Investigating happiness and its related factors in married women referred to health centers of shahroud city.

BACKGROUND: Happiness is one of the most important factors affecting women's mental health. Several factors contribute to happiness in different societies.
OBJECTIVES: The aim of this study was to investigate the level of happiness in married women and its related factors.
MATERIALS AND METHODS: This was a cross-sectional study with stratified sampling proportional to different age groups of married women in selected health centers (based on socioeconomic status). Subjects were 379 married women. The Oxford Happiness Inventory (scale: 0-87) was used to measure happiness. The Enrich Marital Satisfaction Inventory including 47 questions (scale: 47-235) and demographic information questionnaires were also used. Descriptive statistics, correlation, T-test, One-way ANOVA and Regression were used to analyze data.
RESULTS: The mean of happiness was 45.11 ± 14.40. Marital satisfaction was 164.68 ± 28.33 and 64% of the participants had a relative marital satisfaction. Univariate analysis of happiness showed significant effects of husband and wife education, husband job, economic status, stress in past six months, marital satisfaction and having social activates, but was not statistically significant for other factors (P < 0.05). Adjusting for the confounding effect of other variables, multiple linear regressions showed significant association of happiness with marital satisfaction, economic status and social activity.
CONCLUSIONS: Regarding lower level of happiness of married women in Shahroud comparing to some other studies in Iran and abroad, leisure time programs, training life skills especially stress management skills, increasing marital satisfaction and improving economic status should be considered.

1. Background

Happiness is the most basic human issue for all generations and the most central motive of human goals (1). Happiness causes positive attitudes toward life, positive self-concept, desirable attitudes and fulfillment upon oneself and others and results in mental health and emotional balance, hopefulness toward the future, desirable and satisfactory attitude toward self and others and balanced social relations. In addition, it avoids hatred, conscious selection of life’s goals, trying to fulfilling the goals, avoids wasting time and sloth, increases life achievements, having high life indicators, better performance of body immune system against stress, better sleep, higher tendency to help others, better occupational-educational performance, better decision making and some others (2). Based on Lu et al. happiness has three essential parts including positive emotion, life satisfaction and lack of negative emotions like anxiety and depression. They found that positive relations with others, life purposefulness, personality growth, loving others and life are among the components of happiness. Happiness is not the opposite of depression, but absence of depression is necessary to achieve happiness. If happiness is just the opposite of depression, it is not required to check and measure it because depression has been studied well (3). Studies have shown that unhappy and unsatisfied people have more depression and anxiety and do not like their outcomes more than happy and satisfied individuals; suicide and death rate is higher among them and have a shorter life. Furthermore, delinquency and addiction have been reported more in this group (4).

The results of Neto study using the Oxford inventory on 171 Portuguese subjects showed a positive predictive association between happiness and life satisfaction, confidence and sociability; however, there was a negative association between happiness and social anxiety, being shy, alone and flustered (5). Many factors affect happiness including family, work and social environment, income, education, intelligence, values, beliefs and faith, some personality features, mental and physical health, emotional relations, self-esteem, social supports, martial satisfaction, enjoying work environment, freedom in home, women’s rights in society, loving others and nature, philanthropic activities, life purposefulness, reduction of demands and comparisons, motivation and some others (1, 2, 6). Happiness in adults has a great association with marital status. Kobau et al. showed that married/living with partner individuals feel more happiness and life satisfaction than those who have never got married, widowed or divorced/separated (7). Much research throughout the world clarified the importance of happiness for mental health of women, but studies of happiness in Iran are very scarce. Understanding factors affecting women’s mental health is of great importance in every society, because their health and happiness have significant effects on family and society. Regarding the limitation of studies on women’s happiness and its related factors in Iran, investigating happiness level of married women and its related factors of Shahroud city seems necessary. It is hoped that the results of the present study would provide better insight into factors affecting happiness and mental health of married women, leading to promotion of happiness and vitality in the society.

2. Objectives

Regarding the importance of happiness in mental health and women’s vulnerability and assisting positivist psychology through gaining information about happiness, the present study was performed to investigate the level of happiness and its related factors in married women.

3. Materials and Methods

The present cross-sectional study was conducted on 379 married women of Shahroud city, Iran in 2013, from January to May. In the first stage, cluster sampling was performed for choosing health centers (Baghzendan, Mohammadi, Mahdiabad and Azima) based on their local socio-economic status. In the second stage, stratified sampling proportional to age groups of women referred to health centers was performed. According to the number of subjects in Morgan table, 361 and with calculating 5% attrition rate, 379 women considered for the sample size. Including criteria were live husband, living together with their husband, literate and lack of known psychiatric diseases. Excluding criterion was unwillingness to participate in the study. The research ethics committee of Shahroud University of Medical Sciences approved the study (with the code of 9140 in 26/11/2012). After explaining the purposes of study and getting informed consent from all the participants, the questionnaires were distributed among them. Participants were informed that that they could leave the study at any time. None of the participants left the study.

The instruments were Oxford standard inventory of happiness, Enrich marital satisfaction questionnaire and researcher made questionnaire including 24 questions to obtain demographic data and some other features of the participants. Oxford standard inventory includes 29 4-item questions scored from zero to three (total score 0-78 with no cut-off point). It is a reliable and valid questionnaire (8). The reliability and validity of the test were measured by Bahrami et al. showing a high total correlation score for all 29 items. Cronbach's alpha coefficient were calculated in the first (r = 0.94), second (r = 0.91) and third (r = 0.85) ones (9). Short form of Enrich marital satisfaction questionnaire (47 questions) has been used in different studies as a valid instrument to measure marital satisfaction. Psychometric properties of the questionnaire was cheeked by Fowers and Olson (10). This scale is related to the changes happening during human life and is sensitive to the changes occurring in family. Each topic of this questionnaire is related to one important area. Evaluation of these areas within a marital relation can describe couples’ potential problems and specify their areas of strength and support. Moreover, it can be used as a specialized tool for couples who seek supporting their marital relationships with consultations. The answers were based on five-point Likert scale (fully agree, agree, not agree nor disagree, disagree and fully disagree). Every item was given a score of 1-5. For questions 1, 2, 3, 5, 7, 9, 10, 17, 25, 26, 27, 28, 29, 34, 36, 44, “fully agree” got a score of 5, “agree” 4, “not agree nor disagree” 3, “disagree” 2 and “fully disagree” 1. For other questions, “fully agree” got 1, “agree” 2, “not agree nor disagree” 3, “disagree” 4 and “fully disagree” 5. Scores below 30 (the mean of 50 and standard deviation of 10) show severe dissatisfaction of marital life, 40-60 relative and moderate, 60-70 high satisfaction and more than 70 as very high satisfaction with marital life (in the scale with mean of 50 and compared with other means with ± 1 and 2 SD) (11). SPSS software version 16 was used to analyze data in the two stages. Normality of variables was checked by Kolmogorov-Smirnov test. Variables of marital satisfaction and happiness were calculated in different groups. T-test (comparing the means of two groups), One-way ANOVA (comparing mean in more than two groups) and Pearson correlation were performed for all factors in the first stage. In the second stage to control the confounding effect of other variables, multiple linear regression test was used. Variables with significance level lower than 0.02 in the first stage entered multiple linear regressions through stepwise method. Finally, variables with P < 0.05 were remained in the regression.

4. Results

Totally, 379 married women were studied. Table 1 showed demographic characteristics of the participants. The mean and standard deviation (Mean ± SD) of women’s age was 33.51 ± 8.40. In total, 76.5% were housewives, 73.4% were residing in the city and 62.8% had moderate or lower economic status. Mean ± SD of marital satisfaction was 164.68 ± 28.33 and 64% of the samples had a relative marital satisfaction. In univariate analysis, happiness level in different groups of spouse job and education, economic status, stress during past six months, marital satisfaction and social activities were significantly different. The effect of other factors was not significant (Table 1). With omitting confounding effect of other variables, multiple linear regressions showed marital satisfaction, economic status and participation in social activities as predictive factors of happiness (Table 2).

Table 1.

