Analysis of risk association characteristics and protective factors of anxiety and depression comorbidity in infertility patients-data mining research based on Apriori association rules

Analysis of risk association characteristics and protective factors of anxiety and depression comorbidity in infertility patients-data mining research based on Apriori association rules | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis of risk association characteristics and protective factors of anxiety and depression comorbidity in infertility patients-data mining research based on Apriori association rules Zhijia Zhang, Li Song, Huifang Liu, Lijuan Cheng, Qihua Huang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8213937/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Objective: To explore potential association rules of anxiety-depression comorbidity in infertility patients, providing a reference for developing management strategies. Methods: In this study, using convenience sampling, we enrolled 194 infertility patients who were treated at Guangdong Hospital of Traditional Chinese Medicine's Reproductive Centre between May and September 2025. Subsequently, the Apriori algorithm was applied to analyse variables associated with anxiety-depression comorbidity events. Results: In total, eleven association rules for anxiety-depression comorbidity in infertility patients were identified, encompassing various combinations of variables, including mild anxiety and urban residence, aged 31 - 40 years, with a history of miscarriage, holding a bachelor's degree or higher, and undergoing assisted reproductive technology. Conclusion During infertility treatment, healthcare professionals should give priority to patients' mental health, paying special attention to the risk of anxiety-depression comorbidity in individuals showing the aforementioned association rules and strengthening psychological management for these patients. infertility anxiety-depression comorbidity mental health association rules Background Infertility refers to a female reproductive health issue where couples, without using contraceptive measures and maintaining a regular sexual life, fail to achieve a clinical pregnancy for at least 12 months. The World Health Organization (WHO) has classified it as the third most significant disease, following cancer and cardiovascular and cerebrovascular diseases [ 1 ] . Based on the data from the National Bureau of Statistics, the infertility rate in China ranges from 12% to 18% [ 2 ] . Infertility is not not only a physical health problem, but also a significant psychological burden on patients. Clinical studies have shown that a significant majority of infertility patients, with figures as high as 96.6% in China, experience moderate to severe fertility-related psychological stress [ 3 ] . Infertility can evoke a range of complex emotions, including feelings of loss, guilt, and shame. These emotions can manifest in various psychological and physical health issues, such as anxiety, depression, diminished self-esteem, social withdrawal, and sleep disturbances. Among them, the incidence of anxiety and The prevalence of depression symptoms is the highest [ 4 ] , and anxiety and depression often occur simultaneously, known as comorbid anxiety and depression (CAD). WHO statistics show that the prevalence of anxiety and depression in infertile women worldwide is about 25% -60% [ 5 ] . It is noteworthy that negative emotions such as anxiety and depression not only impair patients' physiological functions and reduce their social participation ability, but also increase the risk of adverse treatment outcomes [ 6 , 7 ] .Therefore, it it is of significant clinical value to systematically monitor and intervene in the comorbidity of anxiety and depression among infertility patients. Based on this, this study uses Apriori algorithm to carry out data mining and analysis of anxiety and depression comorbidity events in infertility patients, aiming to screen association rules with predictive value ( i.e., key attribute combinations that induce anxiety and depression comorbidity ), and provide reference for clinical management of anxiety and depression in infertility patients. Methods Study design and participants Employing the convenience sampling method, infertile patients treated in the reproductive department of Guangdong Provincial Hospital of Traditional Chinese Medicine from May to September 2025 were chosen as the research subjects. Inclusion criteria: 1) Conforming to the diagnostic criteria in the 2024 edition of the Clinical Practice Guidelines for the Prevention and Treatment of Infertility in People women of childbearing age diagnosed with infertility ; 2 ) aged 20–45 years ; 3 ) Participated in the investigation voluntarily based on informed consent. Exclusion criteria : 1 ) patients with severe mental disorders or other serious diseases of the physical system ( such as cancer, tumor, etc. ) ; 2 ) Individuals who have experienced major life stress events or trauma in the past six months. A total of 200 questionnaires were collected in this study, and 4 invalid questionnaires were excluded due to The data was incomplete. A total of 196 patients were ultimately included, and all patients were informed and gave their consent. Measures Demographic information Drawing on previous research and clinical experience, the research team discussed and devised a general information questionnaire for infertility patients, encompassing the patient's age, education level, place of residence, whether the spouse is an only child, employment status, whether they resigned due to treatment, and the cost of treatment. The degree of pressure on family finances, marital status, reproductive history, living conditions, history of adjuvant therapy, and other relevant information. Patients' Health Questionnaire Depression Scale-9item(PHQ-9) It was compiled by Spitzer et al.in 1999 according to the DSM-IV diagnostic criteria, in which the PHQ-9 corresponds to 9 core symptoms of depression in DSM-IV. In 2009, Bian Cuidong and other scholars sinicized PHQ-9 to form a Chinese version of PHQ-9 [ 8 ] . The scale uses a four-level scoring method. The item scoring range is from 0 point ( not at all ) to 3 points ( almost every day ). The total score of the scale ranges from 0 to 27 points. The higher the total score, the more significant the individual 's depressive symptoms. According to the total score, the degree of depression can be divided : mild depression (≥ 5 points ) 10 is divided into moderate depression (≥ 10 points ) and severe depression (≥ 15 points ). The Chinese version of PHQ-9 Cronbach 's α coefficient was 0.857, and the reliability and validity were good. Generalized Anxiety Disorder 7-itemscale(GAD-7) As part of PHQ, GAD-7 is a simple and reliable screening tool for anxiety symptoms, which was completed by He Xiaoyan in 2010 [ 9 ] . The scale consists of 7 items, using 0 ( no ) ~ 3 ( almost daily ) level score, the total score range of 0 ~ 21 points, the higher the score, the more significant the anxiety symptoms, the cut-off values were 5 points ( mild anxiety ), 10 points ( moderate anxiety ), 15 points ( severe anxiety ), Cronbach 's α coefficient was 0.898, good reliability and validity. Irrational Procreative Cognition Questionnaire(IPCQ) The scale was revised by M.Fekkes et al. The internal consistency Cronbach 's α coefficient of the English version was 0.87, and the reliability was good. The Chinese version of the IPCQ still retains 14 items [ 10 ] , using the Likert 5-level scoring method : 1 point corresponds to ' completely disagree ', and 5 points correspond to ' completely agree '. The subjects responded according to the degree of recognition of the statements of each item. The total score of the scale ranged from 14 to 70 points. Taking 42 as the boundary value of the high and low level of irrational fertility cognition, the higher the score, the more significant the irrational degree of female education cognition. The internal consistency Cronbach 's α coefficient of the Chinese version of the scale was 0.87. COMPI Fertility Problem Stress-Short Form(COMPI-FPSS-SF) The scale was compiled by Sobral and other scholars in 2017 as a self-assessment fertility stress assessment tool. The amount of a total of 9 items ; among them, 2 items were scored by Likert 5, and 7 items were scored by Likert 4. The total score of the scale ranged from 9 to 38 points. The higher the score, the more significant the fertility-related stress of infertility patients. The Cronbach 's α coefficient of the Chinese version of the scale was 0.907, and the reliability and validity were good. The scale was divided into high pressure boundary value with total score ≥ 22 [ 11 ] . Ethics considerations The study protocol was approved by the Research Ethics Committee of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine (approval no.BE2025-035-01) and adhered to the Declaration of Helsinki. Data were collected and stored on secure servers maintained by the Wen juan xing