2013. Vol.4, No.11, 845-849
Published Online November 2013 in SciRes (
Open Access 845
Marital Satisfaction and Mental Health in Multiple Sclerosis
Patients’ and Healthy Individuals’ Accordance to Sex
Bita Ajilchi1, Arezoo Shomali Oskoei2, Flor Rezaeai Kargar3
1Department of Psychology , Faculty of Human Science,
Science and Research Branch University, Islamic Azad University (IAU), Tehran, Iran
2Department of Psychology , Faculty of Human Science,
Islamic Azad University of Rudehen (RIAU), Tehran, Iran
3Department of Psychology and Social Science, Central Tehran Branch,
Islamic Azad University (IAU), Tehran, Iran
Email: *
Received August 26th, 2013; r evised September 27th, 2013; accepted October 29th, 2013
Copyright © 2013 Bita Ajilchi et al. This is an open access article distributed under the Creative Commons At-
tribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
The aim of this study was to compare marital satisfaction and mental health in male and female multiple
sclerosis patients with healthy males and females. In a correlation study, 59 MS patients in Tehran (31 fe-
male and 28 male, with a range of 25 to 55 years old) were selected by the random cluster sampling me-
thod and 59 healthy individuals were matched with them in sex and age. Then both groups filled in the
marital satisfaction questionnaire of Enrich and GHQ. The test of multi-variance analysis showed that,
regardless of the gender, for people with MS disease, the marital satisfaction and the whole of its sub-
scales except the religion and the mental health and its all sub-scales, are established at a significantly low
level. However, the comparison of these groups due to the gender showed that in the satisfaction elements
and personality issues, the relationship between marital and leisure time of women patients is worse than
men; however, healthy women scores in financial management are lower than healthy men. In addition, in
the elements of mental health, women and men patients are similar to each other but healthy women have
higher physical symptoms than healthy men (P < .05). These results represent the necessity of applying
approaches to increase the satisfaction of the marital and mental health of patients and training the cou-
ples for cooperation and higher perception.
Keywords: Multiple Sclerosis; Marital Satisfaction; Mental Health
The disease of Multiple Sclerosis (MS) is a chronic progres-
sive and disabling disease of the central neural system that is seen
frequently among young people. Symptoms commonly include
sensory disorder, infirmity, spasm, vision disorder, and cogni-
tive disorder, trembling of limbs, disorder in urination, sexual
functional disorder, and amnesia, auditory failure, blurring of
vision and squinting in patients (Delisa, 1998; Levis, 2000;
Nortvedt et al., 2007; Smeltzer & Bar, 2008). Observations
show that this disease is two or three times more common in
women than men; it does not have a definite treatment and the
aim of the treatment is to prevent the progressive disability
from the chronic attacks, relapses and recurrence of the disease
and or chronic progression of the disease (Compston Lassman,
Ebers et al., 1998; Brown, 2005; Harrison, 2008). The nature
and intensity of the symptoms of this disease appear in different
fields of cognition, sensory factors and movement of the limbs.
It also has a profound impact on the social and mental cognitive
functions in the related patient (McReynolds, Koch, & Rum-
rill, 1999). About 30% of these patients require home support
being provided by couples in this case. (Buchanan, Radin,
Chakravorty, & Tyry, 2009). The greatest potential impacts of
this disease can be the adaptive challenges with this disorder,
having problems with marital relations and sexual function and
family separation (Glantz, Chamberiain, Liu et al., 2009; Den-
nison Moss-Morris & Chalder, 2009), reduction of marital satis-
faction, decrease of satisfaction in physical intimacy and the re-
duction of relational levels (Perrone, Gor don, & Tschopp, 2006).