Happiness Score Based on Demographic Characteristics and Personal Factors Among Married Women Referred to Health Centers of Shahroud, 2013[a]

Categories	Results	Happiness	P Value
Women's job			0.94[b]
Housewife	290 (76.5)	45.25 ± 14.54
Household jobs	7 (1.80)	44.14 ± 12.24
Outdoor jobs	82 (21.6)	44.72 ± 14.21
Women's education			0.003[b]
Illiterate	8 (2.10)	28.00 ± 23.51
Reading and writing (primary)	41 (10.8)	46.54 ± 17.79
Secondary	48 (12.7)	44.96 ± 14.51
High school	26 (6.90)	39.62 ± 14.49
Diploma	119 (31.4)	45.09 ± 13.74
University	137 (36.1)	46.80 ± 12.39
Husband's job			0.005[b]
Employee	112 (29.6)	45.40 ± 13.70
Worker	82 (21.6)	40.29 ± 15.33
Teacher	12 (3.20)	51.75 ± 10.48
Private	154 (40.6)	48.43 ± 14.56
Retired	6 (1.60)	42.82 ± 18.29
Others	13 (3.40)	52.38 ± 10.38
Husband's education			< 0.001[b]
Reading and writing (Primary school)	45 (11.9)	37.51 ± 12.88
Secondary	62 (16.40)	47.08 ± 17.48
High school and diploma	144 (38.00)	44.09 ± 14.25
University	128 (33.80)	47.98 ± 12.35
Residency			0.15[b]
City	278 (73.40)	45.97 ± 12.62
Village	97 (25.60)	42.71 ± 16.24
Region	4 (1.10)	42.50 ± 12.96
Economic status			0.001[b]
Very bad	7 (1.80)	22.86 ± 12.99
Bad	18 (4.70)	37.44 ± 15.01
Mid	213 (56.20)	43.88 ± 12.76
Good	128 (33.80)	48.23 ± 12.57
Very good	13 (3.40)	57.23 ± 12.28
Serious stress during past six months			0.001[b]
No	278 (73.40)	48.69 ± 12.83
Death of relatives (closed or others)	54 (14.20)	42.72 ± 14.41
Serious sickness of closed family members	20 (5.30)	42.20 ± 12.33
Emotional breakdown	4 (4.20)	20.00 ± 19.44
Others	16 (1.10)	40.19 ± 17.76
Two simultaneous stress	7 (1.80)	23.86 ± 12.12
Social activity			0.01[c]
No	240 (63.30)	42.79 ± 15.23
Yes	139 (36.70)	47.40 ± 12.58
Close friend			0.1[b]
No	73 (19.30)	44.47 ± 17.23
< 4	199 (52.50)	44.45 ± 14.03
4-10	76 (20.10)	45.00 ± 12.60
≥ 11	31 (8.20)	51.19 ± 12.73
Marital satisfaction		164.68 ± 28.33	0.01[d]
Husband's age		38.24 ± 9.07	0.356[d]
Education difference with spouse		1.27 ± 0.25	0.004[d]

aData are presented as No. (%) or Mean ± SD.

bOne-Way ANOVA.

cPearson Correlation.

dT-test.

Table 2.

Stepwise Multiple Linear Regression Analysis of Predictive Independent Variables of Married Women’s Happiness[a]

Predictive Variables	Non-standardized Coefficient		Standardized Coefficient		Confidence Interval		Sig
	B Coefficient	Standard Error	Beta	t	Lower	Upper
Constant	-11.376	4.228		-2.691	-19.689	-3.063	< 0.001
Marital satisfaction	0.317	0.020	0.623	15.762	0.277	0.356	< 0.001
Economic status	2.548	0.811	0.124	3.143	0.954	4.143	0.002
Participation in social activities	2.532	1.135	0.085	2.231	0.301	4.764	0.026
Women's education	0.070			-1.776			0.076
Husband's job	0.042			1.110			0.268
Husband's education	0.034			-0.843			0.400
Difference of education with spouse	0.030			-0.770			0.442
Residency	0.048			1.216			0.225
Close friends	0.012			-0.308			0.758
Stress during past six months	0.054			-1.386			0.167
F = 106.604	Adjusted R Square = 0.456		R Square = 0.46, P < 0.001

aThe model explained and resulted 46% of women's happiness correctly.

