Reliability and validity of the Kansas Marital Satisfaction Scale (KMSS) in infertile people

Couples' Psychological Resources and Marital Satisfaction: The Mediating Role of Marital Support

The aim of this study was to assess the interdependent relations among psychological resources, marital support, and marital satisfaction in married couples from the perspective of both dyad members, using the Actor-Partner-Interdependence-Model (APIM) approach. One hundred and fifty-one heterosexual married couples (N = 302) completed questionnaires assessing psychological resources (dispositional optimism and sense of mastery), marital support, marital satisfaction, social desirability, and demographic variables. Structural equation modeling (SEM) was used to test a proposed mediation model adopting the dyadic approach. It was found that husbands' and wives' own psychological resources contributed positively to their own perceptions of marital support and that marital support mediated the effects of these resources on their own (actor-actor effect) and on their spouses' marital satisfaction (actor-partner effect). The results highlight the important contribution of each dyad member's own psychological resources, as well as the valuable role of perceived support as a mediator, regardless of gender. Hence, clinical practice should encourage individuals to invest in maintaining their personal assets and abilities because of their positive effect on expanding intra- and inter- processes of well-being within the marriage.

Gottman's sound relationship house and relational resilience through infertility for couples

Some couples report that their relationship satisfaction increases through the experience of infertility. Few studies exist which explain how this phenomenon occurs through specific variables. We hypothesized that John Gottman's constructs of friendship and intimacy as well as shared meaning could explain how couples can achieve increased relationship satisfaction. We examined a regression analysis of cross-sectional retrospective individual data for couples who are either experiencing infertility currently or have done so in the recent past. In our nonclinical sample (n = 903), mediation analyses indicated significant influencing pathways for the Gottman shared meaning system, indicating that this construct may explain how couples achieve greater emotional bonding and couple satisfaction through infertility. These findings provide couple therapists with potential areas of focus for couples navigating infertility through the lens of Gottman Method Couple Therapy, including ways to encourage deeper mutual shared meaning amidst the infertility experience.

Psychometric properties of dyadic data from the Marital Quality Scale of Indonesian Javanese couples

BACKGROUND

Researchers have demonstrated that various measurement concepts and dimensions depend on context and timing.

OBJECTIVES

The current study aimed to determine the psychometric properties of the Javanese couples' marital quality scale based on validity and reliability METHODS: In total 840 participants or 420 marital dyad from Java, Indonesia, were involved in this study. The psychometrics properties scale was analyzed using exploratory and confirmatory factor analysis, convergent and discriminant analysis, and composite reliability.

RESULTS

The exploratory factor analysis found relationship quality to consist of support, physical proximity, warmth, communication, acceptance and respect, role sharing, and responsibility factors. Well-being quality consists of happiness, harmony, and problem-solving. The fit of the measurement model was obtained using confirmatory factor analysis. The fit model was also found in the husband's and wife's groups, with no differences between them. The high correlations between wife-husband factors also proved the validity based on convergent and discriminant evidence. The reliability coefficient was high for each dimension and construct.

DISCUSSION

This analysis shows that the marital quality scale developed has information on psychometric properties that can be useful for researchers and the practicians using the marital quality instrument of Javanese couples in particular.

History of infertility and sexual dysfunction in midlife women: Is there a link?

BACKGROUND

Infertility has been linked with an increased risk of sexual dysfunction in reproductive-aged women, with longer periods of infertility associated with a greater risk.

AIM

The study's aim was to examine whether a history of infertility treatment in women is linked to sexual dysfunction during midlife.

METHODS

The cross-sectional study was conducted among sexually active women, between the ages of 45 and 65 years, who sought consultation at the women's health clinics at a US tertiary care center. History of infertility treatment was assessed with a single question that asked participants if they were treated for infertility in the past. The association between a history of infertility treatment and sexual dysfunction-which was diagnosed by a combination of Female Sexual Function Index score ≤26.55 and Female Sexual Distress Scale-Revised score ≥11-was assessed in a multivariable logistic regression model that adjusted for multiple confounders.