Indeed, the disease of MS affects intimacy and sexual relations
in various ways. These impacts can appear as the reduction or a
tendency to reluctance towards the sexual relations or difficulty
in having friendly relations with his or her partner. These im-
pacts are also from the direct changes of the related disease and
or due to the struggles against the disease as well as adaptation
with these impacts on the patient’s life (Fully & Varner, 2011;
cited in Caleb, 2011). This kind of pressure of keeping a partner
with chronic disease not only reduces the quality of marital re-
lations but also damages any sexual relations between couples
as well (O’Conner, McCabe, & Firth, 2008). Along with this,
Woollett and Edelmann (1988), in their research found that the
marital satisfaction among couples with MS is lower than the
same people without this disease. Also, McPheters and Sand-
berg (2010) in their studies found that the quality of couple re-
lations has a positive relationship with physical functions of
*Corresponding author.
people with MS and that depression with physical function has
a negative relationship with these patients. The quality of mari-
tal relations with a partner’s depression has a negative relation-
ship in both patients and couples. They concluded that couples
with a high quality of marital relations can present with this di-
sease as well. McCabe (2002) concluded that men with MS
have higher sexual dysfunction than healthy men. Also, coping
and level of cognitive function can be considered as the crucial
predictors for the sexual satisfaction, sexual dysfunction and
satisfaction of relations with couples in women with MS. Peo-
ple with MS face hard treatment, side effects, medication and
physical disabilities along with psychological consequences are
due to the un pr edic tab l e s ymp toms of t he d is e ase; this c an a lso p ro-
duce harmful factors such as being precluded from life targets,
unemployment, disorder of income, frustrations with relation-
ships, leisure time activities, the chores of daily life and the re-
duction of life quality and marital satisfaction (Jansen, 2003;
Hakimo, 2000; cited in Dennison et al., 2009; Nort Wodet et al.,
2007). In fact, along with these physical changes brought about
by the disease, the psyche of these people is being affected by
the related problems and physical limitations potentially annoy-
ing them. (Rugliatti, 2006; Janardan, 2002). In addition to this,
the nature of this disease affects the sub-cortical and central
neural areas of these patients and impacts on their mental health.
(Jannati & Azimi, 2002). Along with this, Mahmoodi, Nasiri
and Niaz Azari (2008) found that there is a dysfunction of the
mental health of people with MS so that they not only have
intensely harsh physical problems, but also they suffer from so-
cial problems, anxiety and depression. Jahanbakhshian and
Zandipour (2011) also found a significant difference between
the mental health of people with MS and healthy ones. How-
ever, some researchers such as Malachy et al. (2007) in their
studies concluded that many patients with MS report high lev-
els of recovery or quality of personal life and social-psycho-
logical adjustment despite the main problems of physical health
and considerable limitations of their social and interpersonal re-
lations. These controversial issues in the results represent the
lack of disease symptoms and healthy status in predicting the
life quality, adaptation of the relations and mental health of the se
people. They show that there are other factors, of course. John-
son et al. (2004 cited in Malachy, 2007) consider this situation
originated from the complex relationships between variables
and different adaptive processes. McCabe (2002) has consider-
ed the cognitive levels and application of copings most useful
in this case. It seems that another factor is most effective in
these results but not observed in the background of this research;
it is the gender that has been tested in the research that should
be reviewed in this regard. One of the studies carried out on the
women with MS has shown that the study of educational issues
and speaking to an expert nurse of the MS disease reduces the
problems related to the sexual relations among these people sig-
nificantly. (Christopherson, 2006, cited in Kalb, 2011). Tomp-
kins, Roeder, Thomas, Kimberly and Koch (2013) also found
that the presentation of an enriched program to people with MS
can recover their marital functions and psychological health in
this regard. Researches carried out are as follows in this area:
Fully et al. (2001); Gholikhani (2006); Saheb al Zamani and
Rashvand (2007); Paya mani et al. (2011); Shoaa Kazemi (2009).
They also showed that the presentation of an optimized consult-
ing program, supportive mental therapeutically, necessary train-
ing in relation to the disease, changing life styles, enhancing the
religious element of coping, problem-solving, emotional rela-
tions, marital satisfaction and satisfaction of sexual relations,
can improve the mental health and life quality of these patients.
According to what was stated before, in most research on peo-
ple with MS, any differences were not observed in terms of the
gender and, also, no other comparisons were found in this case.
Hence, the present study has been fulfilled in relation to the
mental health and marital satisfaction of people with MS in
comparison to healthy people while considering the role of gen-
der. Alongside this, the present study tries to respond to the
question, what is the difference between healthy people and
people with MS in terms of marital satisfaction and mental
health according to gender. The hypotheses of study are:
1) There are difference between marital satisfaction of male
and female with MS and healthy men and women.
