1. Background
Family is known as one of the oldest and most flexible social institutions in human history. Nearly all individuals generally grow up in a family, and most eventually form their own (1). The family resulting from the marriage bond between a man and a woman has many manifestations in human social life, including constructive interactions between people and the existence of love that fosters sincerity and empathy (2). Upon choosing the right life partner and entering into a marriage contract, a family is then founded, providing a sense of security, belonging, and self-respect. It also enables individuals to achieve personal and social growth and development by satisfying their physical, sexual, and emotional needs (3).
Notably, marital adjustment and satisfaction are of utmost importance in marriage, as the latter depends on the extent to which couples’ needs and desires are met by each other. At the onset of marriage, almost all report high marital happiness (MH), but in many marriages, some signs of distress typically appear over the first few years of life (4). Women show their intimacy in the form of love, affection, and warm feelings, but men consider intimacy more with respect to participating in many activities, having physical contact, spending time with each other, and showing sexual behaviors. In this line, body image (BI) is one of the major factors associated with sexual performance, sexual satisfaction, and MH.
The mental image is accordingly an abstract word that includes information, feelings, and even conscious and unconscious perceptions about one’s body. This concept consists of individual feelings about the size, sex, function, and ability of the body (5). The mental image of the body thus consists of two dimensions, viz., perceptual dimension (namely, a person’s evaluation of one’s body size) and cognitive-emotional dimension (that is, a person’s attitude toward the body shape). As soon as a person considers oneself to be lower than the desired or ideal standards, they may have unsuitable feelings and attitudes toward oneself, such as low self-esteem or self-confidence, or depression, and even in some cases face academic failure. From this perspective, one of the significant psychological concepts making men and women worried is the mental image of the body (6).
While the cultural context of society puts much emphasis on the value of external attractiveness, especially for women, there are gradually increasing concerns about BI. More than a few factors, such as sociocultural values, social comparison, the importance of outward attractiveness in society, and negative experiences regarding interactions with others, also fuel such concerns. Nowadays, people of different classes devote much attention to one’s body and its external appearance, so all (particularly women) seek to change their body, face, and appearance in accordance with the beauty models promoted and accepted within society (7). Besides, women seem to be much more sensitive to one’s body and mental image than men (8).
As well, women residing in rural areas may show a more positive BI than their urban counterparts thanks to the nature of rural life. For example, different BI experiences in rural women may mean that they are under less pressure to change their body or appearance, and indeed, appearance may be a more salient component of their self-concepts compared with those in urban women. Furthermore, mate selection decisions may have less to do with appearance in rural areas, where women merely live under considerable patriarchal control (9).
Women’s dissatisfaction with their BI can thus be the result of a gap between one’s mental image, achieved in the process of socialization, and the characteristics of the ideal woman pictured in society, which seems to be different based on the culture and society in each historical period. Sometimes, such conditions push women toward mental and emotional conflicts, anxiety, low self-confidence, and depression (10). Women with a negative BI are accordingly subjected to a lower level of sexual satisfaction and MH (11). In this vein, Meltzer and McNulty found that a desirable BI could expand MH and sexual satisfaction in couples. Upon controlling the components of body mass index (BMI), general self-esteem, and neuroticism, they had further reported that women’s perceptions of their sexual attractiveness had positively helped boost MH in couples (12).
Of note, MH can reflect people’s level of happiness associated with marital relationships or a combination of being pleased due to many factors specific to such relationships. It is a multifaceted and multidimensional concept, concentrating on psychological, socioeconomic, and spiritual aspects (13). Marital happiness is also one of the effective factors in resolving marital conflicts; it has been identified as the most common strength of happy couples during conflict resolution. The main difference between happy and unhappy couples is that spouses understand each other well when problems arise (14).
Many other factors can further affect BI, such as age at marriage, age difference at marriage, duration of marriage, level of education, occupation, sufficient income, roles, type of marriage (inter- and intra-family ones), number of children, personality traits, mental health status, feelings, relationships, intimacy, marital commitment, religion and spirituality, and sexual needs (15).
