The Mediating Effect of Anger Control on the Relationship Between Sexual Satisfaction and Marital Adjustment in Individuals Receiving Hemodialysis Treatment

The Mediating Effect of Anger Control on the Relationship Between Sexual Satisfaction and Marital Adjustment in Individuals Receiving Hemodialysis Treatment | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Mediating Effect of Anger Control on the Relationship Between Sexual Satisfaction and Marital Adjustment in Individuals Receiving Hemodialysis Treatment Sabri TOĞLUK, Sidar GÜL This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7484489/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract It is clear that hemodialysis is a stressful process, causes many sexual satisfaction and anger problems, and may lead to impaired marital adjustment. This study aims to examine the relationship between sexual satisfaction and marital adjustment in individuals receiving hemodialysis treatment and to confirm the effect of anger control on this relationship using mediation analysis. This descriptive and cross-sectional study was conducted with 138 individuals receiving hemodialysis treatment between March and May 2024 in a province in the Southeastern Anatolia region of Turkey. Data were collected using the Personal Information Form, Controlled Anger Scale, Marital Adjustment Scale and Golombok-Rust Sexual Satisfaction Scale. In statistical analysis, t-test, ANOVA, Tukey test, Pearson correlation coefficient analysis and Hayes' Process Macro Model 4 (to test the mediating effect) were used. Factors affecting marital adjustment were male gender (p < 0.01), marrying for love (p = 0.01), and age between 56–65 years (p = 0.001). Sexual dissatisfaction was negatively associated with anger control (a =-1.648, p ≤ 0.001), anger control was positively associated with marital adjustment (b = 0.290, p ≤ 0.001), and sexual dissatisfaction was negatively associated with marital adjustment (c = -2.424, p ≤ 0.001). After including anger control, while sexual dissatisfaction was still negatively associated with marital adjustment (c' =-0.2902, p ≤ 0.001), its effect was reduced. The mediating effect of anger control on the relationship between sexual satisfaction and marital adjustment was − 0.479, and the variance explained by the model was 20.2%. Anger control mediated the negative effect of sexual dissatisfaction on marital adjustment. Sexual satisfaction and marital adjustment can be strengthened by encouraging the development of anger control among individuals receiving hemodialysis treatment. Anger control Hemodialysis treatment Marital adjustment Sexual satisfaction Figures Figure 1 Figure 2 Introduction Chronic renal failure (CRF) is a serious condition that requires urgent attention. It involves a gradual decline in kidney function. As kidney function deteriorates, waste products and excess fluid accumulate in the body, increasing the risk of cardiovascular problems, infections, anemia and bone disorders [1, 2]. CRF affects around four million people worldwide, and its prevalence continues to rise. It can affect individuals of all ages, mostly adults, underlining the seriousness and prevalence of the disease [2]. In CRF patients, problems with sexual satisfaction often arise due to the symptoms of the disease and the intensive treatments required. These problems are often due to a combination of physical symptoms associated with the disease, such as fatigue, libido changes and hormonal imbalances, as well as side effects of intensive treatments such as dialysis or medication regimens [3, 4]. Studies have found that decreased libido, oligospermia, and anorgasmia are pretty common in the majority of male CRF patients [5, 6]. It has been reported that female CRF patients have complaints of decreased orgasm capacity, vaginal dryness, arousal and desire [7, 8]. For these reasons, addressing sexuality should be an integral part of the care of CRF patients [9, 10]. Problems with sexual satisfaction in CRF patients may further complicate emotional factors such as anger control and marital adjustment [11, 12]. Sexual satisfaction, which includes positive or negative evaluations of individuals' sexual experiences, is one of the decisive factors affecting marital adjustment because it is related to marital satisfaction [13]. Research has consistently shown that CRF can profoundly affect the dynamics of marital relationships [14]. The problems associated with CRF not only bring physical challenges but also emotional and psychological stressors that can strain the bond between spouses. As couples navigate the complexities of managing this disease, sexual satisfaction problems often create barriers to communication, intimacy and support [15, 16]. In this process, where sexual satisfaction problems affect marital adjustment, anger is often one of the most important emotional problems faced by CRF patients. The representation of CRF patients' anger includes symptoms attributed to the disease, chronicity of the condition, dependence on medical devices, changes in dietary routine, and negative consequences such as financial and social problems [17, 18]. When the complexity of sexual satisfaction problems is added to these existing problems, managing anger can become increasingly difficult. This difficulty can disrupt intimate relationships, strain communication and emotional bonding between spouses, and ultimately jeopardize marital harmony [ 6, 12, 17, 19]. A deeper understanding and proactive strategies are needed to strengthen the anger control, sexual satisfaction and marital adjustment of CRF patients whose ability to maintain a healthy and satisfying relationship in the face of adversity is ultimately affected. The foundation for building these understandings and strategies is based on studies examining the sexual satisfaction, anger control, and marital adjustment of CRF patients. Although many researchers have separately analyzed the relationships between anger control, marital adjustment, and sexual satisfaction [3, 10, 13, 14, 15, 19], there is a limitation in understanding the exact mediating role of anger control in the relationship between sexual satisfaction and marital adjustment. The general hypothesis model developed in this study was based on anger control as a moderator of biopsychosocial responses and adjustment and empirical evidence from the studies mentioned above (Fig. 1 ). Therefore, the model was used to investigate the relationships between anger control, sexual satisfaction and marital adjustment. In this respect, anger control may be associated with increased satisfaction in sexual life, which in turn may be associated with increased satisfaction in marital life. However, improving the relationship between anger control, sexual satisfaction and marital adjustment in CRF patients worldwide remains an underappreciated and understudied topic. Moreover, researchers in Turkey have only addressed the overall impact of CRF on quality of life and sexual and psychosocial problems [3, 6, 10, 20, 21, 22]. This study examines the relationships between sexual satisfaction, anger control, and marital harmony within the framework of Freud's psychoanalytic theory, which emphasizes the role of internal conflicts and unconscious processes in shaping behavior [23]. According to Freud, repressed emotions and unconscious drives influence an individual's emotional experiences and social relationships; therefore, anger control and sexual satisfaction are critical psychological factors in determining marital harmony. Building on this theoretical perspective, the present study aims to investigate the potential mediating role of anger control in the relationship between sexual satisfaction and marital harmony among individuals undergoing hemodialysis treatment.In recent years, sexual dysfunction, depression, anger, and marital harmony problems have been reported frequently among hemodialysis patients. These difficulties adversely affect not only the patients’ quality of life but also spousal relationships and overall family integrity. Therefore, examining the psychosocial factors that determine marital adjustment in hemodialysis patients in greater detail is both clinically relevant and academically necessary. Most existing studies have primarily focused on sexual dysfunction and overall quality of life in hemodialysis patients. The novelty of the present study lies in examining the mediating role of anger control, which provides a new perspective for understanding their psychosocial adjustment. This perspective may offer significant contributions not only to patient care but also to strengthening marital relationships. Based on the conceptual foundations mentioned above, the hypotheses formulated for this study are as follows: H1: There is a statistically significant negative relationship between sexual dissatisfaction and marital adjustment. H2: There is a statistically significant negative relationship between anger management and sexual dissatisfaction. H3: Anger management and marital adjustment have a statistically significant positive relationship. H4: Anger control has a mediating role in the relationship between sexual satisfaction and marital adjustment. Methods Purpose and type of research A descriptive cross-sectional design was used in this study. Population and sample of the study The study was conducted between March and May 2024 in the Dialysis Centers of Siirt Education Research and Siirt Kurtalan State Hospitals. The study population comprised 150 individuals receiving hemodialysis treatment in Siirt Education Research - Siirt Kurtalan State Hospitals Dialysis Centers. The sample selection was aimed at reaching the entire population, and 140 individuals who met the research criteria were reached. The inclusion criteria were that each patient had received dialysis treatment for at least 6 months, received hemodialysis 3 times a week, was literate, was over 18 years of age, was married and voluntarily participated in the study. Exclusion criteria were: history of alcohol and substance abuse, malignant tumors or multi-organ system failure, any primary surgical intervention in the previous 3 months, infectious disease including syphilis, HIV and hepatitis B, physical or psychological problem that would prevent completion of the data collection forms. After removing two incomplete questionnaires, the study ended with 138 participants. Participants receiving hemodialysis treatment were dialyzed at least three times a week, and each session lasted 4 hours. The post hoc power analysis of the research was calculated using the G* Power 3.1.9.7 program [24]. As a result of the calculation performed using the research data with a total sample size of 138, the correlation value of the research was calculated as 0.450, and the power of the research was calculated as (1-β) .99 with a 5% margin of error (α = .05) for correlation analysis. Data collection measurements Data were collected through the Personal Information Form, the Controlled Anger Scale (CARS), the Marital Adjustment Scale (MARS) and the Golombok-Rust Sexual Satisfaction Scale (GRS). Personal Information Form This form, developed by the researchers in accordance with the literature [10, 16, 22], includes 19 questions, including demographic data such as the participants' age, gender, education, income and family status and disease-specific information such as disease duration, compliance, and history of physical and psychiatric problems. Controlled Anger Scale (CAS) The scale, whose original name is 'The State-Trait Anger and Anger Expression Scale' [25], was developed by Spielberg, Forgays, & Forgays and adapted into Turkish by Özer, and its validity and reliability were established. The scale is divided into subscales as "Trait Anger (10 items)" and "Anger Expression Style (24 items)". The "Anger Expression Style" subscale has 3 different sub-dimensions, and these are "Controlled Anger (8 items)", "Outward Anger (8 items)" and "Inward Anger (8 items)". The scale includes a Likert-type scoring ranging between 1 and 4 for each item. High scores obtained from the "Controlled Anger" subscale used in this study indicate the controllability of anger. Cronbach's Alpha internal