Investigation of the Relationship between Family Mental Functioning and the Level of Education Among the Staff of Three Hospitals

The family is considered as one of the most important institutions that affect people's physical and mental health and is able to provide people with physical, emotional and social balance. Family is the most important institution of society; and many social science researches are based on this institution. This is the first study to investigate the relationship between family mental functioning and the level of education. This is a descriptive-analytical, epidemiological study conducted on 232 employees of three hospitals. The sampling was done randomly. In this study, first, the subjects were asked to complete a demographic questionnaire, and then the McMaster questionnaire was used to assess family functioning. The family functioning score was higher in samples having MSc and PhD (12.194) than other levels of education (p-value= 0.0001), in addition, family functioning score in samples whose head of household had PhD (79.195), was higher than the other samples (p-value= 0.0001). In this study, an increase in family level of education led to an increase in family mental functioning as well, that is likely because people who have a higher level of education use better problem-solving techniques, higher communication skills, and verbal level and employ it in the challenges of life, and maybe people with fewer psychological problems had the ability to achieve a higher level of education.


INTRODUCTION
Family is a unique of a social system whose members' relationship is based on biological, legal, emotional, geographical, and historical factors 1,2 .
Family as the main social institution has assigned a large number of social science researches to itself 3 .The family is considered as one of the most important institutions that affect people's physical and mental health that is able to provide people with physical, emotional and social balance 4 .Family members with different roles, needs and experiences are constantly interacting with each other to maintain balance and stability of the family 5 .
Attention to family health and its internal environment indicated in factors such as couples satisfaction in life, would be of prime importance.Following life satisfaction, there would be less marital discords, leading to reduction in divorce rate in society.With a reduction in divorce rate, a warm family center will further ensure public health.There are different opinions on whether family affects the society, is influenced by it, or acts independently.Alexis De Tocquevile, Argust Conte, Frédéric le Play, and Emile Durkheim, all believe with different reasons that family is affected by the society.While Russell believes that in the modern world, the individual of family rationalism is not under the tyranny of society, but also acts alongside and parallel to it.It is just the traditional society that can even control and direct its members' emotions 2 .Studies carried out in the field of psychopathology on a number of students to investigate the relationship between parents' level of education and the prevalence of mental disorders and abnormalities in children, showed that the children of parents with higher levels of education were less affected by psychological trauma [6][7][8] .Comparative investigation of the background and effects of violence against women in the family in those referred to medical centers, women who were victims of their husbands' violence compared with other married women with no background of domestic violence, indicated that both victim women and their husbands had lower level of education 9,10 .Not in all family lives is there a peace, affection, and love environment, as a result a number of families live in a stressful and restless environment that in addition to impact on ethics, behavior, and daily activities of spouses, affects the ethics, behavior, and character of their children 2 .Level of education can also have an impact on marital satisfaction.It has been observed that the higher level of education increases the overall marital satisfaction and improves sexual relations as well 11 .The results of the investigation of the relationship between family, emotional, and social factors and child abuse, abused children compared with children who have not been abused, indicated lower educational level of the parents of the children abused 12 .
This study aims to investigate the relationship between family mental functioning and level of education in the employees of two hospitals.