platform, which complies with Chinese data security laws. Access to the dataset was limited to the principal investigators through a password - protected account, and the anonymized data was solely utilized for aggregate statistical analysis. Statistical analysis The Apriori algorithm was employed via SPSS Modeler 18.0 software to analyze the association rules of comorbid anxiety and depression. For qualitative data, the number of cases and percentage (%) were used for statistical description. Results Basic information of infertility patients Among the 196 infertility patients, 121 patients had anxiety and depression comorbidity. Based on whether the patients had anxiety and depression comorbidity, they were divided into an anxiety and depression comorbidity group and a non-anxiety and depression comorbidity group. The basic data of the two groups of patients are shown in Table 1 . Table 1 Basic information of the two groups of patients (example: %) Variable Anxiety and depression comorbidity group (n = 121) Non-anxiety and depression comorbidity group (n = 75) Age 20 ~ 30 25(20.7%) 17(22.7%) 31 ~ 40 85(70.2%) 48(64.0%) > 40 11(9.1%) 10(13.3%) Education Junior high school and below 16(13.2%) 12(16.0%) High school (technical secondary school ) 20(16.5%) 10(13.3%) Junior college 29(24.0%) 10(13.3%) Bachelor degree and above 56(46.3%) 43(57.3%) Place of residence Rural 21(17.4%) 19(25.3%) Township 16(13.2%) 11(14.7%) City 84(69.4%) 45(60.0%) Whether the spouse is the only child Yes 48(39.7%) 17(22.7%) No 73(60.3%) 58(77.3%) Normal employment with in 3 months Yes 79(65.3%) 58(77.3%) No 42(34.7%) 17(22.7%) Resigned due to treatment Yes 104(86.0%) 63(84.0%) No 20(14.0%) 12(16.0%) The degree of pressure on the family economy caused by the cost of treatment No pressure at all 7(5.8%) 10(13.3%) Mild pressure 41(33.9%) 31(41.3%) Medium pressure 34(28.1%) 19(25.3%) Larger pressure 38(31.4%) 15(20.0%) Unbearable 1(0.8%) 0(0%) Marital status First marriage 110(90.9%) 68(90.7%) Remarried 11(9.1%) 7(9.3%) Have no children Have 89(73.6%) 52(69.3%) No 32(26.4%) 23(30.7%) Living conditions Live with spouse only 94(77.7%) 52(69.3%) Live with your parents 7(5.8%) 2(2.7%) Live with spouse parents 20(16.5%) 21(28.0%) Years of marriage ( years ) 2ཞ5 54(44.6%) 38(50.7%) 6ཞ10 46(38.0%) 21(28.0%) > 10 21(17.4%) 16(21.3%) Infertility duration( years ) 1ཞ3 61(50.4%) 49(65.3%) 4ཞ6 40(33.1%) 16(21.3%) > 6 20(16.5%) 10(13.3%) Number of abortions ( times ) 0 79(65.3%) 40(53.3%) 1 28(23.1%) 28(37.3%) ≥ 3 14(11.6%) 7(9.4%) Number of times of receiving assisted reproductive technology( times ) 0 28(23.1%) 35(46.7%) 1 38(31.4%) 12(16.0%) 2 25(20.7%) 7(9.3%) ≥ 3 30(24.8%) 21(28.0%) PHQ-9 No 40(33.1%) 67(89.3%) Mild 59(48.8%) 8(10.7%) Moderate 17(14.0%) 0(0%) Severe 5(4.1%) 0(0%) GAD-7 No 11(9.1%) 75(100%) Mild 86(71.1%) 0(0%) Moderate 19(15.7%) 0(0%) Severe 5(4.1%) 0(0%) IPCQ Low 70(57.9%) 59(78.7%) High 51(42.1%) 16(21.3%) COMPI-FPSS-SF Low 40(33.1%) 57(76.0%) High 81(66.9%) 18(24.0%) Association rule analysis results of infertility patients without anxiety and depression comorbidity events When 'no anxiety' is combined with certain socio - demographic characteristics, the protective effect becomes more pronounced. These characteristics include shorter infertility years (1–3 years), shorter marriage years (2–5 years), whether the spouse is an only child, and living solely with the spouse. This outlines a typical portrait of patients with low psychological risk : individuals who are in the early stage of diagnosis and treatment, have a high-quality spouse support system, and have less pressure on the family environment, as shown in Table 2 ( posterior 1 : anxiety and depression comorbidity, posterior 2 : no anxiety and depression comorbidity ). Table 2 Association rules for predicting ' no comorbidity of anxiety and depression ' The former item Support Confidence Lift No anxiety, infertility duration of 2 ~ 5 years, only living with a spouse 20.408 92.5 2.417 No anxiety, infertility duration 1 ~ 3 years. 27.041 92.453 2.416 No anxiety, spouse is not the only child 29.592 91.379 2.388 No anxiety, married for 2 to 5 years. 21.429 90.476 2.364 Association rule analysis results of anxiety and depression comorbidity events in infertility patients 'Single mild anxiety ' is an extremely high-risk warning signal for the development of anxiety and depression comorbidity. The analysis results indicate that the rule with 'single mild anxiety' as the core feature has a confidence level ranging from 90% to 100%, suggesting that the vast majority, or even all, patients with mild anxiety will eventually experience comorbid anxiety and depression events, as shown in Table 3 ( the latter 1 : no comorbid anxiety and depression, 2 : comorbid anxiety and depression ). Table 3 Association rules of ' comorbid anxiety and depression ' The former item Support Confidence Lift Single mild anxiety 43.878 100.0 1.620 Single mild anxiety, living in the city 31.122 100.0 1.620 Single mild anxiety, 31 ~ 40 years old 30.102 100.0 1.620 Single mild anxiety, history of abortion 29.08 100.0 1.620 Single mild anxiety, high fertility pressure 28.571 100.0 1.620 Single mild depression, high fertility stress 24.50 93.75 1.519 Single mild depression, 31–40 years old 22.448 90.91 1.473 Single mild anxiety, undergraduate and above 21.938 100.0 1.620 Single mild anxiety, abortion history, living in the city 21.938 100.0 1.620 Single mild anxiety, 31–40 years old, receiving assisted reproductive technology. 21.428 100.0 1.620 High fertility pressure, abortion history, living in the city 21.428 90.48 1.465 Discussion Basic Characteristics of Anxiety-Depression Comorbidity in Infertility Patients Analysis of data from 196 infertility patients showed that the co-occurrence rate of anxiety and depression was 59.18%, slightly higher than the 30% − 50% range reported in previous studies [ 13 ] . This suggests that the overall psychological burden of current infertility patients is already at a high level. Moreover, multiple studies have confirmed that the detection rate of emotional disorders in such patients gradually rises with prolonged treatment cycles [ 14 ] . Within this study, the anxiety-depression comorbidity group predominantly consisted of highly educated, first-time married individuals aged 31–40 years, with marriage durations mostly between 6 and 10 years. They had all undergone assisted reproductive technology (ART) treatment, and some patients voluntarily resigned from employment to undergo treatment while experiencing significant financial strain. Concurrently, they exhibited high subjective fertility pressure scores, manifesting as mild anxiety or depressive states, accompanied by relatively prominent irrational fertility cognitions (e.g., ‘infertility equates to personal failure’). Regarding potential factors influencing comorbidity, the findings reveal a paradox of psychological vulnerability among highly educated groups. Previous research often regarded higher education as a protective factor for mental health in infertility patients, suggesting lower anxiety-depression risks among those with lower educational attainment [ 15 ] . However, the findings of the present study may be attributed to the higher expectations for reproductive quality among highly educated patients, which result in intensified negative emotions such as self-denial and reduced self-worth after treatment failure. Furthermore, this group exhibits a stronger ability to actively seek medical resources, often prolonging treatment cycles (e.g., multiple referrals, various treatment approaches) to improve the chances of pregnancy success rates. The inherent uncertainty of prolonged treatment progressively intensifies psychological pressure, ultimately eroding the 'protective effect' of higher education and creating a psychological chain of 'high expectations - high investment - high stress'. Secondly, women aged 31 to 40 confront dual pressures: the physiological decline in fertility, along with the societal stigma attached to being an 'advanced maternal age' mother. This dual burden intensifies fertility anxiety [ 16 ] . Existing research shows that patients with infertility lasting ≥ 10 years have a significantly higher risk of depression. In this study, co-morbid patients aged 31–40 are at the crucial end stage of their ‘fertility prime’. Treatment uncertainties, such as repeated ART failures, can easily trigger feelings of ‘learned helplessness’ [ 17 , 18 ] . Furthermore, patients in this age group are frequently at a pivotal stage in their career development, necessitating repeated balancing between ‘professional advancement’ and ‘fertility treatment’. This role conflict further undermines their psychological resilience and weakens emotional regulation capacity. Moreover, the significant costs of assisted reproductive technologies, coupled with urban living expenses and occupational pressures, form a major source of financial anxiety [ 19 ] . A notably high proportion of patients in the co-morbid group in this study chose to resign