Living with singleness: needs and concerns of never-married women over 35

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This is particularly true in those countries where religion and cultural expectations are salient in everyday life. In this context, the present study investigated the needs and concerns of Iranian never-married women aged 35 and older. Methods : This qualitative study involved a conventional content analysis. Interviews were done with 23 never-married women aged 36-64 years in Iran. Results : A total of 773 codes, 22 subcategories, 8 categories, and 3 themes were extracted from the interviews. The 3 themes were: 1. mental-spiritual lack; categories were lack of emotional support, uncertain future, mental rumination, and sexual worries; 2. reform of culture and society; categories were adverse effect of culture and being overlooked in society; 3. loneliness arising from disability; categories were aging and loneliness and sickness and loneliness. Conclusions : The results of the analysis indicate that the needs and concerns of never-married women over the age of 35 years in Iran remain unmet. This suggests that policymakers and health planner should take into consideration the growing number of never-married women as a societal reality deserving of attention. Psychology never-married women personal needs personal concerns qualitative study cultural and religious expectations Background Maslow's argument for a hierarchy of needs is based on the idea that the people different needs have range from basic level of physical needs to the highest level of self-actualization ( 1 ). All individuals, whether single or married, have such needs, but such fundamental and individual needs appear to be somewhat overlooked in single people. According to the International Conference on Population and Development (ICPD), reproductive health refers to a state of complete physical, mental, and social well-being associated with the reproductive system and its processes and functions. Despite an urgent need to improve all aspects of reproductive health, there are unfortunately social barriers and discrimination with respect to access to reproductive health ( 2 ). Studies have shown that single females feel lonely, less attractive, less satisfied with life, and have functional problems with respect to social relationship and self-confidence ( 3 , 4 ). Single women also experience a status of isolation and stigma ( 5 ). Women in this category are more likely to develop psychological disorders such as depression, aggression, and obsessive-compulsive disorder. They also face problems living independently and communicating with friends. Furthermore, they are likely to experience emotional, psychological and supportive deprivation, and also to be subject to gender inequality ( 6 ). A study by Kajbaf (2008) focused on the psychological consequences of never-married females and males aged 32 to 42 in Iran. Kajbaf found that these people were depressed, socially excluded, and concerned about their finances and personal independence ( 7 ). In contrast, having a partner is claimed to satisfy a person's need for belonging, and people in committed sexual relationships are happier than single individuals ( 3 ). In contrast to so-called individualistic societies, in collectivistic societies such those in Africa, South and Central America, Southern Europe and Asia ( 8 ), staying single into old age can be contrary to cultural norms and traditions. These cultures treat marriage in young adulthood as a developmental task ( 9 ) and carry the expectation that couple relationships should persist into old age ( 8 , 9 ). Against this kind of background, social norms can adversely affect the lives of single women and their reproductive health ( 10 , 11 ). For instance, a study on never-married women in Iran found that not being married was considered a social stigma ( 12 ). Despite the expectations that obtain in collectivistic societies, in recent years the number of single women has increased globally ( 13 ). Statistics also indicate that after the age of 35, the marriage rate for Iranian women decreases ( 14 ). Most studies of single women have focused on young unmarried women, but it is important to consider all age groups and the full range of individual and social characteristics ( 15 ). Furthermore, given that culture (and in particular Islamic culture) permeates all aspects of people's lives (including values and marriage), the attitudes, values and concerns of single women in Western countries are different from Muslim women ( 16 ). Research on the psychosocial health of never-married women in Iran is scarce and consequently little is yet known in any detail about the needs and concerns of this group. Knowing more about theses matters and would also help inform society’s response and what might be done to address them. To this end, this study investigated the needs and concerns of never-married women over 35 years of age in Iran. Methods This qualitative study aimed at discovering the needs and concerns of never-married women over 35 years of age in Iran. Participants 23 never-married women aged 36-64 years were selected from groups differing in age, education, employment status, living status (living with family or alone), and city of residence through purposive sampling. Inclusion criteria included Iranian nationality and signature of written informed consent (see below). Exclusion criteria were severe mental issues such as substance use disorder, major depressive disorders, bipolar disorders, or schizophrenia (based on self-declarations). Data Collection Data were collected from semi-structured, in-depth, face-to-face interviews until data saturation. A total of 28 interviews were conducted with 23 participants, and their needs and concerns were examined thoroughly. After drafting the interview questions, if the researcher did not understand some parts of the interview or if further questions emerged, a second interview was arranged. Each interview lasted about 60-90 minutes (average 75 minutes). Interview location was selected according to participants' preferences and included, health centers, religious institutes, parks, and workplaces. The following questions were posed to gain entry to the interviewee’s world: "In your opinion, what are the needs of never-married women?”; "What is your understanding and experience of such needs?”; "Do such women have preoccupations? How about you?” Analytical questions such as "Can you explain more or give an example?” assisted the researcher during the interviews. Data Analysis Data were analyzed using Graneheim and Lundman's ( 17 ) conventional content analysis and inductive reasoning method as follows: The recorded interviews were all transcribed and then read through several times to build up a general impression. The text was divided into semantic units and coded. Codes were organized into subcategories based on similarities, then subcategories were placed in different categories based on internal similarities and external differences from other subcategories. Finally, the themes were created as latent content in the text. Data Validity Four Guba and Lincoln ( 18 ) criteria were used to establish data validity. Data credibility was met by conducting in-depth interviews, code readings, and data referring (immersion in the data). In order to achieve reliability, an additional observer not involved in the study analyzed the data. To aid generalizability, diverse samples of participants were recruited, the research steps were recorded, and the interviews were analyzed by individuals other than the participants in the study. Finally, to achieve data consistency, the research team reviewed the interviews, codes, subcategories, and categories. Results Participants' socio-demographic characteristics are summarized in Table 1. A total of 773 codes, 22 subcategories, 8 categories, and 3 themes were extracted from the interviews (Table 2). The first theme was labeled “mental-spiritual lack”; the following topics were the basis of the first theme: lack of emotional support, uncertain future, mental rumination, and sexual concerns: Lack of emotional support This category was formed by combining three sub-categories, 1. need for a companion, 2. need to love and be loved, and 3. striving to be a mother: One of the unmet needs that the never-married women suffered from was not having a companion. One participant said, "... "When an older person gets married, she actually wants a companion" (64 years old). The participants also needed someone to love and to be loved by him. "I have everything now ..., I just want someone to love me" (38 years old). From the participants' point of view, the desire to become a mother is an innate need for women. One participant said, "Everyone gathers around me calling me 'Madam or Professor', but I wish someone would call me Mom instead!” (41 years old). Uncertain future This category had three subcategories: 1. fear of permanent celibacy, 2. fear of unsuccessful marriage in the future, and 3. fear of being an imposition on family members. One participant said, "I'm always afraid that I'll grow old and stay single ...” (40 years old). At the same time, participants were worried about an unsuccessful marriage in the future. "I'm worried that I can't be able to cope with married life, and he may not be the person who can comfort me ...." (36 years old). Being an imposition on others was another concern of the participants. "When I see everyone going somewhere with their family, but I have to go with my brother family, I feel I'm a burden on their lives” (38 years old). Mental rumination This was composed of sub-categories: 1. psychological insecurity 2. incessant never-ending despair, 3. feeling guilty, 4. incessant continuous regret formed this category. One participant, talking about psychological insecurity, said, "As you grow older, you need mental security; you want to have peace of mind with your husband ...” (39 years old). Despair was another psychological concern of the participants. "How can I know whether someone will marry me in the future ...” (43 years old). Some participants also felt guilty. "We wronged ourselves by not getting married and hurt ourselves mentally and physically" (37 years old). At the same time, the women also had a desire for married life. "It's very difficult to see girls younger than