Another factor that affects BI is marital offence-specific forgiveness (MOF), a multidimensional motivational construct defined as the act of resentment in a marital relationship. Oftentimes, forgiving resentments is the only way to heal this injury, and forgiveness is the vital tactic to reconnect and strengthen positive feelings, thus improving marital relationships and leading to a more peaceful and productive life (16). Forgiveness means letting go of negative thoughts, feelings, and behaviors in response to incorrect ones, and replacing them with positive behaviors and reactions in dealing with aggression caused by injury (17, 18).
2. Objectives
Considering the role that marital relationships can have in mental health, identifying the factors influencing BI can be an important effort in the domain of marital life. As BI and its associated concerns are observed more in women, the aim of the present study was to address whether there is a relationship between BI, MOF, and MH in married women aged 20 - 35, living in urban and rural areas and referring to the comprehensive community health centers in the city of Jahrom, Fars province, Iran.
3. Methods
This descriptive, cross-sectional study was conducted in the city of Jahrom, Fars province, Iran, with the statistical population comprising married women aged 20 - 35 residing in urban and rural areas and referring to the comprehensive community health centers in this region. Stratified-cluster sampling was utilized for the selection process. The statistical population was divided into two groups: Urban and rural women, and a specific number of samples were chosen from each group based on the percentage of their population. The sample size for this study was determined based on the research by Azarkish et al. (19) with a standard deviation of 26.19 and a confidence level of 90% for a survey study. With knowledge of the statistical population size, 606 people were selected using formulas outlined by Meeker et al. (20). To select the study samples in each group, cluster sampling was employed. Four centers out of seven were chosen as the urban cluster, and seven out of 15 centers were designated as rural ones. Subsequently, samples were selected via simple random sampling from those visiting the comprehensive community health centers and other affiliated bases. The questionnaire was administered to women at health centers and covered bases under the supervision of healthcare workers (21, 22). Consent was obtained from all participants who met the inclusion criteria, including being married, aged between 20 - 35 years, absence of sexually transmitted infections, absence of mental health problems (according to information in the Integrated Health System: Sib), good general health status (self-reported), absence of specific diseases such as multiple sclerosis (MS) or cancers, no chronic diseases such as diabetes mellitus, hypertension (HTN), and hypothyroidism, no addiction history, no history of cosmetic surgery, married for at least five years, literacy level equivalent to middle school graduation at a minimum, no plans for divorce, and willingness to cooperate in the study. Incomplete questionnaires returned by participants or their immigration constituted the exclusion criteria.
3.1. Tools
The Multidimensional Body-Self Relations Questionnaire (MBSRQ) was administered to evaluate participants’ attitudes toward different dimensions of BI. This questionnaire comprised three subscales: Appearance evaluation (AE) (AE, 54 items), scored as follows: (1) For “definitely disagree”; (2) for “somewhat disagree”; (3) for “no opinion”; (4) for “somewhat agree”; and (5) for “definitely agree”, body area satisfaction (BAS, 9 items) scored as follows: (1) For “completely dissatisfied”; (2) for “somewhat dissatisfied”; (3) for “no opinion”; (4) for “somewhat satisfied”; and (5) for “completely satisfied” and self-classified weight (SCW, 6 items). The validity of the main parts of this questionnaire had already been examined and confirmed Menzel JE et al. (22), and its reliability had also been established by Zar-Shenas et al. in Iran (23). The internal consistency was 0.81.
The Marital Offence-Specific Forgiveness Scale (MOFS) was further applied to assess MOF. This questionnaire contained 10 statements and two subscales of benevolence (Items 2, 5, 9, 10) and resentment-avoidance (Items 4, 6, 7, 8, 1, 3). Respondents needed to indicate their agreement or disagreement with each statement based on a six-point Likert-type Scale (from 1 = strongly disagree to 6 = strongly agree). The validity of this tool had been confirmed by Erkan (24), and its reliability had also been established in Iran by Sanai et al. (25). The internal consistency was 0.79.
