Evaluating the interrelationship of mindfulness, sexual relational concern, and health related behaviors on women’s life satisfaction through path analysis

Abstract

Background

Life satisfaction, a fundamental dimension of subjective well-being, exerts a positive influence on both physical and mental health outcomes. The present research aims to explicate the intricate interplay among mindfulness, sexual relational concerns, and health-related behaviors concerning women’s life satisfaction, employing a path analysis framework.

Methods

The current cross-sectional study, conducted between July and August 2024, involved a cohort of 250 Iranian women aged 18 to 45 years. Participants were selected based on predefined inclusion criteria. A team of five researchers designed and implemented the study. Data collection utilized a demographic-midwifery questionnaire, the Satisfaction with Life Scale (SWLS), the Freiburg Mindfulness Inventory (FMI), and the sexual relational concerns subscale of the Sexual Satisfaction Scale for Women (SSS-W). A convenience sampling method was employed to recruit participants. Statistical analyses, including univariate and multivariate linear regression, as well as path analysis, were performed using SPSS version 23 and AMOS version 22. For all analyses, statistical significance was determined at a threshold of P < 0.05.

Results

In the path analysis model, mindfulness showed significant effects on life satisfaction (β = 0.22, P < 0.001) and sexual relational concerns (β = −0.21, P < 0.001). While sexual relational concerns exhibited a negative association with life satisfaction, this relationship was not statistically significant (β = −0.11, P = 0.087). Smoking emerged as a salient predictor, demonstrating significant effects on both life satisfaction (β = −0.13, P = 0.031) and body mass index (BMI) (β = −0.14, P = 0.021). Notably, mindfulness presented as the most influential variable; a one-unit increase in mindfulness was associated with increases of 0.26 and 0.22 in life satisfaction in univariate and multivariate regression analyses, respectively (P < 0.001). Additionally, individual factors, including economic status, smoking habits, age, and the presence of chronic diseases, contributed to the prediction of life satisfaction in these analyses.

Conclusion

Mindfulness demonstrated a significant association with both life satisfaction and sexual relational concerns. Furthermore, a correlation was observed between smoking and both life satisfaction and BMI. These findings suggest that interventions targeting mindfulness and health-promoting behaviors may be beneficial in enhancing life satisfaction and addressing relational challenges among women of reproductive age.

Highlights

Mindfulness contributes to greater life satisfaction and decreases sexual relational concerns.

Smoking is associated with lower BMI and decreased life satisfaction.

Individuals with better mental health tend to experience higher life satisfaction.

Background

Life satisfaction, a central construct within subjective well-being [1], is frequently conceptualized as being synonymous with happiness and quality of life [2], and it exerts a positive effect on both physical and mental health [3]. It is formed by biological factors, such as an individual’s physical condition, as well as socio-psychological elements, including social ties and psychological requirements [4]. Salient factors affecting life satisfaction encompass an individual’s income satisfaction [5], occupational status [6] age [7], chronic illnesses [8], mindfulness [9], and anxiety within interpersonal connections [10]. Considering the heterogeneity of life satisfaction across individuals and varied settings, its analysis is pertinent in diverse contexts [5], notably among women during their reproductive age, substantially affecting their own health, the well-being of their offspring, and societal outcomes via their behaviors and emotional states.

Mindfulness is an increasingly acknowledged practice with salutary effects on both physical and mental well-being [11]. Contemporary research indicates that interventions employing mindfulness techniques demonstrate efficacy in mitigating psychological issues, such as depression and anxiety, thereby contributing to an enhanced overall quality of life [12]. Through its influence on neural mechanisms and responses to stressors, mindfulness has been shown to reduce the prevalence and intensity of anxiety, depressive symptoms, and perceived stress levels [13, 14]. Mindfulness may contribute to enhanced mental health through the promotion of cognitive flexibility, self-management skills, emotional regulation capacities, self-compassion, and personal clarification [15]. However, the precise underlying mechanisms by which mindfulness remain to be fully elucidated, and a comprehensive theoretical framework that accounts for mindfulness and its related meditative practices is yet to be definitively established [16]. Higher mindfulness correlates with enhanced mental health, improved physical health, greater life satisfaction [9, 11], more robust self-care practices, more satisfying interpersonal relationships, and healthier physiological responses to stress [17]. Furthermore, brief interventions employing mindfulness meditation have demonstrated an increase in self-reported life satisfaction immediately following the exercise [18].

