Effects of Uncertainty on Depression in Women Undergoing Assisted Reproductive Technology: The Mediating Role of Perceived Stigma and the Moderated Mediation by Spousal Support

Women undergoing assisted reproductive technology (ART) often experience depression linked to treatment-related uncertainty. This study examined whether perceived stigma mediates the relationship between uncertainty and depression and whether spousal support moderates this effect. PROCESS Macro Model 14 was used, controlling for miscarriage experience, counseling history, and spousal proactiveness. Conditional indirect effects and the moderated mediation index were assessed using bootstrapping with 95% confidence intervals. Uncertainty significantly predicted perceived stigma (β = 0.56, p < 0.001) and depression (β = 0.54, p = 0.002). Perceived stigma also significantly affected depression (β = 0.61, p < 0.001). However, spousal support (β = -0.09, p = 0.617) and its interaction with stigma (β = 0.02, p = 0.913) were not significant. While indirect effects remained significant at all spousal support levels, the moderated mediation index was nonsignificant (95% CI: -0.15 to 0.21). Perceived stigma mediates the effect of uncertainty on depression, but spousal support does not moderate this pathway. Interventions should target uncertainty and stigma reduction to improve mental health in women undergoing ART.