2) There are difference between mental health of male and
female with MS and healthy men and women.
The statistical community of the women and men with MS
referred to MS clinics of the Tehran cosmopolitan research plan
is of the correlation type. Among these clinics in Tehran, three
clinics were selected by the random clustering method and all
of the married people referred to these clinics including 59, (31
female and 28 male) ranging from 25 - 55 years old, were taken
up for participation in this research and 59 healthy ones were
assimilated in terms of age and gender. Then, both groups re-
sponded to the Enrich Satisfaction Questionnaire (1989) and
Goldenberg Mental Health Questionnaire (GHQ; Goldenberg &
Hillier, 1972).
Enrich Marital Satisfaction Questionnaire
This questionnaire is a 115 question tool applied for meas-
ureing the satisfaction level in marital relations and is compos-
ed of 14 sub-scales. The process of scoring is as 0, 1, 2, 3, 4 of
Likert type and the higher score shows the higher satisfaction.
Olson et al. (1989) measured alpha coefficients for the marital
satisfaction, personality issues, verbal relation, conflict resolu-
tion, financial management, leisure time, sexual relation, chil-
dren and parenting, relatives and friends and the equal roles of
men and women and they are as follows: .81, .73, .68, .75, .74
.76, .48, .77, .72, and .71. Soleimanian (1994) obtained the
reliability of the questionnaire as .93 alpha coefficients. The
correlation coefficient of this questionnaire was obtained with
the scales of family satisfaction from .41 to .60 and with life
satisfaction this was governed from .33 to .41 representing the
signs of construct validity of the questionnaire (cited in Mo-
hammadizadeh Ebrahimi, 2008). In the present study, Cronbach
alpha obtained was .63.
Mental Health Q u e s ti o n n a ir e (GHQ)
This questionnaire was designed by Goldberg for the whole
social community in 1972 including 28 questions measuring the
mental status of people during one month; its minor scales are
subjected to psychosomatic symptoms, anxiety and insomnia,
social dysfunction and severe depression and it of course is a
complete score. The most suitable scoring method is the use of
the Likert simple pattern with scores of 0, 1, 2, and 3. The score
23 and higher represents the lack of mental health. The reliabil-
Open Access
ity using the correlation coefficient measurement has been re-
ported as .87 with SCL90 (Babyvardi, 1997). Also, the corre-
lation coefficient between four scales of the questionnaire is .33
to .61 (Jaafarnezhad, 2003). The reliability of this test has been
measured in two different studies using Cronbach alpha coeffi-
cient .87 (Chan & Chan, 1983) and .92. (Yazdanpanah, 2005,
cited in Mohammadi, 2007). Cronbach alpha obtained is .83 in
this research.
According to Table 1, we found that both groups of patients
and healthy people are assimilated together in variables of age
and gender.
According to Table 2, there are differences between means
of two groups. To assess significance of these differences
ANOVA were used.
Table 3 shows that there is a significant difference between
people with MS and healthy people in the variable of marital
satisfaction and the whole of its sub-scales except the religious
orientation. Also, in the comparison of the genders, there is a
significant difference between the personality issues, children
and parenting, relatives and friends and religious orientation. In
addition to this, there is observed a significant difference be-
tween the interaction of the disease with gender of women with
MS with men with this disease in comparison with healthy men
and women in the personality issues, marital relati ons, financ ial
management and le isure time activities (p < .05).
As it shown in Table 4, it is observed that there is a signifi-
cant difference between people with MS and healthy people in
terms of mental health and the whole sub-scales related to this
process. Also, in the process of interaction of the disease to the
gender, there is found a significant difference between the psy-
chosomatic symptoms elements (p < .05).
In the present study, according to Table 3, it is specified that
regardless of the gender, people with MS have obtained lower
grades than healthy ones in relation to the marital satisfaction
and its whole sub-scales except the religious orientation. This
result is coincident with the researches of Volvet and Edelman
(1988), McCabe (2002), Prone et al. (2006), O’Conner et al.
