":["Daqing, China"]},{"name":"Obstetrics Department, The Fifth Affiliated Hospital of Harbin Medical University","place":["Daqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e37725","DOI":"10.1097\/MD.0000000000037725","article-title":"Infertile women of Ethiopia: psychological challenges and coping strategies","volume":"103","author":"Adane","year":"2024","journal-title":"Medicine (Baltimore)"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1111\/sjop.12666","article-title":"A multimethod assessment to study the relationship between rumination and gender differences","volume":"61","author":"Ando","year":"2020","journal-title":"Scand. J. Psychol."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1017\/S1352465822000534","article-title":"Evaluating the efficacy of an internet-based cognitive behavioural therapy intervention for fertility stress in women: a feasibility study","volume":"51","author":"Bjornsdottir","year":"2023","journal-title":"Behav. Cogn. Psychother."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1080\/10615806.2010.529901","article-title":"Assessing posttraumatic cognitive processes: the event related rumination inventory","volume":"24","author":"Cann","year":"2011","journal-title":"Anxiety Stress Coping"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1007\/s00737-020-01029-9","article-title":"Psychological coping strategies associated with improved mental health in the context of infertility","volume":"24","author":"Chernoff","year":"2021","journal-title":"Arch. Womens Ment. Health"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/j.tics.2019.12.009","article-title":"Avoid Cohen's 'small', 'medium', and 'large' for power analysis","volume":"24","author":"Correll","year":"2020","journal-title":"Trends Cogn. Sci."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1299","DOI":"10.2147\/PRBM.S405580","article-title":"Social support mediates the relationship between coping styles and the mental health of medical students","volume":"16","author":"Dai","year":"2023","journal-title":"Psychol. Res. Behav. Manag."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1177\/10901981211057109","article-title":"Importance of personality factors in determining the psychological consequences of infertility: a systematic review","volume":"49","author":"Darolia","year":"2022","journal-title":"Health Educ. Behav."},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci11050621","article-title":"Investigating the relationship between autistic traits, ruminative thinking, and suicidality in a clinical sample of subjects with bipolar disorder and borderline personality disorder","volume":"11","author":"Dell'Osso","year":"2021","journal-title":"Brain Sci."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"831","DOI":"10.3761\/j.issn.0254-1769.2013.09.021","article-title":"Reliability and validity of the simplified Chinese version of event related rumination inventory among accidentally injured patients","volume":"48","author":"Dong","year":"2013","journal-title":"Chin. J. Nurs."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1007\/s10815-021-02361-4","article-title":"Changes in sexual behaviour, anxiety symptoms, and quality of couple relationship of patients with infertility during the COVID-19 lockdown","volume":"39","author":"Dong","year":"2022","journal-title":"J. Assist. Reprod. Genet."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.1093\/humrep\/dez046","article-title":"Infertility-related distress and female sexual function during assisted reproduction","volume":"34","author":"Facchin","year":"2019","journal-title":"Hum. Reprod."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1024438","DOI":"10.3389\/fpubh.2023.1024438","article-title":"The value of motherhood and psychological distress among infertile women: the mediating role of coping strategies","volume":"11","author":"Foti","year":"2023","journal-title":"Front. Public Health"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19031464","article-title":"Childlessness: concept analysis","volume":"19","author":"Gouni","year":"2022","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"329","DOI":"10.16187\/j.cnki.issn1001-4918.2011.03.008","article-title":"The influence of rumination to negative and positive affection: based on its relationships with loneliness and emotional intelligence","volume":"27","author":"Guo","year":"2011","journal-title":"Psychol. Dev. Educ."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1037\/0033-2909.127.6.773","article-title":"Development of gender differences in depression: an elaborated cognitive vulnerability-transactional stress theory","volume":"127","author":"Hankin","year":"2001","journal-title":"Psychol. Bull."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1837","DOI":"10.1016\/S0277-9536(02)00208-3","article-title":"Global infertility and the globalization of new reproductive technologies: illustrations from Egypt","volume":"56","author":"Inhorn","year":"2003","journal-title":"Soc. Sci. Med."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1400223","DOI":"10.3389\/fpsyg.2024.1400223","article-title":"Emotion regulation use in daily-life and its association with success of emotion-regulation, self-efficacy, stress, and state rumination","volume":"15","author":"Int-Veen","year":"2024","journal-title":"Front. Psychol."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e0280054","DOI":"10.1371\/journal.pone.0280054","article-title":"Women infertility and common mental disorders: a cross-sectional study from North India","volume":"18","author":"Kamboj","year":"2023","journal-title":"PLoS One"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1007\/s00404-020-05614-2","article-title":"Social support, self-efficacy, cognitive coping and psychological distress in infertile women","volume":"302","author":"Khalid","year":"2020","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2024.03.012","article-title":"The health context paradox in the relationship between victimization, classroom bullying attitudes, and adolescent depression: an analysis based on the hlm model","volume":"354","author":"Li","year":"2024","journal-title":"J. Affect. Disord."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"895510","DOI":"10.3389\/fpubh.2022.895510","article-title":"Grit and life satisfaction among college students during the recurrent outbreak of COVID-19 in China: the mediating role of depression and the moderating role of stressful life events","volume":"10","author":"Liu","year":"2022","journal-title":"Front. Public Health"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1186\/s40359-025-02948-x","article-title":"The adaptation of the infertility distress scale into Chinese: cross-cultural adaptation, reliability and validity","volume":"13","author":"Liu","year":"2025","journal-title":"BMC Psychol."