Interpersonal relationships significantly affect different life domains, encompassing physical and mental health, as well as mortality rates. The presence of distress within intimate relationships elevates an individual’s susceptibility in these domains [19]. Notably, a positive correlation exists between heightened anxiety experienced in interpersonal relationships and diminished life satisfaction [10]. Conversely, elevated life satisfaction is associated with positive psychological states and a reduction in both anxiety and stress levels [2]. Sexual relational concerns/anxiety in women — arising from their spousal relationships, specifically those pertaining to their husbands’ fidelity [20] — can culminate in psychosexual difficulties. These difficulties can manifest as sexual dysfunction, a compromised body image, and diminished sexual gratification [21]. Empirical evidence from a study indicates that relational concern and sexual worries are major predictive factors of marital satisfaction among infertile women [22]. An alternative perspective suggests that cultivating mindfulness within couples has the potential to enhance relationship satisfaction and foster greater partner acceptance, concurrently mitigating relational stress [23]. Consequently, the dynamic interplay among mindfulness, interpersonal relationship concerns, and, as specifically examined in this study, sexual relational concerns, regarding life satisfaction, appears to be a complex phenomenon warranting further empirical investigation. Although prior studies have frequently emphasized the association between sexual variables and marital satisfaction [4], the integrated influence of mindfulness, relational concerns, and health-related lifestyle choices on life satisfaction among women of reproductive years has received limited scholarly attention. This relative neglect results in lacunae within our comprehension of the synergistic effects of these determinants on overall life satisfaction.

Health-related behaviors exert a considerable influence on life satisfaction, as evidenced by factors such as body mass index (BMI) [24] and smoking status [25]. A study conducted by Karyani et al. (2019) on a sample of 600 Iranian individuals [24] revealed a robust correlation among health-related quality of life, BMI, the presence of chronic diseases, and overall health status with individuals’ reported life satisfaction. Individuals with diminished life satisfaction and reduced social support exhibited a higher propensity for smoking [26]; however, it is noteworthy that certain investigations have failed to establish a statistically significant correlation between smoking behavior and life satisfaction [27]. The empirical evidence concerning the association between smoking and BMI presents inconsistencies. While some research suggests a positive correlation, indicating a link between obesity and smoking [28], other studies, particularly focusing on female populations, have demonstrated an inverse relationship, suggesting an association between thinness and smoking [29].

This study used path analysis modeling in women of reproductive age to clarify the relationships among mindfulness, sexual relational concerns, health behaviors, and life satisfaction, given existing contradictions and gaps. Regression analysis further examined individual and obstetric variables to comprehensively understand factors influencing life satisfaction in this population, who are at the peak of social and family engagement. This study aims to clarify the interrelationship of mindfulness, sexual relational concern, and health-related behaviors in relation to women’s life satisfaction through a path analysis model. This study hypothesizes that mindfulness reduces sexual anxiety, thereby increasing life satisfaction in women. It also explores the positive impact of health-related behaviors on their life satisfaction. The findings will expand current understanding and offer models for improving women’s life satisfaction, contributing to improved mental, individual, and social well-being.

Methods

Study design

This cross-sectional study took place at women’s clinics affiliated with Babol University of Medical Sciences, where gynecologists, midwives, and students offer diagnostic and therapeutic services to women of reproductive age. We selected patients visiting these clinics for participation. Data collection occurred in July and August 2024 using a convenience sample based on specified inclusion criteria.

Sample size and sampling

The sample size for this research was determined through a review of prior research [30] that explored the relationships among the variables of interest. To ensure the acquisition of the maximum sample size, the lowest reported standardized coefficient (β = 0.29) was employed. Employing a confidence level of 95% and a statistical power of 95%, the GPower version 3 software indicated a minimum requirement of 58 participants for the initial phase of the study. However, to adequately control for potential confounding influences within the planned multivariate regression analysis (which incorporates 10 variables), a total sample size of at least 250 participants was deemed necessary for the present research.

Participants

A study population comprising women aged 18 to 45 years, residing in Babol, Iran, was recruited for participation. The defined inclusion criteria mandated that participants be married, be literate, report the absence of any adverse health events within the past 6 months, and have no documented history of sexually transmitted infections in either partner or any mental health disorders. The sole exclusion criterion was the non-completion of a minimum of 10% of the questionnaire [31].

Facilities and equipment

We invited women of reproductive age from selected clinics to complete questionnaires on demographics, midwifery, life satisfaction, mindfulness, and sexual relational concerns. All responses were self-reported in a relaxed environment. The demographic-midwifery questionnaire covered age, husband’s age, BMI, education, occupation, residence, economic status, marriage duration, marriage type, number of marriages, smoking habits, chronic diseases (including diabetes, hypertension, hypothyroidism, rheumatoid arthritis, joint and back issues, ovarian insufficiency, and cardiovascular problems), psychiatric history, number of children, history of abortion and infertility, pain during intercourse, urinary incontinence, menstrual regularity, contraceptive methods, and history of unintended pregnancy.

The Satisfaction with Life Scale (SWLS), designed by Diener et al. (1985), serves as an instrument to assess an individual’s overall evaluation of their life satisfaction. While its initial formulation comprised 48 items distributed across three distinct factors, subsequent empirical studies have substantiated its effective reduction to a concise set of five items. Participants respond to each item using a 7-point Likert-type scale, ranging from 1 (strongly disagree) to 7 (strongly agree). The total scores obtained from the scale range from 5 to 35, with lower scores indicative of diminished life satisfaction. Empirical evidence corroborates the scale’s validity. Specifically, Bayani et al. (2007) reported a Cronbach’s alpha coefficient of 0.83 and a test-retest reliability coefficient of 0.69. Furthermore, convergent validity was demonstrated through significant positive correlations with scores on the Oxford Happiness Inventory and significant negative correlations with scores on the Beck Depression Inventory (BDI). These psychometric properties suggest that this scale represents a valuable instrument for psychological research conducted within the Iranian context [32].

