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1 Journal of Renewable Natural Resources Bhutan ISSN: The relationship between family function and the quality of life in people with MS and normal people. Alyeh Rafati*, Emad Yousefi MA in Psychology, Islamic Azad University, Kish International Branch, Iran Department of Psychology,Islamic Azad University, Qeshm Branch, Iran *Corresponding author's ABSTRACT At the recent study, aiming at examining the relation between family function and life quality in people with MS and normal people, a sample of 60 patients who came to vice-chancellor for treatment of Hormozgan University of Medical Sciences were selected as sample group. Participants completed the desired questionnaires including life quality questionnaire (WHOQOL-BREF), and family function assessment questionnaire (FAD-I). FINDINGS: a) A significant correlation between most components of family function and the life quality of patients with MS; b) a significant regression for life quality of patients with MS based on family function components, and predictability of.4 percent of variance of the quality of life of patients with MS based on family performance; c) the best predictors of the quality of life of patients with MS are expressing emotions and roles variables. Key Words: Family performance, life quality INTRODUCTION: MS is one of the diseases of the present century that unfortunately a large group of people are affected by it. What causes this disease is not yet known and various theories are presented by expatriates but a certain therapy hasn't presented yet. This disease is called autoimmune or viral, and there is no convincing cause for it. More surprisingly, they believe viral is one the reasons that causes the disease while it hasn't yet proved for them The disease has different signs and symptoms and also has a variety of effects and consequences. Retardation and finally disability, limitation in movements, stress, mental-emotional and neurological disorders, depression, and are among the important and major effects which can influence on social and individual life of these patients, and can isolate them. Social protection is interpersonal interactions between members of social networks which is in the form of bilateral and informal relations that are spontaneous and beneficial, and has two functional domains of perceived and structural social protection, and the size of social network. The perceive social protection reflects the individuals idea about presented protections, and the size of social network comes back to all people whom are known by individual or patient. Heydari (008) examined the issue," The relationship between perceived social protection and size of social network with life quality of patients with MS", aiming at to study effect and relations of social protection with life quality in patients with MS. MS is one of the most

2 stressful events of life that leaves negative effects on the quality of life and increases social protection. This study was done on a group of 0 patients who were confined to bed in Firooagar, Hazrat Rasool hospitals, and MS Institute of Imam Khomeini complex hospital, and were selected through continues sampling method. The results of this study present large information about the importance of perceived social protection to improve the quality of life of the patients, The disease changes the patient's life direction, creates lots of problems in all physical, mental, social, economical, and family aspects of their life, it leads to increased sense of dependency, dcrseaed self confidence, increased sense of vulnerability, confusion, pain, physical symptoms, and disorganized thought in those who have caught to the disease, it disrupts daily actions, social activities, and peace of mind, and instead creates new roles, and it makes patients to be more dependent to others and have less ability to protect others, and the patient cannot participate in normal social activities. All these problems with prolonged hospitalization, frequent visits to the doctor, different treatments, their side effects, and high cost of treatments lowers the quality of life the patients. The total results of the study show that, social protection is known as the strongest opposition forces for successful and easy confrontation at the time that patients are affected by MS and stressful conditions, and it can facilitate tolerance of the problems by patients, and through a mediate role between stressful factors of life and revealing physical and mental problems, and strengthening people recognition, it leads to decreased experienced tension, increased survival, and improved healthcare condition, and eventually increases the quality of life of people. Social protection has positive effect on economical, social, mental, and physical health of people; and it leads to improved quality of patients' life, to create good feeling towards life, better general assessment towards life, and better dealing with diseases. Protection and positive social relations have positive effects on physical and mental health of patients make it patients have less symptoms of disease. Perceived social protection is an important reliever domain for economical concerns. Social protection has also an important role relieving negative effects of the disease on psychological aspects of patients, and it is associated with experiencing less perturbation, feeling more control, improving self-confidence, reducing effects of negative evident on life, and improving quality of life. Adequate protection of patients' families improves the quality of life of family members and provides much better protection for patients and improved their quality of life. Family performance has a relation with mental health of individuals (Janani, 000). There is a relation between poor performance of family and children's caught by physical symptoms, anxiety, sleep disorders, depression, and disorders in social performance( Saadatmand, 1997). Family performances can be very different t, the main function of family should be meeting individual needs of family's members (Peikarestan, 001). Disorder in family function can encounter family system with problems, and consequently it disrupts health and development of family and influence on psychological health of its members (Miraza Jani, 007). Since psychological health and the quality of life has a significant relation with life quality ( Janani,0000), it is expected that increase or decrease in quality of life leads to change in family performance, hence, the recent study is seeking to identify that whether here is a relation between family function and quality of life of patients with MS and normal people? 971

