Zohreh Karimian Kakolaki1  , Seyed Saeed MazloomyMahmoodabad2 , Sakineh Gerayllo3 , Fatemeh Heidari4* , Bahareh Motaghi Dastenaei5 , Firoozeh Sharifi6
 

 

How to cite this paper:
KarimianKakolaki Z, MazloomyMahmoodabad SS, Gerayllo S, Heidari F, Motaghi Dastenaei B, Sharifi F. Path Analysis to Determine the Relationship between Marital Dissatisfaction, Premenstrual Syndrome and Emotional Dimension of Quality of Life in Women. J Community Health Research. 2018; 7(3): 140-146.

Introduction

Marital satisfaction is the most important factor affecting the success of the couple's life (1). Marital satisfaction is a situation in which a husband and wife have a positive evaluation of their marital relationships (2). Marital satisfaction is assessed using various concepts such as roles, interpersonal relationships, motivations, privacy compliances and prosperities (3). Morowati Sharifabad et al. in their study demonstrated that women’s dissatisfaction in Iranian women was 56.7% (4).
The quality of life is described as a person's mental feelings of life, and is referred to the understanding of one's condition in a culture and a system of values (5).
Factors such as health conditions, quality of marriage, and family life affect quality of life (6). Quality of Life (QOL) is a multidimensional concept and includes all aspects of individuals’ lives. The World Health Organization (1993) defined QOL as “the individuals’ perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. QOL is by definition a subjective concept that can be affected by various factors, such as a person’s physical, psychological, and social conditions, and health-related QOL is an important part of general QOL (6).
Emotional dimension of quality of life can be influenced by various issues. Symptoms of premenstrual syndrome affect the emotional dimension of quality of life (5). Premenstrual syndrome is a physical, psychological, and emotional symptom that occurs in women's premenstrual period (7). Premenstrual syndrome causes interruption of daily relationships and activities, if the symptoms intensify, the person's life and comfort will be affected. This behavior change has an important impact on family performance (8). Studies such as Sahin et al. and Maleki et al. showed that quality of life, especially in emotional and psychological aspects, has a weaker score in women with premenstrual syndrome (5, 9). Women's health is one of the developmental indicators of the United Nations, because women are more vulnerable than men (10). The assessment of health-related quality of life can provide a comprehensive picture of population health that is used to monitor public health, identify health needs and priorities, evaluate the effectiveness of interventions, and compare interventions with each other (11). Morowati et al. and Hoga et al. studies have shown the association between premenstrual syndrome and marital dissatisfaction (4, 7, 12, 13). In studies by Sahin et al , Maleki et al, Delara et al. and Dean et al. refers to the relationship between premenstrual syndrome and quality of life, especially emotional dimension (5, 9, 14, 15). In most studies, common statistical techniques have been used to determine the relationship and correlation of structures. However, today the use of path analysis is a more accurate statistical technique, which is used to determine a causal pattern among variables, especially when an optimal model for the design of interventions is needed (16).
To the best of our knowledge, there is no study that can show the relationship between marital dissatisfaction and premenstrual syndrome and
the emotional dimension of quality of life schematically. Understanding the relevance and impact of these three indicators on each other and the planned interventions for women and their families can help to improve each of these indicators. Therefore, this study was conducted by Path Analysis to determine the relationship between marital dissatisfaction, premenstrual syndrome, and emotional quality of life in women in Yazd.
Methods
This cross-sectional study was conducted on 246 women who referred to the health centers in the suburbs of Yazd. Sampling was conducted in August 2016 to March 2017. According to the same study (17), the level of confidence was 0.95, the prevalence of PMS  p = %80, and d = 0.5 sample was estimated. Tools to collect data in this study were Quality Of Life questionnaire SF36, PMS (Premenstrual Syndrome Screening Tool) screening questionnaires and the demographic data.
Measures
" Short Form Health Survey (SF-36)"