The Freiburg Mindfulness Scale Short-Form (FMI-SF), a 14-item self-report instrument developed by Wallach et al. (2004) for application within the general population, exhibits robust semantic validity, with a Cronbach’s α coefficient of 0.86 [33]. Participants respond to each item using a 4-point Likert-type scale, with response options ranging from 1 (rarely) to 4 (almost always); notably, item 13 is reverse-scored. The total score on the FMI-SE can range from 14 to 56, with elevated scores indicative of greater mindfulness. In 2015, Ghasemi Jobaneh et al. evaluated the validity and reliability of the FMI using a sample of 400 Iranian university students. Participants completed the FMI along with measures assessing “emotion regulation” and “self-control.” The short form of the scale demonstrated robust reliability, evidenced by a retest reliability coefficient, a Cronbach’s alpha of 0.92, and an ordinal theta of 0.93. Furthermore, a subset of 60 participants exhibited a test-retest reliability coefficient of 0.83 over a four-week interval. These findings provide strong support for the reliability and validity of this questionnaire within the Iranian population [34].

The Sexual Relational Concerns Scale constitutes one of the five dimensions of the 30-item Sexual Satisfaction Scale for Women (SSS-W), developed and validated by Maston and Trapnell (2005). The SSS-W demonstrates an overall Cronbach’s alpha coefficient of 0.94, while the relational concerns subscale exhibits a Cronbach’s alpha of 0.88. Notably, the highest test-retest reliability (r = 0.80) belonged to the relational concerns domain, particularly among women experiencing sexual dysfunction. Participants respond to items using a 5-point Likert scale, and the total score for the scale is derived by summing the scores of the individual items. This dimension ranges from a minimum score of 6 to a maximum of 30, with elevated scores denoting greater relational concerns. Roshan Chesley et al. (2014) evaluated the validity and reliability of the Persian version of this scale. Their analysis supported the five-factor model, as evidenced by a root mean square error of approximation (RMSEA) of 0.08, and overall Cronbach’s alpha coefficient of 0.96, with individual dimensions ranging from 0.82 to 0.91. Furthermore, test-retest reliability coefficients for the total score and its subscales varied between 0.73 and 0.97 [35]. The present research places particular emphasis on this dimension because of its established importance in the context of sexual satisfaction and the consequent necessity for precise sample responses.

Statistical analysis

Following data collection, descriptive patient information was analyzed using statistical indicators for both quantitative variables—assuming normality through mean and standard deviation—and qualitative variables through frequency percentages. To predict life satisfaction, univariate and multivariate linear regression analyses were conducted, incorporating all study variables to account for confounding factors. Regression coefficients and their 95% confidence intervals were reported. Additionally, path analysis evaluated the relationship between mindfulness and life satisfaction, mediated by sexual relational concern. The assessment of the path model included chi-square statistics, degrees of freedom, the comparative fit index (CFI), and the root mean square error of approximation (RMSEA). Analyses were conducted using SPSS version 23 and AMOS version 22, with a significance level set at (P < 0.05).

Results

Data from 250 reproductive-age women were analyzed. The mean age was 35.07 (SD 7.14), and the mean BMI was 27.73 (SD 5.12). Fourteen women (5.6%) reported being married twice, 77 (31%) experienced pain during intercourse, and 81 (32%) had a history of miscarriage. The demographic and obstetric characteristics are detailed in Tables 1 and 2. The mean total life satisfaction score was 22.62 (SD 6.86), while the mean scores for relational concerns and mindfulness were 14.47 (SD 6.06) and 35.75 (SD 6.17), respectively (Table 3).

Table 1.

Demographic characteristics among reproductive-age women attending clinics at hospitals affiliated with Babol University of Medical Sciences

Variables		Mean ± SD
Age (in year)		35.07 ± 7.14
Husband’s age (in year)		40.03 ± 7.71
BMI (kg/m2)		27.73 ± 5.12
Length of marriage (in year)		13.72 ± 7.56
Variables	Items	Frequency (%)
Education	Under diploma Diploma University education	73 (29.2) 104 (41.6) 73 (29.2)
Residence	Village City	106 (42.4) 144 (57.6)
Job	Unemployed Employed	188 (75.2) 62 (24.8)
Number of marriages	once twice	236 (94.4) 14 (5.6)
Type of marriage	traditional modern	203 (81.2) 47 (18.8)
Economic situation	weak average good and great	28 (11.2) 153 (61.2) 69 (27.6)
Smoking	No Yes	229 (91.6) 21 (8.4)
underlying disease	No Yes	130 (52.0) 120 (48.0)
Number of underlying diseases	no disease one disease Two or more diseases	130 (52.0) 96 (38.4) 24 (9.6)
A history of psychiatric disease	No Yes	242 (96.8) 8 (3.2)

Table 2.