consistency coefficient for the "Controlled Anger" subscale was found to be 0.84 by Özer [26]. In this study, Cronbach's Alpha internal consistency coefficient of the scale was 0.89. Marital Adjustment Scale (MAS) The scale developed by Locke and Wallace was adapted into Turkish by Tutarel Kışlak [27, 28]. This 15-item scale has two sub-dimensions, namely "Agreement (first 9 items) and Style (items 10–15)" and is scored with a score between 0 and 6. The total score obtained from the scale is between 0 and 60. Scores above 43 points are considered compatible in marital relations, while scores below 43 are incompatible. The Cronbach's Alpha internal consistency coefficient of the scale was calculated as 0.80 [28]. In this study, the Cronbach's Alpha internal consistency coefficient of the scale was calculated as 0.81. Golombok-Rust Sexual Satisfaction Scale (GRSSS) The scale developed by Rust and Golombok was adapted into Turkish by Tuğrul and colleagues [29, 30]. The scale has two forms for men and women, each consisting of 28 questions. The five-point Likert-type scale has a total of 7 sub-dimensions, 5 of which are typical "frequency, communication, satisfaction, avoidance and touch" in female and male forms, "vaginismus and orgasm disorder" in female form, and "erectile dysfunction and premature ejaculation" in male form. The raw scores obtained from the scale are then converted into standard scores ranging from one to nine. The cut-off point of the scale is five points, and a score of five or above indicates that sexual intercourse or functions are impaired in that sub-dimension [30]. Turan calculated the scale's Cronbach Alpha internal consistency coefficient as 0.94 for women and 0.83 for men [31]. This study calculated the Cronbach Alpha internal consistency coefficient as 0.90 for women and 0.89 for men. Data collection process Research data were collected between March and May 2024. Before the questionnaires were given to the respondents, the purpose of the research was explained, and written consent was obtained from the respondents who had volunteered to take part in the study. Participants were provided with the questionnaire and filled in individually. The participants took approximately 15–20 minutes to complete the forms. Data evaluation IBM SPSS Statistics 23 (SPSS Inc., Chicago, IL, USA) and PROCESS macro 3.0 [32]. were used for data analysis. Kolmogorov-Smirnov test revealed problems with normality (all ps < .05). Descriptive statistics were used to analyze anger control, sexual satisfaction, and marital adjustment among participants. In contrast, Cronbach's α was used to assess the reliability of the instruments. Differences in anger management, sexual satisfaction, and marital adjustment based on participants' descriptive characteristics were analyzed using independent t-tests and one-way ANOVA, and post-hoc tests were performed using the Tukey method. Correlations between anger management, sexual satisfaction and marital adjustment were analyzed using the Pearson correlation coefficient. To determine the mediating role of anger control in the relationship between sexual satisfaction and marital adjustment, "Multiple Mediation Model 4" was conducted through PROCESS Macro developed by Hayes [32]. Whether the mediating role of the mediating variable was statistically significant was examined on 5000 bootstrap samples. The study's independent variable was sexual satisfaction, the mediating variable was anger management, and the criterion variable was marital adjustment. The significance level was taken as 0.01. Ethical aspects of the research The “Declaration of Helsinki Principles” were followed at all stages of the study. Before starting the study, ethics committee approval was obtained from the Siirt University Health Sciences Non-Interventional Clinical Research Ethics Committee (11.03.2024, 6631). In addition, institutional permission was obtained from the management of the hospitals where the study was conducted and the provincial health directorate (18.03.2024, E-71987595-774.07-239564843). Before starting the study, the purpose of the study and its voluntary nature were explained to all individuals participating in the study. It was also stated that the data obtained from the research would be kept confidential and would only be used for scientific purposes. Informed consent was obtained from all participants in the study. Results The mean age of the participants was 58.56 ± 11.09 years, and 52.9% were female. 52.9% of the participants were only literate, 80.4% lived in the provincial center, 93.5% did not work in any income-generating job, and 58.4% stated that their income level was moderate. 43.5% of the participants stated that they had an arranged marriage, 79.7% lived in a nuclear family, 50.6% were of Kurdish ethnic origin, 94.2% had children, and the average number of children was 5.64 ± 2.75. The mean age of the spouses of the participants was 59.06 ± 12.66 years; 58.7% were only literate, and 80.4% were not employed in any income-generating job. The mean duration of CRF diagnosis was 6.39 ± 6.20 years; 69.6% had good treatment compliance, 79.7% had an additional disease (most commonly heart failure, hypertension and diabetes mellitus, respectively), and 46.4% had a history of psychiatric problems (most commonly depression, anxiety and suicidal ideation, respectively) (Table 1 ). Table 1 Descriptive characteristics of participants (n = 138) Characteristics n % Gender Female 73 52.9 Male 65 47.1 Education level Only literate 73 52.9 Primary school 43 31.2 High school and ↑ 22 15.9 Place of residence Provincial centre 111 80.4 District centre 17 12.3 Village 10 7.3 Employment status Working 9 6.5 Not working 129 93.5 Perceived income level Poor 39 28.3 Moderate 82 58.4 Good 17 12.3 Form of marriage Marriage with dating 22 15.9 Arranged marriage without love 56 40.6 Arranged marriage with love 60 43.5 Family type Nuclear family 110 79.7 Extended family 28 20.3 Ethnic group Turkish 64 46.4 Kurdish 70 50.7 Arabic 4 2.9 Childbearing status Yes 130 94.2 No 8 5.8 Husband's education level Only literate 81 58.7 Primary school 45 32.6 High school and ↑ 12 8.7 Husband's employment status Working 27 19.6 Not working 111 80.4 Perception of compliance with CRF treatment Poor 6 4.3 Medium 36 26.1 Good 96 69.6 Presence of physical disease Yes 110 79.7 No 28 20.3 Having psychological problems Yes 64 46.4 No 74 53.6 Mean ± SD* Min-Max** Age (years) 58.56 ± 11.09 27–84 Duration of marriage (years) 36.60 ± 13.43 2–62 Number of children 5.64 ± 2.75 1–14 Age of spouse (years) 59.06 ± 12.66 25–88 Duration of CRF disease (years) 6.39 ± 6.20 1–30 *SD: Standart Deviation, **Min-Max: Minimum- Maximum The mean total score of the participants was 18.23 ± 6.07. The total mean score of the participants was 36.72 ± 9.82, and the mean scores of the agreement and style sub-dimensions were 28.79 ± 8.44 and 7.92 ± 2.58, respectively. The total mean score of the participants was 7.17 ± 1.52 and the mean scores of frequency (6.60 ± 1.68), communication (7.32 ± 2.47), avoidance (6.15 ± 1.62), touching (6.65 ± 1.68) and vaginismus/erectile dysfunction (6.03 ± 1.33), orgasm/premature ejaculation (5.77 ± 2.06) sub-dimensions were 5 or above (Table 2 ). Table 2 The distribution of mean total scores and sub-dimensions of the CAS, MAS, and GRSS of participants Scalesand sub-dimensions Number of item Score range Mean ± SD * Min. – Max. ** Total CAS 8 8–32 18.23 ± 6.07 8–29 Total MAS 15 0–58 36.72 ± 9.82 3–54 Agreement 9 0–41 28.79 ± 8.44 0–12 Style 6 0–17 7.92 ± 2.58 0–43 Total GRSS 28 1–9 7.17 ± 1.52 3–9 Frequency 2 1–9 6.60 ± 1.68 1–9 Contact 2 1–9 7.32 ± 2.47 1–9 Satisfaction 4 1–9 4.74 ± 1.88 1–9 Avoidance 4 1–9 6.15 ± 1.62 1–9 Touching 4 1–9 6.65 ± 1.68 1–9 Vaginismus/ Erectile Dysfunction 4 1–9 6.03 ± 1.33 3–9 Orgasm Disorder/Premature Ejaculation 4 1–9 5.77 ± 2.06 1–9 *SD: Standart Deviation, **Min-Max: Minimum- Maximum In this study, many factors that may affect participants' sexual satisfaction, anger control and marital adjustment were analyzed. There was a statistically significant difference between gender and the mean scores obtained from the CAS, MAS and GRSS scales and between the groups (p < 0.01). There was a statistically significant difference between family type and the mean scores obtained from the GRSS (p = 0.022). The mean scores of the participants with different marital styles on the total MAS were significantly different (p = 0.01). It was shown that the marital adjustment of the participants who married lovingly was significantly higher than the participants with other marital styles. The mean scores obtained from the total MAS with the spouse's age differed significantly (p = 0.001). It showed that the marital adjustment of the participants whose spouses were 56–65 years old was significantly higher than that of the others (Table 3 ). Table 3 Comparison of the mean GRSS, CAS and MAS scores according to the descriptive characteristics of participants (n = 138) Characteristics Total GRSS Total CAS Total MAS Age groups (years) 54 and ↓ 7.13 ± 1.57 19.15 ± 6.17 36.46 ± 8.77 Between 55–64 7.16 ± 1.62 17.83 ± 6.31 38.04 ± 10.20 65 and ↑ 7.22 ± 1.37 17.75 ± 5.73 35.57 ± 10.44 Test and significance F = 0.039 p = 0.962 F = 0.759 p = 0.470 F = 0.751 p = 0.474 Gender Female 6.78 ± 1.63 16.46 ± 6.28 39.04 ± 9.32 Male 7.61 ± 1.25 20.23 ± 5.18 34.12 ± 9.79 Test and significance t=-3.329 p = 0.001 t=-3.851 p < 0.001 t = 3.02 p = 0.003 Education level Only literate 7.15 ± 1.61 17.47 ± 6.24 38.23 ± 9.97 Primary school 7.20 ± 1.50 18.25 ± 5.95 33.93 ± 9.15 High school and ↑ 7.18 ± 1.29 20.72 ± 5.26 37.18 ± 9.82 Test and significance F = 0.020 p = 0.980 F = 2.467 p = 0.089 F = 2.688 p = 0.072 Place of residence Provincial centre 7.19 ± 1.51 17.99 ± 6.28 36.63 ± 9.35 District centre 7.17 ± 1.70 18.35 ± 5.38 39.70 ± 8.43 Village 6.90 ± 1.44 20.80 ± 4.44 32.70 ± 10.06 Test and significance F = 0.174 p = 0.841 F = 0.984 p = 0.377 F = 1.642 p = 0.197 Employment status Working 7.55 ± 1.01 21.0 ± 4.69 38.66 ± 13.41 Not working 7.14 ± 1.55 18.04 ± 6.12 36.58 ± 9.57 Test and significance t=-0.776 p = 0.439 t=-1.415 p = 0.159 t = 0.612 p = 0.542 Perceived income level Poor 7.28 ± 1.66 18.76 ± 5.95 37.89 ± 9.34 Moderate 7.24 ± 1.47 18.45 ± 6.08 36.04 ± 10.27 Good 6.58 ± 1.37 16.00 ± 6.18 37.29 ± 8.83 Test and significance F = 1.451 p = 0.238 F = 1.360 p = 0.260 F = 0.497 p = 0.610 Form of marriage Marriage with dating 7.27 ± 1.38 18.40 ± 5.92 39.43 ± 9.51* Arranged marriage without love 7.57 ± 1.34 16.93 ± 5.92 32.95 ± 9.44 Arranged marriage with love 6.83 ± 1.66 19.57 ± 6.09 35.30 ± 9.66 Test and significance F = 2.909 p = 0.058 F = 2.813 p = 0.064 F = 4.731 p = 0.01 Duration of marriage (years) 28 and ↓ 7.43 ± 1.44 19.45 ± 5.66 34.81 ± 9.29 Between 29–43 7.04 ± 1.66 16.66 ± 6.50 37.32 ± 10.48 44 and ↑ 7.11 ± 1.43 18.90 ± 5.70 37.52 ± 9.52 Test and significance F = 0.758 p = 0.470 F = 2.811 p = 0.064 F = 0.965 p = 0.384 Family type Nuclear family 6.53 ± 1.62 18.50 ± 6.09 36.81 ± 9.38 Extended family 7.33 ± 1.46 17.17 ± 5.96 36.35 ± 11.58 Test and significance t = 2.379 p = 0.022 t = 1.035 p = 0.303 t = 0.221 p = 0.825 Ethnic group Turkish 7.18 ± 1.45 18.98 ± 5.98 37.27 ± 8.37 Kurdish 7.28 ± 1.52 18.00 ± 5.82 35.47 ± 9.37 Arabic 6.68 ± 1.74 16.68 ± 7.33 40.06 ± 14.91 Test and significance F = 0.990 p = 0.374 F = 0.984 p = 0.376 F = 1.562 p = 0.214 Childbearing status Yes 8.12 ± 1.35 18.06 ± 6.06 38.12 ± 9.14 No 7.11 ± 1.51 21.12 ± 5.86 36.63 ± 9.89 Test and significance t = 1.835 p = 0.069 t = 1.389 p = 0.167 t = 0.414 p = 0.679 Age of spouse (years) 55 and ↓ 7.27 ± 1.54 18.89 ± 5.78 33.46 ± 9.67 Between 56–65 7.20 ± 1.65 18.60 ± 6.24 38.33 ± 9.04* 66 and ↑ 7.04 ± 1.38 17.21 ± 6.69 38.26 ± 10.07 Test and significance F = 0.279 p = 0.757 F = 1.000 p = 0.370 F = 4.104 p = 0.001 Husband's education level Only literate 7.32 ± 1.49 18.38 ± 6.43 36.25 ± 10.42 Primary school 7.04 ± 1.58 17.53 ± 5.65 36.73 ± 9.07 High school and ↑ 6.66 ± 1.49 19.91 ± 4.98 39.83 ± 8.35 Test and significance F = 1.209 p = 0.302 F = 0.781 p = 0.460 F = 0.689 p = 0.504 Husband's employment status Working 6.96 ± 1.76 16.96 ± 5.48 37.00 ± 8.95 Not working 7.22 ± 1.46 18.54 ± 6.19 36.65 ± 10.06 Test and significance t = 0.715 p = 0.479 t = 1.219 p = 0.225 t = 0.162 p = 0.872 Perception of compliance with CRF treatment Poor 7.00 ± 2.00 18.76 ± 5.95 37.89 ± 9.34 Medium 7.33 ± 1.41 18.45 ± 6.08 36.04 ± 10.27 Good 7.07 ± 1.54 16.00 ± 6.18 37.29 ± 8.83 Test and significance F = 0.283 p = 0.754 F = 1.360 p = 0.26 F = 0.497 p = 0.610 Duration of CRF disease (years) 3 and ↓ 7.38 ± 1.52 18.11 ± 5.86 35.79 ± 10.54 Between 4–7 6.82 ± 1.57 18.82 ± 6.18 36.73 ± 8.93 8 and ↑ 7.21 ± 1.43 17.78 ± 6.39 38.15 ± 9.66 Test and significance F = 1.670 p = 0.192 F = 0.306 p = 0.737 F = 0.664 p = 0.506 Presence of physical disease Yes 7.22 ± 1.52 18.10 ± 6.11 36.90 ± 10.09 No 6.96 ± 1.52 18.78 ± 5.98 36.00 ± 8.82 Test and significance t = 0.815 p = 0.417 t = 0.532 p = 0.596 t = 0.436 p = 0.664 Having psychological problems Yes 7.10 ± 1.49 17.92 ± 6.78 36.39 ± 10.10 No 7.22 ± 1.55 18.51 ± 5.41 37.01 ± 9.63 Test and significance t = 0.462 p = 0.645 t = 0.569 p = 0.570 t = 0.370 p = 0.712 * Group that makes a difference A statistically significant, negative, and medium-strength relationship existed between participants’ GRSS scores and the CAS scores (r=-0.413, p < 0 .001). A statistically significant, negative, and medium-strength relationship existed between participants’ GRSS scores and the MAS scores (r =-0.450, p < 0.001). There was a statistically significant, negative, and medium-strength relationship between participants’ CAS scores and the MAS scores (r =-0.335, p < 0.001) scores (Table 4 ). Table 4 The corelations values of participants’ the GRSS, the CAS and the MAS 1 2 3 1. GRSS 1 2. CAS -0.413* 1 3. MAS -0.450* 0.335* 1 *= p < 0 .001 The effect of anger control as a single mediator was tested (Fig. 2 ). Sexual dissatisfaction was negatively associated with anger control (a =-1.648, p ≤ 0.001), anger control was positively associated with marital adjustment (b = 0.290, p ≤ 0.001), and sexual dissatisfaction was negatively associated with marital adjustment (c = -2.424, p ≤ 0.001). After including anger control, while sexual dissatisfaction was still negatively associated with marital adjustment (c' =-0.2902, p ≤ 0.001), its effect was reduced, and the variance explained by the model was 20.2%. The indirect mediation effect calculated by the product of coefficients (a*b) was − 0.479 (se = 0.272, 95%CI =-1.077, -0.031), indicating a significant partial mediation effect of anger control. Therefore, anger control mediated the negative effect of sexual dissatisfaction on marital adjustment. Discussion The hypotheses formed in line with the aim of this study were discussed in the literature. According to our study results, marital adjustment decreases significantly as sexual dissatisfaction increases in individuals with CRF. Studies have shown that there is a relationship between marital adjustment and sexual functions [33, 34]. Sexual satisfaction, which includes positive or negative evaluations of individuals' sexual experiences, is one of the decisive factors affecting marital adjustment because it is related to marital satisfaction [13]. This result shows that the study's first hypothesis (H1) was confirmed. CRF can profoundly affect the dynamics of marital relationships [14]. According to our study results, sexual dissatisfaction decreases significantly as anger control increases in individuals with CRF. In this process in which sexual satisfaction problems affect marital adjustment, anger is often one of the most important emotional problems faced by CRF patients. Adverse outcomes such as symptoms attributed to the disease, chronicity of the condition, dependence on medical devices, change in dietary routine, and financial and social problems have been identified in the representation of CRF patients' anger [17, 18]. Both men and women with CRF often have various problems with sexual satisfaction due to the biopsychosocial symptoms of the disease and the intensive treatments required [3, 4, 5, 6, 7, 8]. This result confirms the study's second hypothesis (H2). Problems with sexual satisfaction in CRF patients further complicate emotional factors such as anger management and marital adjustment [11, 12]. According to our study results, marital adjustment increases significantly as anger control increases in individuals with CRF. Studies have found that the complexity of sexual satisfaction problems makes it more difficult to manage anger. These difficulties can disrupt close relationships, cause strain on communication and emotional bonding between spouses, and ultimately jeopardize marital adjustment [6, 12, 17, 19]. This result shows that the study's third hypothesis (H3) was confirmed. In this process, where sexual satisfaction problems affect marital adjustment, anger is often one of the most important emotional problems faced by CRF patients. The representation of CRF patients' anger includes negative consequences such as symptoms attributed to the disease, chronicity of the condition, dependence on medical devices, change in dietary routine, and financial and social problems [17, 18]. According to our study results, as anger control increases in individuals with CRF, the negative effect of sexual dissatisfaction on marital adjustment decreases. Therefore, anger control had a mediating effect on the negative effect of sexual dissatisfaction on marital adjustment. This finding shows that the study's last hypothesis (H4) was also confirmed. Problems with sexual satisfaction in CRF patients further complicate emotional factors such as anger control and marital adjustment [11, 12]. Limitations The present study is not without limitations. First, the study was of a descriptive cross-sectional type. Future studies should replicate the study using longitudinal designs to provide a more robust view of the causal relationships between variables. The second limitation was the use of self-reports to collect the study data. There is a higher likelihood of recall bias in a self-reported data study. Therefore, the use of explicit self-report measures may be limiting. The generalizability of this study is limited by its reliance on data collected from two dialysis centers. Therefore, expanded regional studies with increased sample sizes are needed to confirm these findings. Future studies should also aim to extend the current research and explore other variables involved in the relationship between sexual satisfaction and marital adjustment. Conclusions and recommendations In conclusion, in this study, sexual dissatisfaction was found to affect the marital adjustment of individuals with CRF both directly and through anger control. Our study results show that as anger control increases in individuals with CRF, the negative effect of sexual dissatisfaction on marital adjustment decreases. Anger management training to be provided to individuals with CRF may have positive results on sexual dissatisfaction problems and marital adjustment. A deeper understanding and proactive strategies are needed to strengthen anger control, sexual satisfaction and marital adjustment of CRF patients whose ability to maintain a healthy and satisfying relationship in the face of adversity is affected. Given the significant impact of CRF on a patient's marital adjustment, healthcare providers must address sexuality-related issues openly and regularly as part of the overall care plan. By encouraging discussions about sexual health, healthcare providers can help patients overcome these challenges, offer supportive resources and improve their overall well-being. In addition, the topic of sexuality in Turkey creates shyness. Conducting studies in different samples and increasing the academic literature on sexuality in Turkey will illuminate this darkness. Abbreviations CAS Controlled Anger Scale CRF Chronic Renal Failure GRSS Golombok-Rust Sexual Satisfaction Scale MAS Marital Adjustment Scale SD Standart Deviation Declarations Acknowledgements The authors would like to thank all the individuals receiving dialysis treatment who shared their time and experience to participate in this study. Authors’ contributions ST: designed, searched literature, investigation, resources, conceptualization, implementation, analyzed the data, wrote the manuscript. SG: investigation, implementation, conceptualization, analyzed the data, wrote the manuscript. Funding This study received no financial support Data availability The data that supports the findings of this study are available from the corresponding author upon a reasonable request. contact adress: [email protected] Competing interests The authors declare no competing interests. Ethics approval and consent to participate Before starting the study, ethics committee approval was obtained from the Siirt University Health Sciences Non-Interventional Clinical Research Ethics Committee (11.03.2024, 6631). In addition, institutional permission was obtained from the management of the hospitals where the study was conducted and the provincial health directorate (18.03.2024, E-71987595-774.07-239564843). Consent for publication Not applicable. Author details XXX, XXX References Amirkhani, M., Shokrpour, N., Bazrafcan, L., Modreki, A., Sheidai, S.: The effect of resilience training on stress, anxiety, depression, and quality of life of hemodialysis patients: a randomized controlled clinical trial. Iranian Journal of Psychiatry and Behavioral Sciences. 15 (2), (2021). https://doi.org/10.5812/ijpbs.104490 Bello, A.K., Okpechi, I.G., Osman, M.A., Cho, Y., Htay, H., Jha, V., Wainstein, M., Johnson, D.W.: Epidemiology of haemodialysis outcomes. Nature Reviews Nephrology. 18 (6), 378–395 (2022). https://doi.org/10.1038/s41581-022-00542-7 Tunçkiran, M.A., Hoscan, M.B.: Sexual partner satisfaction of the patients with chronic renal failure. 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Noro Psikiyatri Arsivi. 54 (2), 137–142 (2017). https://doi.org/10.5152/npa.2016.12677 Ören, B., Enç, N.: Quality of life in chronic haemodialysis and peritoneal dialysis patients in Turkey and related factors. International Journal of Nursing Practice. 19 (6), 547–556 (2013). https://doi.org/10.1111/ijn.12098 Sabanciogullari, S., Taskin Yilmaz, F., Güngör, F.I., Söylemez, S., Benli, R.B.: Sexual function in patients with chronic renal failure on hemodialysis and its effects on patients’ perception of health and life satisfaction. Sexuality and Disability. 33 (2), 175–186 (2015). https://doi.org/10.1007/s11195-015-9398-4 Freud, S. (1930). Civilization and Its Discontents . London: Hogarth Press. Faul, F., Erdfelder, E., Lang, A.G., Buchner, A.: G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods. 39 (2), 175–191 (2007). https://doi.org/10.3758/BF03193146 Spielberger, D., Forgays, D.G., Forgays, D.K.: Factor structre of the state-trait anger expression inventory. Journal of Personality Assessment. 69 (3):497-507 (1997). Özer, A.K.: Preliminary Study of Trait Anger and Anger Expression Style (Anger-Style) Scales. Turkish Journal of Psychology. 9 (31):26–35 (1994). Locke, H.J., Wallace, K.M.: Short marital-adjustment and prediction tests: their reliability and validity. Marriage and Family Living. 21 (3), 251 (1959). https://doi.org/10.2307/348022 Tutarel Kislak, S.: Reliability and validity study of marital adjustment scale. Journal of Psychiatry Psychology Psychopharmacology. 7 (1), 50–57 (1999). Rust, J., Golombok, S.: The GRISS: A psychometric instrument for the assessment of sexual dysfunction. Archives of Sexual Behavior. 15 (2), 157–165 (1986). https://doi.org/10.1007/BF01542223 Tugrul, C., Öztan, N., Kabakçi, E.: Standardization study of Golombok-Rust sexual satisfaction scale. Turkish Journal of Psychiatry. 4 (2), 82–88 (1993). Turan Evren, E.: Examining the relationship between marital conflict perceptions and social skills of 9-10 year old children. Master’s thesis. Maltepe University; (2014). Hayes, A.: Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (2nd ed.). Guilford Press. (2017). Beach S, O’Leary KD, Sandeen EE. Depression in Marriage: A Model for Etiology and Treatment. New York. (1990). Türkseven, A., Söylemez, I., Dursun, P.: Relationship between sexual dysfunctions and marital adjustment Kriz Dergisi. 28 (1), 9-20 (2020). Additional Declarations No competing interests reported. 