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 Table of Contents  
Year : 2022  |  Volume : 9  |  Issue : 2  |  Page : 140-145

The prevalence and related factors with demand or withdraw couples communication pattern

1 Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
2 Department of Reproductive Health and Midwifery, Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
3 Department of Medical-surgical Nursing, Nursing and Midwifery School of Amol, Mazandaran University of Medical Sciences, Sari, Iran
4 Department of Family Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
5 Department of Reproductive Health and Midwifery, Sexual and Reproductive Health Research Center; Department of Reproductive Health and Midwifery,Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran

Date of Submission18-May-2020
Date of Acceptance17-Feb-2021
Date of Web Publication10-Jun-2022

Correspondence Address:
Prof. Soghra Khani
Department of Reproductive Health and Midwifery, Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JNMS.JNMS_53_20

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Context: Many couples' problems are related to failure a successful relationship.
Aim: The aim of this study was to investigate the demand/withdraw communication pattern and its related factors between couples.
Setting and Design: This cross-sectional study was performed on couples in Sari, Iran, 2018.
Materials and Methods: This study was performed on 260 couples living in Sari who were selected through cluster sampling. Data were collected using a social-medical questionnaire, NEO Personality Inventory, General Health Questionnaire, Enrich couple scale, and couples Communication Patterns Questionnaire (CPQ).
Statistical Analysis Used: For data analysis, we used descriptive (mean standard deviation [SD]) and frequency and inferential statistics (simple and multiple regression model).
Results: The mean (SD) of women's age was 34.08 (7.71) years, whereas the mean (SD)and of men's age was 39.13 (9.18) years. Furthermore, 34.2% of women and 38.8% of men used the demand/withdraw communication pattern. The results of regression showed that the variables of flexibility (P = 0.036), conscientiousness (P = 0.011), and satisfaction of socioeconomic status (P = 0.038) were positively and current pregnancy (P = 0.005) and female marriage age (P = 0.019) were had negatively correlated with demand/ withdraw communication pattern in both women and men
Conclusion: According to the results, there was a relationship between couples' demand/withdraw communication pattern and demographic characteristics, marital satisfaction, and personality traits. Therefore, it is recommended that the factors related to couples' communication patterns to provide a solution to promote these patterns toward constructive communication pattern and take effective steps toward preventing marital conflicts for establishing a more efficient relationship.

Keywords: Couples, Communication, Pattern, Satisfaction, Sociological characteristics

How to cite this article:
Hasani-Moghadam S, Ganji J, Sharif Nia H, Aarabi M, Khani S. The prevalence and related factors with demand or withdraw couples communication pattern. J Nurs Midwifery Sci 2022;9:140-5

How to cite this URL:
Hasani-Moghadam S, Ganji J, Sharif Nia H, Aarabi M, Khani S. The prevalence and related factors with demand or withdraw couples communication pattern. J Nurs Midwifery Sci [serial online] 2022 [cited 2022 Jun 25];9:140-5. Available from: https://www.jnmsjournal.org/text.asp?2022/9/2/140/347153

  Introduction Top

Communication is a way to exchange message to achieve purposes of marriage.[1] Communication allows the couple to discuss and exchange information with each other and to understand the needs of each other.[2],[3] The purpose of a couple's relationship is to meet their needs.[4] That is why the most common problem raised by unhappy couples is the failure to establish a relationship that can lead to separation and divorce.[1] Divorce ratio are of the most valid indicators of marital disturbance.[1],[4] Divorce is one of the most significant concerns for the general public, which can affect the social, physical, and mental status of all family members and ultimately the health of the community.[5] Divorce reduces one's quality of life, advances disease progression and even accelerates the process of death.[6] According to statistics from the National Organization for Civil Registration, In Iran, 175,604 out of 608,416 marriages and in mazandarn province 7787 out of 20,755 marriages in 2018 resulted in divorce.[7] Among Iranian couples, the divorce rate is steadily rising, probably due to recent social and demographic changes, including greater urban migration and increased women's employment. The increasing divorce rate among young Iranian couples, in addition to family and social damages, has a negative impact on population growth in Iran.[2],[3]