OUTCOMES

The primary outcome was sexual dysfunction in midlife women.

RESULTS

The analysis included 5912 women, with a mean age of 54.1 years. Nearly 16% of women reported receiving treatment for infertility. More than half the women (55%) had sexual dysfunction: 56.3% of those with previous fertility treatments and 54.4% of those without any fertility treatment (P = .3). Receiving treatment for infertility in the younger years did not significantly increase the odds of sexual dysfunction in midlife in univariate (odds ratio, 1.08; 95% CI, 0.94-1.24; P = .3) and multivariable analyses (odds ratio, 1.11; 95% CI, 0.96-1.29; P = .17).

CLINICAL IMPLICATIONS

While infertility is known to be predictive of sexual dysfunction in women during their reproductive years, there was no association between a history of infertility treatment and sexual dysfunction in midlife women in the current study.

STRENGTHS AND LIMITATIONS

The study used validated questionnaires accounting for sexual complaints and distress and adjusted for multiple confounding factors. Limitations include the selection bias introduced by the study of women presenting for evaluation of sexual dysfunction, which may have been a result of factors stronger than the influence of infertility. Other limitations include the study's cross-sectional nature with suboptimal racial and ethnic representation.

CONCLUSION

Although infertility is commonly associated with female sexual dysfunction in women of reproductive age, the association was not present in midlife women in the current study.

Adverse childhood experiences and sexual dysfunction in midlife women: Is there a link?

BACKGROUND

One in 3 children has had at least 1 adverse childhood experience (ACE), and ACEs have been associated with multiple medical and psychiatric morbidities in women later in life, including greater menopause symptom burden.

AIM

To evaluate the association between ACEs and female sexual dysfunction (FSD) in midlife women.

METHODS

A cross-sectional analysis from DREAMS-the Data Registry on Experiences of Aging, Menopause, and Sexuality-was conducted with questionnaires completed by women aged 40 to 65 years who presented to a women's health clinic at Mayo Clinic in Rochester, Minnesota, from May 2015 to December 2016. History of ACEs was obtained with the validated ACE questionnaire. FSD was assessed by the Female Sexual Function Index and the Female Sexual Distress Scale-Revised.

OUTCOMES

The association between ACEs and FSD (defined as Female Sexual Function Index score ≤26.55 and Female Sexual Distress Scale-Revised score ≥11) was evaluated via a multivariable logistic regression model, adjusting for age, menopause status, hormone therapy use, anxiety, depression, relationship satisfaction, hot flash severity, and history of abuse in the past year.

RESULTS

Women (N = 1572) had a mean age of 53.2 years. Overall 59% reported having at least 1 ACE. When compared with no ACEs, a history of ≥4 ACEs significantly increased the odds of not being sexually active (odds ratio, 1.83; 95% CI, 1.30-2.57; P < .001). Among sexually active women, the proportion of women with FSD increased sequentially as the number of ACEs increased. In the univariate analysis, a history of ≥4 ACEs significantly increased the odds of FSD as compared with no ACEs (odds ratio, 2.12; 95% CI, 1.50-2.99; P < .001). The association remained statistically significant in the multivariable analysis after adjusting for confounders (odds ratio, 1.75; 95% CI, 1.15-2.68; P = .009).

CLINICAL IMPLICATIONS

The findings highlight an opportunity for clinicians to screen for ACEs in women with sexual dysfunction and offer appropriate treatment and counseling as indicated.

STRENGTHS AND LIMITATIONS

Strengths of the study include the large cohort, the use of validated tools for assessment of ACEs and FSD, and the adjustment for multiple potential confounding factors. Limitations include the cross-sectional study design, recall bias in reporting ACEs and recent abuse, and the low representation of racially and ethnically diverse women in the cohort.

CONCLUSION

The study demonstrates an increased risk of sexual inactivity and sexual dysfunction in midlife women who experienced childhood adversity. The sexual dysfunction in women with ACEs seems to be independent of other factors that potentially affect female sexual function in midlife.