Obstetric characteristics among reproductive-age women attending clinics at hospitals affiliated with Babol University of Medical Sciences

Variables	Items	Frequency (%)
Number of children	Childless Just one child two children Three children and more	49 (19.6) 86 (34.4) 102 (40.8) 13 (5.2)
History of infertility	No Yes	227 (90.8) 23 (9.2)
Contraception method	Withdrawal Condom Oral contraception IUD	195 (78.0) 28 (11.2) 15 (6.0) 12 (4.8)
Regular menstruation	No Yes	73 (29.2) 177 (70.8)
unwanted pregnancy	No Yes	179 (71.6) 71 (28.4)
Abortion	No Yes	169 (67.6) 81 (32.4)
Urinary incontinence	No Yes	223 (89.2) 27 (10.8)
Dyspareunia	No Yes	173 (69.2) 77 (30.8)

Table 3.

Descriptive indices of key variables among reproductive-age women attending clinics at hospitals affiliated with Babol University of Medical Sciences

Variables	Total Mean	Standard Deviation	Minimum-Maximum
life satisfaction	22.62	6.86	7–35
Relational concern	14.47	6.06	6–30
Mindfulness	35.75	6.17	21–54

Univariate and multivariate linear regression analyses (Tables 4 and 5) identified mindfulness, economic status, and smoking as key independent determinants of life satisfaction. Higher mindfulness scores in women correlated with increased life satisfaction, showing an increase of 0.26 points in univariate and 0.22 points in multivariate analyses for each unit increase in mindfulness (P < 0.05). Better economic status also correlated with higher life satisfaction; each unit increase in economic status led to a 4.58-point increase in univariate analysis and 3.90 points in multivariate analysis (P < 0.05). Conversely, smoking negatively impacted life satisfaction, decreasing scores by 3.58 points in univariate and 3.80 points in multivariate analyses (P < 0.05).

Table 4.

Univariate regression analysis of the relationship between life satisfaction, mindfulness, relational concern, and women’s characteristics

Variables	β (SE)	Beta	95% (CI)	P
Mindfulness	0.26 (0.06)	0.24	0.13 to 0.40	< 0.001
Relational concern	-0.14 (0.07)	-0.13	-0.28 to -0.007	0.039
Age	-0.14 (0.06)	-0.15	-0.26 to -0.02	0.015
Husband’s age	-0.07 (0.05)	-0.08	-0.18 to 0.03	0.171
BMI	0.15 (0.08)	0.11	-0.009 to 0.32	0.064
Education (under diploma/ diploma/ University education)	0.66 (0.56)	0.07	-0.45 to 1.78	0.243
Economic situation (weak/ average/ good and great)	4.58 (0.66)	0.40	3.27 to 5.88	< 0.001
Length of marriage	-0.08 (0.05)	-0.09	-0.20 to 0.02	0.125
Type of marriage (traditional/ modern)	1.02 (1.11)	0.05	-1.16 to 3.02	0.358
History of infertility (no/yes)	-1.68 (1.50)	-0.071	-4.64 to 1.27	0.263
Abortion (no/yes)	-1.67 (0.92)	-0.11	-3.49 to 0.14	0.070
Unwanted Pregnancy	− 0.70 (0.96)	-0.04	-2.60 to 1.19	0.466
Urinary incontinence (no/yes)	-1.52 (1.39)	-0.06	-4.27 to 1.23	0.278
Dyspareunia (no/yes)	-0.89 (0.94)	-0.06	-2.74 to 0.96	0.345
Smoking (no/yes)	-3.58 (1.55)	-0.14	-6.64 to -0.52	0.022
underlying disease (no/yes)	-2.27 (0.85)	-0.16	-3.96 to -0.58	0.009
Number of underlying diseases	-1.43 (0.54)	-0.16	-2.50 to -0.36	0.009

Table 5.

The correlation between life satisfaction and mindfulness, as well as relational anxiety, considering all variables in the multivariate regression analysis

Variables	β (SE)	Beta	95% (CI)	P
Mindfulness	0.22 (0.06)	0.20	0.10 to 0.35	< 0.001
Relational Concern	-0.04 (0.06)	-0.03	-0.17 to 0.08	0.519
Age	-0.11 (0.10)	-0.12	-0.32 to 0.08	0.256
Husband’s age	0.07 (0.09)	0.08	-0.10 to 0.26	0.400
BMI	0.15 (0.08)	0.11	-0.006 to 0.30	0.060
Education (under diploma/ diploma/ University education)	-0.31 (0.55)	-0.35	-1.40 to 0.78	0.572
Economic situation (weak/ average/ good and great)	3.90 (0.66)	0.34	2.60 to 5.21	< 0.001
Length of marriage	-0.06 (0.07)	-0.06	-0.21 to 0.09	0.429
History of infertility (no/yes)	-1.87 (1.37)	-0.07	-4.5 to 0.82	0.173
Abortion (no/yes)	-0.91 (0.84)	-0.06	-2.5 to 0.74	0.280
Urinary incontinence (no/yes)	-0.36 (1.28)	-0.01	-2.90 to 2.16	0.775
Smoking (no/yes)	-3.80 (1.49)	-0.15	-6.75 to -0.86	0.012
underlying disease (no/yes)	-1.38 (1.36)	-0.10	-4.07 to 1.30	0.311
Number of underlying diseases	-0.36 (0.85)	-0.04	-2.05 to 1.32	0.671