The use of a defective communication pattern is one of the reasons for starting and increasing divorce. The defective communication patterns reduce correct understanding of couples, impede spouse support, prevent the effort to satisfy the needs of each other, prevent one another from understanding conflicting views, and eventually lead to marital problems and dissatisfaction. In contrast, healthy and productive communication patterns are among the most important factors of marital satisfaction. One of these defective patterns is the demand/withdrawal communication pattern, in which in this pattern, one of the couples tries to get involved in the relationship while the other withdraws. This pattern is in the form of a cycle in which increasing one element increases another. The exacerbation of this pattern leads to permanent marital problems[8],[9] and also to the negative and conflicting relationships that result in the inefficiency of the family system.[10] Limited studies have examined the demand/withdraw communication pattern and related factors. In one study, the demand/withdrawal pattern and reciprocal avoidance were associated with depression, substance abuse and violence.[11] The result of another study showed the demand/withdrawal pattern was correlated with the health of couples.[12] The result of another study also showed an association between demand/withdrawal pattern and depression.[13] In one study, the result showed There was a negative relationship between the demand/withdrawal pattern and marital adjustment.[14]

Given the limitation of a specific study investigating the demand/withdraw communication pattern and related factors, especially among couples in Mazandaran, and that the demand/withdraw communication pattern is more associated with marital conflict and divorce than other communication patterns,[15] the present study aimed to investigate the prevalence and related factors of demand/withdraw communication pattern.

  Materials and Methods Top

The present cross-sectional descriptive-analytic study was conducted on couples residing in the city of Sari in 2018. The project was approved by the Deputy of Research and the Ethics Committee of Mazandaran University of medical science (IR.MAZUMS.REC.1398.3077). Inclusion criteria were residence in the city of Sari, at least educational level of primary school, current living with spouse, and at least 1 year of marriage. Exclusion criteria included incomplete questionnaires more than 15%.[16]

In this study, 35 factors were measured. For each factor, 15 samples were considered. That was calculated to be 524 (262 couples) with respect to cluster sampling and taking into account the effect size of 1.5. The researcher started sampling after to select 262 couples (524 persons) in the city of Sari 27 clusters of 10 households were considered and the main cluster heads identified randomly in each region based on the population covered and the code of records available. Mailing addresses were obtained using the code of records. From this point, moving to the right, the households meeting the inclusion criteria were selected to reach 10 households per cluster. The objectives were fully explained to the study participants and participants signed a written consent form. They were assured about the confidentiality of the information and leave the study freely at any time. If they were not one of the couples, questioners must be in time, for questioning when both the wife and the spouse were present. For them, how to complete the questionnaires was explained. After checking the questionnaires to answer each question, they were taken from them.

In this study, the data collection tools were as follows:

Demographic profile-Fertility Questionnaire

This questionnaire was set at two sections: Demographic characteristics such as female age, and fertility information such as type of method of contraception, pregnancy, and menstruation history.

ENRICH Couple Scale

This questionnaire comprises of 35 items that used to assessment marital satisfaction. In David Elson's study, the Cronbach's alpha coefficient of the questionnaire for the subscales of marital satisfaction, communication, conflict resolution, and ideal distortion, were 86%, 80%, 84%, and 83%, respectively,[17] and in Daneshpour study in Iran, the Cronbach's alpha coefficient of the questionnaire for the subscales were obtained 68%, 78%, 62%, and 77%.[18] Scoring is based on the Likert scale. Each question is given a score of 1–5. Scores below 30 are considered as severe dissatisfaction, grades 30–40 as dissatisfaction and grades 40–60 as satisfaction and grades 60–70 as good satisfaction and scores above 70 as excellent satisfaction of the marital relationship between couples.

Christensen-Sullaway couples' communication pattern questionnaire

The purpose of this questionnaire is to evaluate the behavior of couples at a bilateral level and the relationship between spouses in three scales (a) mutual constructive communication pattern, (b) cross-avoidance communication pattern, and (c) demand/withdraw communication pattern. This questionnaire comprises of 35 items. In Christensen's study, the reliability of this questionnaire was reported as Cronbach's alpha coefficient for its subscales from 0.50 to 0.78.[19] In Iran, Ebadatpour standardized this questionnaire and in order to validate the questionnaire, the correlation between the scales of this questionnaire and the enrich questionnaire was calculated. The results showed that all scales of this questionnaire were correlated with Enrich Marital Satisfaction Questionnaire. The correlation coefficients for all 3 scales of the questionnaire, were 0.58 for mutual constructive communication pattern, −0.58 for cross-avoidance communication pattern and −0.35 for demand/withdraw communication pattern, respectively. All were significant at the alpha level of 0.01.[20] Scoring was such that each question was given a score of 1–9 based on the Likert scale. To determine the frequency of couples' demand/withdraw communication pattern, the cut-off point of this pattern was first obtained by calculating one-half of the difference between maximum and minimum scores. Then, a bivariate variable was constructed, so that code 0 was given to the score lower than the cut-off point, and code 1 was given to the score above the cut-off point, followed by calculating the frequency of these bivariate variables.