due to treatment demands (such as frequent follow-up appointments or bed rest as medically advised), aligning with findings from Fertility Network UK [ 20 ] . Although resignation may temporarily ease the time conflict between treatment and work, the disruption of income directly intensifies living pressures, forming a vicious cycle of ‘treatment stress → voluntary resignation → financial strain → heightened anxiety and depression which further worsens psychological well-being [ 21 ] . Concurrently, sociocultural pressures stemming from family structure and marital duration warrant attention [ 22 ] . Under China's traditional belief that ‘more children bring greater blessings patients endure multifaceted pressures from spouses and in-laws. Couples who have been married for 6–10 years typically maintain established lifestyles. In such cases, reproductive failure disrupts domestic equilibrium, strains marital bonds, and becomes an additional trigger for emotional disorders. Moreover, the traumatic experience of ART and associated cognitive distortions constitute significant contributing factors. Studies indicate that among ART patients, anxiety prevalence stands at approximately 32% and depression prevalence at around 36% [ 23 ] . Hormonal fluctuations during ovarian stimulation can trigger emotional instability, while the ‘bereavement-like grief’ following failed embryo transfer often leads to emotional breakdown. The loss of bodily autonomy during invasive procedures like egg retrieval may induce post-traumatic stress disorder [ 20 ] . Concurrently, over Half of the women with comorbidities demonstrate irrational fertility beliefs, directly associating 'reproductive outcomes' with 'life value' and viewing 'infertility as a personal failure'. This cognitive distortion notably exacerbates the psychological impact of treatment failure, heightens self-denial, and serves as a primary catalyst for comorbid events [ 10 ] . Early diagnosis and treatment, coupled with support systems, exert a mitigating effect on anxiety-depression comorbidity. Among the predictive association rules for ‘absence of anxiety-depression comorbidity’, the combinations of ‘no anxiety with an infertility duration of 1–3 years’ and ‘no anxiety with a spouse who is not an only child’ form two core protective factor clusters. This indicates that anxiety, depression, and reproductive stress among infertility patients surge with prolonged infertility duration, aligning with Hu Shuang et al.'s findings [ 11 ] . Potential explanations include: patients with 1–3 years of infertility are typically in the early stages of diagnosis and treatment [ 24 ] , have not yet developed pessimistic expectations about reproductive outcomes, while maintaining physiological advantages (such as ovarian reserve) and demonstrating greater psychological resilience; In families where the spouse is not an only child, fertility expectations tend to show greater dispersion. Data reveal that 39.7% of co-morbid patients had an only child spouse, compared to just 22.7% in the non-co-morbid group. This disparity places co-morbid patients under the the burden of being the ‘sole bearer of reproductive responsibility’, which significantly increases familial pressure. Furthermore, the protective effect observed in the scenario of ‘no anxiety + living solely with spouse’ [ 25 ] may arise because such cohabiting patients encounter fewer intergenerational conflicts regarding reproductive values. They are more inclined to establish a ‘joint coping’ support pattern, thereby minimizing emotional interference stemming from generational tensions. This aligns with existing research concluding that ‘nuclear family structures may alleviate psychological burdens for infertility patients’ [ 25 ] . Mild anxiety serves as a critical early warning sign for the co-occurrence of anxiety and depression. Results indicate that association rules centred on ‘isolated mild anxiety’ consistently demonstrate 100% confidence levels. This substantiates mild anxiety as a highly effective predictor of comorbid development. In this study, nearly all patients exhibiting mild anxiety ultimately developed comorbidity. This suggests mild anxiety may represent a ‘tipping point’ for emotional deterioration: at this stage, patients' cognitive assessment of reproductive stress has already become distorted. Without timely intervention, this cognitive bias readily combines with reproductive stress to form a ‘cognitive bias - stress amplification’ cycle, ultimately triggering depression [ 26 ] . The study further revealed that the combination rule of ‘mild anxiety alone + other factors’ maintained 100% confidence, suggesting a cumulative impact of risk factors. Specifically, women aged 31–40 experience a ‘dual pressure period’, marked by declining reproductive function and societal expectations regarding family planning [ 27 ] . The fiercely competitive urban living environment further intensifies patients' perceived stress. When these factors synergistically interact with mild anxiety, the risk of comorbidity rises exponentially. Conclusions This study employed the Apriori algorithm to determine that the co-occurrence rate of anxiety and depression among infertility patients reached 59.18%, with ‘mild anxiety alone’ emerging as a highly significant early warning indicator for such comorbidity. Conversely, ‘infertility duration of 1–3 years’, ‘spouse not being an only child’, and ‘absence of anxiety’ were identified as crucial protective factors for preventing and controlling comorbidity. Conversely, the 31–40 age cohort, urban residence, high fertility pressure, and high levels of irrational cognition significantly elevate the risk of comorbidity. These findings not only provide empirical support for establishing a ‘tiered screening – targeted intervention’ management system for anxiety-depression comorbidity in clinical practice but also point the way towards optimising multidisciplinary collaboration models integrating reproductive and psychological care. Further multi-centre longitudinal studies are required to validate the causal relationships between these factors and comorbidity, continuously refine intervention strategies, and ultimately achieve deep integration of physiological treatment with psychological support. This will tangibly improve the physical and mental health status and reproductive outcomes of infertility patients. Declarations Acknowledgements We are grateful to all hospital administrators and nurses who took part in this study. Author contributions Study conception and design:ZJZ, QHH, LS; Data collection: LJC, HFC, ZJZ; Data analysis and interpretation: LS, ZJZ; Article drafting: LS, ZJZ. Manuscript critical review: QHH, LJC. All authors have carefully reviewed the article and approved the final draft. Funding This research received no funding support. Data availability The data supporting the findings of this study are available on request from the corresponding author. The data is not publicly available due to privacy or ethical restrictions. Ethics approval and consent to participate The study underwent review and received approval from the Research Ethics Committee of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine (approval No. BE2025-035-01). The study protocol conformed to the Declaration of Helsinki, with voluntary participation and electronic informed consent obtained prior to survey access. 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Chin J Family Plann. 2024;32(12):2718–23. Zhu Yuhuan L, Lanying Z, Ling, et al. Analysis of Fertility Pressure and Its Influencing Factors Among Older Women with Infertility [J]. Women Children's Health J. 2024;3(24):184–8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 27 Dec, 2025 Reviewers agreed at journal 27 Dec, 2025 Reviewers invited by journal 19 Dec, 2025 Editor invited by journal 28 Nov, 2025 Editor assigned by journal 28 Nov, 2025 Submission checks completed at journal 28 Nov, 2025 First submitted to journal 26 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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14:23:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8213937/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8213937/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98826507,"identity":"d61da05a-7042-4f0e-a022-f3668ffbcd63","added_by":"auto","created_at":"2025-12-22 18:55:14","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":35748,"visible":true,"origin":"","legend":"","description":"","filename":"1.1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8213937/v1/94efb6a16d9e7a3bac50d9a4.docx"},{"id":99308084,"identity":"048db801-40b3-4833-a01d-bc04bc48870b","added_by":"auto","created_at":"2025-12-31 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16:43:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1131657,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8213937/v1/a88e645d-9b86-4f36-b921-ecc39a8a50db.