you got married, but you got nothing ...” (42 years old). Sexual worries This category consisted of two sub-categories: 1. concerns if meeting sexual needs 2. forced to ignore sexual needs. Concerns about consequences of meeting sexual needs were seen in the interviews. "Well, a never-married women who wants to satisfy her sexual needs in any way will not have a good result and will cause harm ...” (36 years old). Some participants had to ignore their sexual needs. "We do not have a husband to meet this need ... So, this feeling is lost in us" (37 years old). The second theme in the study (the reform of culture and society) consisted of two categories: 1 adverse effect of culture, and 2. being overlooked in society. Adverse effect of culture This category had three sub-categories as 1. stigma of being single, 2. stereotypical thinking of people, and 3. failure to provide reproductive health services without judgment. Stigma was one of the concerns seen in the participants. "When I say somewhere that I'm not married, people totally change their opinions about me ... They think I must have a problem that I'm single” (42 years old). Never-married women believed that people's opinions about them should change. "When people know a single women lives in an apartment, they have negative opinions about her ... they think their husbands are in danger" (39 years old). At the same time, the stigma of receiving reproductive health services and Iranian laws and traditions regarding the hymen was one of the obstacles for participants attending a woman's clinics for problems with their reproductive system. "... Once when I went to the hospital for my vaginal infection, the ladies asked me why did you get the infection!?” (37 years old). Being overlooked in society This category had three sub-categories: 1. need to set up partner-finding agencies for singles, 2. need for skills to live alone, and 3. need for financial support. Under this heading are the following observations by interviewees: "It is necessary to establish institutions for never-married people where they can receive some services ... to find someone to marry "(42 years old). "Educational institutions should be established to teach never-married women how to have a single life because no one has taught us this before ...” (52 years old). Other responses referred to the need to have income and concerns about financial problems. "My problem today is an economic problem. If I had a salary, I could live very well ...” (64 years old). Loneliness arising from Disability- associated loneliness was the third theme in the concerns of most of the participants. The theme consisted of two categories: 1. aging, and 2. disease. They felt that aging and disease are difficult given that everyone experiences one if not both, but they are much more difficult for a single person. Aging and loneliness Two subcategories, 1. fear of aging due to disability and 2. fear of losing fertility formed this category. One of the things that never-married women mentioned was fear of aging associated with disability. "When you grow older, your efficiency and power decline. I hope it doesn't happen to me, but if it does, a bitter future awaits me" (42 years old). At the same time, fear of losing fertility with age was another important issue in the lives of the participants. "One of my worries is that my reproductive age is coming to an end" (45 years old). Sickness and loneliness This category also had two subcategories: 1. fear of emerging diseases, and 2. fear of diseases without a supporter. Participants stated: "... I always say thank God that I am healthy now, but what should I do if I come down with a disease in the future? ..." (58 years old). "The only person who takes care of me is my mother, and if one day she dies, who will take care of me when I come down with a disease" (37 years old). Discussion The key findings of the present qualitative study were that never-married women aged 35 years and older reported particular needs and concerns. Specifically, responses yielded three key themes: mental-spiritual lack, reform of culture and society, and disability-associated loneliness (each of was comprised of categories and subcategories). The results of the present study add significantly to the current literature in that participants’ views covered a broad variety of neglected emotional, psychological, sexual, and social needs and concerns. The range of responses also provides an illustrative portrait of the ways in which their needs and concerns relate to culture and of their desire for society and the people within it to view them differently. Results are now discussed in more detail. Participants in this study wanted to get married in order to have a companion, to become a mother, to love and be loved. In this respect, the present findings are consistent with the results reported by Greitemeyer (2009); this study showed that single individuals feel lonely and want company in their social lives ( 19 ). Sharp (2007) also found that single women were stressed and worried about being alone, and their greatest concern was not having any children ( 20 ). The family is the most important source of support and intimacy among people, but over time, people lose their parents and become lonelier, so they want to have someone who loves them. At the same time, the need to be a mother appears to be innate in every woman ( 21 ). In fact, by becoming a mother, women can have someone to love and be loved by in old age and, because the only way to become a mother in Iran is to get married, the participants wanted to get married. Study participants also worried that they would remain unmarried for the rest of their lives and would become a burden on their families in their old age. At the same time they were afraid to enter into unsuitable marriages and thereby to suffer harm. This finding is consistent with the study by Kajbaf (2008); in this study, never-married women cited one of their concerns as not finding a suitable mate over time and consequently accepting marriage to the wrong person ( 22 ). In Iran, women usually live with their families until marriage. This pattern is also found in far Eastern societies such as Indonesia and Malaysia ( 23 ). Qaderzadeh (2017) showed that never-married women in traditional societies are less likely to live independently and feel they are a burden on others as they get older ( 24 ). When parents pass away, women are sometimes forced to live with their siblings, and even if they have an income they feel they are a burden. Being a burden on others causes self-loathing, feelings of insignificance, a diminished sense of belonging, and isolation ( 25 ). Rumination followed by such emotions as psychological insecurity, incessant despair, guilt, and regret from witnessing the lives of married people were frequently seen in the participants' responses. Having mental security is one of the basic human needs that, if met, can give a person peace of mind ( 26 ). The results of Janicka's (2015) study showed that married women felt more mentally secure than single women ( 27 ). The reason for their psychological security was probably because they felt valued and that they had someone to support them in making important decisions. In another study (Soulsby, 2015), married people scored better on mental health than single people ( 28 ). Evidence suggests that in Iran, never-married women over 35 years of age are less likely to get married ( 29 ). Thus, never-married older women gradually lose hope of finding a husband, and they have negative feelings such as guilt due to not paying attention to God's orders regarding marriage, as well as constant regret over their past mistakes. These results are consistent with the findings from Sharp's (2007) study. In this study, females mentioned that they constantly thought that something was wrong in their lives, and their greatest mistake was that they were getting too old for marriage and children ( 20 ). In Saili's (2018) study, never-married women also had feelings such as incompetence, regrets over missed opportunities, and guilt ( 16 ). Fulfilling sexual needs (worrying about the consequences sexual needs are met and, on the other hand, having to ignore them because they do not have a spouse) was one of the major concerns of the study participants. Given that the cultural and religious rules of Iranian Islamic culture mandate that the only way to satisfy sexual needs is to get married ( 30 ), people who do not have a spouse can feel they have no choice but to ignore their sexual needs. This finding is consistent with the results of the study by Mroczeka (2013), which was conducted on older single individuals. The participants stated that because they did not have a spouse to meet their sexual needs, they had no choice but to deny them ( 31 ). On the other hand, women who fulfill this need feel guilty because, according to Islam, having sexual intercourse outside marriage is unacceptable and a major sin. Participants also expressed the view that their society's culture is unfair to single people and should be corrected. In the present study, most participants were concerned about singleness stigma, and they considered this stigma to be a product of society's stereotypes about single individuals. This stigma caused feelings of low self-esteem, low value, and incompetence in never-married women. This was also evident in the Azmawati (2015) study ( 32 ). In Eastern societies, marriage is considered an important cultural imperative and celibacy reflects social incompatibility ( 33 ). At the same time, while questioning people's private lives is quite repugnant in Western societies, in Eastern societies such as Indonesia questions about marital status and children are commonplace in social interactions, and judgments are voiced about the lives of single people ( 34 ). In Iranian society, staying single, particularly in old age, can raise questions in people's minds and pity for singles. Women in this category are more likely to maintain contact with friends who are also single and avoid talking too much in public. In contrast, in Western societies single people have an easier social life and can live happily ( 32 ). Another problem for single women was the fear of being labeled when in receipt of health services for genital problems. The results of Abedini's (2014) study on never-married female students showed that these women avoided seeking help from health services for genital problems ( 35 ). Since in Iran having an intact hymen until marriage is highly valued, this influences the use by never-married women of reproductive health services such as the Pap test is influenced by this culture ( 36 ). As women get older, the incidence of reproductive cancers increases and they need more frequent check-ups ( 37 ). The law in Iran treats damage to the hymen, whether accidental or during a routine examination, as an offense ( 38 ). Consequently, even doctors refuse to perform vaginal examinations on never-married women and this can lead to late diagnosis of the disease or impose high costs on them. According to the results of one study, the possibility of damage to the hymen during a routine examination is one of the most important reasons for never-married women not to refer themselves to reproductive health services in Iran ( 39 ). This points to the need for plans to address what is both a legal and a social problem around the genital screening of never-married women. Moreover, such individuals should not be judged when referring to health centers. Creating agencies that can introduce single people to one another for marriage was a need expressed by several participants in this study. In traditional societies, single women are not supposed to express their feelings or take the initiative when encountering a suitable marriage partner and instead to accept that marriage proposal should be made by men. Thus, many of these women, despite knowing of potential appropriate partners, fail to marry. These findings are consistent with Ibrahim's (2009) study in Malaysia ( 40 ). Teaching life skills to this group of women was another prominent topic in participants' statements. The growing numbers of never-married older women has been a disconcerting development for a traditional society such as Iran ( 32 ). Thus, it is very important to teach singleness life skills to those who do not already have any preparation or training for living a single life. Given the traditional expectation in Iranian society that people will live with their parents and then their spouses and children, there has been no planning to prepare and support single women in living alone. This could be achieved through provision of classes and training to enable them to live a better and happier life as single women. However, some studies have shown that single women can actually live more happily than married women because they are freer and have better quality contact with friends and family ( 23 ). In the present study, most women had a job or were looking for a job, but a small number who did not have a job complained about their dependence on their families and considered it one of the duties of the government to give them a job or insure them for old age. Having higher education and a job are one of the most important reasons for not marrying among women, and having a job allows them to live happily, freely, and independently ( 32 , 41 ). However, there are also never-married women who inadvertently remain single and do not have a job; these women feel anxious and a burden to others. In fact, not having a job was a problem in the lives of some participants and sometimes causes them to be permanently dependent on their families. Loneliness arising from aging and sickness were other concerns of never-married women. Loss of fertility with age was another significant concern in the lives of the participants. Loss of fertility and subsequent anxiety were also apparent among the participants in Saili's (2018) study ( 16 ). Fear of emerging diseases such as cancer as they aged and, on the other hand, lack of support in times of illness caused concern among participants. Women who have never been married are forced to accept loneliness in old age, and instead of living with husbands and children and receiving support from them, rely on substitutes such as friends ( 42 ). The results of Hanske's (2016) study on the effect of marriage on cancer diagnosis showed that, at the time of breast cancer diagnosis, significantly more unmarried women than married women were found to be at a more advanced stage of cancer (p>0.0001), and unmarried women were at greater risk and with a poorer prognosis (AHR [1] 1.35; 95% CI 1.28-1.43) ( 43 ). The most important problem for such individuals in old age and disease is being alone, which is particularly noticeable with the death of parents and the loss of older supporters. Conclusions This study showed that never-married women over 35 in Iran have very wide and varied emotional, psychological, sexual and social needs and concerns. In order to meet these needs and address their concerns, the collaborative effort of various organizations, politicians, planners, sociologists, and even families is essential. In the meantime, reforming society's culture and government support could be very helpful. List of Abbreviations AHR: Adjusted Hazard Ratio Declarations Ethics approval and consent to participate The Tehran University of Medical Sciences (IR.TUMS.VCR.REC.1398.420, 17/07/2019) approved the study, which was performed in accordance with the current and seventh edition of the Declaration of Helsinki ( 44 ). Participants were informed about the study goals and methods, the confidential and secure data handling, and their voluntary participation, and informed consent was obtained. Consent for publication Not applicable. Availability of data and materials The dataset generated and analyzed during this study contains interviewee's quotation which could disclose the identity of participants. Because of the confidentiality of information, especially the challenge examined in this study is critical in many countries, such as ours, the dataset is not publicly available. But upon reasonable request, we can transfer your demand to corresponding author. Competing interests The authors declare that they have no competing interest. Funding This survey was sponsored and supported by Tehran University of Medical Sciences. Funding source has not any role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. Authors' contributions All authors read and approved the final manuscript. SPS and ZT designed the qualitative study. SPS performed interviews, which were analyzed by ZT and SPS. SPS wrote the manuscript which ZT and SB commented upon. SB worked on the completion of the manuscript. Acknowledgements This study is a part of PhD dissertation. We thank Nick Emler (University of Surrey, Surrey UK) for proofreading the manuscript, and all women who participated in this study. References Maslow AH. Teoria hierarchii potrzeb [The theory of the hierarchy of needs]. In: J. Reykowski (ed.), Problemy osobowości i motywacji w psychologii amerykańskiej [Problems of personality and motivation in american psychology]. Warszawa: PWN. 1964. WHO. Programming for adolescent health and development. Report of a WHO/UNFPA/UNICEF study group. Available from: https:// www.who.int/maternal_child_adolescent/documents/trs_886/en/ . 1999 [Accessed 12 March 2020]. Adamczyk K. 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Being Single as a Social Barrier to Access Reproductive Healthcare Services by Iranian Girls. Int J Health Policy Manag. 2017;6(3):147-53. doi: 10.15171/ijhpm.2016.107. Ibrahim R, Hassan Z. Understanding singlehood from the experiences of never-married Malay Muslim women in Malaysia: Some preliminary findings. European Journal of Social Sciences. 2009;8(3):395-405. Azmawati AA. I Am Not Alone”:Managing Singleness-Exploring Single Malay Muslim Women’s Voices in Malaysia. Forum, Komunikasi. 2011;9(1):1-16. Shah Alam:UiTM Press. Band-Winterstein T, Manchik-Rimon C. The experience of being an old never-married single: a life course perspective. Int J Aging Hum Dev. 2014;78(4):379-401. DOI: 10.2190/AG.78.4.d. El Ibrahimi S, Pinheiro PS. The effect of marriage on stage at diagnosis and survival in women with cervical cancer. Psycho-Oncology. 2017;26(5):704-10. https://doi.org/10.1002/pon.4070. Association WM. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA. 2013;310(20):2191-4. DOI: 10.1001/jama.2013.281053. Tables Table 1: Individual-social characteristics of participants Number Age Education Job Living Status Living of City 1 37 MSc Student Living with Family Tabriz 2 36 PhD Student Clerk Living with Family Kermanshah 3 40 MSc Clerk Living with Family Karaj 4 45 Elementary School Clerk Living with Family Tabriz 5 38 Student Clerk Living with Family Sardroud 6 52 BSc Retired Living Alone Sardroud 7 40 BSc Clerk Living with Family Tabriz 8 38 BSc Clerk Living Alone Ilam 9 41 Doctor Academic Member Living with Family Tabriz 10 42 Doctor Without Job Living Alone Ardebil 11 40 PhD Student Academic Member Living with Family Shiraz 12 42 Elementary school Without job Living with Family Marand 13 52 High School Without Job Living with Family Tehran 14 42 MSc Teacher Living with Family Mashhad 15 48 Elementary School Without Job Living with Family Maragheh 16 64 Diploma Tailor Living Alone Tehran 17 39 Diploma Teacher Living with Family Marand 18 36 PhD Student Student Living with Family Gorgan 19 40 BSc Nurse Living with Family Tabriz 20 38 Diploma Without job Living with Family Khoy 21 53 Elementary School Without job Living Alone Tehran 22 50 Doctor Academic Member Living Alone Sari 23 43 Elementary School Barber Living with Family Tabriz Table 2: Subcategories, categories, and themes extracted from interviews Subcategories Categories Themes Need for a companion Lack of emotional support Mental-spiritual lack Need to love and be loved Striving to be a mother Fear of permanent celibacy Uncertain future Fear of unsuccessful marriage in the future Fear of being an imposition on family members Psychological insecurity Mental rumination Incessant never-ending despair Feeling guilty Incessant continuous regret Concerns if meeting sexual needs Sexual worries Forced to ignore sexual needs Stigma of being single Adverse effect of culture Reform of culture and society Stereotypical thinking of people Failure to provide reproductive health services without judgment Need to set up partner-finding agencies for singles Being overlooked in society Need for skills to live alone Need for financial support Fear of aging due to disability Aging and loneliness Loneliness arising from disability Fear of losing fertility