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01:00:57","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":110954,"visible":true,"origin":"","legend":"","description":"","filename":"af5bde3c46964e0f866c9dea5cb174661structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7484489/v1/2da423982b5b04cb055f3d79.xml"},{"id":91917533,"identity":"98520a1e-9dbb-434f-8748-7c1abd53a7d3","added_by":"auto","created_at":"2025-09-23 01:00:57","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":115714,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7484489/v1/1e92076b1b02887eb7afe18c.html"},{"id":91917523,"identity":"e3add739-2a73-4355-8281-355075b5e65f","added_by":"auto","created_at":"2025-09-23 01:00:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":36464,"visible":true,"origin":"","legend":"\u003cp\u003eHypothesized theoretical model\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7484489/v1/f5690c8d766679871120c5b3.png"},{"id":91917524,"identity":"ae89a56f-a2f8-4bb9-a832-47b1fd0bb875","added_by":"auto","created_at":"2025-09-23 01:00:57","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":62561,"visible":true,"origin":"","legend":"\u003cp\u003eEffects of on sexual satisfaction on marital adjustment with the mediator of anger control (N = 205).\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea \u003c/sup\u003e= Effect of Sexual Satisfaction on Anger Control\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb = \u003c/sup\u003eEffect of Anger Control on Marital Adjustment\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ec \u003c/sup\u003e= Direct effect of Sexual Satisfaction on Marital Adjustment\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ec’ \u003c/sup\u003e= Total effect of Sexual Satisfaction on Marital Adjustment (with the mediator of Anger Control)\u0026nbsp;\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7484489/v1/b6c3d6c9659751e1a184c8d0.png"},{"id":105729042,"identity":"fb36d7d0-8de9-4c98-a886-78826be63d76","added_by":"auto","created_at":"2026-03-30 11:13:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1637420,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7484489/v1/dde83f48-7667-448f-9336-36d658248e0a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Mediating Effect of Anger Control on the Relationship Between Sexual Satisfaction and Marital Adjustment in Individuals Receiving Hemodialysis Treatment","fulltext":[{"header":"Introduction","content":"\u003cp\u003eChronic renal failure (CRF) is a serious condition that requires urgent attention. It involves a gradual decline in kidney function. As kidney function deteriorates, waste products and excess fluid accumulate in the body, increasing the risk of cardiovascular problems, infections, anemia and bone disorders [1, 2]. CRF affects around four million people worldwide, and its prevalence continues to rise. It can affect individuals of all ages, mostly adults, underlining the seriousness and prevalence of the disease [2].\u003c/p\u003e\u003cp\u003eIn CRF patients, problems with sexual satisfaction often arise due to the symptoms of the disease and the intensive treatments required. These problems are often due to a combination of physical symptoms associated with the disease, such as fatigue, libido changes and hormonal imbalances, as well as side effects of intensive treatments such as dialysis or medication regimens [3, 4]. Studies have found that decreased libido, oligospermia, and anorgasmia are pretty common in the majority of male CRF patients [5, 6]. It has been reported that female CRF patients have complaints of decreased orgasm capacity, vaginal dryness, arousal and desire [7, 8]. For these reasons, addressing sexuality should be an integral part of the care of CRF patients [9, 10].\u003c/p\u003e\u003cp\u003eProblems with sexual satisfaction in CRF patients may further complicate emotional factors such as anger control and marital adjustment [11, 12]. Sexual satisfaction, which includes positive or negative evaluations of individuals' sexual experiences, is one of the decisive factors affecting marital adjustment because it is related to marital satisfaction [13]. Research has consistently shown that CRF can profoundly affect the dynamics of marital relationships [14]. The problems associated with CRF not only bring physical challenges but also emotional and psychological stressors that can strain the bond between spouses. As couples navigate the complexities of managing this disease, sexual satisfaction problems often create barriers to communication, intimacy and support [15, 16].\u003c/p\u003e\u003cp\u003eIn this process, where sexual satisfaction problems affect marital adjustment, anger is often one of the most important emotional problems faced by CRF patients. The representation of CRF patients' anger includes symptoms attributed to the disease, chronicity of the condition, dependence on medical devices, changes in dietary routine, and negative consequences such as financial and social problems [17, 18]. When the complexity of sexual satisfaction problems is added to these existing problems, managing anger can become increasingly difficult. This difficulty can disrupt intimate relationships, strain communication and emotional bonding between spouses, and ultimately jeopardize marital harmony [ 6, 12, 17, 19].\u003c/p\u003e\u003cp\u003eA deeper understanding and proactive strategies are needed to strengthen the anger control, sexual satisfaction and marital adjustment of CRF patients whose ability to maintain a healthy and satisfying relationship in the face of adversity is ultimately affected. The foundation for building these understandings and strategies is based on studies examining the sexual satisfaction, anger control, and marital adjustment of CRF patients. Although many researchers have separately analyzed the relationships between anger control, marital adjustment, and sexual satisfaction [3, 10, 13, 14, 15, 19], there is a limitation in understanding the exact mediating role of anger control in the relationship between sexual satisfaction and marital adjustment. The general hypothesis model developed in this study was based on anger control as a moderator of biopsychosocial responses and adjustment and empirical evidence from the studies mentioned above (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Therefore, the model was used to investigate the relationships between anger control, sexual satisfaction and marital adjustment. In this respect, anger control may be associated with increased satisfaction in sexual life, which in turn may be associated with increased satisfaction in marital life. However, improving the relationship between anger control, sexual satisfaction and marital adjustment in CRF patients worldwide remains an underappreciated and understudied topic. Moreover, researchers in Turkey have only addressed the overall impact of CRF on quality of life and sexual and psychosocial problems [3, 6, 10, 20, 21, 22]. This study examines the relationships between sexual satisfaction, anger control, and marital harmony within the framework of Freud's psychoanalytic theory, which emphasizes the role of internal conflicts and unconscious processes in shaping behavior [23]. According to Freud, repressed emotions and unconscious drives influence an individual's emotional experiences and social relationships; therefore, anger control and sexual satisfaction are critical psychological factors in determining marital harmony. Building on this theoretical perspective, the present study aims to investigate the potential mediating role of anger control in the relationship between sexual satisfaction and marital harmony among individuals undergoing hemodialysis treatment.In recent years, sexual dysfunction, depression, anger, and marital harmony problems have been reported frequently among hemodialysis patients. These difficulties adversely affect not only the patients\u0026rsquo; quality of life but also spousal relationships and overall family integrity. Therefore, examining the psychosocial factors that determine marital adjustment in hemodialysis patients in greater detail is both clinically relevant and academically necessary. Most existing studies have primarily focused on sexual dysfunction and overall quality of life in hemodialysis patients. The novelty of the present study lies in examining the mediating role of anger control, which provides a new perspective for understanding their psychosocial adjustment. This perspective may offer significant contributions not only to patient care but also to strengthening marital relationships.\u003c/p\u003e\u003cp\u003eBased on the conceptual foundations mentioned above, the hypotheses formulated for this study are as follows:\u003c/p\u003e\u003cp\u003eH1: There is a statistically significant negative relationship between sexual dissatisfaction and marital adjustment.\u003c/p\u003e\u003cp\u003eH2: There is a statistically significant negative relationship between anger management and sexual dissatisfaction.\u003c/p\u003e\u003cp\u003eH3: Anger management and marital adjustment have a statistically significant positive relationship.\u003c/p\u003e\u003cp\u003eH4: Anger control has a mediating role in the relationship between sexual satisfaction and marital adjustment.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePurpose and type of research\u003c/h2\u003e\u003cp\u003eA descriptive cross-sectional design was used in this study.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePopulation and sample of the study\u003c/h3\u003e\n\u003cp\u003eThe study was conducted between March and May 2024 in the Dialysis Centers of Siirt Education Research and Siirt Kurtalan State Hospitals. The study population comprised 150 individuals receiving hemodialysis treatment in Siirt Education Research - Siirt Kurtalan State Hospitals Dialysis Centers. The sample selection was aimed at reaching the entire population, and 140 individuals who met the research criteria were reached. The inclusion criteria were that each patient had received dialysis treatment for at least 6 months, received hemodialysis 3 times a week, was literate, was over 18 years of age, was married and voluntarily participated in the study. Exclusion criteria were: history of alcohol and substance abuse, malignant tumors or multi-organ system failure, any primary surgical intervention in the previous 3 months, infectious disease including syphilis, HIV and hepatitis B, physical or psychological problem that would prevent completion of the data collection forms. After removing two incomplete questionnaires, the study ended with 138 participants. Participants receiving hemodialysis treatment were dialyzed at least three times a week, and each session lasted 4 hours. The post hoc power analysis of the research was calculated using the G* Power 3.1.9.7 program [24]. As a result of the calculation performed using the research data with a total sample size of 138, the correlation value of the research was calculated as 0.450, and the power of the research was calculated as (1-β) .99 with a 5% margin of error (α\u0026thinsp;=\u0026thinsp;.05) for correlation analysis.\u003c/p\u003e\n\u003ch3\u003eData collection measurements\u003c/h3\u003e\n\u003cp\u003eData were collected through the Personal Information Form, the Controlled Anger Scale (CARS), the Marital Adjustment Scale (MARS) and the Golombok-Rust Sexual Satisfaction Scale (GRS).\u003c/p\u003e\n\u003ch3\u003ePersonal Information Form\u003c/h3\u003e\n\u003cp\u003eThis form, developed by the researchers in accordance with the literature [10, 16, 22], includes 19 questions, including demographic data such as the participants' age, gender, education, income and family status and disease-specific information such as disease duration, compliance, and history of physical and psychiatric problems.