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of risk association characteristics and protective factors of anxiety and depression comorbidity in infertility patients-data mining research based on Apriori association rules","fulltext":[{"header":"Background","content":"\u003cp\u003eInfertility refers to a female reproductive health issue where couples, without using contraceptive measures and maintaining a regular sexual life, fail to achieve a clinical pregnancy for at least 12 months. The World Health Organization (WHO) has classified it as the third most significant disease, following cancer and cardiovascular and cerebrovascular diseases \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Based on the data from the National Bureau of Statistics, the infertility rate in China ranges from 12% to 18% \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Infertility is not not only a physical health problem, but also a significant psychological burden on patients. Clinical studies have shown that a significant majority of infertility patients, with figures as high as 96.6% in China, experience moderate to severe fertility-related psychological stress \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Infertility can evoke a range of complex emotions, including feelings of loss, guilt, and shame. These emotions can manifest in various psychological and physical health issues, such as anxiety, depression, diminished self-esteem, social withdrawal, and sleep disturbances. Among them, the incidence of anxiety and The prevalence of depression symptoms is the highest \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e, and anxiety and depression often occur simultaneously, known as comorbid anxiety and depression (CAD). WHO statistics show that the prevalence of anxiety and depression in infertile women worldwide is about 25% -60% \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. It is noteworthy that negative emotions such as anxiety and depression not only impair patients' physiological functions and reduce their social participation ability, but also increase the risk of adverse treatment outcomes \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.Therefore, it it is of significant clinical value to systematically monitor and intervene in the comorbidity of anxiety and depression among infertility patients. Based on this, this study uses Apriori algorithm to carry out data mining and analysis of anxiety and depression comorbidity events in infertility patients, aiming to screen association rules with predictive value ( i.e., key attribute combinations that induce anxiety and depression comorbidity ), and provide reference for clinical management of anxiety and depression in infertility patients.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and participants\u003c/h2\u003e \u003cp\u003eEmploying the convenience sampling method, infertile patients treated in the reproductive department of Guangdong Provincial Hospital of Traditional Chinese Medicine from May to September 2025 were chosen as the research subjects. Inclusion criteria: 1) Conforming to the diagnostic criteria in the 2024 edition of the Clinical Practice Guidelines for the Prevention and Treatment of Infertility in People women of childbearing age diagnosed with infertility ; 2 ) aged 20\u0026ndash;45 years ; 3 ) Participated in the investigation voluntarily based on informed consent. Exclusion criteria : 1 ) patients with severe mental disorders or other serious diseases of the physical system ( such as cancer, tumor, etc. ) ; 2 ) Individuals who have experienced major life stress events or trauma in the past six months. A total of 200 questionnaires were collected in this study, and 4 invalid questionnaires were excluded due to The data was incomplete. A total of 196 patients were ultimately included, and all patients were informed and gave their consent.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eDemographic information\u003c/h2\u003e \u003cp\u003eDrawing on previous research and clinical experience, the research team discussed and devised a general information questionnaire for infertility patients, encompassing the patient's age, education level, place of residence, whether the spouse is an only child, employment status, whether they resigned due to treatment, and the cost of treatment. The degree of pressure on family finances, marital status, reproductive history, living conditions, history of adjuvant therapy, and other relevant information.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePatients' Health Questionnaire Depression Scale-9item(PHQ-9)\u003c/h3\u003e\n\u003cp\u003eIt was compiled by Spitzer et al.in 1999 according to the DSM-IV diagnostic criteria, in which the PHQ-9 corresponds to 9 core symptoms of depression in DSM-IV. In 2009, Bian Cuidong and other scholars sinicized PHQ-9 to form a Chinese version of PHQ-9 \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. The scale uses a four-level scoring method. The item scoring range is from 0 point ( not at all ) to 3 points ( almost every day ). The total score of the scale ranges from 0 to 27 points. The higher the total score, the more significant the individual 's depressive symptoms. According to the total score, the degree of depression can be divided : mild depression (\u0026ge;\u0026thinsp;5 points ) 10 is divided into moderate depression (\u0026ge;\u0026thinsp;10 points ) and severe depression (\u0026ge;\u0026thinsp;15 points ). The Chinese version of PHQ-9 Cronbach 's α coefficient was 0.857, and the reliability and validity were good.\u003c/p\u003e\n\u003ch3\u003eGeneralized Anxiety Disorder 7-itemscale(GAD-7)\u003c/h3\u003e\n\u003cp\u003eAs part of PHQ, GAD-7 is a simple and reliable screening tool for anxiety symptoms, which was completed by He Xiaoyan in 2010\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. The scale consists of 7 items, using 0 ( no )\u0026thinsp;~\u0026thinsp;3 ( almost daily ) level score, the total score range of 0\u0026thinsp;~\u0026thinsp;21 points, the higher the score, the more significant the anxiety symptoms, the cut-off values were 5 points ( mild anxiety ), 10 points ( moderate anxiety ), 15 points ( severe anxiety ), Cronbach 's α coefficient was 0.898, good reliability and validity.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eIrrational Procreative Cognition Questionnaire(IPCQ)\u003c/h2\u003e \u003cp\u003eThe scale was revised by M.Fekkes et al. The internal consistency Cronbach 's α coefficient of the English version was 0.87, and the reliability was good. The Chinese version of the IPCQ still retains 14 items \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e, using the Likert 5-level scoring method : 1 point corresponds to ' completely disagree ', and 5 points correspond to ' completely agree '. The subjects responded according to the degree of recognition of the statements of each item. The total score of the scale ranged from 14 to 70 points. Taking 42 as the boundary value of the high and low level of irrational fertility cognition, the higher the score, the more significant the irrational degree of female education cognition. The internal consistency Cronbach 's α coefficient of the Chinese version of the scale was 0.87.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCOMPI Fertility Problem Stress-Short Form(COMPI-FPSS-SF)\u003c/h3\u003e\n\u003cp\u003eThe scale was compiled by Sobral and other scholars in 2017 as a self-assessment fertility stress assessment tool. The amount of a total of 9 items ; among them, 2 items were scored by Likert 5, and 7 items were scored by Likert 4. The total score of the scale ranged from 9 to 38 points. The higher the score, the more significant the fertility-related stress of infertility patients. The Cronbach 's α coefficient of the Chinese version of the scale was 0.907, and the reliability and validity were good. The scale was divided into high pressure boundary value with total score\u0026thinsp;\u0026ge;\u0026thinsp;22\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eEthics considerations\u003c/h3\u003e\n\u003cp\u003e The study protocol was approved by the Research Ethics Committee of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine (approval no.BE2025-035-01) and adhered to the Declaration of Helsinki. Data were collected and stored on secure servers maintained by the Wen juan xing platform, which complies with Chinese data security laws. Access to the dataset was limited to the principal investigators through a password - protected account, and the anonymized data was solely utilized for aggregate statistical analysis.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe Apriori algorithm was employed via SPSS Modeler 18.0 software to analyze the association rules of comorbid anxiety and depression. For qualitative data, the number of cases and percentage (%) were used for statistical description.