How Resilience Mitigates Depression After IVF-ET Failure: A Moderated Mediation Model of Hope, Social Relations, and Income in China

Xiaoyu Wang,1 Mengye Yang,2 Yan Zhang,2 Yan Zhang,1 Yiwen Lin,1 Shijing Sun,1 Ling Jiang1 1Department of Nursing, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, People’s Republic of China; 2Reproductive Genetic Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, People’s Republic of ChinaCorrespondence: Ling Jiang, Department of Nursing, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, 26th Daoqian Road, Suzhou, 215000, People’s Republic of China, Email [email protected] Mengye Yang, Reproductive Genetic Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, 26th Daoqian Road, Suzhou, 215000, People’s Republic of China, Email [email protected]: Failed in vitro fertilization–embryo transfer (IVF-ET) cycles may exacerbate depressive symptoms among women. Resilience is widely recognized as a protective factor for psychological well-being. However, its role in alleviating depressive symptoms among women failed IVF-ET cycles in China remains insufficiently explored.Purpose: To explore how resilience affects depressive symptoms among women failed IVF-ET cycles in China, where strong emphasis is placed on family lineage.Patients and Methods: The cross-sectional study included 315 women failed IVF-ET cycles between June and December 2024. The 10-item Connor-Davidson Resilience Scale, the Patient Health Questionnaire, the Chinese version of the Herth Hope Index, and the social and marital relations subscales of the Fertility Quality of Life Scale were used for measurements. A moderated mediation model was tested in Mplus 8.3 to examine the direct and indirect effects of resilience on depressive symptoms, with hope and social relations as mediators and household income and healthcare payment methods as moderators.Results: Resilience is negatively related to depressive symptoms, with hope and social relations acting as mediators. Additionally, household income moderates the pathway through which resilience influences depressive symptoms via hope, whereas the method of healthcare payment does not exhibit a moderating effect.Conclusion: Resilience plays a critical role in mitigating depressive symptoms among women failed IVF-ET cycles in China, exerting both direct and indirect effects through the pathways of hope and social relations. Socioeconomic factors also serve as moderators in this process. To effectively support this population, the health system should integrate cultural context into the design of interventions by providing targeted psychological and social support and advocating for policy-level economic assistance.Keywords: depressive symptoms, resilience, failed IVF-ET cycles, mental health, socioeconomic factors