Fouad and Fahje

infertility, this study focuses only on women. The study was designed to investigate the following hypotheses:

1. That social support is negatively correlated with depres-

sion.

2. That social support is positively correlated with self-

esteem.

3. That self-esteem is positively correlated with internal locus of control.

4. That depression is negatively correlated with internal locus of control.

METHODOLOGY

Sixty-one white female subjects, drawn from four sources, participated in this study. The mean age of the participants was 31 years old. The study also examined the number of years the woman had been trying to get pregnant, the number of years she had been involved in infertility testing and treatment, and whether she had any children.

The data were collected through four methods. In the first method, information about the study was printed in the local Resolve newsletter, published by Resolve, a support group for infertile people. Women were asked to call the researcher if they were interested in participating. In the second method, women who were participating in local infertility education and support groups were contacted by mail and asked to call the researcher if they were interested in participating. In the third method, printed information about the study was made available through local infertility specialists with the authors' phone for contact. Finally, the study was announced at a national conference for infertile couples and interested women were instructed to contact the researcher at the conference.

The overall return rate was 73%. Participants who were contacted through Resolve, support groups, and the national conference (90% of the sample) were a special subsample of infertile women who seek support from others.

The quantitative data were measured and examined by using the following four instruments.

The Coopersmith Self-Esteem Inventory (CSE) measured self-esteem. The CSE is a 25-item instrument that measures self-evaluative attitudes that one holds in social, academic, family, and personal expectations. It measures self-esteem as an expression of approval or disapproval, which indicates the extent to which a person perceives herself or himself successful, competent, and worthy. It is among the most widely used of the various self-esteem inventories (Peterson & Austin, 1985). The Coopersmith Self-Esteem Inventory is brief and is easily scored. It is reliable and stable, with Kuder-Richardson 20 estimates in excess of .80 (Peterson & Austin, 1985). This instrument is also well researched, well documented, and widely used.

The Beck Depression Inventory (BDI) is a 21-item instrument that measures the presence and degree of depression in adolescents and adults. Each item on the BDI corresponds to a specific category of depressive symptoms or attitudes.

The Beck Depression Inventory is easily administered and scored and is extremely useful in mental health settings as a screening device, since it correlates well with psychiatric ratings of depression. The following guidelines are given by the author as ranges for scoring:

0-9 Normal Range

10-15 Mild Depression

16-19 Mild to Moderate Depression

• 20-29 Moderate to Severe Depression • 30-63 Severe Depression

The primary disadvantage of the Beck Depression Inventory is that there is no administrative or technical manual available for its use. Studies have been done to determine reliability and validity, with a reliability coefficient of .91 and a concurrent validity of .65 (Stehouwer, 1985). Overall, results of reliability and validity studies strongly support the Beck Depression Inventory as a useful measure for assessing depression.

Rotter's Internal-External Scale was used to measure locus of control. It is a 29-item instrument that measures the degree to which individuals believe that reinforcements or punishments are a result of their own action or a result of outside forces that are beyond their control.

The reliability coefficient for the Internal-External Scale is .70. A number of studies have been done that give evidence for its construct validity (Hirsch & Scheibe, 1967). The InternalExternal Scale is an instrument that measures the relationship between internal locus of control and good adjustment and, accordingly, between external locus of control and maladjustment. It is easily administered and simply scored by summing the number of external beliefs endorsed.

Brown and Heath's (1984) Social Support Inventory (SSI) is a 39-item instrument that investigates the amount of social support the individual perceives that she or he needs, the amount of support that she or he receives, and how satisfied she or he is with the amount of support received. The 39 items are representative of one of four classes of interpersonal needs drawn from literature on social support:

1. Esteem needs. Information and feedback that one is liked, valued, respected, loved, or needed by others.

2. Expressive needs. Encouragement and reinforcement to express positive and negative thoughts and feelings about self, current situation, and future.

3. Guidance needs. Guidance and assistance in, and modeling of, appraisal, goal setting, problem definition, problem solving, decision making, and coping strategies.

4. Utilitarian needs. Provision of money, goods, or services to deal with emergency and nonemergency situations.

Three scores are given on the SSI. The total perceived fit score (SSI-PF) is the sum of the perceived supply of support subtracted from the need ratings. The larger the discrepancy between what is given and needed, the poorer the satisfaction with social support. The second score is the subject's subjective satisfaction (SSI-SS), which is the total sum of satisfaction ratings over all items. Finally, the last item is a General Satisfaction (GS) item scored from not at all satisfied (1) to very satisfied (10), indicating overall satisfaction with the social support received over the past month.

Reliability and validity studies have been done on the SSI, with split-half reliability on odd versus even items at .90. Pearson Product-Moment correlations among the major predictor and criterion measures provide consistent support for the validity of the SSI (Brown, Brady, Lent, Wolfert, & Hall, 1987). The obtained data were then analyzed using correlational analysis for each of the continuous variables studied. The obtained correlations were studied with respect to each of the four hypotheses.