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eBasic information of infertility patients\u003c/h2\u003e \u003cp\u003eAmong the 196 infertility patients, 121 patients had anxiety and depression comorbidity. Based on whether the patients had anxiety and depression comorbidity, they were divided into an anxiety and depression comorbidity group and a non-anxiety and depression comorbidity group. The basic data of the two groups of patients are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic information of the two groups of patients (example: %)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAnxiety and depression comorbidity group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;121)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon-anxiety and depression comorbidity group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;75)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026thinsp;~\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25(20.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17(22.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u0026thinsp;~\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85(70.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48(64.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11(9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(13.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJunior high school and below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(13.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(16.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003cp\u003e(technical secondary school )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20(16.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(13.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJunior college\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29(24.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(13.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor degree and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56(46.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43(57.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePlace of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21(17.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19(25.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTownship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(13.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11(14.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84(69.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45(60.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWhether the spouse is the only child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48(39.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17(22.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73(60.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58(77.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNormal employment with in 3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79(65.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58(77.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42(34.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17(22.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResigned due to treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104(86.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63(84.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20(14.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(16.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eThe degree of pressure on the family economy caused by the cost of treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo pressure at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7(5.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(13.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41(33.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31(41.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedium pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34(28.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19(25.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLarger pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38(31.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15(20.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnbearable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst marriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e110(90.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68(90.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRemarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11(9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(9.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHave no children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHave\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89(73.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52(69.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32(26.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23(30.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eLiving conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLive with spouse only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94(77.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52(69.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLive with your parents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7(5.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(2.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLive with spouse parents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20(16.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(28.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eYears of marriage ( years )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2ཞ5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54(44.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38(50.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6ཞ10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46(38.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(28.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21(17.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(21.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eInfertility duration( years )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1ཞ3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61(50.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49(65.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4ཞ6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40(33.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(21.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20(16.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(13.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eNumber of abortions ( times )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79(65.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40(53.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28(23.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28(37.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(11.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(9.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eNumber of times of receiving assisted reproductive technology( times )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28(23.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35(46.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38(31.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(16.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25(20.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(9.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30(24.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(28.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ePHQ-9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40(33.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67(89.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59(48.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8(10.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17(14.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5(4.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eGAD-7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11(9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75(100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86(71.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19(15.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5(4.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIPCQ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70(57.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59(78.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51(42.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(21.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOMPI-FPSS-SF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40(33.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57(76.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81(66.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(24.