Adjusted for age, husband’s age, BMI, education, economic situation, length of marriage, history of infertility, abortion, urinary incontinence, dyspareunia, smoking, underlying disease, number of underlying diseases, mindfulness and relational concern

Several variables were significant only in univariate linear regression analysis, including Sexual relational concern, age, chronic disease, and the number of chronic diseases. The study found that Sexual relational concern was inversely related to life satisfaction, with a 0.14-point decrease in women’s life satisfaction for each unit increase in the concern score (p < 0.05). Although this variable did not achieve significance in multivariate analysis, its increase was still linked to lower life satisfaction. Additionally, increasing age negatively affected life satisfaction, with each additional year leading to a 0.14-point decrease. Furthermore, the presence of chronic disease was associated with a 2.27-point reduction in life satisfaction among reproductive-age women compared to those without any of the chronic diseases studied (p < 0.05). Each additional chronic disease resulted in a further 1.43-point decrease in life satisfaction (p < 0.05). To ensure the validity of the multivariate regression results, multicollinearity diagnostics were performed. The Variance Inflation Factor (VIF) values for all predictors ranged from 1.12 to 2.08, and Tolerance values were all above 0.47. These findings fall well within acceptable thresholds (VIF < 5; Tolerance > 0.2), indicating no serious multicollinearity among the independent variables included in the model.

The path analysis model in Fig. 1 illustrates that mindfulness influences life satisfaction, mediated by sexual relational concern, with smoking and BMI as additional variables. The model demonstrated strong indicators, with a Chi-square value of 0.004 and an insignificant significance level (p = 0.952). The CFI index was 1.000, Chi-square degrees of freedom at 0.004, and RMSEA at 0.002. Among the main variables, mindfulness had the strongest effect on life satisfaction (β = 0.22, P < 0.001), followed by mindfulness affecting relational concern (β = -0.21, P < 0.001). The weakest link was sexual relational concern’s impact on life satisfaction (β = -0.11, P = 0.087). Notably, smoking significantly affected BMI (β = -0.14, P = 0.021) and life satisfaction (β = -0.13, P = 0.031). However, the effects of BMI on relational concern (β = 0.11, P = 0.088), life satisfaction (β = 0.11, P = 0.071), and smoking on relational concern (β = 0.06, P = 0.367) and mindfulness (β = -0.02, P = 0.720) were not statistically significant.

Fig. 1.

The impact of standard correlation coefficients of mindfulness on life satisfaction, mediated by relational anxiety, while accounting for smoking and body mass index in the path analysis model

Discussion

The current research employed a path analysis framework to delineate the intricate associations among mindfulness, sexual relational concerns, and health-related behaviors concerning women’s life satisfaction. The findings of this study revealed a statistically significant and direct relationship between mindfulness and life satisfaction. Conversely, a direct and inverse correlation was observed between smoking and life satisfaction. Notably, mindfulness was found to significantly reduce sexual relational concerns; however, the latter did not function as a mediator in the relationship between mindfulness and life satisfaction. Moreover, the study demonstrated that demographic variables, including age, economic status, and chronic illnesses, were significant predictors of women’s life satisfaction.

Mindfulness- Sexual Relational Concerns -Life Satisfaction

This study identified mindfulness as a significant predictor of life satisfaction, a finding consistent with prior studies [9, 36]. As a cognitive skill, mindfulness cultivates a nonjudgmental awareness of present experiences, encompassing thoughts, emotions, and physiological sensations [37]. This implies that individuals exhibiting higher levels of mindfulness possess an enhanced capacity to effectively manage stress, adapt to unforeseen circumstances, and navigate interpersonal dynamics, thereby contributing to greater life satisfaction. Moreover, the practice of mindfulness has been shown to significantly mitigate sexual relational concerns. The construct in question demonstrates a positive correlation not solely with enhanced life satisfaction but also with reduced sexual relational concerns. Interventions predicated on mindfulness are receiving increasing scholarly attention to resolve issues related to sexual dysfunction [38]. Contemporary empirical data suggests that these interventions yield positive outcomes in mitigating mental health adversities, such as depression and anxiety, while concurrently improving overall quality of life [12]. Furthermore, a separate study established a significant association between heightened mindfulness and decreased sexual distress, alongside elevated self-reported sexual performance in female participants [17]. The outcomes observed in the current research corroborate these prior empirical findings.

The current research also posited that sexual relational concerns act as a mediator in the association between mindfulness and life satisfaction. The findings demonstrated that sexual relational concerns exerted a negative influence on life satisfaction; however, this effect was not statistically significance.