3 METHODOLOGY The research method is correlation and casual comparative. STATISTICAL UNIVERSE AND SAMPLE The statistical universe of the study includes all patients affected by MS who came to vicechancellor for treatment of Hormozgan University of Medical Sciences. Because of the small population, the sample size was 60 participants, and the available sampling method was used. DATA COLLECTION TOOLS Quality of life questionnaire: This questionnaire is used for assessing the quality of life of individual during the past two weeks. The World Health Organization (WHO) in 1989 has created it in collaboration with 15 international centers. The number of questions is 4 questions in 4 areas, which the first questions do not belong to any of areas and generally assesses the health and quality of life in general. So, the questionnaire has totally 6 questions which has the following domains: The quality of life questionnaire has 4 following domains: a) Physical health domain b) Psychological domain c) Social relationship domain d) Environmental domain The execution procedure is self-report The Family Function Assessment Inventory (FAD-I): The family assessment scale that is based on theoretical method the theory of systems is intended to describe organizational and structural characteristics of families (Hamidi, 005). This model presents 6 dedicated and 1 public dimensions for family function, and measures interaction patterns between family members to distinguish between efficient and non-efficient functions (Bahari, 000). FINDINGS Table1. Mean, standard deviation, and correlation coefficients between family function components and quality of life of patients with MS Parameter Mean St.deviation variable 1.roles 85 / 1 / 1.solving problem 1 / 0 / 34 0 / 11 3.Expressing emotions 84 /1 0 / 85 0 / /41* 4.family performance 40 /0 / 8 0 /533** 0 / /0** 5. life 1 /14 1 / 5 0 /43** 0 / /41** 0 /315** quality

4 > 0/0. **P>0/00 *. *P00 N= According to table, there is a significant relation between roles, expressing emotions, and general function of family with quality of life of patients affected by MS (P<0.01), and this correlation is direct and positive, that is, the better and more is level of family function, the more will add to the quality of life of individuals, and vice versa. The results also show that, the correlation between components of solving problem and quality of life is not significant. Table. Mean st.deviation, and correlation coefficients between components of family function and the quality of life of normal people parameter mean St.deviation variable 1.roles 85 / 1 / 4.solving problem 1 /30 0 / 8 0 / expressing emotions 3 /10 / 51 0 /813** 0 /330** 4.general performance 13 /8 0 / 4 0 /55** 0 /810** 0 /514** of family 5. life quality 4 / 18 / 1 0 /41** 0 / 11 0 / /118* >0/0. **P>0/00 *. *P00 N= According to table, there is a significant relation between the quality of life of normal people and roles (P<0.01), and this correlation is direct and positive, that is the more and better is family function, the more will improve the quality of life of individuals, and vice versa. Also, there is a significant correlation between quality of life of normal people and general function of family (P<0.05). Table 3.Mean, standard deviation, and correlation coefficients between scores of family function and quality of life of individuals parameter Mean St.deviation variable 1.roles / 35 5 / 3.solving problem 45 /8 4 / 41 0 / 01 3.expressing emotions 00 / / 0 /5** 0 / 38 4.general function of 188 / 14 / 5 0 /15** 0 / /53** family 5.life quality 8 / 5 1 / 4 0 /301** 0 / 3 0 /481** 0 /311** 989