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eAssociation rule analysis results of infertility patients without anxiety and depression comorbidity events\u003c/h2\u003e \u003cp\u003eWhen 'no anxiety' is combined with certain socio - demographic characteristics, the protective effect becomes more pronounced. These characteristics include shorter infertility years (1\u0026ndash;3 years), shorter marriage years (2\u0026ndash;5 years), whether the spouse is an only child, and living solely with the spouse. This outlines a typical portrait of patients with low psychological risk : individuals who are in the early stage of diagnosis and treatment, have a high-quality spouse support system, and have less pressure on the family environment, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e ( posterior 1 : anxiety and depression comorbidity, posterior 2 : no anxiety and depression comorbidity ).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation rules for predicting ' no comorbidity of anxiety and depression '\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe former item\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupport\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConfidence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLift\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo anxiety, infertility duration of 2\u0026thinsp;~\u0026thinsp;5 years, only living with a spouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20.408\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.417\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo anxiety, infertility duration 1\u0026thinsp;~\u0026thinsp;3 years.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92.453\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.416\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo anxiety, spouse is not the only child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29.592\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91.379\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.388\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo anxiety, married for 2 to 5 years.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21.429\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90.476\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.364\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eAssociation rule analysis results of anxiety and depression comorbidity events in infertility patients\u003c/h2\u003e \u003cp\u003e'Single mild anxiety ' is an extremely high-risk warning signal for the development of anxiety and depression comorbidity. The analysis results indicate that the rule with 'single mild anxiety' as the core feature has a confidence level ranging from 90% to 100%, suggesting that the vast majority, or even all, patients with mild anxiety will eventually experience comorbid anxiety and depression events, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e ( the latter 1 : no comorbid anxiety and depression, 2 : comorbid anxiety and depression ).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation rules of ' comorbid anxiety and depression '\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe former item\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupport\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConfidence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLift\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle mild anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43.878\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.620\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle mild anxiety, living in the city\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31.122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.620\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle mild anxiety, 31\u0026thinsp;~\u0026thinsp;40 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.620\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle mild anxiety, history of abortion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.620\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle mild anxiety, high fertility pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28.571\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.620\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle mild depression, high fertility stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.519\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle mild depression, 31\u0026ndash;40 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22.448\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.473\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle mild anxiety, undergraduate and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21.938\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.620\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle mild anxiety, abortion history, living in the city\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21.938\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.620\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle mild anxiety, 31\u0026ndash;40 years old, receiving assisted reproductive technology.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21.428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.620\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh fertility pressure, abortion history, living in the city\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21.428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.465\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eBasic Characteristics of Anxiety-Depression Comorbidity in Infertility Patients\u003c/h2\u003e \u003cp\u003eAnalysis of data from 196 infertility patients showed that the co-occurrence rate of anxiety and depression was 59.18%, slightly higher than the 30% \u0026minus;\u0026thinsp;50% range reported in previous studies\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. This suggests that the overall psychological burden of current infertility patients is already at a high level. Moreover, multiple studies have confirmed that the detection rate of emotional disorders in such patients gradually rises with prolonged treatment cycles\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Within this study, the anxiety-depression comorbidity group predominantly consisted of highly educated, first-time married individuals aged 31\u0026ndash;40 years, with marriage durations mostly between 6 and 10 years. They had all undergone assisted reproductive technology (ART) treatment, and some patients voluntarily resigned from employment to undergo treatment while experiencing significant financial strain. Concurrently, they exhibited high subjective fertility pressure scores, manifesting as mild anxiety or depressive states, accompanied by relatively prominent irrational fertility cognitions (e.g., \u0026lsquo;infertility equates to personal failure\u0026rsquo;). Regarding potential factors influencing comorbidity, the findings reveal a paradox of psychological vulnerability among highly educated groups. Previous research often regarded higher education as a protective factor for mental health in infertility patients, suggesting lower anxiety-depression risks among those with lower educational attainment\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. However, the findings of the present study may be attributed to the higher expectations for reproductive quality among highly educated patients, which result in intensified negative emotions such as self-denial and reduced self-worth after treatment failure. Furthermore, this group exhibits a stronger ability to actively seek medical resources, often prolonging treatment cycles (e.g., multiple referrals, various treatment approaches) to improve the chances of pregnancy success rates. The inherent uncertainty of prolonged treatment progressively intensifies psychological pressure, ultimately eroding the 'protective effect' of higher education and creating a psychological chain of 'high expectations - high investment - high stress'. Secondly, women aged 31 to 40 confront dual pressures: the physiological decline in fertility, along with the societal stigma attached to being an 'advanced maternal age' mother. This dual burden intensifies fertility anxiety\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Existing research shows that patients with infertility lasting\u0026thinsp;\u0026ge;\u0026thinsp;10 years have a significantly higher risk of depression. In this study, co-morbid patients aged 31\u0026ndash;40 are at the crucial end stage of their \u0026lsquo;fertility prime\u0026rsquo;. Treatment uncertainties, such as repeated ART failures, can easily trigger feelings of \u0026lsquo;learned helplessness\u0026rsquo;\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Furthermore, patients in this age group are frequently at a pivotal stage in their career development, necessitating repeated balancing between \u0026lsquo;professional advancement\u0026rsquo; and \u0026lsquo;fertility treatment\u0026rsquo;. This role conflict further undermines their psychological resilience and weakens emotional regulation