The observed outcome implies a multifaceted and intricate interaction among the investigated variables. More precisely, the relationship between sexual relational concerns and life satisfaction is potentially modulated by factors like lifestyle choices, mental health, and sociocultural norms, which were not incorporated into the current model. The primary focus of this study was the examination of the interrelationships among mindfulness, sexual relational concerns, health-related behaviors, and life satisfaction. While the current study did not yield a statistically significant association between sexual relational concerns and life satisfaction, a discernible trend indicated that elevated levels of sexual relational concerns correlated with diminished life satisfaction. Consequently, this inverse relationship, despite the lack of statistical significance, merits rigorous further inquiry. These findings hold potential clinical relevance within therapeutic contexts and should be of interest to practitioners, therapists, and scholars engaged in this domain of research. This suggests that the proximity of the p-value to the significance level possibly implies the real-world relevance of this relationship, thereby necessitating further inquiry in subsequent research endeavors. The observed inverse correlation between concerns and life satisfaction aligns with prior empirical evidence. To illustrate, while a limited number of studies have focused on the interplay between sexual variables and life satisfaction [4], a substantial body of work has examined the associations between sexual and marital quality [39, 40]. Elevated sexual distress has been shown to induce a substantial reduction in the quality of sexual life experienced by infertile women [41]. Contemporary research has elucidated the role of anxiety as a mediator influencing the relationship between quality of life and sexual satisfaction [42]. Furthermore, studies have demonstrated a negative association between interpersonal relationship anxiety and life satisfaction in both males and females [10]. The divergent results observed in the present study imply that the impact of sexual relational may be modulated by additional variables, encompassing individual capacities and sociocultural contexts that are interwoven with relational concerns. An alternative perspective posits the primacy of mindfulness in navigating ephemeral sexual relational concerns, thereby advocating for the cultivation of mindfulness-based skills as a means to improve life satisfaction and diminish the burden associated with sexual relational concerns.

Health-Related Behaviors and Life Satisfaction

This study established a correlation between smoking and diminished life satisfaction in women, a finding consistent with prior research [25, 43]. Smoking exhibits negative effects on physical health and various organs [44], and is also linked to the prevalence of mental health disorders, such as depression and anxiety [45]. Consequently, it is generally anticipated that smokers would report lower levels of life satisfaction compared to their non-smoking counterparts [25]. However, a recently conducted study on Indian students indicated comparable levels of life satisfaction between the two groups [27]. This disparity might originate from variations in demographic and cultural characteristics. In the Iranian context, smoking among women encounters greater social disapproval, potentially culminating in feelings of shame, stress, and anxiety. Conversely, in India, it is plausible that cultural or systemic factors may buffer the impact of smoking on individuals’ life satisfaction. Consequently, the interpretation of findings concerning the relationship between unhealthy behaviors and life satisfaction necessitates a careful consideration of the prevailing cultural, social, and structural environments.

This study established an association between smoking behavior and a reduced BMI. The potential for nicotine to induce weight loss is attributed to its capacity to stimulate metabolic processes and suppress appetite [46]. While the precise mechanisms mediating the observed relationship between smoking and BMI are not yet fully elucidated, nicotine appears to represent a salient contributing factor. Existing evidence indicates that nicotine may lead to an elevation in circulating leptin concentrations among smokers. Leptin, a peptide hormone originating from adipose tissue and commonly recognized as the satiety hormone, functions to suppress appetite and stimulate increased energy expenditure. In contrast, alternative theoretical frameworks posit a dose-dependent association, whereby BMI demonstrates an inverse correlation with the quantity of cigarettes consumed [47]. Furthermore, smokers, notably adolescents and women, may employ smoking as a weight management strategy, using it as a replacement for eating, thereby culminating in a decrease in caloric intake [48]. Previous studies propose a possible link between smoking and a lower BMI, even when considering shared genetic and environmental influences within families [49]. The body of research in this area, however, reveals intricate and conflicting findings. Although certain studies suggest a potential positive correlation between heavy smoking (defined as exceeding 20 cigarettes per day) and obesity when contrasted with moderate or light smokers and non-smokers, these results are not consistently observed across all research. These inconsistencies may stem from variations in individual metabolic characteristics and the diverse effects of nicotine on physiological mechanisms among various people [50]. Cultural factors, such as the societal emphasis on thinness for women in cultures that value specific aesthetic ideals, or the use of cigarettes as a means of coping with stress and social pressures, may moderate this relationship. These findings underscore the necessity for further investigation into the cultural and social nuances that influence the association between smoking and BMI.

