Introduction
Domestic violence is a common public health problem worldwide, which includes child abuse, spousal abuse, and elder abuse [1]. Spousal abuse refers to any behavior that causes physical, sexual, or psychological harm to an intimate partner [2], and is the most common type of violence against women worldwide [1]. The World Health Organization (WHO) estimates that, globally, 1 in 3 women has experienced physical and/or sexual violence in their lifetime [3]. Although the official statistics of Iran do not mention the statistics of violence against women, the prevalence of IPV in Iran is in the range of 30-80% [4]. Spousal abuse has negative effects on the quality of life of women, including its effect on nutritional status, digestive problems, increase in blood pressure, unwanted pregnancy, depression and suicide, postpartum hemorrhage, postpartum depression, low birth weight, and premature delivery [5-10]. In various studies, various factors such as the age of the couples and their age difference [11], poverty, sexual problems, alcohol and drug addiction, gender of the child, lack of emotional interest in the spouse, psychiatric disorders, cultural and social differences, the number of children and the level of education [12، 13] and the personality traits of couples [14-16] have been considered effective in the occurrence of spousal abuse. Personality encompasses stable tendencies and characteristics that determine similarities and differences in thoughts, feelings, and actions of people that continue over time and cannot be considered as the sole result of social and biological pressures of the moment [17]. Existing studies show that the personality traits of neuroticism and extroversion significantly predict domestic violence against women [16،‌ 18-20]. However, in a study, no relationship between people’s personality traits and committing or accepting domestic violence was reported [21].
Although it is necessary to understand the pattern of interpersonal relationships and identify the personality traits of couples that cause domestic violence, no study has investigated the personality traits of couples (both husband and wife) in Iran. The existing studies have examined the personality traits of women as victims of domestic violence [16-20] or the personality traits of women and men who are not married [21، 22]. Considering that understanding the personality traits of couples may help experts develop an appropriate therapeutic approach to domestic violence [23], this study aims to determine the relationship between the personality traits of couples and spousal abuse in women of reproductive age in Iran.

Materials and Methods

Study design and samples
In this descriptive-analytical study with a cross-sectional design, the study population consists of women of reproductive age covered by health centers in Sari, Iran, and their husbands in 2022. The sample size was determined 170 pairs using G*Power software, version 3.1 based on the results of Oginyi et al. [15], who reported a correlation coefficient of 0.35 between neuroticism and psychological violence, and by considering a 99% confidence interval (α=0.01), a test power of 95% (β=0.01), and a 25% sample drop. Sampling was done from among the 22 health centers in three municipal regions of Sari City. In this regard, 3 health centers were selected from each region purposefully. Then, samples were selected according to the population of covered women aged 15-49 in each center. The women who met the entry criteria and had the registered data in the Parsa system were selected systematically. The sampling interval [27] was obtained by dividing the number of units in the study population (n=4564) by the number of desired samples (n=170). The first sample was selected by selecting a random number between 1 and 27. If a sample did not agree to the study, the next couple was included in the study, and the sampling continued by observing the interval between the units. The sampling was done after obtaining ethical approval from Mazandaran University of Medical Sciences from August to December 2022.
The inclusion criteria were willingness to participate in the study, Iranian citizenship, reading and writing literacy, being married, age 15-49, couples being monogamous and living together for at least one year. Exclusion criteria were pregnancy, menopause, infertility, having a history of mental illnesses that lead to drug use, and failure to answer more than 15% of the questions in the questionnaire. After the initial evaluation based on the entry and exit criteria in the Parsa system, a phone call was made to the eligible couples. While explaining the study objectives, they were asked to come to the center with their husbands if they agreed to participate in the study. Then, written informed consent was obtained from them, and they were asked to complete the questionnaires at home. They were assured that their information would remain confidential. The questionnaires take about 35-40 minutes to complete.

Instruments
The tools used in this study included a sociodemographic form (surveying age, duration of marriage, level of education, employment status, number of children, and gender of children), the spousal abuse questionnaire used in Ghahari et al.’s study [24], and Goldberg’s international personality item pool (IPIP).
The spousal abuse questionnaire has 44 items measuring emotional abuse (20 items), physical abuse (10 items), and sexual abuse (14 items) rated on a 4-point Likert scale as never (1 point), sometimes (2 points), often (3 points) and always (4 points). For its internal consistency, Cronbach’s α coefficient was 0.92, and the test re-test reliability coefficient was 0.98 [24].
The IPIP is a 50-item tool that measures five personality traits of neuroticism, openness to experience, conscientiousness, agreeableness, and extroversion based on a 5-point Likert scale from 1 (completely disagree) to 5 (completely agree). Higher scores indicate higher levels of the trait (except for neuroticism, where higher scores indicate lower neuroticism) [25]. The validity of this questionnaire varies from 0.36 to 0.80 [26]. Khormai et al., for the reliability of the Persian version of the IPIP tool, reported a Cronbach’s α from 0.77 to 0.88 [27].