(2009), McPeters and Sandberg (2010). The lack of differences
between people with MS and healthy people in the religious
orientation represents the depth of religious beliefs in the Ira-
nian population. Because, when they are faced with this kind of
gigantic problem, the religious orientation cannot be changed in
these people and their beliefs reduced in this regard. Meanwhile,
belief in God and other religious resources can be established as
a great supportive factor assisting them in the recovery of the
disease. According to Shoaa Kazemi (2009), if these people
have much religious belief when facing the disease, they will be
more hopeful of overcoming their illness and having much bet-
ter general health in this regard. Also Table 3 shows that with-
out considering the related disease, women have got lower
scores and grades than men in terms of personality issues, chil-
dren and parenting, relatives and friends as well as religious
orientation; but, in interaction of the disease to the gender, wo-
men have got lower grades than men in the personality issues,
marital relations and leisure time activities in comparison to
healthy people. In the element of financial management, it is
Table 1.
Demographical features and match evaluation of both groups.
MS group Healthy group
Variable Ma Sdb M Sd t Sig level
Gender 1.48 .50 1.15 .50 .000 1.000
Age 2.70 1.16 2.75 1.30 .224 .823
Note: aM = Mea n, bSd = Standard deviation.
Table 2.
Descriptive values of marital satisfaction and mental health of people
with MS and healthy people accordance to gender.
MS group Healthy group
Variable GenderM Sd M Sd
Male 171.64 28.48 238.5737.75
satisfaction Female149.42 39.40 240.10 37.29
Male 18.64 4.07 20.36 4.83
Personality issue sFemale13.97 6.22 19.20 4.47
Male 18.43 4.26 22.57 4.16
Marital relationsFemale15.00 5.25 22.87 4.91
Male 18.64 3.93 23.21 5.49
resolution Female15.39 5.91 23.42 5.92
Male 17.14 4.38 27.00 5.90
management Female17.35 4.71 22.90 7.54
Male 18.64 4.05 21.07 5.34
Leisure times
activities Female15.10 5.29 22.32 4.24
Male 17.14 5.40 23.00 6.34
Relations Female16.26 4.41 22.90 5.99
Male 18.36 3.91 25.71 8.52
Children and
parenting Female16.74 4.86 21.26 11.12
Male 17.50 3.50 23.14 5.04
Relatives a nd
friends Female16.13 3.55 21.19 4.55
Male 19.00 4.13 19.36 8.85
orientation Female17.42 5.39 16.16 6.75
Male 55.79 13.47 28.21 9.68
Mental healthFemale53.19 11.18 31.71 9.17
Male 14.71 3.79 8.29 4.32
symptoms Female13.97 3.80 10.84 4.30
Male 15.00 4.24 7.00 3.09
Anxiety and
insomnia Female14.26 4.77 8.45 2.67
Male 14.64 3.50 8.57 1.79
dysfunction Female14.00 3.77 8.03 2.47
Male 11.43 4.16 4.36 3.56
depression Female10.97 2.17 4.39 3.55
Open Access 847
Table 3.
Group difference for the marital satisfaction of people with MS and
healthy people accorda n c e to the gender.
Dependent variable Msa F P<
Marital satisfa ction 182718.769 142.246.0005
Personality issues 364.247 14.861.003
Marital rela tions 1061.69 6 48.938.0005
Group (MS
Conflict resolution 1168.511 40.538.0005
Financial management1745.786 52.745.0005
Leisure time activities685.624 30.678.0005
Sexual rela ti ons 1149.788 37.817.0005
Children a n d p arenting1036.999 17.639.002
Relatives and friends843.342 48.639.0005
Religious orientation5.971 .144 .705
Marital satisfa ction 3151.382 2.453.120
Personality issues 242.524 9.895.002
Marital rela tions 72.021 3.320.071
Conflict resolution 68.460 2 .375.126
Financial management111.013 3.35 4.070
Leisure tim e activities38.742 1.733.191
Sexual rela ti ons 7.087 .233 .630
Children a n d p arenting271.156 4.612.034
Relatives and friends81.094 4. 6 77.033
Religious orientation167.825 4.055.046
Marital satisfa ction 4148.803 3.320.075
Personality issues 95.773 3.907.050
Marital rela tions 102.239 4.23 9.032
Conflict resolution 88.105 3 .057.083
Financial management136.566 4.12 6.045
Leisure time activities169.285 7.575.007
Sexual rela ti ons 4.568 .150 .699
Children a nd parenting59.327 1.010.317
Relatives and friends2.460 .142 .707
Group* gender
Religious orientation19.191 . 4 64 .497
Note: aMean square s , Df = 1.
observed that healthy women are significantly lower than
healthy men in comparison to the patients. In this relationship,
it can be stated that excitement impairments happen in response
to the beginning of the disability from the disease; this can af-
fect the couples making their independence and intimacy
change completely. The change of role in this relationship, from a
partner to a supporter, changes basically the dynamic of the re-
lationship. Moreover, the impacts of the cognitive changes on
this relationship should be considered. The existence of the di-
sease’s progressive conditions, the disease existence before be-
Table 4.
Group differences for the mental health of people with MS and healthy
people accordance to the gender.
Dependent variable Ms F P<
Mental health 17701.48 150.27 .0005
symptoms 671.95 41.48 .0005
Anxiety 1402.17 99.06 .0005
Social dysfunction1066.18 120.31 .0005
Severe de pression1370.99 120.26 .0005
Mental he alth 6.00 .05 .822
symptoms 24.00 1.48 .23
Anxiety 3.71 .26 .61
Social dysfunction10.28 2.16 .28
Severe depression1.37 .12 .73
Mental health 272.60 2.31 .13
symptoms 80.08 4.94 .03
Anxiety 35.394 2.501 .117
Social dysfunction.079 .009 .925
Group* gender
Severe de pression1.772 .155 .694
Note: *means intera ction between group and gender.
ginning relationship or marriage, and sexual dysfunction are the
most essential factors making the related process dangerous in
this regard (Chandler & Brown, 1998; Halvorsen & Metz, 1992;
Volvet & Edelman, 1988). The above mentioned factors can
destroy and devastate these people’s personality through reduc-
ing the stability of excitement, unsuitable copings and adapta-
tions, and unawareness of accurate information in this relation-
ship and the feeling of hopelessness. Since people have diffi-
culties solving their problems together, the process of intimacy
and quality of relations between them play a key role in this
case. The reduction and change of leisure time activities can
also result from these people’s economical, cultural, mental and
social issues. Based on the findings of the present study, the
above-mentioned subjects are more accurate with women rep-
resenting that women are more susceptible to this disease than
men, significantly in terms of cognition and excitement. In
other words, the physical, social, supportive and cognitive limi-
tations of the disease can influence the personality issues, ma-
rital relations and leisure time of women significantly. Men
with MS also have these problems due to the same mentioned
limitations as women. Indeed, due to the loss of occupational
situations, wrecked functioning and problems regarding the
progression of the disease take these people’s financial func-
tioning out of their control; however, healthy men have better
functioning in financial issues. Also, according to Table 4, we
found that, regardless of the gender, people with MS have lo-
wer mental health than healthy ones significantly. The results of
the above mentioned research are coincident with researches of
Rogliati (2006), Janardan (2002), McPeters and Sandberg (20 10),
Mahmoodi et al. (2008), Jahanbakhshian and Zandi (2011).
Open Access
Open Access 849
Also, regardless of the disease, no greater significant variables
in women than men were observed. But in interactions of the
disease with the gender, both men and women with this disease
are not different in terms of mental health but healthy women
have higher psychosomatic symptoms than healthy men in com-
parison to men and women with MS. It should be mentioned
that it is apparent that these patients show greater symptoms
due to the nature of the disease than healthy people. However,
males and females with this disease have similar symptoms of
the disease while in healthy people physical signs have been
shown in women more than men. The results of the present
study indicate that, in addition to the given approaches and ne-
cessary training in the field of enriching the marital relations
and upgrading the quality of the mental health of these patients
and their spouses, presentation of cognitive education and more
support to recover the status of the personality issues and mari-
tal relations of women with this disease and preparation of sui-
table activities for their leisure time can be a great approach and
may be a vital way to reduce the symptoms of this disease as
well. The population of people with MS is limited to Tehran ci-
ty, small sample size and inconsideration of illness sever levels
are limitations of this study. According to this, wider research
society, bigger sample size and categorizing the sample based
on levels of illness are suggested for future studies.
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