Effectiveness of a marital relationship skills training intervention on marital adjustment among individuals in Hosanna Town, Southwest Ethiopia: A randomized-controlled trial

Marital distress increases the risk of morbidity and mortality by altering psychological and biological health, including cardiovascular and endocrine function. Numerous interventions have been developed to mitigate marital distress. However, most of these interventions had very specific content and were limited to certain segments of the population. This study was conducted to evaluate the effectiveness of a marital relationship skills training intervention on the marital adjustment of married people in Ethiopia. We conducted a randomized-controlled trial study on 80 married people with low marital satisfaction. We used STATA 14 statistical software to process the data. The results of an Independent sample's t test analysis showed that marital relationship skills training had a significant impact on the marital adjustment of distressed couples (p = 0.001, 95% confidence interval: 0.79-1.10). A marital relationship skills training intervention can effectively improve marital adjustment and can be used as a treatment for marital distress.

The Mediation Role of an Individual's and Couple's Psychological Factors, Including Parenting in the Prediction of Relational and Marital Satisfaction

The goal of this study was to widen the scope of the social component of family sustainability. The fundamental goal of this non-experimental, quantitative study was to look at the links between parenting correlates, personality characteristics, marital satisfaction, and well-being in couples, as well as to construct explanatory prediction models for relational and marital satisfaction. The study focused on the effects of personality traits, parental self-efficacy, and attachment to marital and relational satisfaction. The test instruments applied were: the Experiences in Close Relationships-Revised, Marital Adjustment Test, Couple Satisfaction Index, Relationship Satisfaction Scale, Family Distress Index, Generalized Self-Efficacy Scale (adapted to the role of a parent), Mowen's Personality Scale, and demographic data. A total of 238 Romanians answered the online survey, recruited based on a convenience sampling method. Participants in this research were individuals who were both married and had at least one child. The main findings show that agreeableness, openness, conscientiousness, anxious and avoidant attachment, and marital adjustment predict the satisfaction in the relationship, and openness partially mediates the association between marital adjustment and relationship satisfaction. Parental self-efficacy appears to influence the association between relationship satisfaction and marital satisfaction. An increased parental self-efficacy score predicts an increased relationship satisfaction and marital satisfaction. The higher the parental self-efficacy, the higher the satisfaction in the relationship, which leads to an increase in satisfaction in the couple. These results show that marital adjustment and adaptation are related to relational satisfaction, and these relationship are partially mediated by an individual's openness. Despite some limitations, the current study significantly contributes to couples therapies and interventions in terms of physical and mental health, and the study provides insight into the experiences and perspectives of married individuals with children in Romania.

The Development of the Love and Respect Marriage Scale

The constructs of love and respect have been known to be essential ingredients contributing positively to marital satisfaction, but to-date they have mostly been measured using separate scales. However, given the overlap between both constructs this study set out, using self-report methodologies, to develop a comprehensive scale which measures both love and respect known as The Love and Respect Marriage Scale. Using a nonclinical community Singapore sample (n = 400), an initial item pool was developed, and through exploratory factor analysis, a robust factor structure emerged that consisted of eight subscales and 46 items. This factor structure was shown to be a consistent and cross-culturally acceptable model using samples from USA, n = 396, South Africa, n = 390, Nigeria, n = 364, and India, n = 306. Good reliability values were achieved. Construct, convergent, divergent, and incremental validity were also demonstrated as comparisons were made with shorter established marriage scales. Implications and advantages of a longer marital scale were discussed.Supplemental data for this article is available online at https://doi.org/10.1080/0092623X.2021.1963362 .

The Persian version of the revised dyadic adjustment scale (RDAS): a validation study in infertile patients

Background

Infertility can have a powerful impact on marital quality. The Revised Dyadic Adjustment Scale (RDAS) is a widely used measure of marital quality. This scale has not been validated in infertile patients. Therefore, this study aimed to evaluate the reliability and validity of the RDAS in a sample of infertile patients.