NEO personality inventory

This questionnaire comprises of 60 items. Costa and Mc care reported a Cronbach's alpha coefficient between 0.68 and 0.86.[21] In Iran, the validity and reliability of this questionnaire was performed by Grossi Farshi. In the standardization of NEO test, which was performed on a sample of 2000 students from Tabriz, Shiraz and medical universities of these two cities, the correlation coefficient of the 5 main dimensions was between 0.56 and 0.87. Cronbach's alpha coefficients in each of the main factors of irritability, extroversion, openness, adaptability, and conscientiousness were 0.86, 0.73, 0.56, 0.68, and 0.87 were obtained. In order to evaluate the content validity of this test, the correlation between the two forms of personal reports and the observer evaluation form was used, with a maximum correlation of 0.66 in the extraversion factor and a minimum of 0.45 in adjustment factor.[22] All 60 questions have 5 options that are scored by Likert method. Each question is assigned a score of zero to four, and the range of scores is between zero and 48 for each of the five dimensions.

Data were analyzed using SPSS Version 25 (Spss Inc, IBM Corporation, University in Chicago). software. First, the normality of the data distribution was evaluated by skewness-kurtosis test. Then, the data were described using descriptive statistics (frequency, mean [SD]). The relationship between factors associated with demand/withdraw communication pattern was investigated using simple linear regression and finally the factors with significant relationship were inserted into the multiple-regression model to determine the predictive variables of demand/withdraw communication pattern among the couples. Significant levels for all tests were considered <0.05.

  Results Top

In the present study, two couples were excluded due to incomplete questionnaires. Finally, 260 couples were enrolled in the study. The demographic characteristics of the study participants are shown in [Table 1]. In this study, all of data were normal.
Table 1: Demographic characteristics of couples

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In addition, the related factors and their relationship with demand/withdraw communication patterns in women and men are presented in [Table 2] and [Table 3]. The results of regression showed that the variables of flexibility (P = 0.036), conscientiousness (P = 0.011), and satisfaction of socioeconomic status (P = 0.038) were positively associated and current pregnancy (P = 0.005) and female marriage age (P = 0.019) had negative correlation with demand/withdraw communication pattern in couples that P values for each variable were the same in both women and men.
Table 2: Regression of factors related to demand/withdraw communication pattern in women

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Table 3: Regression of factors related to demand/withdraw communication pattern in men

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  Discussion Top

Suitable communication patterns significantly affect the life current, whereas improper communication can result in the separation of couples.

According to the results of the present research, 38.8% of men and 34.2% of women use the demand/withdraw communication patterns. Using the demand/withdraw communication pattern by couples could lead to decreased marital satisfaction (especially when there are a demander wife and a withdrawer husband) and might predict divorce.[23] In this respect, the more use of demand/withdraw communication pattern results in the lower level of marital compatibility.[14]

According to the results of the current study, there was a positive relationship between satisfaction with the socio-economic status and demand/withdraw communication pattern in men and women. In this respect results of studies showed that divorce rates increased with an increase in each couple's unemployment rate and financial problems,[24] and suitable socioeconomic status had a positive effect on the stability of marriage and resolving problems between couples through greater access to resources and facilities.[25],[26] But the results of a study showed that the effect of men's and women's incomes on marriage and divorce is different. In this study, the increased income of men had a positive and significant relationship with marriage stability and a negative association with divorce, women's income level decreased marriage stability while having no significant effect on divorce[27] and a sudden increase in household income, increased the possibility of divorce only in men.[28] This result can be justified by expressing that the higher the level of couples' satisfaction with socioeconomic status, the more the use of the demand/withdraw communication pattern. In other words, the improved economic status would increase spouses' expectations of each other, and in case of the presence of a demander husband and a withdrawer wife, the expectation of one of the two is not fulfilled, which can lead to problems between couples, as well as incompatibility and divorce. This could be justified by expressing that the employment of one of the spouses and their financial independence could increase the expectation level and withdrawing from the other spouse.