Fear of emerging diseases Sickness and loneliness Fear of diseases without a supporter Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revision 24 Mar, 2021 Reviewers agreed at journal 04 Mar, 2021 Reviews received at journal 28 Feb, 2021 Reviewers agreed at journal 26 Feb, 2021 Reviewers invited by journal 26 Feb, 2021 Editor assigned by journal 16 Feb, 2021 Editor invited by journal 16 Feb, 2021 Submission checks completed at journal 16 Feb, 2021 First submitted to journal 13 Feb, 2021 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-239227","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":12034502,"identity":"b2750ab9-b528-4164-99c1-de51375b4d5b","order_by":0,"name":"Shakiba Pourasad Shahrak","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shakiba","middleName":"Pourasad","lastName":"Shahrak","suffix":""},{"id":12034503,"identity":"21bf3e0d-d96f-4d9e-987a-a6fd18862789","order_by":1,"name":"Serge Brand","email":"","orcid":"","institution":"University of Basel","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Serge","middleName":"","lastName":"Brand","suffix":""},{"id":12034504,"identity":"b3df1fae-eedd-484d-a681-6e758d7b9cd7","order_by":2,"name":"Ziba Taghizadeh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBklEQVRIiWNgGAWjYDACZh4wlcAGJCQYG2yAJDFaDiC0pBGhhQGqhQGi5TBhLfLtvAc/f6ipzePjP/zwxscd5xP7ZzcffMBQYxONSwtjM1+yxIFjx4vZGI4ZW848cztxxp1jyQYMx9JyG3B5hZnHQOIA27HENsYGM2nettuJDTdyzEAuxKmFjZnH+MeBf0AtzOzfpP+2nUucT0gLDzOPmcTBtprENjYeM2nGtgOJGwhpkWDmS7M423cgsY2Hp9iyty3ZeOONtGSDBDx+ke8/e/hGxbe6xPn9xzfe+NlmJzvvRvLBBx9qbHBqgYLDcJYjWGUCfuUgUAdn2RNWPApGwSgYBSMNAADoGGAkw0EYOAAAAABJRU5ErkJggg==","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Ziba","middleName":"","lastName":"Taghizadeh","suffix":""}],"badges":[],"createdAt":"2021-02-13 09:59:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-239227/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-239227/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13661155,"identity":"533e4832-136a-4866-be3c-1e1e928a8802","added_by":"auto","created_at":"2021-09-17 10:28:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":255655,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-239227/v1/214f67ed-ca38-4db4-97b9-35433d0cef97.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Living with singleness: needs and concerns of never-married women over 35","fulltext":[{"header":"Background","content":"\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Maslow's argument for a hierarchy of needs is based on the idea that the people different needs have range from basic level of physical needs to the highest level of self-actualization (\u003ca href=\"#_ENREF_1\"\u003e1\u003c/a\u003e). All individuals, whether single or married, have such needs, but such fundamental and individual needs appear to be somewhat overlooked in single people.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; According to the International Conference on Population and Development (ICPD), reproductive health refers to a state of complete physical, mental, and social well-being associated with the reproductive system and its processes and functions. Despite an urgent need to improve all aspects of reproductive health, there are\u0026nbsp; unfortunately social barriers and discrimination with respect to access to reproductive health (\u003ca href=\"#_ENREF_2\"\u003e2\u003c/a\u003e).\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Studies have shown that single females feel lonely, less attractive, less satisfied with life, and have functional problems with respect to social relationship and self-confidence (\u003ca href=\"#_ENREF_3\"\u003e3\u003c/a\u003e, \u003ca href=\"#_ENREF_4\"\u003e4\u003c/a\u003e). Single women also experience a status of isolation and stigma (\u003ca href=\"#_ENREF_5\"\u003e5\u003c/a\u003e). Women in this category are more likely to develop psychological disorders such as depression, aggression, and obsessive-compulsive disorder.\u0026nbsp; They also face problems living independently and communicating with friends. Furthermore, they are likely to experience emotional, psychological and supportive deprivation, and also to be subject to gender inequality (\u003ca href=\"#_ENREF_6\"\u003e6\u003c/a\u003e). A study by Kajbaf (2008) focused on the psychological consequences of never-married females and males aged 32 to 42 in Iran. Kajbaf found that these people were depressed, socially excluded, and concerned about their finances and personal independence (\u003ca href=\"#_ENREF_7\"\u003e7\u003c/a\u003e). In contrast, having a partner is claimed to satisfy a person's need for belonging, and people in committed sexual relationships are happier than single individuals (\u003ca href=\"#_ENREF_3\"\u003e3\u003c/a\u003e).\u003c/p\u003e\n\u003cp\u003eIn contrast to so-called individualistic societies, in collectivistic societies such those in Africa, South and Central America, Southern Europe and Asia (\u003ca href=\"#_ENREF_8\"\u003e8\u003c/a\u003e), staying single into old age can be contrary to cultural norms and traditions. These cultures treat marriage in young adulthood as a developmental task (\u003ca href=\"#_ENREF_9\"\u003e9\u003c/a\u003e) and carry the expectation that couple relationships should persist into old age (\u003ca href=\"#_ENREF_8\"\u003e8\u003c/a\u003e, \u003ca href=\"#_ENREF_9\"\u003e9\u003c/a\u003e). Against this kind of background, social norms can adversely affect the lives of single women and their reproductive health (\u003ca href=\"#_ENREF_10\"\u003e10\u003c/a\u003e, \u003ca href=\"#_ENREF_11\"\u003e11\u003c/a\u003e). For instance, a study on never-married women in Iran found that not being married was considered a social stigma (\u003ca href=\"#_ENREF_12\"\u003e12\u003c/a\u003e).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Despite the expectations that obtain in collectivistic societies, in recent years the number of single women has increased globally (\u003ca href=\"#_ENREF_13\"\u003e13\u003c/a\u003e). Statistics also indicate that after the age of 35, the marriage rate for Iranian women decreases (\u003ca href=\"#_ENREF_14\"\u003e14\u003c/a\u003e).\u003c/p\u003e\n\u003cp\u003eMost studies of single women have focused on young unmarried women, but it is important to consider all age groups and the full range of individual and social characteristics (\u003ca href=\"#_ENREF_15\"\u003e15\u003c/a\u003e). Furthermore, given that culture (and in particular Islamic culture) permeates all aspects of people's lives (including values and marriage), the attitudes, values and concerns of single women in Western countries are different from Muslim women (\u003ca href=\"#_ENREF_16\"\u003e16\u003c/a\u003e). Research on the psychosocial health of never-married women in Iran is scarce and consequently little is yet known in any detail about the needs and concerns of this group.\u0026nbsp;\u0026nbsp; Knowing more about theses matters and would also help inform society\u0026rsquo;s response and what might be done to address them. To this end, this study investigated the needs and concerns of never-married women over 35 years of age in Iran.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; This qualitative study aimed at discovering the needs and concerns of never-married women over 35 years of age in Iran.\u003c/p\u003e\n\u003cp\u003eParticipants\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 23 never-married women aged 36-64 years were selected from groups differing in age, education, employment status, living status (living with family or alone), and city of residence through purposive sampling. Inclusion criteria included Iranian nationality and signature of written informed consent (see below). Exclusion criteria were severe mental issues such as substance use disorder, major depressive disorders, bipolar disorders, or schizophrenia (based on self-declarations).\u003c/p\u003e\n\u003cp\u003eData Collection\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Data were collected from semi-structured, in-depth, face-to-face interviews until data saturation. A total of 28 interviews were conducted with 23 participants, and their needs and concerns were examined thoroughly. After drafting the interview questions, if the researcher did not understand some parts of the interview or if further questions emerged, a second interview was arranged. Each interview lasted about 60-90 minutes (average 75 minutes). Interview location was selected according to participants' preferences and included, health centers, religious institutes, parks, and workplaces. The following questions were posed to gain entry to the interviewee\u0026rsquo;s world: \"In your opinion, what are the needs of never-married women?\u0026rdquo;; \"What is your understanding and experience of such needs?\u0026rdquo;; \"Do such women have preoccupations? How about you?\u0026rdquo; Analytical questions such as \"Can you explain more or give an example?\u0026rdquo; assisted the researcher during the interviews.\u003c/p\u003e\n\u003cp\u003eData Analysis\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Data were analyzed using Graneheim and Lundman's (\u003ca href=\"#_ENREF_17\"\u003e17\u003c/a\u003e) conventional content analysis and inductive reasoning method as follows:\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003eThe recorded interviews were all transcribed and then read through several times to build up a general impression.\u003c/li\u003e\n\u003cli\u003eThe text was divided into semantic units and coded.\u003c/li\u003e\n\u003cli\u003eCodes were organized into subcategories based on similarities, then subcategories were placed in different categories based on internal similarities and external differences from other subcategories.\u003c/li\u003e\n\u003cli\u003eFinally, the themes were created as latent content in the text.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eData Validity\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Four Guba and Lincoln (\u003ca href=\"#_ENREF_18\"\u003e18\u003c/a\u003e) criteria were used to establish data validity. Data credibility was met by conducting in-depth interviews, code readings, and data referring (immersion in the data). In order to achieve reliability, an additional observer not involved in the study analyzed the data. To aid generalizability, diverse samples of participants were recruited, the research steps were recorded, and the interviews were analyzed by individuals other than the participants in the study. Finally, to achieve data consistency, the research team reviewed the interviews, codes, subcategories, and categories.