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

## TL;DR

Women undergoing infertility treatments feel more depressed due to uncertainty, which is worsened by perceived stigma, but spousal support does not help reduce this effect.

## Contribution

This study identifies perceived stigma as a mediator between treatment uncertainty and depression in women undergoing ART, with no significant moderation by spousal support.

## Key findings

- Uncertainty significantly predicts perceived stigma and depression in women undergoing ART.
- Perceived stigma significantly affects depression, but spousal support does not moderate this effect.
- Interventions should focus on reducing uncertainty and stigma to improve mental health outcomes.

## Abstract

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.

Uncertainty about infertility treatment significantly increases depression in women undergoing ART.Perceived stigma mediates the relationship between uncertainty and depression, whereas spousal support does not significantly moderate this mediation.To reduce psychological distress, interventions should focus on minimizing treatment‐related uncertainty and reducing internalized stigma through identity‐affirming and coping‐oriented strategies.

Uncertainty about infertility treatment significantly increases depression in women undergoing ART.

Perceived stigma mediates the relationship between uncertainty and depression, whereas spousal support does not significantly moderate this mediation.

To reduce psychological distress, interventions should focus on minimizing treatment‐related uncertainty and reducing internalized stigma through identity‐affirming and coping‐oriented strategies.