BMI did not demonstrate a statistically significant moderating effect on the association between smoking and life satisfaction. Furthermore, the association between BMI and life satisfaction remains equivocal. While certain studies indicate a negative correlation, wherein elevated BMI values are associated with diminished life satisfaction [51], contrasting evidence, including research conducted in Indonesia, has revealed a positive association. This suggests that, within specific contextual frameworks, a higher, potentially unhealthy BMI may correlate with increased levels of happiness and perceived well-being [52]. The observed inconsistencies and the statistically non-significant association in this study may be attributed to the confounding influence of socio-cultural determinants, mental health, and the prevalence of chronic illnesses. Specifically, BMI presents limitations as an accurate indicator of overall health status and may primarily reflect socio-economic status. Furthermore, prevailing aesthetic ideals within certain societal contexts can culminate in the interpretation of elevated BMI as a marker of health problems, consequently diminishing an individual’s life satisfaction. Conversely, certain cultural contexts may interpret a high BMI as an indicator of advantageous economic status [52, 53]. Consequently, the observed correlation between BMI and life satisfaction in this study is likely influenced by the complex interplay of physical and mental health variables, cultural norms, and lifestyle choices, including physical activity.

Although certain pathways within the hypothesized model were not statistically significant, their interpretation continues to offer theoretical insights. For example, the association between smoking and relational concerns (β = 0.06, p = 0.367), and the link between BMI and relational concerns (β = 0.11, p = 0.088), failed to reach the conventional threshold for statistical significance. These findings potentially indicate that variables such as partner interactions, self-perception of body image, and prevailing sociocultural standards may exert a more substantial influence on the formation of relational concerns than broad health-related behaviors. Furthermore, measurement constraints, unobserved mediating variables, or inadequate statistical power for these particular relationships may have contributed to the observed non-significant results.

The Connection Between Economic Status and Life Satisfaction

Univariate and multivariate linear regression analyses demonstrated a robust and independent relationship between economic status and life satisfaction. This observation is consistent with prior research conducted in Iran by Rajabi Gilan et al. (2021), which similarly established a positive association between higher economic status and greater life satisfaction [5]. Contemporary investigations further suggest that improvements in subjective socioeconomic status are associated with increased life satisfaction [54]. Conversely, individuals with perceptions of lower income and economic standing frequently exhibit tendencies toward pessimism [55]. In contrast, individuals with elevated income levels generally report higher levels of subjective well-being [56, 57]. Cumulatively, socioeconomic status exhibits a positive correlation with life satisfaction and overall happiness, mediated through subjective well-being [58]. Conversely, a precarious economic standing exerts a substantial and persistent adverse effect on mental health, functioning as a key determinant in the development of mental, behavioral, and chronic physical conditions, including documented links to mental health disorders, substance abuse, and a spectrum of illnesses [59]. Consequently, the reinforcement of economic policies alongside the augmentation of health and social services—encompassing psychological counseling, educational initiatives, and individual empowerment—are deemed critical for enhacing quality of life and overall satisfaction. Furthermore, economic status and individual income levels can affect both smoking behavior and BMI. Previous research has established an inverse correlation between income and smoking [60]. Additionally, lower socioeconomic standing is frequently associated with higher BMI, a phenomenon potentially attributable to diminished access to nutritious foods, reduced consumption of fruits and vegetables, and increased intake of foods high in sugar and fat [61]. Although the qualitative nature and data collection constraints of the current research prevented the integration of socioeconomic status into the path analysis model, it is plausible that higher socioeconomic status acts as a moderator in the associations among smoking, BMI, and life satisfaction. Therefore, future research endeavors should regard economic status as a potential moderating variable.

Univariate Analysis Results

In a univariate analytical framework, relational concerns, age, chronic diseases, and the co-occurrence of multi-morbidities were identified as factors associated with life satisfaction. However, upon the inclusion of additional variables in the analytical model, these initial factors no longer demonstrated a statistically significant predictive capacity for life satisfaction, demonstrating that their apparent influence may be mediated or confounded by the presence of other, more potent variables.

Age demonstrates a negative correlation with life satisfaction, as younger individuals typically report greater levels of satisfaction. This trend is potentially attributable to the increased physical ailments and life adversities encountered in later stages of life. However, empirical investigations have yielded inconsistent findings. For instance, An Hsin-Yu et al.’s (2020) research demonstrated a positive association between age and life satisfaction [62], contrasting with another study that aligns with the initial premise by documenting a decline in satisfaction with advancing age [7]. Some studies propose a U-shaped trajectory in the association between age and life satisfaction, characterized by a decline until midlife followed by a subsequent increase [63]. However, alternative perspectives contend that the post-midlife elevation in satisfaction is negligible, thus questioning the validity of the U-shaped model [64]. As a result, the precise nature of the age-life satisfaction nexus remains indeterminate, with various moderating variables, including gender, cultural context, socioeconomic status, and psychological attributes, necessitating further scholarly inquiry for comprehensive elucidation.