capacity. Moreover, the significant costs of assisted reproductive technologies, coupled with urban living expenses and occupational pressures, form a major source of financial anxiety\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. A notably high proportion of patients in the co-morbid group in this study chose to resign due to treatment demands (such as frequent follow-up appointments or bed rest as medically advised), aligning with findings from Fertility Network UK \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Although resignation may temporarily ease the time conflict between treatment and work, the disruption of income directly intensifies living pressures, forming a vicious cycle of \u0026lsquo;treatment stress \u0026rarr; voluntary resignation \u0026rarr; financial strain \u0026rarr; heightened anxiety and depression which further worsens psychological well-being\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Concurrently, sociocultural pressures stemming from family structure and marital duration warrant attention\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. Under China's traditional belief that \u0026lsquo;more children bring greater blessings patients endure multifaceted pressures from spouses and in-laws. Couples who have been married for 6\u0026ndash;10 years typically maintain established lifestyles. In such cases, reproductive failure disrupts domestic equilibrium, strains marital bonds, and becomes an additional trigger for emotional disorders. Moreover, the traumatic experience of ART and associated cognitive distortions constitute significant contributing factors. Studies indicate that among ART patients, anxiety prevalence stands at approximately 32% and depression prevalence at around 36%\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. Hormonal fluctuations during ovarian stimulation can trigger emotional instability, while the \u0026lsquo;bereavement-like grief\u0026rsquo; following failed embryo transfer often leads to emotional breakdown. The loss of bodily autonomy during invasive procedures like egg retrieval may induce post-traumatic stress disorder\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Concurrently, over Half of the women with comorbidities demonstrate irrational fertility beliefs, directly associating 'reproductive outcomes' with 'life value' and viewing 'infertility as a personal failure'. This cognitive distortion notably exacerbates the psychological impact of treatment failure, heightens self-denial, and serves as a primary catalyst for comorbid events\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEarly diagnosis and treatment, coupled with support systems, exert a mitigating effect on anxiety-depression comorbidity.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAmong the predictive association rules for \u0026lsquo;absence of anxiety-depression comorbidity\u0026rsquo;, the combinations of \u0026lsquo;no anxiety with an infertility duration of 1\u0026ndash;3 years\u0026rsquo; and \u0026lsquo;no anxiety with a spouse who is not an only child\u0026rsquo; form two core protective factor clusters. This indicates that anxiety, depression, and reproductive stress among infertility patients surge with prolonged infertility duration, aligning with Hu Shuang et al.'s findings \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Potential explanations include: patients with 1\u0026ndash;3 years of infertility are typically in the early stages of diagnosis and treatment \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e, have not yet developed pessimistic expectations about reproductive outcomes, while maintaining physiological advantages (such as ovarian reserve) and demonstrating greater psychological resilience; In families where the spouse is not an only child, fertility expectations tend to show greater dispersion. Data reveal that 39.7% of co-morbid patients had an only child spouse, compared to just 22.7% in the non-co-morbid group. This disparity places co-morbid patients under the the burden of being the \u0026lsquo;sole bearer of reproductive responsibility\u0026rsquo;, which significantly increases familial pressure. Furthermore, the protective effect observed in the scenario of \u0026lsquo;no anxiety\u0026thinsp;+\u0026thinsp;living solely with spouse\u0026rsquo;\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e may arise because such cohabiting patients encounter fewer intergenerational conflicts regarding reproductive values. They are more inclined to establish a \u0026lsquo;joint coping\u0026rsquo; support pattern, thereby minimizing emotional interference stemming from generational tensions. This aligns with existing research concluding that \u0026lsquo;nuclear family structures may alleviate psychological burdens for infertility patients\u0026rsquo;\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMild anxiety serves as a critical early warning sign for the co-occurrence of anxiety and depression.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eResults indicate that association rules centred on \u0026lsquo;isolated mild anxiety\u0026rsquo; consistently demonstrate 100% confidence levels. This substantiates mild anxiety as a highly effective predictor of comorbid development. In this study, nearly all patients exhibiting mild anxiety ultimately developed comorbidity. This suggests mild anxiety may represent a \u0026lsquo;tipping point\u0026rsquo; for emotional deterioration: at this stage, patients' cognitive assessment of reproductive stress has already become distorted. Without timely intervention, this cognitive bias readily combines with reproductive stress to form a \u0026lsquo;cognitive bias - stress amplification\u0026rsquo; cycle, ultimately triggering depression \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. The study further revealed that the combination rule of \u0026lsquo;mild anxiety alone\u0026thinsp;+\u0026thinsp;other factors\u0026rsquo; maintained 100% confidence, suggesting a cumulative impact of risk factors. Specifically, women aged 31\u0026ndash;40 experience a \u0026lsquo;dual pressure period\u0026rsquo;, marked by declining reproductive function and societal expectations regarding family planning \u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. The fiercely competitive urban living environment further intensifies patients' perceived stress. When these factors synergistically interact with mild anxiety, the risk of comorbidity rises exponentially.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study employed the Apriori algorithm to determine that the co-occurrence rate of anxiety and depression among infertility patients reached 59.18%, with \u0026lsquo;mild anxiety alone\u0026rsquo; emerging as a highly significant early warning indicator for such comorbidity. Conversely, \u0026lsquo;infertility duration of 1\u0026ndash;3 years\u0026rsquo;, \u0026lsquo;spouse not being an only child\u0026rsquo;, and \u0026lsquo;absence of anxiety\u0026rsquo; were identified as crucial protective factors for preventing and controlling comorbidity. Conversely, the 31\u0026ndash;40 age cohort, urban residence, high fertility pressure, and high levels of irrational cognition significantly elevate the risk of comorbidity. These findings not only provide empirical support for establishing a \u0026lsquo;tiered screening \u0026ndash; targeted intervention\u0026rsquo; management system for anxiety-depression comorbidity in clinical practice but also point the way towards optimising multidisciplinary collaboration models integrating reproductive and psychological care. Further multi-centre longitudinal studies are required to validate the causal relationships between these factors and comorbidity, continuously refine intervention strategies, and ultimately achieve deep integration of physiological treatment with psychological support. This will tangibly improve the physical and mental health status and reproductive outcomes of infertility patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to all hospital administrators and nurses who took part in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy conception and design:ZJZ, QHH, LS; Data collection: LJC, HFC, ZJZ; Data analysis and interpretation: LS, ZJZ; Article drafting: LS, ZJZ. Manuscript critical review: QHH, LJC. All authors have carefully reviewed the article and approved the final draft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no funding support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are available on request from the corresponding author. The data is not publicly available due to privacy or ethical restrictions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study underwent review and received approval from the Research Ethics Committee of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine (approval No. BE2025-035-01). The study protocol conformed to the Declaration of Helsinki, with voluntary participation and electronic informed consent obtained prior to survey access. The initial page of the questionnaire provided comprehensive information on the study\u0026rsquo;s aims, procedures, and ethical safeguards. Participants were assured that their data would remain confidential and anonymous.