5 > 0/0. **P>0/00 *. *P00 N= According to table 3, there is a significant relation between roles and general function of families and the quality of life of individuals (P<0.01), and this correlation is direct and positive, that is the more and better is the family function, the more will improve the quality of life of individuals, and vice versa Table 4. The summary of step by step regression of family performance and its components on the quality of life of patients affected by MS Mode Variable Index SS D MS F P R R SE l F 1 Expressin regressio /54 54 /54 g n 54 / 5 /001 /41 /85 /1 emotions residue / / 4 3 Roles regressio / /44 1 n /00 /33 /113 / 5 /18 residue / / The results of the regression analysis of above table show that, the regression of life quality of patients with MS from family function component (roles, solving problems, and expressing emotions) is statistically significant and these components explain part of variance of life quality of patients with MS. On the other word, these results show that, the regression coefficients are significant and adequate evidences are available to confirm the hypothesis. On the other word, there is a significant relation between components of family function (roles, solving problems, and expressing emotions) and quality of life of patients affected by MS. These components eventually predict.4 percent of variance of the quality of life of patients with MS. Table5. Summary of statistical characteristics of stepwise regression of family function component on the quality of life of patients with MS Model Variable B SE B T P 1 Expressing emotion 0 / / 18 0 / 41 4 / 11 0 / 001 roles 0 / 14 0 / 1 0 / 1 1 / 1 0 / 04 As tables 4 and 5 show, the best predictors for the quality of life of patients affected by MS are variables of expressing emotions and roles, and the variable of solving problem was eliminated from the regression equation. According to these results, the observed F is significant (P<0.05), and percent variance related to the quality of life of patients affected by MS is explained by expressing emotions and roles. The regressions coefficients of predictive variable show that, expressing emotions (t=3.9, β=.397), and roles (t=.1, β=0.66) can significantly explain the variance of the quality of life of patients with MS.

6 Table6. The summery of the stepwise regression of family function and its components on the quality of life of normal people Model Index SS DF MS F P R R SE 1 regression 38 / 8 38 / 8 residue 51 / 85 / 3 1 /3 0 / / 41 0 / 33 0 / 53 The results of regression analysis in above table show that, the regression component of the quality of life of normal individuals from family function components ( Roles, solving problem, and expressing emotions ) are statistically significant., and these components explain part of the life quality variance of normal people. On the other word, there is a statistically significant relation between components of family function (roles, solving problems, and expressing emotions) and the quality of life of normal people. Table 7.The summery of statistical characteristics of stepwise regression of family function components on the quality of life of normal people Model Variable B SE B T P 1 roles 0 / 80 0 / 0 / 41 4 / 1 0 / 004 As is evident from tables (6) and (7), the best predictors for the quality of life of normal people are roles and the variables of expressing emotions and solving problem are eliminated from the regression equation. According to the results, The observed F is significant (P<0.05), and 14 percent of variance related to the quality of life of normal people is explained by roles. The regression coefficients of predictive variables show that, roles ( t=3.1, β=0.379) can significantly explain the variance of life quality of normal people. Table 8. The stepwise egression model of family function and its components on total quality of life ( in all individuals) Model Index SS DF MS F P R R SE 1 regression 483 / / 81 residue 585 / / 3 / 0 / 00 0 / / / 51 The results of regression analysis in above table show that, the regression of the subjects' quality of life component from family function components ( Roles, solving problems, and expressing emotions ) are statistically significant. And these components explain part of variance of quality life of subjects. On the other word, the results shows that the regression coefficients are significant and adequate evidence are available to confirm hypothesis. On the other word, the relation between family functions components ( roles, solving problem, and expressing emotions ) and the quality of life of subjects is statistically significant. Table 9. The summary of statistical characteristics of stepwise regression of family function on total life quality ( in all individuals)