MATERIALS AND METHODS
This descriptive-analytical study was conducted on 232 employees in three hospitals from which 135 were women and 97 were men.
McMaster questionnaire has been used to assess family functioning in this study.McMaster questionnaire is a 60-item questionnaire to measure family functioning, according to McMaster model, has been developed by Epstein, Baldwin,   and Bishop (1983).This model specifies the structural, professional, interactive features of family.In this scale, there a subscale in addition to the six dimensions that evaluates family general functioning measures and has relatively good reliability and validity in the world [13].Finally, our available questionnaire that has been used in this study included 58 questions.Four options has been considered for each question, "strongly agree, agree, disagree, strongly disagree", to which according to Likert scale the numbers (1-2-3-4) have been assigned, respectively, and then some questions would be reversed according to the key of scoring answer sheet [14].Finally, the lowest score of the questionnaire will be 58 and the highest score will be 232.The information collected in this study has been analyzed by SPSS statistical software (ver: 17).The differences were considered significant if p-value <0.05.Mean and standard deviation tests were used for descriptive analysis.ANOVA, Tukey test, and regression model were used for analytical analysis.
The participants in the study were classified into six levels of education, including Group 3 (illiterates and those having elementary and secondary education), Group 4 (with high school education), Group 5 (diploma), Group 6 (associate), Group 7 (bachelor's degree), and Group 8 (MA and PhD).The frequency, mean family functioning score and standard deviation for each educational group has been specified in Table 1: To investigate the relationship between family functioning score and level of education of the participants, the analysis of variance has been used in in the study that showed a significant difference (p-value= 0.001), then to compare the family functioning score of the participants in the aforementioned levels of education, Tukey test has been used.The results have been shown in Table 2.
According to above table, there has been no significant differences in mean scores of family functioning among illiterate people or those having primary school and secondary school level of education, and they have been classified in the same category.In addition, people having diploma and associate were placed in one category.
The relationship between participants' head of household's level of education and the family functioning score has also been assessed.The subjects have been categorized in 6 levels of education that is shown in Table 3, as follows: Analysis of variance has been used to investigate the relationship between family functioning score and head of household's level of education in the aforementioned 6 levels of education, that indicated a significantly difference.In addition, to separately compare family functioning score of the subjects based on the educational level of the head of household, Tukey test has been used and the results are shown in Table 4: The mean family functioning score in cases with the head of household having illiterate, elementary, secondary, and high school level of education has been lower than families whose head of household's level of education has been diploma, associate, bachelor's degree, MA, and PhD, indicating a significant difference (P-value= 0.0001).In addition, a significant difference has associate and BA also had no significant difference in mean family functioning score had has been put in one category (P-value= 0.2).People whose head of household's level of education has been BA and MA also had no significant difference in mean family functioning score (P-value= 0.2) and has been put in the same category.
The subjects were divided into five groups according to their jobs.Group 1 consists of people who were doctors.Nurses in Group 2, employees in Group 3 (out of medical group), workers in Group 4, and Group 5 included people with other jobs including midwives, assistant paramedics, and paramedics.
Frequency, mean family functioning score and standard deviation of the aforementioned categories are shown in Table 5: To study the relationship between family functioning score and the aforementioned job classification, analysis of variance has been used that showed a significant difference with P-value= 0.0001.
To separately compare the participants' family functioning score in the aforementioned job classification, Tukey test has been used and the results are listed in Table 6: Average family functioning score has been higher among physicians compared with other jobs, indicating a significant difference (P-value= 0.0001).Average family functioning score in nurses showed no significant difference compared with employees (P-value= 0.3), and has been higher than workers, midwives, assistant paramedics, and paramedics, indicating a significant difference (P-value=0.0001).The average family functioning score has been higher in employees compared with workers, indicating a significant difference (P-value= 0.0001).This score has been higher for employees compared to midwives, paramedics, and assistant paramedics, showing a significant difference (P-value= 0.01).The mean family functioning score has been lower in workers compared with the midwives, paramedics, and assistant paramedics, indicating a significant difference (P-value= 0.009).According to the table above, nurses and employees had no significant difference in mean family functioning score (P-value= 0.3) and has been put in the same category.
In conclusion, the mean family functioning score for each level of education has been as follows: In illiterates and those having primary and secondary level of education 141.6, in people with high school education 141.6, in those with diploma or associate degree 156.7 and 160.3, in those with a bachelor's degree 173.8, and in people with Master's degree and PhD 194.1.
According to the above, it is concluded that the mean family mental functioning score increases by higher level of education.Of course, there has been no different functioning score in the illiterate people and those having primary school, secondary school, and high school level of education.

RESULTS AND DISCUSSION
Based on the results obtained in this study, it can be concluded that probably people who have a higher level of education have better problemsolving techniques, communication and verbal skills and employ them in the challenges of the life.When the head of household has a higher level of education, other family members will be further encouraged to gain higher levels of education.People who have higher level of education have less children, as a result their family members is less and there is higher chance of discussion between the family members and they further use general education and the media due to their high level of education.On the other hand, maybe people with fewer psychological problems had the ability to achieve a higher level of education.