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOrganization WH. 1 in 6 people globally affected by infertility: WHO[J]. Z Kardiol. 2023;83(Suppl 6):21\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhai Zhenwu L. What is the true prevalence of lifetime infertility among Chinese women? An analysis based on population survey data [J]. Popul Res. 2020;44(02):3\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Xin L, Yifei C, Chunying, et al. Relationship between Fertility Pressure, General Self-Efficacy and Anxiety in Female Infertility Patients [J]. Chin J Public Health. 2020;36(05):807\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa Dandan B, Caifeng M, Fangxiang, et al. Relationship between Emotional Regulation Strategies and Symptoms of Depression and Anxiety in Infertility Patients [J]. Chin J Mental Health. 2023;37(8):662\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBai Fu, Liu Chang F, Yanjun. Research progress on infertility prevention and control strategies [J]. Chin J Public Health. 2018;34(09):1303\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGu Xuan L, Jin C, Qiong. The Impact of Pregnancy-Related Stress Following IVF on Pregnancy Outcomes in Infertile Patients [J]. Henan Med Res. 2023;32(9):1597\u0026ndash;600.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFavril L, Shaw J, Fazel S. Prevalence and risk factors for suicide attempts in prison[J]. Clin Psychol Rev. 2022;97:102190.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBian Cuidong H, Xiaoyan Q, Jie, et al. Application of the Patient Health Questionnaire Depression Symptom Cluster Scale in General Hospitals [J]. J Tongji Univ (Medical Sci Edition). 2009;30(5):136\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHe Xiaoyan L, Chunbo Q, Jie, et al. Reliability and Validity Study of the Generalised Anxiety Disorder Scale in a General Hospital [J]. Shanghai J Psychiatry. 2010;22(4):200\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao Qing G, Mingxia T, Nan, et al. Correlation between Irrational Fertility Beliefs and Fertility-Related Quality of Life in Infertile Patients [J]. J Reprod Med. 2021;30(5):600\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu Shuang. Chinese Adaptation and Reliability/Validity Testing of the Concise Fertility Stress Scale for Infertility (COMPI-FPSS-SF) [D]. Nursing, China Medical University; 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen YJ, Jhang KM, Wang WF, et al. Applying Apriori algorithm to explore long-term care services usage status-Variables based on the combination of patients with dementia and their caregivers[J]. Front Psychol. 2022;13:1022860.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNik HN, Norhayati MN, Shaiful BI, et al. Worldwide prevalence, risk factors and psychological impact of infertility among women: a systematic review and meta-analysis[J]. BMJ Open. 2022;12(3):e57132.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu Mei L, Yang J, Lingjun Z, Tieying, et al. Research progress on psychological distress in infertility patients [J]. J Nurs Sci. 2024;39(16):120\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYusuf L. Depression, anxiety and stress among female patients of infertility; A case control study[J]. Pak J Med Sci. 2016;32(6):1340\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLakatos E, Szigeti JF, Ujma PP, et al. Anxiety and depression among infertile women: a cross-sectional survey from Hungary[J]. BMC Womens Health. 2017;17(1):48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSousa E, Nery SF, Casalechi M, et al. Characteristics, prevalence and sources of stress in individuals who discontinue assisted reproductive technology treatments: a systematic review[J]. Reprod Biomed Online. 2023;46(5):819\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKlock SC, Greenfeld DA. Psychological status of in vitro fertilization patients during pregnancy: a longitudinal study[J]. Fertil Steril. 2000;73(6):1159\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCooper RL, Brown LL, Tabatabai M, et al. The Effects of Perceived Stress and Cortisol Concentration on Antiretroviral Adherence When Mediated by Psychological Flexibility Among Southern Black Men Living with HIV[J]. AIDS Behav. 2021;25(2):645\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRees E. The true impact of fertility problems: insights from the Fertility Network UK and Middlesex University survey. Hum Reprod. 2023;38(Suppl 2):0\u0026ndash;170.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKiani Z, Simbar M, Hajian S, et al. The prevalence of depression symptoms among infertile women: a systematic review and meta-analysis[J]. Fertil Res Pract. 2021;7(1):6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi D, Wei Z, Li L, et al. A Study on Fertility-Related Stress, Social Support and Coping Strategies Among Infertile Couples [J]. Chin J Family Plann Obstet Gynecol. 2021;13(01):74\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMonroe SM, Harkness KL. Major Depression and Its Recurrences: Life Course Matters[J]. Annu Rev Clin Psychol. 2022;18:329\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFan AT, Tian Q, Li XY, et al. Analysis of mental health status and influencing factors among female infertility patients [J]. J Shandong Univ (Medical Sci Edition). 2020;58(01):106\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTang N, Pei M, Xie L, et al. Relationship Between Dyadic Coping with Anxiety and Depression in Infertile Couples: Gender Differences and Dyadic Interaction[J]. Psychol Res Behav Manag. 2023;16:4909\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Li Z, Haoying F. Survey on Irrational Fertility Perceptions Among Women Assisted by Reproductive Technologies and Associated Factors [J]. Chin J Family Plann. 2024;32(12):2718\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhu Yuhuan L, Lanying Z, Ling, et al. Analysis of Fertility Pressure and Its Influencing Factors Among Older Women with Infertility [J]. Women Children's Health J. 2024;3(24):184\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"infertility, anxiety-depression comorbidity, mental health, association rules","lastPublishedDoi":"10.21203/rs.3.rs-8213937/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8213937/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To explore potential association rules of anxiety-depression comorbidity in infertility patients, providing a reference for developing management strategies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eIn this study, using convenience sampling, we enrolled 194 infertility patients who were treated at Guangdong Hospital of Traditional Chinese Medicine's Reproductive Centre between May and September 2025. Subsequently, the Apriori algorithm was applied to analyse variables associated with anxiety-depression comorbidity events.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eIn total, eleven association rules for anxiety-depression comorbidity in infertility patients were identified, encompassing various combinations of variables, including mild anxiety and urban residence, aged 31 - 40 years, with a history of miscarriage, holding a bachelor's degree or higher, and undergoing assisted reproductive technology.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e During infertility treatment, healthcare professionals should give priority to patients' mental health, paying special attention to the risk of anxiety-depression comorbidity in individuals showing the aforementioned association rules and strengthening psychological management for these patients.\u003c/p\u003e","manuscriptTitle":"Analysis of risk association characteristics and protective factors of anxiety and depression comorbidity in infertility patients-data mining research based on Apriori association rules","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 18:55:10","doi":"10.21203/rs.3.rs-8213937/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-12-27T07:59:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"80650043711107586677969261930609152848","date":"2025-12-27T05:22:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-19T15:36:04+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-28T12:41:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-28T06:19:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-28T06:17:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2025-11-26T14:14:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"590c4b7b-ff6a-4b8f-afe9-8da0febcb8c3","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-22T18:55:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-22 18:55:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8213937","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8213937","identity":"rs-8213937","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}