\u003c/p\u003e\n\u003ch3\u003eControlled Anger Scale (CAS)\u003c/h3\u003e\n\u003cp\u003eThe scale, whose original name is 'The State-Trait Anger and Anger Expression Scale' [25], was developed by Spielberg, Forgays, \u0026amp; Forgays and adapted into Turkish by \u0026Ouml;zer, and its validity and reliability were established. The scale is divided into subscales as \"Trait Anger (10 items)\" and \"Anger Expression Style (24 items)\". The \"Anger Expression Style\" subscale has 3 different sub-dimensions, and these are \"Controlled Anger (8 items)\", \"Outward Anger (8 items)\" and \"Inward Anger (8 items)\". The scale includes a Likert-type scoring ranging between 1 and 4 for each item. High scores obtained from the \"Controlled Anger\" subscale used in this study indicate the controllability of anger. Cronbach's Alpha internal consistency coefficient for the \"Controlled Anger\" subscale was found to be 0.84 by \u0026Ouml;zer [26]. In this study, Cronbach's Alpha internal consistency coefficient of the scale was 0.89.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eMarital Adjustment Scale (MAS)\u003c/h2\u003e\u003cp\u003eThe scale developed by Locke and Wallace was adapted into Turkish by Tutarel Kışlak [27, 28]. This 15-item scale has two sub-dimensions, namely \"Agreement (first 9 items) and Style (items 10\u0026ndash;15)\" and is scored with a score between 0 and 6. The total score obtained from the scale is between 0 and 60. Scores above 43 points are considered compatible in marital relations, while scores below 43 are incompatible. The Cronbach's Alpha internal consistency coefficient of the scale was calculated as 0.80 [28]. In this study, the Cronbach's Alpha internal consistency coefficient of the scale was calculated as 0.81.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eGolombok-Rust Sexual Satisfaction Scale (GRSSS)\u003c/h3\u003e\n\u003cp\u003eThe scale developed by Rust and Golombok was adapted into Turkish by Tuğrul and colleagues [29, 30]. The scale has two forms for men and women, each consisting of 28 questions. The five-point Likert-type scale has a total of 7 sub-dimensions, 5 of which are typical \"frequency, communication, satisfaction, avoidance and touch\" in female and male forms, \"vaginismus and orgasm disorder\" in female form, and \"erectile dysfunction and premature ejaculation\" in male form. The raw scores obtained from the scale are then converted into standard scores ranging from one to nine. The cut-off point of the scale is five points, and a score of five or above indicates that sexual intercourse or functions are impaired in that sub-dimension [30]. Turan calculated the scale's Cronbach Alpha internal consistency coefficient as 0.94 for women and 0.83 for men [31]. This study calculated the Cronbach Alpha internal consistency coefficient as 0.90 for women and 0.89 for men.\u003c/p\u003e\n\u003ch3\u003eData collection process\u003c/h3\u003e\n\u003cp\u003eResearch data were collected between March and May 2024. Before the questionnaires were given to the respondents, the purpose of the research was explained, and written consent was obtained from the respondents who had volunteered to take part in the study. Participants were provided with the questionnaire and filled in individually. The participants took approximately 15\u0026ndash;20 minutes to complete the forms.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eData evaluation\u003c/h2\u003e\u003cp\u003eIBM SPSS Statistics 23 (SPSS Inc., Chicago, IL, USA) and PROCESS macro 3.0 [32]. were used for data analysis. Kolmogorov-Smirnov test revealed problems with normality (all ps\u0026thinsp;\u0026lt;\u0026thinsp;.05). Descriptive statistics were used to analyze anger control, sexual satisfaction, and marital adjustment among participants. In contrast, Cronbach's α was used to assess the reliability of the instruments. Differences in anger management, sexual satisfaction, and marital adjustment based on participants' descriptive characteristics were analyzed using independent t-tests and one-way ANOVA, and post-hoc tests were performed using the Tukey method. Correlations between anger management, sexual satisfaction and marital adjustment were analyzed using the Pearson correlation coefficient. To determine the mediating role of anger control in the relationship between sexual satisfaction and marital adjustment, \"Multiple Mediation Model 4\" was conducted through PROCESS Macro developed by Hayes [32]. Whether the mediating role of the mediating variable was statistically significant was examined on 5000 bootstrap samples. The study's independent variable was sexual satisfaction, the mediating variable was anger management, and the criterion variable was marital adjustment. The significance level was taken as 0.01.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eEthical aspects of the research\u003c/h2\u003e\u003cp\u003e The \u0026ldquo;Declaration of Helsinki Principles\u0026rdquo; were followed at all stages of the study. Before starting the study, ethics committee approval was obtained from the Siirt University Health Sciences Non-Interventional Clinical Research Ethics Committee (11.03.2024, 6631). In addition, institutional permission was obtained from the management of the hospitals where the study was conducted and the provincial health directorate (18.03.2024, E-71987595-774.07-239564843). Before starting the study, the purpose of the study and its voluntary nature were explained to all individuals participating in the study. It was also stated that the data obtained from the research would be kept confidential and would only be used for scientific purposes. Informed consent was obtained from all participants in the study.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean age of the participants was 58.56\u0026thinsp;\u0026plusmn;\u0026thinsp;11.09 years, and 52.9% were female. 52.9% of the participants were only literate, 80.4% lived in the provincial center, 93.5% did not work in any income-generating job, and 58.4% stated that their income level was moderate. 43.5% of the participants stated that they had an arranged marriage, 79.7% lived in a nuclear family, 50.6% were of Kurdish ethnic origin, 94.2% had children, and the average number of children was 5.64\u0026thinsp;\u0026plusmn;\u0026thinsp;2.75. The mean age of the spouses of the participants was 59.06\u0026thinsp;\u0026plusmn;\u0026thinsp;12.66 years; 58.7% were only literate, and 80.4% were not employed in any income-generating job. The mean duration of CRF diagnosis was 6.39\u0026thinsp;\u0026plusmn;\u0026thinsp;6.20 years; 69.6% had good treatment compliance, 79.7% had an additional disease (most commonly heart failure, hypertension and diabetes mellitus, respectively), and 46.4% had a history of psychiatric problems (most commonly depression, anxiety and suicidal ideation, respectively) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive characteristics of participants (n\u0026thinsp;=\u0026thinsp;138)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnly literate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh school and \u0026uarr;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePlace of residence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProvincial centre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistrict centre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVillage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEmployment status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot working\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e93.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePerceived income level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eForm of marriage\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarriage with dating\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eArranged marriage without love\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eArranged marriage with love\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFamily type\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNuclear family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e79.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExtended family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEthnic group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTurkish\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKurdish\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eArabic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eChildbearing status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHusband's education level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnly literate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh school and \u0026uarr;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHusband's employment status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot working\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePerception of compliance with CRF treatment\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedium\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePresence of physical disease\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e79.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHaving psychological problems\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eMin-Max**\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58.56\u0026thinsp;\u0026plusmn;\u0026thinsp;11.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27\u0026ndash;84\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDuration of marriage (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36.60\u0026thinsp;\u0026plusmn;\u0026thinsp;13.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u0026ndash;62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of children\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.64\u0026thinsp;\u0026plusmn;\u0026thinsp;2.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u0026ndash;14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge of spouse (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59.06\u0026thinsp;\u0026plusmn;\u0026thinsp;12.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u0026ndash;88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDuration of CRF disease (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.39\u0026thinsp;\u0026plusmn;\u0026thinsp;6.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e*SD: Standart Deviation, **Min-Max: Minimum- Maximum\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe mean total score of the participants was 18.23\u0026thinsp;\u0026plusmn;\u0026thinsp;6.07. The total mean score of the participants was 36.72\u0026thinsp;\u0026plusmn;\u0026thinsp;9.82, and the mean scores of the agreement and style sub-dimensions were 28.79\u0026thinsp;\u0026plusmn;\u0026thinsp;8.44 and 7.92\u0026thinsp;\u0026plusmn;\u0026thinsp;2.58, respectively. The total mean score of the participants was 7.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52 and the mean scores of frequency (6.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68), communication (7.32\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47), avoidance (6.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62), touching (6.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68) and vaginismus/erectile dysfunction (6.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.33), orgasm/premature ejaculation (5.77\u0026thinsp;\u0026plusmn;\u0026thinsp;2.06) sub-dimensions were 5 or above (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe distribution of mean total scores and sub-dimensions of the CAS, MAS, and GRSS of participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eScalesand sub-dimensions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of item\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eScore range\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMin. \u0026ndash; Max.\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal CAS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u0026ndash;32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e18.23\u0026thinsp;\u0026plusmn;\u0026thinsp;6.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal MAS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u0026ndash;58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e36.72\u0026thinsp;\u0026plusmn;\u0026thinsp;9.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u0026ndash;54\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAgreement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u0026ndash;41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e28.79\u0026thinsp;\u0026plusmn;\u0026thinsp;8.