The Marital Happiness Scale (MHS) was additionally utilized to measure the level of MH in this study. This instrument comprised 10 statements, addressing responsibility toward family, upbringing and education of children, social activities, financial matters, verbal and non-verbal communication, sexual relationships, career progress, self-independence, spouse’s independence, and overall happiness. Scores ranged from 1 for “completely dissatisfied” to 10 for “completely satisfied”. The score range of this questionnaire was between 10 and 100, with scores of 77 and above indicating very high MH, scores of 48 - 76 representing high MH, and scores of 19 - 47 and 18 and below indicating low and very low levels of MH, respectively. The researcher also provided necessary explanations to the participants and asked them to express their feelings exactly on that day and choose the most correct answer. The validity of this tool had been confirmed by Flett et al. (26). Additionally, the validity of the questionnaire had been further established by Isanezhad et al. (as cited by Khojastehmehr et al.) in Iran (27). The internal consistency of MHS was then established by calculating Cronbach’s α coefficient for each extracted subscale, which was 0.98, indicating very high reliability for the questionnaire.
All samples were included in the study after obtaining consent form. To analyze the data of quantitative variables, the Kolmogorov-Smirnov test was first performed to assess normality. Since the data were found to be normal, analysis of variance tests, Pearson correlation, and multivariate regression were employed to investigate differences in quantitative variables at various levels of demographic variables and to explore the mutual relationships between quantitative variables. All tests were analyzed and interpreted at a significance level of 0.05.
Upon collecting the data, they were analyzed using the IBM SPSS Statistics 25 software package, employing frequency, percentage, mean, and standard deviation (mean ± SD), chi-square test, independent-samples t-test, as well as univariate and multivariate regression analysis.
4. Results
The difference in demographic variables between urban and rural women was evaluated using the chi-square test or Fisher’s exact test. The mean age of the study participants was 28.82 ± 4.40, and 31.1% of the cases had a high school diploma. Additionally, 83.4% of the participants were homemakers. The mean age at marriage was 21.11 ± 3.88, and 44.1% of the women had experienced inter-family marriage. The couples had been living together for almost 7.68 ± 4.60 years since their marriage. The age difference between spouses at marriage was 5.42 ± 3.32 years. Moreover, 55.3% of the spouses were self-employed. Notably, the mean sleep duration was 8.37 ± 1.44 hours per 24 hours. Based on the study findings, a statistically significant difference was observed between urban and rural women in terms of education, occupation, age at marriage, marriage meeting mode, duration of marriage, number and gender of children, husband’s occupation and education, monthly income, and sleep duration (P < 0.001) (Table 1).
| Variables | Urban Women | Rural Women | P-Value |
|---|---|---|---|
| Education | < 0.001 | ||
| Elementary school | 19 (5.39) | 60 (23.43) | |
| High school | 31 (8.80) | 66 (25.78) | |
| High school diploma | 161 (45.73) | 104 (40.62) | |
| Bachelor’s degree and higher | 141 (40.05) | 26 (10.15) | |
| Occupation | < 0.001 | ||
| Housewife | 253 (77.5) | 234 (91.40) | |
| Employee | 52 (14.77) | 20 (7.81) | |
| Free job | 27 (1.33) | 6 (2.34) | |
| Age at marriage (y) | < 0.001 | ||
| 12 - 22 | 202 (57.38) | 204 (79.68) | |
| 23 - 34 | 152 (43.18) | 52(20.31) | |
| Marriage meeting mode | < 0.001 | ||
| Family | 130 (36.93) | 138(53.90) | |
| Locality | 98 (27.84) | 53 (20.70) | |
| Introduction by friends | 88 (25) | 53 (20.70) | |
| Other | 36 (10.22) | 12 (4.68) | |
| Marriage duration (y) | < 0.001 | ||
| 1 - 10 | 289 (82.10) | 158 (61.71) | |
| 11 - 20 | 63 (17.89) | 98 (38.28) | |
| Number of children | < 0.001 | ||
| 0 | 42 (11.93) | 40 (15.62) | |
| 1 - 2 | 296 (84.09) | 171 (66.79) | |
| 3 - 4 | 14 (3.97) | 45 (17.57) | |
| Husband’s occupation | < 0.001 | ||
| Employee | 107 (30.39) | 12 (6.68) | |
| Self - employed | 196 (55.68) | 140 (54.68) | |
| Other | 49 (13.92) | 104 (4.62) | |
| Husband’s education | < 0.001 | ||
| Elementary school | 27 (7.67) | 57 (22.26) | |
| High school | 53 (15.05) | 90 (35.15) | |
| High school diploma | 163 (46.30) | 94 (36.71) | |
| Bachelor’s degree and higher | 109 (30.96) | 15 (5.85) | |
| Monthly income (IRR) | < 0.001 | ||
| < 1 million | 33 (9.37) | 124 (48.43) | |
| 1 - 3 million | 220 (62.5) | 117 (45.7.) | |
| 3 - 4 million | 72 (20.45) | 9 (3.51) | |
| 5 million < | 27 (7.67) | 6 (2.34) | |
| Sleep duration per 24 hours | < 0.002 | ||
| 4 - 7 | 95 (26.98) | 63 (24.60) | |
| 8 - 14 | 257 (73.01) | 193 (75.39) |
Comparison of Demographic Variables in Urban and Rural Married Women a
According to the independent-samples t-test results for comparing the mean scores of BI, MOF, and MH in urban and rural women, a statistically significant difference was observed in terms of MH (P < 0.001), while there was no significant difference in BI (P = 0.122) and MOF (P = 0.657) (Table 2).