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RESULTS AND DISCUSSION

The mean scores of each of these instruments were compared to the standardized norms for each instrument. It appears that the women who participated in this study were expressing average self-esteem, mildly internally controlled, mildly depressed, in need of a greater than average amount of social support, not receiving as much social support as they needed, and moderately satisfied with the social support they were receiving.

These findings indicate that, as a group, these women exhibited mild levels of depression and felt that they had a minor amount of control over their own lives. As compared to national norms, they exhibited an average level of self-esteem. The Social Support Inventory indicates that they are a group of women who needed more support than the average woman; they were not receiving as much social support as they would have liked or needed, and they were only moderately happy or satisfied with the amount of support received.

Table 1 represents the correlation matrix that shows the correlations between each variable and their respective levels of significance. Each of the four hypotheses in the study are presented and discussed.

Hypothesis One: Perceived social support is negatively correlated with depression.

Table 1 indicates that the discrepancy between the social support a woman needs and the amount she receives (perceived fit) is positively correlated with depression. It also indicates that her subjective satisfaction with the support received is negatively correlated with depression, as is her general satisfaction with her social support. These findings show that the more depressed the participants were, the more social support they felt they needed; and the less satisfied the participants were with the support they were receiving from others, the higher their levels of depression.

The data support the hypothesis, in that the higher the level of depression, the more support the woman feels she needs and the less satisfied she is with the support that she does receive. The more depressed the participants were, the more support they needed and the less satisfied they were with the actual support that they received from others.

Hypothesis Two: Perceived social support is positively correlated with self-esteem.

Table 1 indicates that the perceived fit between the amount of social support a woman needs and the support she receives is negatively correlated with her self-esteem, and her subjective satisfaction with the support she receives is positively correlated with her self-esteem, as is her general satisfaction with her social support. These findings show that the better the subject felt about herself, the less the discrepancy between the social support she felt she needed and that she received. Findings also indicate that the more satisfied or happy she was with the support she was receiving from others, the higher her level of self-esteem or the better she felt about herself.

These results moderately support the hypothesis, based on indications that the higher the level of self-esteem the woman possesses, the more satisfied she is with the social support she receives. The better she feels about herself, the happier she is with the support that she is receiving. The findings, however, indicate that the higher the level of self-esteem, the less social support she needs.

Psychological Correlates of Infertility TABLE 1

Correlations Among Instruments

CSE IEC

BDI SS-PF SSS

SSS-GS

CSE IEC

-.31*

-.70** -.53** .40**

.45**

.46**

.28* .54**

-.37** .63** -.67**

-.27*

-.57**

-.57** .70**

BDI

SS-PF SSS

SSI-GS

Note. * = p < .05; **p < .01. Abbreviations: CSE Coopersmith Self-Esteem; IEC = Internal-External Control; BDI = Beck Depression Inventory; SS-PF Social Support-Perceived Fit; SSS = Social Support-Subjective Satisfaction; SSS-GS Social Support-General Satisfaction.

Hypothesis Three: Self-esteem is positively correlated with internal locus of control.

Table 1 indicates that there is a negative correlation between self-esteem and internal-external locus of control. Rotter's Internal-External Scale measures the extent to which a person feels her or his life is externally controlled. These results support the hypothesis, in that they indicate a negative correlation between levels of higher self-esteem and external, locus of control. The findings indicate that the better the woman felt about herself, the more internally controlled she appeared to be; and conversely, the more externally controlled she felt herself to be, the lower her level of self-esteem. The better the woman felt about herself, the more she felt in control of her own life. The lower the level of self-esteem, the more she felt that external forces were in control of her life.

Hypothesis Four: Depression is negatively correlated with an internal locus of control.

Table 1 indicates that there is a positive correlation between depression and internal-external locus of control. As stated in the discussion of hypothesis three, the internal-external control instrument measures the degree to which the participant feels that she is externally controlled.

These results support the hypothesis, in that they indicate a positive correlation between depression and an external locus of control. The findings show that the higher the level of depression, the more the woman feels that outside forces are in control of her life. The more depressed she is, the less likely she is to feel as though she can control her own life.

Overall, these results support previous studies. Individuals in the crisis of infertility will likely experience feelings of sadness, depression, and helplessness. This study presents data that support the hypotheses. Correlations indicated a negative correlation between self-esteem and internal-external locus of control. The lower the woman's self-esteem, the more she felt controlled by outside forces. The data also suggested that the higher the level of depression, the more the woman felt that external forces were the controlling factors in her life.

Social support is an extremely necessary system for an individual experiencing a life crisis. This study also supports that hypothesis. This group of women, who are in the midst of the crisis of infertility, display a need for more support than the average woman, are not receiving as much social support as they would like or need, and are only moderately satisfied with the support they do receive.

JOURNAL OF COUNSELING & DEVELOPMENT SEPTEMBER/OCTOBER 1989 VOL. 68