5. Discussion

The mean and standard deviation of happiness was 45.11 ± 14.40 and more than 75% of the participants had a score of happiness higher than 56. One-way ANOVA test showed that women’s happiness had a significant association with women’s education level, spouse job and education, difference of education level with spouse, serious stress during past six months, social activities, economic status and marital satisfaction, but multiple linear regression showed a significant association between happiness and marital satisfaction, economic status and participation in social activities. The results of the study of Amiri and Zarimoqaddam showed that Mean ± SD of happiness of Irak city housewives and those employed as teachers were 44 ± 12.39 and 40.08 ± 13.36, respectively (12). Rohani and Abutalebi showed that Mean ± SD of happiness of Isfahan women employed in different jobs was 45.92 ± 7.88 (13). Findings of Bahrami et al. in students of Isfahan University showed that 65% of the participants had high and 35% had medium level of happiness (9). Nonetheless, the results of Sillick in Australia using Oxford questionnaire (7-point Likert scale, min and max 29-203) showed that Mean ± SD of happiness in women was 168.41 ± 28.44 (14). Based on Chalabi, the mean of happiness (0-100) was 48.60, which is lower than the mean of happiness and more than a half of the participants had happiness less than the mean regarding happiness in macro levels, among 69 countries, Iran had the rank of 61 (15). Based on the results of the present study and other studies in Iran, happiness status is not very desirable. Happiness tends to be expanded in the society and those living with happy people would be more cheerful in future (persons’ happiness depends in part on others) (16). One-way ANOVA showed a significant association between happiness and education level in married women; however, the association was not linear and the mean of happiness of illiterate women had a significant difference with other education level groups. Furthermore, the results of Vazquez et al. showed a positive association between life satisfactions (one of the components of happiness) and education level (17). Nevertheless, the results of Amiri Majd et al. found no significant association between happiness and education; the difference between the above studies could be due to lack of scatteredness of the sample size (12). Because mental welfare and happiness is provided by increased level of health (18) and health of the society is dependent on welfare, educating and empowering women is of great importance (19). Women’s education can have an important role in changing attitude, life style and finally happiness. In the present research, education and job of the husband were among the related factors with happiness, so that women with husbands of higher education had higher levels of happiness. To great prospects, higher education of husbands, especially teachers or professors at university, could help changing attitude, healthy life style because of higher information and finally leading to family happiness. Stress is a factor affecting happiness and there was a significant association between happiness and mental and physical stress. The results of Natvig et al. and Sharifi et al. showed similar results (6, 20). The study of Natvig et al. on 887 Norwegian students showed that increased life stressful experience decreases happiness (6). Probably, physiologic and hormone changes following stress, decrease happiness. The present study showed a significant association between happiness and economic status, so that the more income, the more happiness, which is in line with some other studies (21). Furthermore, some researches revealed that low household income had strong adverse effects on happiness (22). Other studies showed a negative association between happiness and bad economic status, but this was not observed in individuals of good economic status (23). Even if economic status has a little effect on personal mental welfare, but outcomes of good economic status like increase of social supports, more variety of leisure time activities, possibility of reaching health and different educational, social and familial success and increase of the possibility of helping others and participating in philanthropic activities can increase happiness. Moreover, the results of multivariable analysis showed that happiness level of individuals lacking social activities was significantly lower than those with social activities. The time for social activities is a determining factor in suicide rate (24) and social interaction showed positive emotions. Due to biological, psychological and social reasons, social networks result in more happiness through interpersonal relations (16, 25). On the other hand, positive affect is directly correlated with social involvement. High average levels of social activity and low levels of negative affect were associated with high positive affect (26). Furthermore, the number of social activities individuals involved in is strongly related with mental health and welfare outcomes (27). Multivariable analysis showed a positive and significant association between happiness and marital satisfaction. A direct linear association was shown between these two variables, R = 0.66. Many studies (12, 13, 28-32) are in line with the present study, so that marital satisfaction is a predictive factor of happiness and with enhancement of marital satisfaction, happiness increases. On the other hand, with increasing happiness in life, people’s mood improves and their view toward life becomes more positive. In elevated mood, there are more positive and rational behaviors leading to more positive behaviors of others, which can cause marital satisfaction. Generally, lower marital satisfaction is associated with lower mental welfare. The weak point of this study was less participation of some age groups of women because of the place of study. The strength point was full cooperation of participants. Regarding the large number of effective and related factors with happiness, identifying positive and negative factors is important for policy makers to improve the status of happiness in the society. It is strongly recommended to study quality of socioeconomic factors for promoting happiness in women, because women’s happiness can definitely lead to happiness and functioning promotion of family as the most important unit of the society.