Methods

The sample of this methodological study consisted of 254 infertile patients referring to a referral infertility clinic in Tehran, Iran. A battery of questionnaires was administered to the participants, including a demographic/fertility questionnaire, the RDAS, the Relationship Assessment Scale (RAS), the Kansas Marital Satisfaction Scale (KMSS), the Couples Satisfaction Index- 4 Item (CSI-4), the Hospital Anxiety and Depression Scale (HADS), and the Perceived Stress Scale-4 Item (PSS-4). Internal consistency of the scale was assessed with Cronbach’s alpha, construct validity was investigated using confirmatory factor analysis (CFA), and convergent validity was examined by correlating the RDAS with RAS, KMSS, CSI-4, HADS, and PSS-4 instruments.

Results

The mean total RDAS score was 49.26 ± 9.34, and 100 patients (39.4%) had marital distress based on the cut-off value of < 48. The second-order three-factor model of the RDAS exhibited an excellent fit to the data, as indicated by χ²/df = 2.26; CFI = 0.96; GFI = 0.91; NFI = 0.93; IFI = 0.96; RMSEA = 0.071 and SRMR = 0.050. The RDAS and its subscales revealed satisfactory internal consistency that ranged from 0.664 to 0.847. Convergent validity was confirmed by strong correlations between RDAS scores and scores on the RAS, KMSS, and CSI-4. These correlations also tended to be larger than correlations with measures of HADS-anxiety, HADS-depression, and PSS-4. Among demographic/fertility variables, only infertility duration was found to be correlated to the RDAS.

Conclusion

The RDAS is a reliable and valid inventory for measuring marital quality in infertile patients. Further validation studies are needed to generalize the underlying structure of the scale in various populations.

The 6-item Female Sexual Function Index (FSFI-6): factor structure, reliability, and demographic correlates among infertile women in Iran

Background

The 6-item Female Sexual Function Index (FSFI) is a short form of the original 19-item FSFI that measures sexual function in women. The aim of this study was to examine the factor structure and reliability of the FSFI-6 and to determine the demographic correlates of sexual dysfunction among infertile women in Iran.

Results

In total, 250 infertile women participated in this study. The mean total FSFI-6 score was 20.71 ± 5.09. Internal consistency of the FSFI-6 was high (Cronbach’s alpha = 0.856). All inter-item correlations and item-total correlations were in acceptable range. The results of confirmatory factor analysis provided support for a unidimensional model of the FSFI-6. Among demographic and infertility variables, higher women’s age, low education, unwanted marriage, short infertility duration, and low frequency of intercourse were associated with sexual dysfunction.

Conclusions

The FSFI-6 demonstrated sound reliability and validity in this study, supporting its continued use for measuring sexual disfunction among infertile women. Its brevity and comprehensiveness allow a quick assessment both in clinical and research settings.

Iranian infertile couples' strategies to manage social interactions after unsuccessful treatment with assisted reproductive technologies

Many infertile couples feel vulnerable after failed treatment cycles and find insensitive remarks or inappropriate support distressing. They fear that the stress of failed treatment cycles may affect their marriage and lead to marriage breakdown. This study explored the strategies a sample of infertile couples used to manage social interactions after unsuccessful treatment with assisted reproductive technologies. A descriptive qualitative study was conducted with 34 participants including nine infertile couples, nine infertile women and two infertile men with primary infertility, two relatives, and three fertility clinic staff. The participants were selected through purposive sampling at an infertility centre in Iran, between 2016 and 2017. Data were collected using semi-structured face-to-face interviews and analysed by qualitative content analysis approach. Participants found some social interactions after failed assisted reproductive treatment cycles to be distressing and painful. They described tolerating painful emotions which cause them sadness and sorrow as well as feeling embarrassed. As a result, they found they needed to maintain their adopting concealment strategies with their families through not permitting speculation, selective disclosure, not giving details and hiding the truth. This study showed that social interactions following failed assisted reproductive cycles can be upsetting for infertile couples. Couples use different strategies to manage potentially distressing social interactions. Healthcare providers and psychologists may provide a space for safe social interactions in order to help couples to use appropriate strategies in these circumstances.