| Variables and Groups | Mean ± SD | P-Value |
|---|---|---|
| BI | 0.122 | |
| Urban women | 164.73 ± 16.60 | |
| Rural women | 162.33 ± 21.61 | |
| MH | ≤ 0.001 | |
| Urban women | 81.88 ± 10.79 | |
| Rural women | 77.94 ± 15.27 | |
| MOF | 0.657 | |
| Urban women | 37.32 ± 6.08 | |
| Rural women | 37.57 ± 7.81 |
Comparison of Mean Scores of Body Image, Marital Happiness , and Marital Offense-Specific Forgiveness in Urban and Rural Married Women
Regarding the independent-samples t-test outcomes for comparing the mean scores of the AE subscale in both groups of urban and rural women, a statistically significant difference was observed (P < 0.001), whereas there was no statistically significant difference in the subscales of BAS (P = 0.26) and SCW (P = 0.131) (Table 3).
| MBSRQ Subscales and Groups | Mean ± SD | P-Value |
|---|---|---|
| AE | ≤ 0.001 | |
| Urban women | 135.14 ± 14.31 | |
| Rural women | 131.51 ± 19.38 | |
| BAS | 0.26 | |
| Urban women | 13.84 ± 4.16 | |
| Rural women | 15.13 ± 5.01 | |
| SCW | 0.131 | |
| Urban women | 15.75 ± 2.57 | |
| Rural women | 15.68 ± 2.74 |
Comparison of Multidimensional Body-Self Relations Questionnaire Mean Scores in Urban and Rural Married Women
As illustrated in Table 4, MH (β = 0.142, P < 0.001) could affect BI. To explain it and identify the factors impacting BI, the univariate linear regression analysis was used for MOF, MH, education, and age. The main objective was to import the variables whose value was below 0.2 into the multivariate regression analysis. As MH was found to be the only significant variable (P < 0.001), multivariate regression was not needed.
| Variables | β | SE | Sig. | CI | |
|---|---|---|---|---|---|
| Upper Bound | Lower Bound | ||||
| MOF | - 0.17 | 6.47 | 0.68 | - 0.26 | 0.17 |
| MH | 0.142 | 0.59 | 0.001 | - 0.320 | 0.09 |
| Education | 0.24 | 1.23 | 0.55 | 0.93 - | 0.49 |
| Age | - 0.19 | 2.22 | 0.64 | 0.42 - | 0.26 |
Univariate Linear Regression Analysis to Identify BI Based on Demographic Variables and MH
5. Discussion
The mental image of the body is a significant dimension of self-appearance and self-evaluation, shaping an individual's personality. It influences physical, emotional, and attitudinal perceptions, as well as various aspects of psychological, social, sexual, family, and marital satisfaction. To foster a healthy and fulfilling marital life and to adjust with oneself and others, having a realistic mental image is essential (12). Therefore, the present study aimed to investigate the relationship between BI, MOF, and MH.
