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J Res Med Sci. 2019 Jul 24;24:64. doi: 10.4103/jrms.JRMS_790_18. eCollection 2019.

Identification of associated risk factors for the severity of generalized anxiety disorder among Iranian infertile people: An ordinal regression analysis with a flexible link function.

Author information

Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.



Generalized anxiety disorder (GAD) is a common disorder in infertile people. The aim of this study was the identification of associated risk factors for the severity of GAD in infertile people using an ordinal model with a flexible link function.

Materials and Methods:

This cross-sectional study was conducted on 1146 individuals with a couple's infertility problem selected from an infertility center in Tehran, Iran. Data collected using self-administered questionnaires include demographic/clinical information and GAD-7. We used a Bayesian-ordered symmetric power logit (splogit) model to identify the risk factors for the severity of GAD. Furthermore, we implemented standard ordinal models to compare with the ordered splogit model.


Female gender (B coefficient 0.48, 95% credible interval [CrI]: 0.34-0.62), longer duration of infertility (B coefficient 0.03, 95% CrI: 0.01-0.04), previous treatment failure (B coefficient 0.17, 95% CrI: 0.03-0.30), and self-cause of infertility (B coefficient 0.12, 95% CrI: 0.01-0.23) were associated factors with the severity of GAD. The splogit model had a better fit and performance to determine the associated risk factor for the severity of GAD as compared to standard models. It provided more precise estimates of risk factors and one more significant risk factor.


Infertile people with female gender, longer duration of infertility, failure in previous treatments, and self-cause infertility are more likely to experience higher severity levels of GAD and require additional psychological, and support interventions. Furthermore, it can be argued that the ordinal splogit model is more powerful to identify the associated risk factors for the severity of GAD.


Anxiety; Bayesian analysis; generalized anxiety disorder-7; infertility; risk factors

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