The Quality of Marriage Index (QMI): a validation study in infertile patients

OBJECTIVE

Infertility can have a considerable effect on a person's marital satisfaction. The Quality of Marriage Index (QMI) is a self-report inventory to measure global perceptions of marital satisfaction. The current study examined the reliability and validity of the Persian language version of QMI in a sample of infertile patients.

RESULTS

The mean QMI total score was 36.54 ± 6.87. The internal consistency of the scale was good, with a Cronbach's alpha of 0.922. All inter-item correlations and item-total correlations were also in acceptable range. The confirmatory factor analysis results provided evidence for unidimensionality of the scale (χ²/df = 3.10; GFI = 0.97; CFI = 0.99; NFI = 0.99; RMSEA = 0.091 and SRMR = 0.020). The convergent validity of the QMI was demonstrated via significant correlations with measures of the Relationship Assessment Scale, Kansas Marital Satisfaction Scale, and Couples Satisfaction Index-4 Item. These correlations also tended to be larger than correlations with measures of Hospital Anxiety and Depression Scale and Perceived Stress Scale-4 Item. Among demographic/fertility variables, only infertility duration was negatively correlated to QMI scores. In sum, the QMI is a reliable and valid brief inventory for measuring overall marital satisfaction in infertile patients. Trial registration This was a cross-sectional study (NOT clinical trial); thus, the trail registration number is not required for the present study.

The Relationship of Religiosity and Marital Satisfaction: The Role of Religious Commitment and Practices on Marital Satisfaction Among Pakistani Respondents

The sociology of religion focuses on an individual’s social and married life. This research performed the first focalized examination of the influence of spirituality and religiosity on the marital satisfaction of Pakistani Muslim couples and how religious commitment and religious practice strengthens the relationship of married couples. This study incorporates the Kansas Marital Satisfaction scale (KMSS), the Religious Commitment Inventory (RCI-10) and the Religious Practice scale to measure marital satisfaction. Survey questionnaires, including a survey invitation letter and an informed consent form, were sent to married couples residing in five urban areas of Pakistan. The sample consisted of 508 valid responses, 254 males and 254 females, exploring the respondent’s perception of their marital satisfaction. The data received were screened and tested through SPSS version 25. The first step of the data analysis was to examine the impact of religiosity variables (religious commitment, religious practice) on marital satisfaction. Findings indicated that religious commitment and religious practice are vital for a happy married life. The findings help explain the social dynamics of marital satisfaction in Pakistani culture. The results also indicated that religious commitment and religious practice strengthened and promoted marital satisfaction. This study is novel in the context of Pakistani culture and conclusions cannot be generalized to the whole population. Other religious factors may provide further research directions. The results of this study may help practitioners and decision-makers focusing on marital satisfaction issues.

Application of the dyadic data analysis in behavioral medicine research: marital satisfaction and anxiety in infertile couples

BACKGROUND

Dyadic data analysis (DDA) is increasingly being used to better understand, analyze and model intra- and inter-personal mechanisms of health in various types of dyads such as husband-wife, caregiver-patient, doctor-patient, and parent-child. A key strength of the DDA is its flexibility to take the nonindependence available in the dyads into account. In this article, we illustrate the value of using DDA to examine how anxiety is associated with marital satisfaction in infertile couples.

METHODS

This cross-sectional study included 141 infertile couples from a referral infertility clinic in Tehran, Iran between February and May 2017. Anxiety and marital satisfaction were measured by the anxiety subscale of the Hospital Anxiety and Depression Scale and 10-Item ENRICH Marital Satisfaction Scale, respectively. We apply and compare tree different dyadic models to explore the effect of anxiety on marital satisfaction, including the Actor-Partner Interdependence Model (APIM), Mutual Influence Model (MIM), and Common Fate Model (CFM).