7 Model Variable B SE B T P 1 roles 0 / / 1 0 / / 43 0 / 00 As tables 8and 9 show, the best predictor for the total quality of life (patients with MS and normal people) is role variable, and expressing emotions and solving problems variables are eliminated. According to these results, the observed F is significant (P<0.05), and 16 percent of variance related to the quality of life of patients with MS (patients with MS and normal people ) is explained by roles. The coefficients of predictive variables show that roles ( t=3.34, β=0.40) can significantly explain variance of total quality of life ( patients with MS and normal people). DISCUSSION AND CONCLUSION The results showed that, roles, expressing emotions, and general function of family has a significant correlation with the quality of life of patients with MS, and this correlation is positive and direct, that is, the more appropriate and better is family function, the more will improve the quality of life of subjects, and vice versa. The results also showed that, there is not s significant relation between solving problem component and the quality of life of patients with MS. The results also showed that, there is a significant correlation between roles, solving problem, expressing emotion, and general performance of family with life quality in all subjects and this correlation is positive and direct, that is, the more appropriate and better is the family function, the more will increase on the quality of life of subjects, and vice versa. These results are consistent with results of studies by Sehhat, (00); Mahmoodi,(008); David and Keisan,(007); Kim, (010); Milinger et.al, (006); Jaafari et.al,(006); Jamali Zavareh,(008). In potential explanation of significant relation between roles and quality of life we can say that, roles refer to behavioral repetitive patterns through which the family functions are performed. The roles also refer to the family members duties, how is the division of tasks between member, the power planning for fulfilling duties, explaining boundaries and creating rules in order to establish discipline at home ( Hamidi, 005), so it is expected that if any of the elements for roles are well run in family structure, and on the other word, if families that have a member caught he disease have a well performance in role construct, they can improve the quality of life which is applied for each person's understanding of his/her life in the framework of the culture and value system of the person and its relation with goals, expectations, standards, and priorities, that is, if family has a good performance in roles' construct and plays its protective role well, the patients with MS can have better self-understanding in the line with its life's activities, and find achievement to their goals much easier, that in turns leads to improved quality of life the person. It is clear that, the families' dysfunctional in roles construct can bring results that are on the contrary to the potential mentioned results. In explaining the significant relation of expressing emotions and the quality of life of patients with MS we can say that, since expressing emotions are applied for the emotional relationship between family member through awareness of the feelings of the others and expressing feelings to each other (Hamidi,005) so, it is expected that along with increased expressing emotions and emotional relationship and understanding the patients feelings and accepting them, it facilitates the patients' motive for further

8 treatment and finishing therapy procedure.hence, we can say, the family function in expressing emotions construct can improve the quality of life of patients with MS, and vice versa. In potential explanation of significant relation of family function with the quality of life of patients affected by MS we can say that, the family function is related to the family's power in coordination with changes, conflict resolution, the correlation between members, and success in enforcing disciplinary patterns, observing boundaries between people, carrying out the rules and principals governing the institutions aiming at protecting the whole family system (Jaafari, 006). So, it is expected that families which are a desirable level of these characteristics have the more effect on mental and physical health- which is the structural components of the quality of life. On the other hand, quality of life means feeling satisfied about achievements and relationships, peace of mind, having energy and enjoying joys of life, feeling valued, independent, effective adaptation, hope, feeling welfare and playing the roles that are important to a person (Miller, 000; quoted by Ranjbar, 006); therefore, the effective family function i.e. joint efforts of the family members for helping the person with MS and their ideal performance in every aspect of family function (roles, expressing emotions, and problem solving) can have the above-mentioned characteristics on quality of life for the person with MS and in other words will enhance quality of their life. Consistency of this state of family function in stages of diagnosis, during or after treatment, can probably lead to an increasing growth in quality of life. It is assumed that inconsistency or lack of the stated condition of family function would lead to decreasing or failing to enhance quality of life of the people with MS. On explanation of quality of life of the people with MS based on family function factors (roles, problem solving and expressing emotions) it was concluded that the best that the best predictors of quality of life as to those suffering from MS are two variables roles and expressing emotions, and problem solving variable was omitted from the Regression equation. On explanation of quality of life of ordinary people based on family function factors (roles, problem solving and expressing emotions), it was concluded that the best that predictor of quality of life as to ordinary people is the variable roles, and expressing emotions and problem solving variables were omitted from the Regression equation. On explanation of quality of life of all the subjects based on family function factors (roles, problem solving and expressing emotions), it was concluded that the best that the predictors of quality of life in general (as to those suffering from MS as well as ordinary people) is the variable roles, and expressing emotions and problem solving variables were omitted from the Regression equation. In order to explain predictability of quality of life based on roles structure, this finding can suggest that roles are in fact recommended and repeated behaviors existing in a category of mutual activities with other family members. (Steinhauer et al, 1984; quoted by Salari, 001). Therefore, it is expected that in case this structure (roles) is performed well, quality of life of family members will be enhanced because roles are accomplished as efficient as possible to consist of all the essential functions of the family, be divided fairly among the members, follow up the family members duties frequently to be fulfilled, and in case the family can t act well as to the factors associated with roles structure there would most probably be a decrease or failure in enhancing quality of life; because, the most inefficient