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Participants' socio-demographic characteristics are summarized in Table 1.\u003c/p\u003e\n\u003cp\u003eA total of 773 codes, 22 subcategories, 8 categories, and 3 themes were extracted from the interviews (Table 2).\u003c/p\u003e\n\u003cp\u003eThe first theme was labeled \u0026ldquo;mental-spiritual lack\u0026rdquo;; the following topics were the basis of the first theme: lack of emotional support, uncertain future, mental rumination, and sexual concerns:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eLack of emotional support\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis category was formed by combining three sub-categories, 1. need for a companion, 2. need to love and be loved, and 3. striving to be a mother:\u003c/p\u003e\n\u003cp\u003eOne of the unmet needs that the never-married women suffered from was not having a companion. One participant said, \u003cem\u003e\"... \"When an older person gets married, she actually wants a companion\"\u003c/em\u003e (64 years old).\u003c/p\u003e\n\u003cp\u003eThe participants also needed someone to love and to be loved by him. \u003cem\u003e\u0026nbsp;\"I have everything now ..., I just want someone to love me\"\u003c/em\u003e (38 years old).\u003c/p\u003e\n\u003cp\u003eFrom the participants' point of view, the desire to become a mother is an innate need for women. One participant said, \u003cem\u003e\"Everyone gathers around me calling me 'Madam or Professor', but I wish someone would call me Mom instead!\u0026rdquo;\u003c/em\u003e (41 years old).\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eUncertain future\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis category had three subcategories: 1. fear of permanent celibacy, 2. fear of unsuccessful marriage in the future, and 3. fear of being an imposition on family members.\u003c/p\u003e\n\u003cp\u003eOne participant said, \u003cem\u003e\"I'm always afraid that I'll grow old and stay single ...\u0026rdquo; \u003c/em\u003e(40 years old).\u003c/p\u003e\n\u003cp\u003eAt the same time, participants were worried about an unsuccessful marriage in the future. \u003cem\u003e\"I'm worried that I can't be able to cope with married life, and he may not be the person who can comfort me ....\"\u003c/em\u003e (36 years old).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Being an imposition on others was another concern of the participants. \u003cem\u003e\"When I see everyone going somewhere with their family, but I have to go with my brother family, I feel I'm a burden on their lives\u0026rdquo;\u003c/em\u003e (38 years old).\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eMental rumination\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis was composed of sub-categories: 1. psychological insecurity 2. incessant never-ending despair, 3. feeling guilty, 4. incessant continuous regret formed this category.\u003c/p\u003e\n\u003cp\u003eOne participant, talking about psychological insecurity, said, \u003cem\u003e\"As you grow older, you need mental security; you want to have peace of mind with your husband ...\u0026rdquo;\u003c/em\u003e (39 years old).\u003c/p\u003e\n\u003cp\u003eDespair was another psychological concern of the participants. \u003cem\u003e\"How can I know whether someone will marry me in the future ...\u0026rdquo;\u003c/em\u003e (43 years old).\u003c/p\u003e\n\u003cp\u003eSome participants also felt guilty. \u003cem\u003e\"We wronged ourselves by not getting married and hurt ourselves mentally and physically\"\u003c/em\u003e (37 years old).\u003c/p\u003e\n\u003cp\u003eAt the same time, the women also had a desire for married life. \u003cem\u003e\"It's very difficult to see girls younger than you got married, but you got nothing ...\u0026rdquo;\u003c/em\u003e (42 years old).\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eSexual worries\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis category consisted of two sub-categories: 1. concerns if meeting sexual needs 2. forced to ignore sexual needs.\u003c/p\u003e\n\u003cp\u003eConcerns about consequences of meeting sexual needs were seen in the interviews. \u003cem\u003e\"Well, a never-married women who wants to satisfy her sexual needs in any way will not have a good result and will cause harm ...\u0026rdquo;\u003c/em\u003e (36 years old).\u003c/p\u003e\n\u003cp\u003eSome participants had to ignore their sexual needs. \u003cem\u003e\"We do not have a husband to meet this need ... So, this feeling is lost in us\" \u003c/em\u003e(37 years old).\u003c/p\u003e\n\u003cp\u003eThe second theme in the study (the reform of culture and society) consisted of two categories: 1 adverse effect of culture, and 2. being overlooked in society.\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eAdverse effect of culture\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis category had three sub-categories as 1. stigma of being single, 2. stereotypical thinking of people, and 3. failure to provide reproductive health services without judgment.\u003c/p\u003e\n\u003cp\u003eStigma was one of the concerns seen in the participants. \u003cem\u003e\"When I say somewhere that I'm not married, people totally change their opinions about me ... They think I must have a problem that I'm single\u0026rdquo;\u003c/em\u003e (42 years old).\u003c/p\u003e\n\u003cp\u003eNever-married women believed that people's opinions about them should change. \u003cem\u003e\"When people know a single women lives in an apartment, they have negative opinions about her ... they think their husbands are in danger\"\u003c/em\u003e (39 years old).\u003c/p\u003e\n\u003cp\u003eAt the same time, the stigma of receiving reproductive health services and Iranian laws and traditions regarding the hymen was one of the obstacles for participants attending a woman's clinics for problems with their reproductive system. \u003cem\u003e\"... Once when I went to the hospital for my vaginal infection, the ladies asked me why did you get the infection!?\u0026rdquo;\u003c/em\u003e (37 years old).\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eBeing overlooked in society\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis category had three sub-categories: 1. need to set up partner-finding agencies for singles, 2. need for skills to live alone, and 3. need for financial support. Under this heading are the following observations by interviewees:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"It is necessary to establish institutions for never-married people where they can receive some services ... to find someone to marry\u003c/em\u003e\"(42 years old).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"Educational institutions should be established to teach never-married women how to have a single life because no one has taught us this before ...\u0026rdquo;\u003c/em\u003e (52 years old).\u003c/p\u003e\n\u003cp\u003eOther responses referred to the need to have income and concerns about financial problems. \u003cem\u003e\"My problem today is an economic problem. If I had a salary, I could live very well \u003c/em\u003e...\u0026rdquo; (64 years old).\u003c/p\u003e\n\u003cp\u003eLoneliness arising from Disability- associated loneliness was the third theme in the concerns of most of the participants. The theme consisted of two categories: 1. aging, and 2. disease. They felt that aging and disease are difficult given that everyone experiences one if not both, but they are much more difficult for a single person.\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eAging and loneliness\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eTwo subcategories, 1. fear of aging due to disability and 2. fear of losing fertility formed this category.\u003c/p\u003e\n\u003cp\u003eOne of the things that never-married women mentioned was fear of aging associated with disability. \u003cem\u003e\"When you grow older, your efficiency and power decline. I hope it doesn't happen to me, but if it does, a bitter future awaits me\"\u003c/em\u003e (42 years old).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;At the same time, fear of losing fertility with age was another important issue in the lives of the participants. \u003cem\u003e\"One of my worries is that my reproductive age is coming to an end\"\u003c/em\u003e (45 years old).\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eSickness and loneliness\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis category also had two subcategories: 1. fear of emerging diseases, and 2. fear of diseases without a supporter. Participants stated:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"... I always say thank God that I am healthy now, but what should I do if I come down with a disease in the future? ...\"\u003c/em\u003e (58 years old).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"The only person who takes care of me is my mother, and if one day she dies, who will take care of me when I come down with a disease\"\u003c/em\u003e (37 years old).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe key findings of the present qualitative study were that never-married women aged 35 years and older reported particular needs and concerns. Specifically, responses yielded three key themes: mental-spiritual lack, reform of culture and society, and disability-associated loneliness (each of was comprised of categories and subcategories). The results of the present study add significantly to the current literature in that participants\u0026rsquo; views covered a broad variety of neglected emotional, psychological, sexual, and social needs and concerns. The range of responses also provides an illustrative portrait of the ways in which their needs and concerns relate to culture and of their desire for society and the people within it to view them differently. Results are now discussed in more detail.