Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. The prevalence of this syndrome is about 5%-10% [1]. The hyperandrogenic symptoms of this syndrome, and the feeling of imperfection and failure that some of these patients have due to infertility can affect the quality of life [6] and self-satisfaction of these patients [7]. Most women with PCOS are overweight [9]. Various factors can affect the reduction of obesity, one of the most important of which is mindfulness [12]. 
Mindfulness teaches people to accept that thoughts and feelings exist instead of trying to control or suppress their negative thoughts [15]. Higher mindfulness is associated with lower body shaming and can affect the quality of life [17]. People who are more mindful are less likely to compare their bodies to others [18]. Recent studies have shown that mindfulness-based interventions can be beneficial along with routine medical procedures in women with PCOS. Therefore, before dealing with these interventions, it is necessary to find the related factors in different communities to design and formulate intervention and counseling programs according to them to achieve desired results. In this regard, this study aimed to determine relationship of mindfulness with hyperandrogenic symptoms and demographic and fertility factors in women with PCOS.

This is a descriptive correlational study conducted in 2018 on 181 women with PCOS referred to Firoozabadi and Firoozgar hospitals in Tehran, Iran who were selected by continuous sampling method. Data collection tool were 4 questionnaires including a demographic and fertility form, the modified Ferriman-Gallwey Scale for evaluating hirsutism [20], Ludwig Hair Loss Scale [21], and Mindfulness Attention Awareness Scale (MAAS) [22]. MAAS consisted of 15 items rated on a 6-point Likert scale from 1: Almost always to 6: Almost never. The total score ranges from 15 to 90, where higher scores indicate higher mindfulness. Data were analyzed using independent t-test, one-way ANOVA, Kruskal-Wallis test, Pearson correlation test and multiple linear regression analysis in SPSS v. 22 software. Significance level in all tests was considered as P<0.05.

The mean age of participants was 28.04±6.42 ranged from 18 to 46 years. 45.3% of them had a bachelor's degree or higher; 68.2% of married participants were infertile and 31.8% were fertile. The mean of MAAS score was 68.61±9.88. Among the demographic and fertility variables (age, duration of marriage, body mass index or BMI, education and occupation of wife and husband, economic status, satisfaction of husband with the body and appearance of wife, marital and fertility status, parity, history of abortion, drug use) and hyperandrogenic symptoms (acne, alopecia and hirsutism), only the variables of age, duration of marriage, BMI, wife’s education and occupation, economic status, and husband’s satisfaction with wife’s body and appearance had a statistically significant relationship with mindfulness. These variables were entered into the linear regression model by Enter method. The marriage duration variable remained in the model, which predicted 22% of the variance in overall mindfulness score.

In our study, the MAAS mean score of women was 68.61±9.88 which was higher than the median score (52.5). In various studies [24-26], the mean of MAAS score was lower than the median score compared to the present study, which may be related to the higher BMI of the subjects in their study compared to our study. In the present study, there was a significant negative relationship between mindfulness and age. This is against the results of some studies [27, 28] where the mindfulness of older adults was higher than that of younger adults [28]. This discrepancy may be due to the lower age of participants in our study and the increase in symptoms of PCOS with the increase of age. In our study, there was a significant negative relationship between marriage duration and mindfulness, which was consistent with the results of Raja-Khan et al. [25] and Daubenmier et al. [29]. 
Moreover, there was a significant negative relationship between mindfulness and BMI in our study. This is consistent with the results of Katterman et al. [19] and Dalen et al. [30]. In the present study, participants with unfavorable economic status had lower mindfulness score than those with a relatively favorable status, which was consistent with the results of Jensen et al. [32]. Our results showed that participants with very satisfied husbands had a higher mindfulness score than those with indifferent and unsatisfied husbands. This is consistent with results of Burpee et al. [33]. It has been reported that high mindfulness can increase marital satisfaction by improving marital attachment [34]. In our study, the mean MAAS score was not significantly different in terms of the severity of acne, alopecia and hirsutism, which was contrary to the results of Montgomery et al. This discrepancy may be due to the low number of participants in our study with moderate and severe symptoms of acne, alopecia and hirsutism.
In overall, mindfulness was related to age, education and occupation of wife, economic status, husband satisfaction with wife’s body and appearance, BMI, and duration of marriage. Among these variables, only marriage duration was able to predict mindfulness in women. The consideration of these related variables in preparation and development of counseling or educational programs along with other treatments for women with PCOS may lead to better results.

This study was obtained its ethical approval from the Ethics Committee of Iran University of Medical Sciences in Tehran, Iran (Code: IR.IUMS.FMD.REC1396.9413373004). The participants were asked to sign a written informed consent prior to study. They were completely informed of the study purpose and procedures, and were assured of the confidentiality of their information. 

The paper was extracted from the MSc. thesis of the first author, Department of Midwifery and Reproductive Health, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences. 

Conceptualization, methodology, investigation:, Seyedeh Batool Hasanpoor-Azghady, Roghayeh Arbabi Moghaddam, Leila Amiri Farahani; Data analysis: Shima Haghani; Data analysis and interpretation: Roghayeh Arbabi Moghaddam, Seyedeh Batool Hasanpoor-Azghady, and Shima Haghani; Writing, editing and review: Seyedeh Batool Hasanpoor-Azghady, Roghayeh Arbabi Moghaddam. 

The authors declared no conflict of interest.

The authors would like to thank to the Research Vice Chancellor of the Iran University of Educational Sciences as well as the staffs of Firoozabadi and Firoozgar hospitals and the participants who cooperated with the research team.
 

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