The Short Form Health Survey (SF-36) is a generic health-related QOL instrument that was constructed to survey health status in clinical practice and research, health policy evaluations, and the general population (18). The SF-36 is a multi-item scale that assesses eight domains: a) physical functioning, b) role limitation due to physical problems, c) bodily pain, d) general health, e) vitality (energy and fatigue), f) social functioning, g) role limitation due to emotional problems, and h) mental health. The scores range from 0 to 100 and a higher score indicates better health related quality of life. The SF-36 was translated and validated in Persian by Montazeri and colleagues (19). In assessing the internal consistency (to test reliability) the Cronbach’s α coefficient for all eight Quality of Life and Marital Satisfaction in Medical Staff in Iran SF-36 scales ranged from 0.77 to 0.90 with the exception of the vitality scale (a0.65) (6). In this study, only the emotional dimension of the quality of life of this questionnaire has been used.
" Index of Marital Satisfaction "
Index of Marital Satisfaction (IMS) designed by Walter W. Hudson (20). It is used to assess the level of marital satisfaction. The questionnaire consisted of 13 positively worded questions and 12 negatively worded questions. There were 5-point score scales to answer each of these questions. The positively worded items were scored in the reverse such that 1 was rescored as 5, 2 as 4, 3 remained as 3, 4 as 2 and 5 as 1. The positively worded items were 1, 3, 5, 8, 9, 11, 13, 16, 17, 19, 20, 21, and 23. The questionnaire adopts a Likert scoring scale which ranges from rarely or none of the time (1) A little or none of the time (2) Sometimes (3) A good part of the time (4) and Most of the time (5). After this, all the scores were summed up. The index of marital satisfaction was derived from subtracting 25 from the total score. A score below 30 was indicative of marital satisfaction and a score above 30 was indicative of dissatisfaction (2).
Reliability coefficient of the IMS was 0.96 and its concurrent validity has been established. The split-half reliability is reported to be 0.98.
In addition, it has good construct validity
for marital satisfaction index as well as demonstrating convergent and discriminant validations.
" Premenstrual Syndrome Screening Tool "
The PSST, used for screening of the women with PMS, is a 19-item questionnaire in two sections. The first section consists of 14 questions about mood, physical and behavioral symptoms. The second section contains five questions for evaluation of the PMS symptoms' effects on people’s lives. The PSST is constructed by Canada’s McMaster University and Siahbazi et al. (21) It standardized for Iranian population and in the reliability test, Cronbach's alpha was 0.9
and the Content Validity Ratio and Content Validity Index were 0.7 and 0.8, respectively. For diagnosis of moderate or severe PMS, three conditions must be met: (i) for items 1 to 4, at least one should be moderate or severe, (ii) for items 1 to 14, at least four should be moderate or severe and (iii) for the last five items, at least 1 should be moderate. For identification of PMDD, three conditions must be present: (i) for items 1 to 4, at least one should be severe, (ii) for items 1 to 14, at least four should be moderate or severe and (iii) for the last five items, at least 1 should be severe.
" Statistical analysis "
Collected data was coded by SPSS18.  For organization of the data descriptive statistics were used then it analyzed with Pearson correlation and Path analyzes Test. The level of significance was set, a priori, at 0.05. In this paper, the results of regression-based path analysis are used to determine the pattern of the relationship marital dissatisfaction, premenstrual syndrome and the quality of life's affective dimension.
" Ethical approval "
The study approved by the Institutional Review Board at Shahid Sadoughi University of Medical Sciences (code: IR.SSU.SPH.REC.1395.79). The importance, purposes, and methods of this study were explained to the participants. They were told about the volunteering of the study and and the possibility of refusion or withdrawn from the study without being penalized or losing any benefits. The participants were reassured of confidentiality and signed the informed consent form.
Results
The path analysis methods based on regression analysis in this study were as follows:

The results of the regression analysis of steps 2 and 3 are presented in Table (2).

 
Table 1. Correlation coefficient of variables of marital dissatisfaction, premenstrual
syndrome and emotional dimension of quality of life

*P value< 0.001
 
Table 2. Regression analysis of variables of marital dissatisfaction, premenstrual syndrome and
emotional dimension of quality of life

 

Table 3. Direct and indirect effects and the total effect of marital dissatisfaction and premenstrual
syndrome on the emotional dimension of quality of life in path analysis

 

 
 
 
 
 
 
 
 
 
 
 
 

Fig 1. The developed model fitted to the population studied by the regression-based path analysis