The Effect of Remaining Unmarried on Self-Perception and Mental Health Status: A study of Palestinian Single Women

A triangulated design was used to investigate the influences of remaining unmarried on Palestinian women’s self-perception and mental health status. Three-hundred, never-married women between the ages of 25 and 50 years were selected using a convenience sampling technique. All these unmarried respondents filled in the Derogatis SCL.90-R (a self report measure of mental health symptomatology) by themselves. One hundred and sixty three participants of the 300 were successfully interviewed by means of a face-to-face, semi-structured, tape-recorded interviews with 15 open-ended questions. The SCL-90-R was analyzed using the Statistical Package for Social Sciences (SPSS) version 10, guided by Derogatis’s (1983) booklet guide. The 163 interviews were transcribed verbatim, typed on Microsoft Word and analyzed qualitatively using thematic and content analyses according to the guidelines of the phenomenological method. Descriptive statistics, Kruskall-Wallis Tests, Spearman Correlation Coefficients, and multiple regressions were uses to analyze the Derogatis SCL.90-R. A comparison of the major findings of the current study with the findings of relevant previous national and international research was presented. Analyses of the SCL-90-R indicated that unmarried Palestinian women in the current study have more psychological problems as represented through the 3 indices and 9 symptom dimensions of the SCL-90-R, than do Palestinian women in general, and more than the female normative group studied by Derogatis (1983). The findings indicated that about one-third of the respondents complained of moderate and above rates of psychological distress on the SCL-90-R’s ‘global severity index’ and the eight of the nine symptom dimensions. Being highly educated and being in employment were associated with better mental health among the unmarried respondents in the current study. The lower the educational level of the unmarried woman, the more emotional and psychological complaints she is likely to have. Unemployed and poorly educated participants were likely to have more psychological problems than employed and highly educated women. Other independent variables were significant under some circumstances, including family composition, place of living and the age of the participants. The analysis of the interviews indicated that there were multiple reasons for remaining single in the Palestinian society that included sociocultural, psychological, financial, familial, and personal factors. On the other hand, most of the respondents approved that marriage is better than singlehood despite its difficulties and excessive responsibilities. The majority of the respondents were harassed, restricted in living and movement, were censured by their families and society in general, which augmented their feeling of estrangement and alienation in their society. The respondents of the current study varied in their feelings and self-perception as a reaction to remaining unmarried. Some were proud, satisfied, and assertive about themselves, while the others had feelings of sadness, inferiority, worry, over-sensitivity, loneliness, insecurity, pessimism or uncertainty about their future and their families. Somatization, withdrawal, vi interpersonal difficulties, aggression, and escape mechanisms were common reactions and behaviours that were reported by the respondents. However, the feelings and reactions of the unmarried women to remaining unmarried were related to the manner in which they were treated by society and their families, and their own attitudes about remaining single. In terms of how they compared themselves to other women, there were no consistent findings as some respondents believed they were more fortunate or less fortunate than other women in their communities. Being educated, employed, independent, assertive and getting one’s family’s support and understanding had positive influence on the self-perception of the respondents in the current study. Despite the negative feelings that were reported by many respondents, very few had ever consulted a mental health professional or sought counseling. Special consideration should be given to the emotional needs and psychological problems of unmarried Palestinian women. This is a challenging area for mental health professionals and family health care providers. Implications were discussed in relation to mental health practice, social systems and social organizations, and further research with emphasis on gender in health care was recommended. This was the first study in Palestinian society that explored self- perception and the mental health state of the unmarried women. In addition, the present study could be the first study of its kind in Arab countries as far as the literature shows, which investigated "remaining unmarried after age 25" among women and focused on the state of their mental health

Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair

Importance Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors.Objective To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR.Design, Setting, and Participants The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR.Exposure Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia.Main Outcomes and Measures The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients.Results In total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72).Conclusions The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies