Disclosure strategies, social support, and quality of life in infertile women.

STUDY QUESTION Do the strategies women use to disclose information about their infertility to social network members impact the quality of the support they receive and their quality of life? SUMMARY ANSWER The data showed that women who disclosed infertility-related information in direct ways, rather than in indirect ways (e.g. by incremental disclosures or through third parties), to social network members perceived higher quality support and reported greater quality of life related to their infertility experience. WHAT IS KNOWN ALREADY Social support has been shown to buffer stress associated with various health issues including infertility. The way people disclose information about stressors has been associated with the quality of the support they receive. Disclosing information in a way that most effectively elicits support is beneficial because women with infertility who have lower levels of stress are more likely to seek and remain in treatment. STUDY DESIGN, SIZE, DURATION This cross-sectional study of 301 infertile women was conducted in the USA. PARTICIPANTS/MATERIALS, SETTING, METHODS To determine the variation in length of infertility and treatment decisions, we conducted an online survey of 301 American women coping with infertility. We investigated the strategies women used to disclose infertility-related information with social network members, their perceptions of support from friends and family, and their quality of life both in general (overall quality of life) and related to the experience of infertility (fertility quality of life). MAIN RESULTS AND THE ROLE OF CHANCE Direct disclosure of experiences related to infertility was positively and significantly associated with the perceived quality of social support received (P < 0.01). Strategies of disclosure that use entrapment or indirect media were negatively associated with fertility quality of life (P < 0.001). Directly (P < 0.01) and incremental disclosures (P < 0.01) were positively associated with overall quality of life, while the use of humor was negatively associated with overall quality of life (P < 0.01). Perceived support quality also mediated the influence of direct disclosures on women's fertility quality of life (95% CI: 0.18, 1.05) and overall quality of life (95% CI: 0.10, 0.30). This effect is particularly noteworthy for the model predicting fertility quality of life, which exhibited a non-significant main effect with direct disclosures. The non-significant main effect combined with the significant indirect effect suggests that perceived support quality fully mediates the association between direct disclosures and fertility quality of life. LIMITATIONS, REASONS FOR CAUTION The cross-sectional nature of our convenient sample did not allow us to test cause and effect. It is equally plausible that women who perceive support are more likely to disclose. Longitudinal data are necessary to test the cyclic nature of these variables and confirm directionality. WIDER IMPLICATIONS OF THE FINDINGS When women make the decision to reveal information about their infertility, direct disclosure (i.e. face-to-face, clearly, verbally and with the opportunity for an immediate response) was the only strategy that significantly corresponded with perceived support quality and was one of only two strategies that were positively associated with quality of life. To the extent that social support reduces stress, and lower stress increases the chance that people seek and stay in treatment, infertility clinics and therapists can use this information as a low-cost strategy for supporting infertile women. Scholars and practitioners can also instruct women coping with infertility about how to most effectively engage in seeking effective support. STUDY FUNDING/COMPETING INTERESTS No external funding was either sought or obtained for this study and no competing interests are declared.