​Data analysis
Data analysis was done in SPSS software, version 25. using descriptive statistics (Mean±SD, frequency, and percentage), t-test, chi-square test, and logistic regression analysis. The significance was set at 0.05. Variables with a significance level of <0.2 were included in the logistic regression model.

Results
Of 170 participants, only 156 returned the questionnaires complete (response rate: 91.7%). The mean age of women was 36.35±7.67 (ranged 20-49 years) and the mean age of men was 40.96±8.59 (ranged 22-65 years). The couples’ mean marriage length was 14.20±8.46 years, ranging from 1 to 35 years. Other characteristics of the participants are summarized in Table 1.



Most of the women suffered from a mild degree of spousal abuse. Among the mild types of spousal abuse, emotional abuse had the highest prevalence (76.3%). Among the moderate and severe types of spousal abuse, the highest prevalence was related to physical abuse (10.3% and 4.5%, respectively) (Table 2).



Based on the results of the multivariate logistic regression analysis, after controlling the effects of the confounding variables, the conscientiousness of spouses predicted emotional abuse (P=0.03, 95% CI, 0.78%, 0.98,% AOR=0.87). Agreeableness of spouses (P=0.01, 95% CI, 0.86%, 0.98%, AOR=0.91) and women’s neuroticism (P=0.04, 95% CI, 0.88%, 0.99%, AOR=0.94) predicted physical abuse. Neuroticism of women (P=0.03, 95% CI, 0.87%, 0.99%, AOR=0.93) and their husbands (P=0.03, 95% CI, 0.86%, 0.99%, AOR=0.93) predicted sexual violence. Among the demographic factors, husbands’ smoking (P=0.04, 95% CI, 5.41%, 1.01%, AOR=2.34) could predict physical abuse (Table 3).