According to the results of the present study, there was a negative association between current pregnancy and demand/withdraw communication pattern in women and men. The results of two studies were indicative of increased marital intimacy (men) and pregnancy of women.[29],[30] This could be justified by expressing that spouses (men) attempt to provide a suitable condition for their wives in addition to understanding their feelings during pregnancy. Social support during pregnancy, especially when provided by the spouse, decreases anxiety in pregnant women and facilitates their pregnancy process.[31],[32],[33] Moreover, pregnancy decreases the level of using demand/withdraw communication patterns by couples, which results in decreased expectations of men from their pregnant wives and more attention to women's need for emotional support. These behaviors ultimately increase intimacy and improve marital life quality.[32]

In our study, there was a negative relationship between age at marriage of women and demand/withdraw communication pattern (in men and women). Result of two studies showed that marital satisfaction decreased by the increased age of women or the age of any of the spouses.[30],[31] This result could be justified by explaining that women's expectations decrease by increased age at marriage, which can result in fewer marital problems and conflicts.[25] Due to lack of physical, mental, and emotional preparedness, low age at marriage could lead to numerous problems and lower marital satisfaction.[33] It could be expressed that since people have not matured mentally, emotionally, culturally, socially, and economically, they lack most skills required to have a successful marriage and fail to play the role of a spouse. Therefore, they often face many conflicts and mutual incompatibilities in life. The necessity of achieving economic growth and job stability for men with regard to their responsibilities in providing family finances and housing in marriage and finishing the military service results in the preparedness of men for marriage at an age higher than women, which itself could decrease problems and increase marital satisfaction.

In the present study, there was a positive association between personality traits of flexibility and conscientiousness with demand/withdraw communication patterns. To justify these results, we used somehow similar studies in the field. The result of one study showed the personality dimensions of couples played a vital role in the establishment of marital conflicts. In addition, there was a significant difference between couples on the verge of divorce and normal couples regarding the traits of openness to experience and conscientiousness.[32] Moreover, there was a significant correlation between personality types and marital compatibility, so as that a significant, positive relationship was found between conscientiousness and flexibility with marital compatibility.[33] In 2011, the result of a study showed a positive relationship between the personality trait of conscientiousness and marital satisfaction.[34] Furthermore, another study demonstrated a significant, positive relationship between the personality traits of flexibility and conscientiousness with marital satisfaction. This result could be justified by expressing that people with these personality traits have a balanced level of expectations for each other to develop and maintain a successful relationship. In addition, they put more effort into their relationship to have a sense of honesty, cooperation, and trust in their marriage. In addition, it could be deduced that a lower level of marital satisfaction and marriage stability is observed in couples that less adhere to the personality trait of conscientiousness. Furthermore, if individuals are less conscientious, they will be more likely to develop destructive and antisocial behaviors.[34],[35]

One of limitations of study was the absence of men during interrogation. To solve this problem, the interviewers came with prior coordination during their stay at home. In addition, the interviewers were fully checked at the time of delivery and if questionnaires were incomplete, they were explained to the couples again, the questionnaires were completed at the same time and in case of his absence, at another time to receive the questionnaire was referred.

  Conclusion Top

This was a cross-sectional study performed to evaluate the demand/withdraw communication pattern and related factors in couples. According to the results, there was a relationship between couples' demand/withdraw communication pattern and some factors such as demographic characteristics (satisfaction of socioeconomic status, current pregnancy, and female marriage), marital satisfaction, and personality traits (flexibility, conscientiousness). Therefore, it is recommended that the factors related to couples' communication patterns to provide a solution to promote these patterns toward constructive communication pattern and take effective steps toward preventing marital conflicts while establishing a more efficient relationship.

Conflicts of interest

There are no conflicts of interest.

Authors' contributions

S. Hasani moghadam contributed with study conception, data collection, and drafting the manuscript. S. Khani supervised the study design and helped with conducting this study. J. Ganji, M. Aarabi and H. Sharif-Nia were the study advisor. All the authors critically evaluated the paper and provided the final draft.

Financial support and sponsorship

The Student Research Committee of Mazandaran University of Medical Sciences is also grateful for the financial support of this research.


This article was extracted from a master's thesis on counseling in midwifery with a code of 3077 and an ethical code of IR. MAZUMS.REC.1398.3077, approved at the vice-chancellor for research and technology of sexual and reproductive health research center, Mazandaran University of Medical Sciences. Hereby, we extend our gratitude to the vice-chancellor for research and technology and the Sexual and Reproductive Health Research Center, which funded the study, for assisting us in performing the research. andespecially Ms. Donya Nourani, who took the responsibility of the head of the interviewing team of students, as well as the student research committee.

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  [Table 1], [Table 2], [Table 3]


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