\u003c/p\u003e\n\u003cp\u003eParticipants in this study wanted to get married in order to have a companion, to become a mother, to love and be loved. In this respect, the present findings are consistent with the results reported by Greitemeyer (2009); this study showed that single individuals feel lonely and want company in their social lives (\u003ca href=\"#_ENREF_19\"\u003e19\u003c/a\u003e). Sharp (2007) also found that single women were stressed and worried about being alone, and their greatest concern was not having any children (\u003ca href=\"#_ENREF_20\"\u003e20\u003c/a\u003e). The family is the most important source of support and intimacy among people, but over time, people lose their parents and become lonelier, so they want to have someone who loves them. At the same time, the need to be a mother appears to be innate in every woman (\u003ca href=\"#_ENREF_21\"\u003e21\u003c/a\u003e). In fact, by becoming a mother, women can have someone to love and be loved by in old age and, because the only way to become a mother in Iran is to get married, the participants wanted to get married.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Study participants also worried that they would remain unmarried for the rest of their lives and would become a burden on their families in their old age. At the same time they were afraid to enter into unsuitable marriages and thereby to suffer harm. This finding is consistent with the study by Kajbaf (2008); in this study, never-married women cited one of their concerns as not finding a suitable mate over time and consequently accepting marriage to the wrong person (\u003ca href=\"#_ENREF_22\"\u003e22\u003c/a\u003e). In Iran, women usually live with their families until marriage. This pattern is also found in far Eastern societies such as Indonesia and Malaysia (\u003ca href=\"#_ENREF_23\"\u003e23\u003c/a\u003e). Qaderzadeh (2017) showed that never-married women in traditional societies are less likely to live independently and feel they are a burden on others as they get older (\u003ca href=\"#_ENREF_24\"\u003e24\u003c/a\u003e). When parents pass away, women are sometimes forced to live with their siblings, and even if they have an income they feel they are a burden. Being a burden on others causes self-loathing, feelings of insignificance, a diminished sense of belonging, and isolation (\u003ca href=\"#_ENREF_25\"\u003e25\u003c/a\u003e).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Rumination followed by such emotions as psychological insecurity, incessant despair, guilt, and regret from witnessing the lives of married people were frequently seen in the participants' responses. Having mental security is one of the basic human needs that, if met, can give a person peace of mind (\u003ca href=\"#_ENREF_26\"\u003e26\u003c/a\u003e). The results of Janicka's (2015) study showed that married women felt more mentally secure than single women (\u003ca href=\"#_ENREF_27\"\u003e27\u003c/a\u003e). The reason for their psychological security was probably because they felt valued and that they had someone to support them in making important decisions. In another study (Soulsby, 2015), married people scored better on mental health than single people (\u003ca href=\"#_ENREF_28\"\u003e28\u003c/a\u003e). Evidence suggests that in Iran, never-married women over 35 years of age are less likely to get married (\u003ca href=\"#_ENREF_29\"\u003e29\u003c/a\u003e). Thus, never-married older women gradually lose hope of finding a husband, and they have negative feelings such as guilt due to not paying attention to God's orders regarding marriage, as well as constant regret over their past mistakes. These results are consistent with the findings from Sharp's (2007) study. In this study, females mentioned that they constantly thought that something was wrong in their lives, and their greatest mistake was that they were getting too old for marriage and children (\u003ca href=\"#_ENREF_20\"\u003e20\u003c/a\u003e). In Saili's (2018) study, never-married women also had feelings such as incompetence, regrets over missed opportunities, and guilt (\u003ca href=\"#_ENREF_16\"\u003e16\u003c/a\u003e).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Fulfilling sexual needs (worrying about the consequences sexual needs are met and, on the other hand, having to ignore them because they do not have a spouse) was one of the major concerns of the study participants. Given that the cultural and religious rules of Iranian Islamic culture\u0026nbsp; mandate that the only way to satisfy sexual needs is to get married (\u003ca href=\"#_ENREF_30\"\u003e30\u003c/a\u003e), people who do not have a spouse can feel they have no choice but to ignore their sexual needs. This finding is consistent with the results of the study by Mroczeka (2013), which was conducted on older single individuals. The participants stated that because they did not have a spouse to meet their sexual needs, they had no choice but to deny them (\u003ca href=\"#_ENREF_31\"\u003e31\u003c/a\u003e). On the other hand, women who fulfill this need feel guilty because, according to Islam, having sexual intercourse outside marriage is unacceptable and a major sin.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Participants also expressed the view that their society's culture is unfair to single people and should be corrected. In the present study, most participants were concerned about singleness stigma, and they considered this stigma to be a product of society's stereotypes about single individuals. This stigma caused feelings of low self-esteem, low value, and incompetence in never-married women. This was also evident in the Azmawati (2015) study (\u003ca href=\"#_ENREF_32\"\u003e32\u003c/a\u003e). In Eastern societies, marriage is considered an important cultural imperative and celibacy reflects social incompatibility (\u003ca href=\"#_ENREF_33\"\u003e33\u003c/a\u003e). At the same time, while questioning people's private lives is quite repugnant in Western societies, in Eastern societies such as Indonesia questions about marital status and children are commonplace in social interactions, and judgments are voiced about the lives of single people (\u003ca href=\"#_ENREF_34\"\u003e34\u003c/a\u003e). In Iranian society, staying single, particularly in old age, can raise questions in people's minds and pity for singles. Women in this category are more likely to maintain contact with friends who are also single and avoid talking too much in public. In contrast, in Western societies\u0026nbsp; single people have an easier social life and can live happily (\u003ca href=\"#_ENREF_32\"\u003e32\u003c/a\u003e).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Another problem for single women was the fear of being labeled when in receipt of health services for genital problems. The results of Abedini's (2014) study on never-married female students showed that these women avoided seeking help from health services for genital problems (\u003ca href=\"#_ENREF_35\"\u003e35\u003c/a\u003e). Since in Iran having an intact hymen until marriage is highly valued, this influences the use by never-married women of reproductive health services such as the Pap test is influenced by this culture (\u003ca href=\"#_ENREF_36\"\u003e36\u003c/a\u003e). As women get older, the incidence of reproductive cancers increases and they need more frequent check-ups (\u003ca href=\"#_ENREF_37\"\u003e37\u003c/a\u003e). The law in Iran\u0026nbsp; treats damage to the hymen, whether accidental or during a routine examination, as an offense (\u003ca href=\"#_ENREF_38\"\u003e38\u003c/a\u003e). Consequently, even doctors refuse to perform vaginal examinations on never-married women and this can lead to late diagnosis of the disease or impose high costs on them. According to the results of one study, the possibility of damage to the hymen during a routine examination is one of the most important reasons for never-married women not to refer themselves to reproductive health services in Iran (\u003ca href=\"#_ENREF_39\"\u003e39\u003c/a\u003e). This points to the need for plans to address what is both a legal and a social problem around the genital screening of never-married women. Moreover, such individuals should not be judged when referring to health centers.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Creating agencies that can introduce single people to one another for marriage was a need expressed by several participants in this study. In traditional societies, single women are not supposed to express their feelings or take the initiative when encountering a suitable marriage partner and instead to accept that marriage proposal should be made by men. Thus, many of these women, despite knowing of potential appropriate partners, fail to marry. These findings are consistent with Ibrahim's (2009) study in Malaysia (\u003ca href=\"#_ENREF_40\"\u003e40\u003c/a\u003e).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Teaching life skills to this group of women was another prominent topic in participants' statements. The growing numbers of never-married older women has been a disconcerting development for a traditional society such as Iran (\u003ca href=\"#_ENREF_32\"\u003e32\u003c/a\u003e). Thus, it is very important to teach singleness life skills to those who do not already have any preparation or training for living a single life. Given the traditional expectation in Iranian society that people will live with their parents and then their spouses and children, there has been no planning to prepare and support single women in living alone. This could be achieved through provision of classes and training to enable them to live a better and happier life as single women. However, some studies have shown that single women can actually live more happily than married women because they are freer and have better quality contact with friends and family (\u003ca href=\"#_ENREF_23\"\u003e23\u003c/a\u003e).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; In the present study, most women had a job or were looking for a job, but a small number who did not have a job complained about their dependence on their families and considered it one of the duties of the government to give them a job or insure them for old age. Having higher education and a job are one of the most important reasons for not marrying among women, and having a job allows them to live happily, freely, and independently (\u003ca href=\"#_ENREF_32\"\u003e32\u003c/a\u003e, \u003ca href=\"#_ENREF_41\"\u003e41\u003c/a\u003e). However, there are also never-married women who inadvertently remain single and do not have a job; these women feel anxious and a burden to others. In fact, not having a job was a problem in the lives of some participants and sometimes causes them to be permanently dependent on their families.