Discussion
According to the findings of this study, among the types of spousal abuse (emotional, physical, sexual), emotional violence had the highest prevalence, which is consistent with other studies conducted in Sari, Lorestan, Ravansar, Kerman and Isfahan cities of Iran [21، 28-31]. One of the reasons for the high prevalence of emotional abuse, compared to physical abuse, maybe that physical abuse is more prevalent in couples referred to courts and counseling centers, and there are more strict laws about physical violence. On the other hand, today, most of men find physical violence against women distasteful and inappropriate, and women, to maintain their dignity and discipline, are less inclined to express and report physical violence [32]. In contrast to these findings, in a study in Khoi County [33] and also in Ardabil and Ravansar cities, the results showed that sexual abuse was the most common type of violence against women [29، 34]. Also, a study in Ahvaz City showed that physical abuse was the most common type of violence against women [35]. Emotional abuse in these studies is less reported, maybe because most of the abused women are not aware of their rights against spousal abuse, and sometimes they refrain from mentioning it due to the fear of dishonor.
In our study, smoking by the husband was a significant predictor of physical abuse against women (P=0.04), but drug abuse did not have a statistically significant relationship with the occurrence of spousal abuse. Contrary to our study, Saif Rabiei et al. reported a statistically significant relationship between emotional violence against women and drug addiction [36]. Also, in Salehi et al.’s study [37], drug addiction was introduced as a predictor of domestic violence against women by 9.9%. One of the possible reasons for this discrepancy can be the small number of samples who used drugs. In line with our study, Hajian et al. report a relationship between smoking by husband and physical abuse against women [5]. Other studies have also reported a statistically significant relationship between husband’s smoking and domestic violence [38-40]. However, studies such as the study by Manzouri et al. [41] did not find a relationship between husband’s smoking and domestic violence.
In our study, a significant relationship was found between conscientiousness of husbands and emotional violence against women (P=0.03); the men with a personality trait of conscientiousness are 97% less likely to commit emotional violence against their wives. Conscientiousness is associated with planning, responsibility, and self-discipline. People with high conscientiousness are meticulous and efficient, while people with low conscientiousness are spontaneous, careless, and irresponsible. It relates to how people control and regulate their emotions [42، 43]. Overall, people with have higher conscientiousness are expected to have more effective and appropriate behavior in different situations [44]. These people are organized, accurate, efficient, reliable and logical [45]. Consistent with our findings, Amini et al. [18], Motevaliyan et al. [19], and Yalch et al. [20] found a negative correlation between domestic violence against women and the personality trait of conscientiousness. Other studies did not show a significant relationship between them [21، 46، 47].
In the present study, the agreeableness personality trait of husbands was a significant predictor of physical violence against women (P=0.01); the men with the agreeableness trait are 99% less likely to commit physical violence against their wives. Agreeableness include having respect for others and being friendly. The people with this trait are cooperative, respectable, honest, and altruistic [48، 49]. People with high agreeableness trust and forgive more easily and are sometimes a bit simple. Low-agreeable people have hostile, suspicious, and competitive characteristics. Consistent with our findings, some studies found a negative correlation between domestic violence against women and agreeableness [19، 20، 50], while some studies reported no significant relationship between them [15، 16، 21].
In this study, the neuroticism personality trait of women was a predictor of physical abuse against them (P=0.04); the women with this personality trait are 96% more likely to experience physical violence by husbands. Neuroticism is related to a person’s ability to tolerate stressors. The main characteristic of neuroticism is the tendency to experience negative feelings and see the surrounding area as a threatening environment [51، 52]. Neuroticism is associated with anxiety, vulnerability, worry, and low self-confidence. People with high neuroticism are anxious and nervous, while people with low neuroticism (emotionally stable) are calm and relaxed [42، 43]. In fact, because of their high neuroticism, abused women show more impulsive behavior, hostility, anxiety, depression, and vulnerability, which leads to the aggravation of their problems [53]. Oginyi et al. [15], Ghahari et al. [9], Yalch et al. [20], and others [19، 21، 50، 53] also indicated a positive correlation between women’s neuroticism and experiencing physical violence.
Another finding of our study was that the personality trait of neuroticism in husbands predicted sexual abuse of women. In line with this result, studies have shown the existence of this relationship between neuroticism and domestic violence [15، 19، 20، 50، 53]. Clinical experts have diagnosed various emotional disorders such as social fear, depression, and hostility in neurotic people. Negative emotions prevent them from adaptation, and are more likely to have irrational beliefs; they are less able to control their impulses and cope with stress [54، 55]. Spouses with neuroticism have contradictions in feelings, beliefs, and behavior and cannot make a definite and appropriate decision. Due to the existence of such contradictions, they may suddenly become a vindictive liar, or while being kind and affectionate, suddenly become hard-hearted and start impulsive behaviors due to ignoring and not considering the future [56]. Conflict in behavior and personality, psychosomatic diseases such as shortness of breath, chronic indigestion, severe headaches, etc. can be signs of nervous problems, which lead to domestic violence [49]. A neurotic person has unrealistic feelings of superiority, which can be associated with creating tension and dominance [57].
Overall, it can be concluded that personality traits of couples can be considered as important predictors of spousal abuse. Since spousal abuse is the result of dysfunctional interaction between intimate partners, identification of their personality traits can be effective in reducing spousal violence. One of the strengths of our study was that it is the only study in Iran that investigated the personality traits of couples and their relationship with spousal abuse. Also, by using a systematic sampling method, we reduced the possibility of selection bias. However, there were some disadvantages in our study. We used the cross-sectional design, which makes it difficult to interpret the cause and effect of the relationships. The study samples were selected from the health centers; therefore, the results can only be generalized to women visiting health centers. The small sample size was another limitation. It is recommended to use a larger sample size in future studies to investigate the relationship between domestic violence and couples’ personality traits.

Ethical Considerations

Compliance with ethical guidelines
This study was approved by the Ethics Committee of Mazandaran University of Medical Sciences (Code: IR.MAZUMS.REC.1401.265).

Funding
This article was extracted from the master’s thesis of Farzaneh Rassaf, approved by Department of Reproductive Health and Midwifery, Faculty of Nursing and Midwifery. It was funded by the Deputy for Research and the Student Research Committee of Mazandaran University of Medical Sciences.

Authors' contributions
Statistical analysis: Fatemeh Hamidi, Mahmoud Mouszadeh and Zohra Shah Hosseini; design: Farzaneh Rassaf ; Initial draft preparation: Farzaneh Rassaf; final approval: All authors.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank the Deputy for Research of Mazandaran University of Medical Sciences for the financial support and all couples for their cooperation in this study.


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