This study identified a statistically significant inverse correlation between the occurrence and quantity of chronic illnesses (multi-morbidity) and life satisfaction. Correspondingly, existing research suggests that enhanced life satisfaction may mitigate the impact of chronic illnesses [8]. Higher levels of life satisfaction are linked to reduced levels of inflammatory biomarkers, including interleukin-6, fibrinogen, and C-reactive protein, potentially contributing to increased longevity and improved health outcomes [8, 65]. Conversely, diminished life satisfaction, in conjunction with stress and elevated allostatic load, may compromise the body’s ability to maintain physiological equilibrium, thereby increasing the likelihood of chronic disease development [8]. A negative correlation between the prevalence of chronic diseases and life satisfaction has been observed in individuals aged 60 and above [66]. Specifically, a study by G. Liu et al. (2020) indicated that individuals with cardiovascular diseases and multiple concurrent chronic illnesses reported significantly lower levels of life satisfaction compared to those without additional chronic illnesses. Furthermore, their findings revealed an inverse relationship between the number of chronic diseases and life satisfaction [67]. The findings of the current research, consistent with prior studies, emphasize the critical need for interventions aimed at reducing stress and fostering healthier lifestyle choices as a preventative strategy against chronic diseases. It should be mentioned that within a participant cohort exhibiting a mean age of 35.07 years, approximately half of the female subjects self-reported the presence of a chronic condition. This observation highlights a concerning trend toward an earlier manifestation of these health issues in women and presents a potential public health challenge for the broader community.

While univariate analyses indicated that age, chronic diseases, multiple comorbidities, and relational concerns were significant predictors of life satisfaction, these variables did not retain statistical significance in a multivariate regression model that included other predictors. This discrepancy likely arises from shared variance among the independent variables within the multivariate regression. Specifically, the capacity to detect the unique contributions of individual variables exhibiting intercorrelation, such as age and chronic diseases, is diminished in multivariate regression when these variables are simultaneously considered. These results underscore the necessity of careful interpretation of predictor variables when examining outcomes from both univariate and multivariate analytical frameworks. The observed divergence in findings between these approaches can be attributed to the shared variance inherent among predictors within the multivariate model. More precisely, the existence of intercorrelated variables, exemplified by the relationship between age and chronic diseases, has the potential to diminish the observed magnitude of their unique contributions in multivariate regression analyses.

Strengths and Limitations

This study’s principal strength resides in its specific focus on the sexual relational concerns dimension of the SSS-W. This deliberate targeting directly aligns with the study’s conceptual model and stated research objectives. Such a focused approach facilitated a more precise evaluation of the interrelationship between sexual concerns within the relationship context, mindfulness, and health-related behaviors pertaining to women’s overall life satisfaction. Furthermore, the implementation of path analysis furnished a rigorous framework for the conceptualization of intricate interdependencies, with robust goodness-of-fit statistics substantiating the proposed theoretical model. This investigation also yields significant insights within a domain that has garnered comparatively scant scholarly examination in extant literature. However, the restriction of the evaluation to a single dimension of sexual satisfaction may circumscribe the comprehensiveness of the outcomes, as it fails to encapsulate the multifaceted nature of women’s sexual experiences. Future research is encouraged to utilize the full scale to facilitate a more comprehensive understanding of the phenomenon under investigation. Moreover, the reliance on convenience sampling from women’s clinics might have introduced a selection bias, thereby compromising the generalizability of the findings to the broader population. Finally, due to cultural sensitivities and limited resources, the current study did not perform stratified analyses across subgroups. Subsequent investigations should explore these inter-group variations to provide a richer and more nuanced understanding of diverse population segments.

Conclusion

This research revealed statistically significant correlations between mindfulness and both life satisfaction and sexual relational concerns. Furthermore, smoking demonstrated associations with both life satisfaction and BMI. These observations imply potential directions for interventional strategies focused on enhancing life satisfaction and addressing relationship challenges in women of reproductive age. In particular, the promotion of mindfulness practices and the cultivation of awareness regarding healthy behaviors and lifestyles may prove advantageous. Nevertheless, due to the cross-sectional design inherent in this study, the reported findings should be construed as associations rather than definitive evidence of causal relationships. Future longitudinal and experimental studies are warranted to ascertain the directionality and causal nature of these identified associations.

Abbreviations

BMI

Body Mass Index

CI

Confidence Interval

SSS-W

Sexual Satisfaction Scale for women

SPSS

Statistical Package for the Social Sciences

SWLS

Satisfaction with Life Scale

FMI-SE

Freiburg Mindfulness Scale

Author contributions

F.B. & R.F. Conceptualization, Methodology, Writing- Original draft preparation M.SM. Data curation, F.F. & F.B. Visualization, Investigation. F.B. Supervision. HA.N. Methodology, Software Validation, Data analysis. All authors. Approve final manuscript.

Funding

This study was financially supported by Babol University of Medical Sciences. Grant Number: 724135399. Funding source has not any role in the design of the study and collection, analysis and interpretation of data.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This cross-sectional study was approved by the Ethics Committee of Babol University of Medical Sciences (IR.MUBABOL.REC.1403.060). Questionnaires were completed by women who voluntarily participated after being informed about the study’s objectives and providing written informed consent. They were assured that their decision not to participate would not affect their access to diagnostic and therapeutic services. Participants’ privacy and confidentiality were strictly maintained. Helsinki Declaration adhered to.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.