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Loneliness arising from aging and sickness were other concerns of never-married women. Loss of fertility with age was another significant concern in the lives of the participants. Loss of fertility and subsequent anxiety were also apparent among the participants in Saili's (2018) study (\u003ca href=\"#_ENREF_16\"\u003e16\u003c/a\u003e).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Fear of emerging diseases such as cancer as they aged and, on the other hand, lack of support in times of illness caused concern among participants. Women who have never been married are forced to accept loneliness in old age, and instead of living with husbands and children and receiving support from them, rely on substitutes such as friends (\u003ca href=\"#_ENREF_42\"\u003e42\u003c/a\u003e). The results of Hanske's (2016) study on the effect of marriage on cancer diagnosis showed that, at the time of breast cancer diagnosis, significantly more unmarried women than married women were found to be at a more advanced stage of cancer (p\u0026gt;0.0001), and unmarried women were at greater risk and with a poorer prognosis (AHR\u003ca href=\"#_ftn1\" name=\"_ftnref1\"\u003e\u003csup\u003e\u003csup\u003e[1]\u003c/sup\u003e\u003c/sup\u003e\u003c/a\u003e 1.35; 95% CI 1.28-1.43) (\u003ca href=\"#_ENREF_43\"\u003e43\u003c/a\u003e). The most important problem for such individuals in old age and disease is being alone, which is particularly noticeable with the death of parents and the loss of older supporters.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; This study showed that never-married women over 35 in Iran have very wide and varied emotional, psychological, sexual and social needs and concerns. In order to meet these needs and address their concerns, the collaborative effort of various organizations, politicians, planners, sociologists, and even families is essential. In the meantime, reforming society's culture and government support could be very helpful.\u003c/p\u003e"},{"header":"List of Abbreviations","content":"\u003cp\u003eAHR: Adjusted Hazard Ratio\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Tehran University of Medical Sciences (IR.TUMS.VCR.REC.1398.420, 17/07/2019) approved the study, which was performed in accordance with the current and seventh edition of the Declaration of Helsinki (\u003ca href=\"#_ENREF_44\"\u003e44\u003c/a\u003e). Participants were informed about the study goals and methods, the confidential and secure data handling, and their voluntary participation, and informed consent was obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset generated and analyzed during this study contains interviewee's quotation which could disclose the identity of participants. Because of the confidentiality of information, especially the challenge examined in this study is critical in many countries, such as ours, the dataset is not publicly available. But upon reasonable request, we can transfer your demand to corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis survey was sponsored and supported by Tehran University of Medical Sciences. Funding source has not any role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript. SPS and ZT designed the qualitative study. SPS performed interviews, which were analyzed by ZT and SPS. SPS wrote the manuscript which ZT and SB commented upon. SB worked on the completion of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is a part of PhD dissertation. We thank Nick Emler (University of Surrey, Surrey UK) for proofreading the manuscript, and all women who participated in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMaslow AH. Teoria hierarchii potrzeb [The theory of the hierarchy of needs]. In: J. Reykowski (ed.), Problemy osobowości i motywacji w psychologii amerykańskiej [Problems of personality and motivation in american psychology]. Warszawa: PWN. 1964.\u003c/li\u003e\n\u003cli\u003eWHO. Programming for adolescent health and development. Report of a WHO/UNFPA/UNICEF study group. 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July-August 2013;57(1):32-8. https://doi.org/10.1016/j.archger.2013.02.003.\u003c/li\u003e\n\u003cli\u003eAzmawati AA, Hashim IHM, Endut N. \u0026ldquo;DON\u0026rsquo;T MARRY, BE HAPPY!\u0026rdquo; - HOW SINGLE WOMEN IN MALAYSIA VIEW MARRIAGE. SHS Web of Conferences. 2015;18:doi:10.1051/shsconf/20151803001.\u003c/li\u003e\n\u003cli\u003eHimawan KK, Bambling M, Edirippulige S. The Asian single profiles: Discovering many faces of never married adults in Asia. Journal of Family Issues. 2018a;39:3667-89. doi:10.1177/0192513X18789205.\u003c/li\u003e\n\u003cli\u003eHimawan KK, Bambling M, Edirippulige S. What does it mean to be single in Indonesia? Religiosity, social stigma, and marital status among never-married Indonesian adults. Sage Open. 2018;8(3):1-9. https://doi.org/10.1177/2158244018803132.\u003c/li\u003e\n\u003cli\u003eAbedian K, Shahhosseini Z. University students' point of views to facilitators and barriers to sexual and reproductive health services. Int J Adolesc Med Health. 2014;26(3):387-92. doi: 10.1515/ ijamh-2013-0316. [PubMed: 24243747].\u003c/li\u003e\n\u003cli\u003eSychareun V. Meeting the contraceptive needs of unmarried young people: attitudes of formal and informal sector providers in Vientiane Municipality, Lao PDR. Reprod Health Matters. 2004;12(23):55-65. https://doi.org/10.1016/S0968-8080(04)23117-2. [PubMed: 15242224].\u003c/li\u003e\n\u003cli\u003eMohammadi F, Kohan S, Mostafavi F, Gholami A. The Stigma of Reproductive Health Services Utilization by Unmarried Women. Iran Red Crescent Med J. 2016;18(3):e24231. DOI:10.5812/ircmj..\u003c/li\u003e\n\u003cli\u003eIran. Po. Judicial and Legal Commission, Islamic criminal low: Tehran: Parlieamant of Islamic Republic of Iran; 2013.\u003c/li\u003e\n\u003cli\u003eKohan S, Mohammadi F, Mostafavi F, Gholami A. Being Single as a Social Barrier to Access Reproductive Healthcare Services by Iranian Girls. Int J Health Policy Manag. 2017;6(3):147-53. doi: 10.15171/ijhpm.2016.107.\u003c/li\u003e\n\u003cli\u003eIbrahim R, Hassan Z. Understanding singlehood from the experiences of never-married Malay Muslim women in Malaysia: Some preliminary findings. European Journal of Social Sciences. 2009;8(3):395-405.\u003c/li\u003e\n\u003cli\u003eAzmawati AA. I Am Not Alone\u0026rdquo;:Managing Singleness-Exploring Single Malay Muslim Women\u0026rsquo;s Voices in Malaysia. Forum, Komunikasi. 2011;9(1):1-16. Shah Alam:UiTM Press.\u003c/li\u003e\n\u003cli\u003eBand-Winterstein T, Manchik-Rimon C. The experience of being an old never-married single: a life course perspective. Int J Aging Hum Dev. 2014;78(4):379-401. DOI: 10.2190/AG.78.4.d.\u003c/li\u003e\n\u003cli\u003eEl Ibrahimi S, Pinheiro PS. The effect of marriage on stage at diagnosis and survival in women with cervical cancer. Psycho-Oncology. 2017;26(5):704-10. https://doi.org/10.1002/pon.4070.\u003c/li\u003e\n\u003cli\u003eAssociation WM. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA. 2013;310(20):2191-4. DOI: 10.1001/jama.2013.281053.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1: Individual-social characteristics of participants\u003c/p\u003e\n\u003ctable border=\"1\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003eNumber\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003eEducation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eJob\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving Status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eLiving of City\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003eMSc\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eStudent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving with Family\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eTabriz\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003ePhD Student\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eClerk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving with Family\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eKermanshah\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003eMSc\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eClerk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving with Family\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eKaraj\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003eElementary School\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eClerk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving with Family\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eTabriz\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003eStudent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eClerk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving with Family\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eSardroud\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003eBSc\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eRetired\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving Alone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eSardroud\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003eBSc\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eClerk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving with Family\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eTabriz\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003eBSc\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eClerk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving Alone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eIlam\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003eDoctor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eAcademic Member\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving with Family\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eTabriz\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e42\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003eDoctor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eWithout Job\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving Alone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eArdebil\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003ePhD Student\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eAcademic Member\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving with Family\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eShiraz\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e42\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003eElementary school\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eWithout job\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving with Family\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eMarand\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003eHigh School\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eWithout Job\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving with Family\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eTehran\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e42\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003eMSc\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eTeacher\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving with Family\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eMashhad\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003eElementary School\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eWithout Job\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving with Family\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eMaragheh\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e64\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003eDiploma\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eTailor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving Alone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eTehran\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003eDiploma\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eTeacher\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving with Family\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eMarand\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003ePhD Student\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eStudent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving with Family\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eGorgan\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003eBSc\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eNurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving with Family\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eTabriz\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003eDiploma\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eWithout job\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving with Family\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eKhoy\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e53\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003eElementary School\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eWithout job\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving Alone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eTehran\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003eDoctor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eAcademic Member\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving Alone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eSari\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003eElementary School\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eBarber\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLiving with Family\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eTabriz\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2: Subcategories, categories, and themes extracted from interviews\u003c/p\u003e\n\u003ctable border=\"1\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eSubcategories\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"187\"\u003e\n\u003cp\u003eCategories\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"177\"\u003e\n\u003cp\u003eThemes\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eNeed for a companion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" width=\"187\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLack of emotional support\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"12\" width=\"177\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMental-spiritual lack\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eNeed to love and be loved\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eStriving to be a mother\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eFear of permanent celibacy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" width=\"187\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUncertain future\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eFear of unsuccessful marriage in the future\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eFear of being an imposition on family members\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003ePsychological insecurity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"4\" width=\"187\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMental rumination\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eIncessant never-ending despair\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eFeeling guilty\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eIncessant continuous regret\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eConcerns if meeting sexual needs\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"187\"\u003e\n\u003cp\u003eSexual worries\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eForced to ignore sexual needs\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eStigma of being single\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" width=\"187\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdverse effect of culture\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"6\" width=\"177\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eReform of culture and society\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eStereotypical thinking of people\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eFailure to provide reproductive health services without judgment\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eNeed to set up partner-finding agencies for singles\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" width=\"187\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBeing overlooked in society\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eNeed for skills to live alone\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eNeed for financial support\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eFear of aging due to disability\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"187\"\u003e\n\u003cp\u003eAging and loneliness\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"4\" width=\"177\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLoneliness arising from disability\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eFear of losing fertility\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eFear of emerging diseases\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"187\"\u003e\n\u003cp\u003eSickness and loneliness\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eFear of diseases without a supporter\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"never-married women, personal needs, personal concerns, qualitative study, cultural and religious expectations ","lastPublishedDoi":"10.21203/rs.3.rs-239227/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-239227/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Cultural and religious norms and expectations may influence the needs and behavior of single women. This is particularly true in those countries where religion and cultural expectations are salient in everyday life. In this context, the present study investigated the needs and concerns of Iranian never-married women aged 35 and older.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This qualitative study involved a conventional content analysis. Interviews were done with 23 never-married women aged 36-64 years in Iran.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: A total of 773 codes, 22 subcategories, 8 categories, and 3 themes were extracted from the interviews. The 3 themes were: 1. mental-spiritual lack; categories were lack of emotional support, uncertain future, mental rumination, and sexual worries; 2. reform of culture and society; categories were adverse effect of culture and being overlooked in society; 3. loneliness arising from disability; categories were aging and loneliness and sickness and loneliness.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: The results of the analysis indicate that the needs and concerns of never-married women over the age of 35 years in Iran remain unmet. This suggests that policymakers and health planner should take into consideration the growing number of never-married women as a societal reality deserving of attention.\u003c/p\u003e","manuscriptTitle":"Living with singleness: needs and concerns of never-married women over 35","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-02-17 20:52:24","doi":"10.21203/rs.3.rs-239227/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2021-03-24T04:52:15+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"f97e1f48-b0a7-4e58-bd4c-083c47a2c57e","date":"2021-03-04T14:04:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-02-28T19:45:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"df876640-aa98-4cf1-9057-9ba1a00e1313","date":"2021-02-26T13:55:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2021-02-26T13:53:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2021-02-16T09:32:09+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2021-02-16T09:27:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2021-02-16T07:48:31+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2021-02-13T09:50:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"19273216-6ce1-4f4b-9599-6cc6062027e6","owner":[],"postedDate":"February 17th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":2472246,"name":"Psychology"}],"tags":[],"updatedAt":"2021-08-20T05:14:07+00:00","versionOfRecord":[],"versionCreatedAt":"2021-02-17 20:52:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-239227","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-239227","identity":"rs-239227","version":["v1"]},"buildId":"cBFmMYwuxLRRLfASyISRj","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}