The study findings revealed a statistically significant difference between women in both groups concerning education, occupation, age at marriage, mode of marriage meeting, duration of marriage, number and gender of children, husband’s occupation and education, monthly income, and sleep duration per 24 hours. These findings align with those of Haghi et al., Sarma et al., and Li et al. (9, 28, 29). Additionally, the BI mean scores did not exhibit a statistically significant difference between urban and rural women, consistent with findings from Swami et al., Prioreschi et al., and Tiwari (30-32). This suggests that body dissatisfaction has become prevalent across different socioeconomic contexts (33). Moreover, individuals with high levels of happiness may experience a sense of being noticed and attractive to others, leading to a positive self-view (11). The study results further indicated a statistically significant difference in the MH mean scores between urban and rural women, with urban women demonstrating higher levels of MH compared to their rural counterparts. This finding is consistent with reports by Nam and Ahn (33). Urban married women may experience lower levels of cultural stress and receive higher levels of support from their husbands, contributing to greater marital satisfaction. However, the findings of Zare Shahabadi and Montazeri's study were inconclusive, possibly due to the small sample size (34).
Many factors can affect MH in couples, including emotions, violence, communication patterns, sexual relationships, self-concept, self-confidence, awareness of marriage, personality traits, beliefs, family expectations, marital conflicts, and attitudes towards self and marriage (35). Internal and psychological, interpersonal, and sociocultural factors are also considered main mediators in MH (36). Researchers have noted that cultural norms and expectations often lead girls and women to be highly concerned about their BI, investing psychologically in their physical aesthetics, which may undermine their well-being and contribute to mental health problems (37).
The regression analysis in the present study revealed a significant positive relationship between BI and MH. Women's BI appeared to have a more significant influence than men's on romantic relationships. When women perceived that their partners were satisfied with their body weight and shape, they tended to develop a more positive BI (38). Swami et al. similarly concluded that women with a positive perception of BI reported higher levels of MH and mental well-being (30).
Additionally, Chen established a significant positive relationship between BI satisfaction and happiness (39). Therefore, high levels of happiness, by mediating emotional experiences in communication and social environments, could alleviate BI concerns. The relationship between BI and MH is reciprocal; individuals with higher MH tend to have a more positive BI, contributing to greater MH (40).
In this context, a satisfying relationship can serve as psychological support against societal pressure to achieve an ideal BI. Marriage can act as either a risk factor or a protective factor for physical and mental health in this regard. The perceptions, evaluations, and opinions of life partners about a person’s weight and BI significantly impact happiness and unhappiness in marriage (39).
The results of the present study revealed that the MOF mean scores did not exhibit a statistically significant difference between urban and rural women, which aligned with the findings of Paleari et al. (41). Forgiveness, entailing a decrease in negative feelings or an increase in positive ones, contributes to higher-quality marital relationships. When individuals can forgive, it adjusts the relationship between offense and the quality of the marital relationship. Those who forgive their spouses believe in sanctifying their marital relationships, leading to stronger bonds and increased satisfaction (42). Additionally, forgiveness serves as a motivational tool facilitating interpersonal behaviors like reconciliation, preventing anger and retaliatory behavior, and maintaining stable, long-term relationships (43). Thus, having a satisfying relationship can counterbalance cultural pressures to attain an ideal BI, with marriage acting as either a risk or protective factor for individuals' physical and mental health in this regard.
Among the strengths of the study was the development of practical strategies for planning and policymaking to prevent social issues such as divorce and comparing the BI of urban and rural women. However, weaknesses included the inability to generalize results to men and other age groups, and the lack of clinical trials focusing on the study's outcomes. Future research should aim to evaluate these results across various age groups and genders simultaneously, considering different ethnicities and races, and assessing the clinical effectiveness of the study. Moreover, expanding research in this area using self-report questionnaires and qualitative interviews over longer intervention periods is recommended. Overall, adopting a positive psychology approach emphasizing skill-building in healthcare programs can empower women to prevent and manage marital challenges.
A limitation of the study was the low number of visits to comprehensive community health centers by women aged over 35, potentially influencing variations in BI, MOF, and MH across different age groups. As the study was conducted in Jahrom, Fars province, Iran, its results may not be fully generalizable to women from other ethnicities and countries with differing socioeconomic conditions.
5.1. Conclusions
The study results reveal that MH and MOF could lead to a positive BI in married women. In comparison with rural women, urban married women might thus experience lower levels of cultural stress, higher levels of support from their husbands, and greater marital satisfaction. Therefore, promoting education on MH among women could contribute to fostering a positive mental image of their bodies. The findings of the present study can serve as a valuable empirical foundation for the development of educational and health programs for couples, as well as intervention and treatment initiatives aimed at enhancing and stabilizing couples' relationships.