9 way of performing roles is when the family is not able to perform the essential family roles and is reconciled about assigning roles and the concerned responsibilities. This would lead low quality of life. Therefore, in families of people with MS during all the stages diagnosis, treatment, and post-treatment in case roles are effective with the characteristics mentioned, the people suffering from MS will live with a considerably high quality of life. On the other hand, in case we consider quality of life as an intellectual, dynamic, and multi-dimensional concept, i.e. total sum of one s satisfaction of his or her various life aspects (emotional, mental, physical, and social), effectiveness of roles structure can be associated with this dimensions and, in other words, can enhance quality of life of people with MS. In order to explain predictability of quality of life based on the structure of expressing emotions, it can be concluded that as per model of Felce and Perry (1995), quality of life includes emotions, mood, satisfaction, self-esteem development, respect, a feeling of personal welfare and being satisfied with a life dependent upon physical, mental and social needs; therefore, it can be suggested that emotional performance of a family can affect quality of life of every member in that family. On the other hand, emotional performance refers to emotional responsiveness of family in relationships. It discusses if a family can express any kind of different emotions and whether emotional responses of family is appropriate, in terms of quality and quantity, for conditions, and whether family can express any kind of feeling and emotion appropriate to the situation (Steinhauer et al, 1984; quoted by Salari, 001). Then, it is expected that effectiveness of the emotional dimension of family performance which is associated with timely, appropriate and suitable action of family members, can improve quality of life of a person with MS, because when a person with MS receives appropriate emotional reactions, the need for respect and self-esteem which are two of mental elements of quality of life will be highlighted as well, and the person with MS experiences better life satisfaction and quality of life. In this case, predictability of people with MS based on emotional dimension is not beyond expectation. Mahmoudi, gh. & Nassiri, E. (007). Evaluation of the mental health of my patients. MS in Mazandaran, Mazandaran University of Medical Sciences, Year XVIII, No. 68. Heidari, S. & Slhshvryan, A. (008). the relationship between perceived social support and social network size and quality of life of cancer patients, Volume XII, Issue. Kim,Y.(010).Quality of life of cancer survivors and their family caregivers.psychooncology.50, Malinger, J.B. Family;Grigges, J.J&SHilds,C.G.(00). communication and mental health after breast cancer. European Journal of Cancer Care. (4) 4, Felce, D. & Perry, J. (1995). Quality of life: It s definition and measurement. Research in Developmental Disabilities. 16( 1), Sa adatmand, A; (1970). A Study of Family Function Effects on Mental Health of the Children. Islamic Azad University of Roudehen. Mirzajani, Z. (007). Relationship Between Family Function and Identity Style in Third Grade Students in High Schools of Saveh County. MA Thesis, Shahid Beheshti University. Janani, K. (000). Family Function and Mental Health of Students of Boroujerd City. BA Thesis in Psychology, Teacher Training University.

10 Bahari, F. (000). Evaluation and Comparison of Family Performance Among Cases of Nondivorce Couples and Couples in Divorce Referred to Department of Psychiatry in Legal Medicine Organization of Iran. MA Thesis, Teacher Training University. Jafari, A.; Sadri, J.; Fathi Aghdam, Q. (006). Relationship Between Family Performance, Religiousness, and Mental Health and Comparison Among Male and Female Students. Journal of Counseling Research & Developments, Volume 6, N Jamali Zavareh, N. (008). Comparison of Relationship Between Family Function, and Mental health and Optimism in Students of Islamic Azad University of the City of Zavareh. MA Thesis, Shahid Beheshti University. Hamidi, F. (005). Study of Family Structure and Attachment Style in Runaway Girls and Effectiveness of Family Therapy and Supportive Therapy in Changing Them. Journal of Family Research, N. 1. Ranjbar, M. (006). Study of Relationship Between Quality of Life and Job Satisfaction in Employed Psychologists in Departments of Training Hospitals in the City of Tehran. MA Thesis, Alzahra University. Salari, R. (001). Comparison of Family Function in Healthy Adolescents with Depression. MA Thesis, University of Social Welfare and Rehabilitation Sciences. Peykarestan, A. (001). Comparison of Family Function in Families of Adolescent Runaway Girls and Families of Normal Adolescents. MA Thesis. Teacher Training University. 987

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