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u0026ndash;12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStyle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u0026ndash;17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e7.92\u0026thinsp;\u0026plusmn;\u0026thinsp;2.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u0026ndash;43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal GRSS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u0026ndash;9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e7.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u0026ndash;9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u0026ndash;9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e6.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u0026ndash;9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eContact\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u0026ndash;9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e7.32\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u0026ndash;9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSatisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u0026ndash;9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e4.74\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u0026ndash;9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAvoidance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u0026ndash;9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e6.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u0026ndash;9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTouching\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u0026ndash;9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e6.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u0026ndash;9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVaginismus/ Erectile Dysfunction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u0026ndash;9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e6.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u0026ndash;9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOrgasm Disorder/Premature Ejaculation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u0026ndash;9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e5.77\u0026thinsp;\u0026plusmn;\u0026thinsp;2.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u0026ndash;9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e*SD: Standart Deviation, **Min-Max: Minimum- Maximum\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn this study, many factors that may affect participants' sexual satisfaction, anger control and marital adjustment were analyzed. There was a statistically significant difference between gender and the mean scores obtained from the CAS, MAS and GRSS scales and between the groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). There was a statistically significant difference between family type and the mean scores obtained from the GRSS (p\u0026thinsp;=\u0026thinsp;0.022). The mean scores of the participants with different marital styles on the total MAS were significantly different (p\u0026thinsp;=\u0026thinsp;0.01). It was shown that the marital adjustment of the participants who married lovingly was significantly higher than the participants with other marital styles. The mean scores obtained from the total MAS with the spouse's age differed significantly (p\u0026thinsp;=\u0026thinsp;0.001). It showed that the marital adjustment of the participants whose spouses were 56\u0026ndash;65 years old was significantly higher than that of the others (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of the mean GRSS, CAS and MAS scores according to the descriptive characteristics of participants (n\u0026thinsp;=\u0026thinsp;138)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal GRSS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTotal CAS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal MAS\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge groups (years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e54 and \u0026darr;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.15\u0026thinsp;\u0026plusmn;\u0026thinsp;6.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.46\u0026thinsp;\u0026plusmn;\u0026thinsp;8.77\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBetween 55\u0026ndash;64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.83\u0026thinsp;\u0026plusmn;\u0026thinsp;6.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38.04\u0026thinsp;\u0026plusmn;\u0026thinsp;10.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e65 and \u0026uarr;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.75\u0026thinsp;\u0026plusmn;\u0026thinsp;5.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35.57\u0026thinsp;\u0026plusmn;\u0026thinsp;10.44\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest and significance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0.039 p\u0026thinsp;=\u0026thinsp;0.962\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0.759 p\u0026thinsp;=\u0026thinsp;0.470\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0.751 p\u0026thinsp;=\u0026thinsp;0.474\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.46\u0026thinsp;\u0026plusmn;\u0026thinsp;6.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39.04\u0026thinsp;\u0026plusmn;\u0026thinsp;9.32\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.61\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.23\u0026thinsp;\u0026plusmn;\u0026thinsp;5.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34.12\u0026thinsp;\u0026plusmn;\u0026thinsp;9.79\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest and significance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003et=-3.329 \u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003et=-3.851 \u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;3.02 \u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.003\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnly literate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.47\u0026thinsp;\u0026plusmn;\u0026thinsp;6.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38.23\u0026thinsp;\u0026plusmn;\u0026thinsp;9.97\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.25\u0026thinsp;\u0026plusmn;\u0026thinsp;5.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.93\u0026thinsp;\u0026plusmn;\u0026thinsp;9.15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh school and \u0026uarr;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.72\u0026thinsp;\u0026plusmn;\u0026thinsp;5.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.18\u0026thinsp;\u0026plusmn;\u0026thinsp;9.82\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest and significance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0.020 p\u0026thinsp;=\u0026thinsp;0.980\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;2.467 p\u0026thinsp;=\u0026thinsp;0.089\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;2.688 p\u0026thinsp;=\u0026thinsp;0.072\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePlace of residence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProvincial centre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.19\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.99\u0026thinsp;\u0026plusmn;\u0026thinsp;6.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.63\u0026thinsp;\u0026plusmn;\u0026thinsp;9.35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistrict centre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.35\u0026thinsp;\u0026plusmn;\u0026thinsp;5.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39.70\u0026thinsp;\u0026plusmn;\u0026thinsp;8.43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVillage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.80\u0026thinsp;\u0026plusmn;\u0026thinsp;4.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32.70\u0026thinsp;\u0026plusmn;\u0026thinsp;10.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest and significance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0.174 p\u0026thinsp;=\u0026thinsp;0.841\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0.984 p\u0026thinsp;=\u0026thinsp;0.377\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;1.642 p\u0026thinsp;=\u0026thinsp;0.197\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEmployment status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.55\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38.66\u0026thinsp;\u0026plusmn;\u0026thinsp;13.41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot working\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.04\u0026thinsp;\u0026plusmn;\u0026thinsp;6.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.58\u0026thinsp;\u0026plusmn;\u0026thinsp;9.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest and significance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003et=-0.776 p\u0026thinsp;=\u0026thinsp;0.439\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003et=-1.415 p\u0026thinsp;=\u0026thinsp;0.159\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.612 p\u0026thinsp;=\u0026thinsp;0.542\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePerceived income level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.28\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.76\u0026thinsp;\u0026plusmn;\u0026thinsp;5.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.89\u0026thinsp;\u0026plusmn;\u0026thinsp;9.34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.45\u0026thinsp;\u0026plusmn;\u0026thinsp;6.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.04\u0026thinsp;\u0026plusmn;\u0026thinsp;10.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.58\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.00\u0026thinsp;\u0026plusmn;\u0026thinsp;6.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.29\u0026thinsp;\u0026plusmn;\u0026thinsp;8.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest and significance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;1.451 p\u0026thinsp;=\u0026thinsp;0.238\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;1.360 p\u0026thinsp;=\u0026thinsp;0.260\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0.497 p\u0026thinsp;=\u0026thinsp;0.610\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eForm of marriage\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarriage with dating\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.40\u0026thinsp;\u0026plusmn;\u0026thinsp;5.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39.43\u0026thinsp;\u0026plusmn;\u0026thinsp;9.51*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eArranged marriage without love\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.93\u0026thinsp;\u0026plusmn;\u0026thinsp;5.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32.95\u0026thinsp;\u0026plusmn;\u0026thinsp;9.44\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eArranged marriage with love\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.57\u0026thinsp;\u0026plusmn;\u0026thinsp;6.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35.30\u0026thinsp;\u0026plusmn;\u0026thinsp;9.66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest and significance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;2.909 p\u0026thinsp;=\u0026thinsp;0.058\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;2.813 p\u0026thinsp;=\u0026thinsp;0.064\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;4.731 \u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDuration of marriage (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e28 and \u0026darr;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.45\u0026thinsp;\u0026plusmn;\u0026thinsp;5.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34.81\u0026thinsp;\u0026plusmn;\u0026thinsp;9.29\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBetween 29\u0026ndash;43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.66\u0026thinsp;\u0026plusmn;\u0026thinsp;6.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.32\u0026thinsp;\u0026plusmn;\u0026thinsp;10.48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e44 and \u0026uarr;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.11\u0026thinsp;\u0026plusmn;\u0026thinsp;1.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.90\u0026thinsp;\u0026plusmn;\u0026thinsp;5.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.52\u0026thinsp;\u0026plusmn;\u0026thinsp;9.52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest and significance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0.758 p\u0026thinsp;=\u0026thinsp;0.470\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;2.811 p\u0026thinsp;=\u0026thinsp;0.064\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0.965 p\u0026thinsp;=\u0026thinsp;0.384\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFamily type\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNuclear family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.50\u0026thinsp;\u0026plusmn;\u0026thinsp;6.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.81\u0026thinsp;\u0026plusmn;\u0026thinsp;9.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExtended family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.17\u0026thinsp;\u0026plusmn;\u0026thinsp;5.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.35\u0026thinsp;\u0026plusmn;\u0026thinsp;11.58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest and significance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;2.379 \u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.022\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;1.035 p\u0026thinsp;=\u0026thinsp;0.303\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.221 p\u0026thinsp;=\u0026thinsp;0.825\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEthnic group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTurkish\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.98\u0026thinsp;\u0026plusmn;\u0026thinsp;5.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.27\u0026thinsp;\u0026plusmn;\u0026thinsp;8.37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKurdish\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.28\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.00\u0026thinsp;\u0026plusmn;\u0026thinsp;5.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35.47\u0026thinsp;\u0026plusmn;\u0026thinsp;9.37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eArabic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.68\u0026thinsp;\u0026plusmn;\u0026thinsp;7.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40.06\u0026thinsp;\u0026plusmn;\u0026thinsp;14.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest and significance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0.990 p\u0026thinsp;=\u0026thinsp;0.374\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0.984 p\u0026thinsp;=\u0026thinsp;0.376\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;1.562 p\u0026thinsp;=\u0026thinsp;0.214\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eChildbearing status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.06\u0026thinsp;\u0026plusmn;\u0026thinsp;6.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38.12\u0026thinsp;\u0026plusmn;\u0026thinsp;9.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.11\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.12\u0026thinsp;\u0026plusmn;\u0026thinsp;5.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.63\u0026thinsp;\u0026plusmn;\u0026thinsp;9.89\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest and significance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;1.835 p\u0026thinsp;=\u0026thinsp;0.069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;1.389 p\u0026thinsp;=\u0026thinsp;0.167\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.414 p\u0026thinsp;=\u0026thinsp;0.679\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge of spouse (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e55 and \u0026darr;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.89\u0026thinsp;\u0026plusmn;\u0026thinsp;5.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.46\u0026thinsp;\u0026plusmn;\u0026thinsp;9.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBetween 56\u0026ndash;65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.60\u0026thinsp;\u0026plusmn;\u0026thinsp;6.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38.33\u0026thinsp;\u0026plusmn;\u0026thinsp;9.04*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e66 and \u0026uarr;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.21\u0026thinsp;\u0026plusmn;\u0026thinsp;6.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38.26\u0026thinsp;\u0026plusmn;\u0026thinsp;10.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest and significance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0.279 p\u0026thinsp;=\u0026thinsp;0.757\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;1.000 p\u0026thinsp;=\u0026thinsp;0.370\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;4.104 \u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHusband's education level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnly literate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.38\u0026thinsp;\u0026plusmn;\u0026thinsp;6.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.25\u0026thinsp;\u0026plusmn;\u0026thinsp;10.42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.53\u0026thinsp;\u0026plusmn;\u0026thinsp;5.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.73\u0026thinsp;\u0026plusmn;\u0026thinsp;9.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh school and \u0026uarr;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.66\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.91\u0026thinsp;\u0026plusmn;\u0026thinsp;4.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39.83\u0026thinsp;\u0026plusmn;\u0026thinsp;8.35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest and significance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;1.209 p\u0026thinsp;=\u0026thinsp;0.302\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0.781 p\u0026thinsp;=\u0026thinsp;0.460\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0.689 p\u0026thinsp;=\u0026thinsp;0.504\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHusband's employment status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.96\u0026thinsp;\u0026plusmn;\u0026thinsp;5.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.00\u0026thinsp;\u0026plusmn;\u0026thinsp;8.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot working\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.54\u0026thinsp;\u0026plusmn;\u0026thinsp;6.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.65\u0026thinsp;\u0026plusmn;\u0026thinsp;10.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest and significance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.715 p\u0026thinsp;=\u0026thinsp;0.479\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;1.219 p\u0026thinsp;=\u0026thinsp;0.225\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.162 p\u0026thinsp;=\u0026thinsp;0.872\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePerception of compliance with CRF treatment\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.76\u0026thinsp;\u0026plusmn;\u0026thinsp;5.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.89\u0026thinsp;\u0026plusmn;\u0026thinsp;9.34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedium\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.45\u0026thinsp;\u0026plusmn;\u0026thinsp;6.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.04\u0026thinsp;\u0026plusmn;\u0026thinsp;10.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.00\u0026thinsp;\u0026plusmn;\u0026thinsp;6.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.29\u0026thinsp;\u0026plusmn;\u0026thinsp;8.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest and significance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0.283 p\u0026thinsp;=\u0026thinsp;0.754\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;1.360 p\u0026thinsp;=\u0026thinsp;0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0.497 p\u0026thinsp;=\u0026thinsp;0.610\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDuration of CRF disease (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3 and \u0026darr;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.11\u0026thinsp;\u0026plusmn;\u0026thinsp;5.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35.79\u0026thinsp;\u0026plusmn;\u0026thinsp;10.54\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBetween 4\u0026ndash;7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.82\u0026thinsp;\u0026plusmn;\u0026thinsp;6.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.73\u0026thinsp;\u0026plusmn;\u0026thinsp;8.93\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8 and \u0026uarr;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.78\u0026thinsp;\u0026plusmn;\u0026thinsp;6.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38.15\u0026thinsp;\u0026plusmn;\u0026thinsp;9.66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest and significance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;1.670 p\u0026thinsp;=\u0026thinsp;0.192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0.306 p\u0026thinsp;=\u0026thinsp;0.737\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0.664 p\u0026thinsp;=\u0026thinsp;0.506\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePresence of physical disease\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.10\u0026thinsp;\u0026plusmn;\u0026thinsp;6.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.90\u0026thinsp;\u0026plusmn;\u0026thinsp;10.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.78\u0026thinsp;\u0026plusmn;\u0026thinsp;5.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.00\u0026thinsp;\u0026plusmn;\u0026thinsp;8.82\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest and significance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.815 p\u0026thinsp;=\u0026thinsp;0.417\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.532 p\u0026thinsp;=\u0026thinsp;0.596\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.436 p\u0026thinsp;=\u0026thinsp;0.664\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHaving psychological problems\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.10\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.92\u0026thinsp;\u0026plusmn;\u0026thinsp;6.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.39\u0026thinsp;\u0026plusmn;\u0026thinsp;10.10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.51\u0026thinsp;\u0026plusmn;\u0026thinsp;5.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.01\u0026thinsp;\u0026plusmn;\u0026thinsp;9.63\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest and significance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.462 p\u0026thinsp;=\u0026thinsp;0.645\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.569 p\u0026thinsp;=\u0026thinsp;0.570\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.370 p\u0026thinsp;=\u0026thinsp;0.712\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e* Group that makes a difference\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA statistically significant, negative, and medium-strength relationship existed between participants\u0026rsquo; GRSS scores and the CAS scores (r=-0.413, p\u0026thinsp;\u0026lt;\u0026thinsp;0 .001). A statistically significant, negative, and medium-strength relationship existed between participants\u0026rsquo; GRSS scores and the MAS scores (r =-0.450, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). There was a statistically significant, negative, and medium-strength relationship between participants\u0026rsquo; CAS scores and the MAS scores (r =-0.335, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) scores (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe corelations values of participants\u0026rsquo; the GRSS, the CAS and the MAS\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e1. GRSS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e2. CAS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.413*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e3. MAS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.450*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.335*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e*= p\u0026thinsp;\u0026lt;\u0026thinsp;0 .001\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe effect of anger control as a single mediator was tested (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Sexual dissatisfaction was negatively associated with anger control (a =-1.648, p\u0026thinsp;\u0026le;\u0026thinsp;0.001), anger control was positively associated with marital adjustment (b\u0026thinsp;=\u0026thinsp;0.290, p\u0026thinsp;\u0026le;\u0026thinsp;0.001), and sexual dissatisfaction was negatively associated with marital adjustment (c = -2.424, p\u0026thinsp;\u0026le;\u0026thinsp;0.001). After including anger control, while sexual dissatisfaction was still negatively associated with marital adjustment (c' =-0.2902, p\u0026thinsp;\u0026le;\u0026thinsp;0.001), its effect was reduced, and the variance explained by the model was 20.2%. The indirect mediation effect calculated by the product of coefficients (a*b) was \u0026minus;\u0026thinsp;0.479 (se\u0026thinsp;=\u0026thinsp;0.272, 95%CI =-1.077, -0.031), indicating a significant partial mediation effect of anger control. Therefore, anger control mediated the negative effect of sexual dissatisfaction on marital adjustment.