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1146\/annurev-clinpsy-032814-112733","article-title":"Thinking about rumination: the scholarly contributions and intellectual legacy of Susan Nolen-Hoeksema","volume":"11","author":"Lyubomirsky","year":"2015","journal-title":"Annu. Rev. Clin. Psychol."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1388","DOI":"10.1080\/08870446.2022.2154353","article-title":"The role of perseverative cognition in the job strain-health outcome relationship","author":"McCarrick","year":"2023","journal-title":"Psychol. Health"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/S0015-0282(99)00164-8","article-title":"The fertility problem inventory: measuring perceived infertility-related stress","volume":"72","author":"Newton","year":"1999","journal-title":"Fertil. Steril."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1037\/0021-843x.100.4.569","article-title":"Responses to depression and their effects on the duration of depressive episodes","volume":"100","author":"Nolen-Hoeksema","year":"1991","journal-title":"J. Abnorm. Psychol."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"173","DOI":"10.3109\/0167482x.2011.609950","article-title":"Testing the psychometric properties of mandarin version of the fertility problem inventory (M-FPI) in an infertile Chinese sample","volume":"32","author":"Peng","year":"2011","journal-title":"J. Psychosom. Obstet. Gynaecol."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1016\/j.jbtep.2013.05.004","article-title":"Cueing an unresolved personal goal causes persistent ruminative self-focus: an experimental evaluation of control theories of rumination","volume":"44","author":"Roberts","year":"2013","journal-title":"J. Behav. Ther. Exp. Psychiatry"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"96","DOI":"10.5539\/gjhs.v8n5p96","article-title":"Factors associated with marital satisfaction in infertile couple: a comprehensive literature review","volume":"8","author":"Samadaee-Gelehkolaee","year":"2015","journal-title":"Glob J Health Sci"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1007\/978-3-030-78771-4_17","article-title":"Event-related rumination inventory: a validation process in the Greek language","volume":"1337","author":"Seliniotaki","year":"2021","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"e3450","DOI":"10.1002\/smi.3450","article-title":"A longitudinal examination of appraisal, coping, stress, and mental health in students: a cross-lagged panel network analysis","volume":"40","author":"Spataru","year":"2024","journal-title":"Stress. Health"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"189","DOI":"10.22074\/IJFS.2021.139093.1039","article-title":"Infertility stigma: a qualitative study on feelings and experiences of infertile women","volume":"15","author":"Taebi","year":"2021","journal-title":"Int. J. Fertil. Steril."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"2064","DOI":"10.1093\/humrep\/den227","article-title":"Psychological implications of infertility in women with polycystic ovary syndrome","volume":"23","author":"Tan","year":"2008","journal-title":"Hum. Reprod."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"e0240175","DOI":"10.1371\/journal.pone.0240175","article-title":"Band of mothers: childbirth as a female bonding experience","volume":"15","author":"Tasuji","year":"2020","journal-title":"PLoS One"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"967","DOI":"10.1007\/s10964-022-01732-z","article-title":"Online racial discrimination, critical consciousness, and psychosocial distress among black and Latino adolescents: a moderated mediation model","volume":"52","author":"Thomas","year":"2023","journal-title":"J. Youth Adolesc."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"824789","DOI":"10.3389\/fpsyg.2022.824789","article-title":"Learning about your mental health from your playlist? Investigating the correlation between music preference and mental health of college students","volume":"13","author":"Wang","year":"2022","journal-title":"Front. Psychol."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1421739","DOI":"10.1177\/00302228261421739","article-title":"Complementary conceptions of death in Chinese tradition according to Taoism, Buddhism, and Confucianism","author":"Wang","year":"2026","journal-title":"Omega (Westport)"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"45","DOI":"10.3760\/cma.j.cn121094-20201027-00599","article-title":"The influence of workplace violence on burnout sense in clinical nurses","volume":"40","author":"Wei","year":"2022","journal-title":"Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1093459","DOI":"10.3389\/fpsyg.2022.1093459","article-title":"The impact of stigma on mental health and quality of life of infertile women: a systematic review","volume":"13","author":"Xie","year":"2022","journal-title":"Front. Psychol."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"3080","DOI":"10.13329\/j.cnki.zyyjk.2020.0772","article-title":"Relationships between anxiety and depression disorders and work stress, coping style, social support in medical staff","volume":"36","author":"Yang","year":"2020","journal-title":"Occupation Health"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"926040","DOI":"10.3389\/fpsyt.2022.926040","article-title":"The mediating role of coping style in the relationship between sleep quality and burnout: a cross-sectional study among psychiatric nurses","volume":"13","author":"Yin","year":"2022","journal-title":"Front. Psych."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1186\/s12905-021-01246-z","article-title":"The social stigma of infertile women in Zhejiang Province, China: a questionnaire-based study","volume":"21","author":"Zhang","year":"2021","journal-title":"BMC Womens Health"}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1784271\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T11:59:35Z","timestamp":1776081575000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1784271\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,13]]},"references-count":43,"alternative-id":["10.3389\/fpsyg.2026.1784271"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2026.1784271","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,13]]},"article-number":"1784271"}}