RESULTS

This study demonstrated a practical application of the dyadic models. These dyadic models provide results that appear to give different interpretations of the data. The APIM analysis revealed that both men's and women's anxiety excreted an actor effect on their own marital satisfaction. In addition, women's anxiety exerted a significant partner effect on their husbands' marital satisfaction. In MIM analysis, in addition to significant actor effects of anxiety on marital satisfaction, women's reports of marital satisfaction significantly predicted men's marital satisfaction. The CFM analysis revealed that higher couple anxiety scores predicted lower couple marital satisfaction scores.

CONCLUSION

In sum, the study highlights the usefulness of DDA to explore and test the phenomena with inherently dyadic nature. With regard to our empirical data, the findings confirmed that marital satisfaction was influenced by anxiety in infertile couples at both individual and dyadic level; thus, interventions to improve marital satisfaction should include both men and women. In addition, future studies should consider using DDA when dyadic data are available.

The relationship between marital satisfaction and depression in infertile couples: an actor-partner interdependence model approach

BACKGROUND

Much evidence consistent with the Marital Discord Model of Depression (MDMD) suggests that marital discord is associated with depression, but no studies examine the relationship between marital satisfaction and depression at the dyadic level in infertile couples. This study examined the effect of actors' and partners' marital satisfaction on depressive symptoms in husband-wife dyads with infertility using an innovative dyadic analysis approach, the Actor-Partner Interdependence Model (APIM).

METHODS

In this cross-sectional study, the sample comprised of 141 infertile couples in the evaluation phase of treatment. We collected data in a referral infertility center in Tehran, Iran between February and May 2017. Marital satisfaction and depression were measured using ENRICH marital satisfaction scale and Hospital Anxiety and Depression Scale, respectively, before starting the treatment. Dyadic analysis applying the APIM was used. In this study, actor effect is the impact of a person's marital satisfaction on his/her own depression. Partner effect is the impact of a person's marital satisfaction on his/her partner's depression.

RESULTS

The APIM analysis revealed that both men and women's marital satisfaction excreted an actor effect on their own depression (β = - 0.412, P < 0.001; β = - 0.263, P = 0.002, respectively). Furthermore, men's marital satisfaction exerted a significant partner effect on their wives' depression symptoms (β = - 0.170, p = 0.047). However, the wives' marital satisfaction was not related to their husbands' depressive symptoms (β = - 0.028, P = 0.735).

CONCLUSIONS

The findings support that the MDMD is a valid theoretical model for the conceptualization of marital satisfaction and depressive symptoms among infertile couples and suggest that interventions to reduce depressive symptoms should include both men and women.

Prevalence of generalized anxiety disorder and its related factors among infertile patients in Iran: a cross-sectional study

BACKGROUND

Generalized anxiety disorder (GAD) is one of the most prevalent anxiety disorders among infertile patients. This study aimed to determine the prevalence of GAD and its associated factors among infertile patients in Tehran, Iran.

METHODS

This cross-sectional study included 1146 infertile patients in a referral fertility center in Tehran, Iran between May and October 2017. GAD was measured using the Generalized Anxiety Disorder-7 (GAD-7) scale. The associations between GAD and demographic/fertility characteristics were estimated using simple and multiple logistic regression with odds ratio (OR) and 95% confidence interval (CI).

RESULTS

The mean total GAD-7 score was 6.61 (SD = 5.32). Using a cut-off value of 10, the prevalence of GAD was 28.3%. In adjusted analysis, female sex (OR = 2.54, 95% CI = 1.88-3.42, P < 0.001), low educational level (OR = 1.45, 95% CI = 1.08-1.94, P = 0.012), high infertility duration (OR = 1.05, 95% CI = 1.01-1.09, P = 0.013), and treatment failure (OR = 1.52, 95% CI = 1.13-2.04, P = 0.006) were associated with GAD.

CONCLUSIONS

The prevalence of GAD is relatively high in infertile patients. We conclude that all infertile patients should be screened for symptoms of GAD and treated for this disorder as need arises.