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe hypotheses formed in line with the aim of this study were discussed in the literature. According to our study results, marital adjustment decreases significantly as sexual dissatisfaction increases in individuals with CRF. Studies have shown that there is a relationship between marital adjustment and sexual functions [33, 34]. Sexual satisfaction, which includes positive or negative evaluations of individuals' sexual experiences, is one of the decisive factors affecting marital adjustment because it is related to marital satisfaction [13]. This result shows that the study's first hypothesis (H1) was confirmed. CRF can profoundly affect the dynamics of marital relationships [14].\u003c/p\u003e\u003cp\u003eAccording to our study results, sexual dissatisfaction decreases significantly as anger control increases in individuals with CRF. In this process in which sexual satisfaction problems affect marital adjustment, anger is often one of the most important emotional problems faced by CRF patients. Adverse outcomes such as symptoms attributed to the disease, chronicity of the condition, dependence on medical devices, change in dietary routine, and financial and social problems have been identified in the representation of CRF patients' anger [17, 18]. Both men and women with CRF often have various problems with sexual satisfaction due to the biopsychosocial symptoms of the disease and the intensive treatments required [3, 4, 5, 6, 7, 8]. This result confirms the study's second hypothesis (H2). Problems with sexual satisfaction in CRF patients further complicate emotional factors such as anger management and marital adjustment [11, 12].\u003c/p\u003e\u003cp\u003eAccording to our study results, marital adjustment increases significantly as anger control increases in individuals with CRF. Studies have found that the complexity of sexual satisfaction problems makes it more difficult to manage anger. These difficulties can disrupt close relationships, cause strain on communication and emotional bonding between spouses, and ultimately jeopardize marital adjustment [6, 12, 17, 19]. This result shows that the study's third hypothesis (H3) was confirmed. In this process, where sexual satisfaction problems affect marital adjustment, anger is often one of the most important emotional problems faced by CRF patients. The representation of CRF patients' anger includes negative consequences such as symptoms attributed to the disease, chronicity of the condition, dependence on medical devices, change in dietary routine, and financial and social problems [17, 18].\u003c/p\u003e\u003cp\u003eAccording to our study results, as anger control increases in individuals with CRF, the negative effect of sexual dissatisfaction on marital adjustment decreases. Therefore, anger control had a mediating effect on the negative effect of sexual dissatisfaction on marital adjustment. This finding shows that the study's last hypothesis (H4) was also confirmed. Problems with sexual satisfaction in CRF patients further complicate emotional factors such as anger control and marital adjustment [11, 12].\u003c/p\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThe present study is not without limitations. First, the study was of a descriptive cross-sectional type. Future studies should replicate the study using longitudinal designs to provide a more robust view of the causal relationships between variables. The second limitation was the use of self-reports to collect the study data. There is a higher likelihood of recall bias in a self-reported data study. Therefore, the use of explicit self-report measures may be limiting. The generalizability of this study is limited by its reliance on data collected from two dialysis centers. Therefore, expanded regional studies with increased sample sizes are needed to confirm these findings. Future studies should also aim to extend the current research and explore other variables involved in the relationship between sexual satisfaction and marital adjustment.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions and recommendations","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003cp\u003eIn conclusion, in this study, sexual dissatisfaction was found to affect the marital adjustment of individuals with CRF both directly and through anger control. Our study results show that as anger control increases in individuals with CRF, the negative effect of sexual dissatisfaction on marital adjustment decreases. Anger management training to be provided to individuals with CRF may have positive results on sexual dissatisfaction problems and marital adjustment. A deeper understanding and proactive strategies are needed to strengthen anger control, sexual satisfaction and marital adjustment of CRF patients whose ability to maintain a healthy and satisfying relationship in the face of adversity is affected. Given the significant impact of CRF on a patient's marital adjustment, healthcare providers must address sexuality-related issues openly and regularly as part of the overall care plan. By encouraging discussions about sexual health, healthcare providers can help patients overcome these challenges, offer supportive resources and improve their overall well-being. In addition, the topic of sexuality in Turkey creates shyness. Conducting studies in different samples and increasing the academic literature on sexuality in Turkey will illuminate this darkness.\u003c/p\u003e\u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCAS \u0026nbsp; \u0026nbsp;Controlled Anger Scale\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCRF \u0026nbsp; \u0026nbsp;\u0026nbsp;Chronic Renal Failure\u003c/p\u003e\n\u003cp\u003eGRSS \u0026nbsp; Golombok-Rust Sexual Satisfaction Scale\u003c/p\u003e\n\u003cp\u003eMAS Marital Adjustment Scale\u003c/p\u003e\n\u003cp\u003eSD \u0026nbsp; \u0026nbsp; Standart Deviation\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all the individuals receiving dialysis treatment who shared their time and experience to participate in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eST: designed, searched literature, investigation, resources, conceptualization, implementation, analyzed the data, wrote the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSG: investigation, implementation, conceptualization, analyzed the data, wrote the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no financial support\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that supports the findings of this study are available from the corresponding author upon a reasonable request. \u0026nbsp; contact adress: [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBefore starting the study, ethics committee approval was obtained from the Siirt University Health Sciences Non-Interventional Clinical Research Ethics Committee (11.03.2024, 6631). In addition, institutional permission was obtained from the management of the hospitals where the study was conducted and the provincial health directorate (18.03.2024, E-71987595-774.07-239564843).\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\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXXX, XXX\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAmirkhani, M., Shokrpour, N., Bazrafcan, L., Modreki, A., Sheidai, S.: The effect of resilience training on stress, anxiety, depression, and quality of life of hemodialysis patients: a randomized controlled clinical trial. 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(1990).\u003c/li\u003e\n\u003cli\u003eT\u0026uuml;rkseven, A., S\u0026ouml;ylemez, I., Dursun, P.: Relationship between sexual dysfunctions and marital adjustment Kriz Dergisi. \u003cstrong\u003e28\u003c/strong\u003e(1), 9-20 (2020).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Anger control, Hemodialysis treatment, Marital adjustment, Sexual satisfaction","lastPublishedDoi":"10.21203/rs.3.rs-7484489/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7484489/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIt is clear that hemodialysis is a stressful process, causes many sexual satisfaction and anger problems, and may lead to impaired marital adjustment. This study aims to examine the relationship between sexual satisfaction and marital adjustment in individuals receiving hemodialysis treatment and to confirm the effect of anger control on this relationship using mediation analysis. This descriptive and cross-sectional study was conducted with 138 individuals receiving hemodialysis treatment between March and May 2024 in a province in the Southeastern Anatolia region of Turkey. Data were collected using the Personal Information Form, Controlled Anger Scale, Marital Adjustment Scale and Golombok-Rust Sexual Satisfaction Scale. In statistical analysis, t-test, ANOVA, Tukey test, Pearson correlation coefficient analysis and Hayes' Process Macro Model 4 (to test the mediating effect) were used. Factors affecting marital adjustment were male gender (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), marrying for love (p\u0026thinsp;=\u0026thinsp;0.01), and age between 56\u0026ndash;65 years (p\u0026thinsp;=\u0026thinsp;0.001). Sexual dissatisfaction was negatively associated with anger control (a =-1.648, p\u0026thinsp;\u0026le;\u0026thinsp;0.001), anger control was positively associated with marital adjustment (b\u0026thinsp;=\u0026thinsp;0.290, p\u0026thinsp;\u0026le;\u0026thinsp;0.001), and sexual dissatisfaction was negatively associated with marital adjustment (c = -2.424, p\u0026thinsp;\u0026le;\u0026thinsp;0.001). After including anger control, while sexual dissatisfaction was still negatively associated with marital adjustment (c' =-0.2902, p\u0026thinsp;\u0026le;\u0026thinsp;0.001), its effect was reduced. The mediating effect of anger control on the relationship between sexual satisfaction and marital adjustment was \u0026minus;\u0026thinsp;0.479, and the variance explained by the model was 20.2%. Anger control mediated the negative effect of sexual dissatisfaction on marital adjustment. Sexual satisfaction and marital adjustment can be strengthened by encouraging the development of anger control among individuals receiving hemodialysis treatment.\u003c/p\u003e","manuscriptTitle":"The Mediating Effect of Anger Control on the Relationship Between Sexual Satisfaction and Marital Adjustment in Individuals Receiving Hemodialysis Treatment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-23 01:00:52","doi":"10.21203/rs.3.rs-7484489/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7f791596-5470-42b9-ae81-301c37e64e58","owner":[],"postedDate":"September 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-29T22:24:06+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-23 01:00:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7484489","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7484489","identity":"rs-7484489","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}