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correlation between this questionnaire and the self-esteem visual analog scale was 0.618 (P=0.01). In Iran, Ahmadi and Poorsharifi (2013) studied the validity and reliability of the questionnaire and its Cronbach α coefficient was found as 0.85. Hopkins symptoms checklist 5-item questionnaire has four choices (from “not at all” to “very much”). The mean score for each item was calculated and higher scores indicate more psychological problems. Because this scale was used for the first time, the validity and reliability of the scales were rechecked in the Iranian context (backwardforward). Ten faculty members of Kerman University of 36 January 2019, Volume 7, Number 1 Medical Sciences reviewed the content of the scale and agreed upon the appropriateness of the contents. To reassess the reliability of the translated scale, a pilot study was done on applicants of cosmetic surgery and then the alpha coefficient value of the instrument internal consistency was computed 0.92 so the translated scale presented acceptable reliability and validity. The validity and reliability of the questionnaire were evaluated by Kvalevaag who reported its internal correlation coefficient as 0.92 (Kvalevaag et al., 2013). In the present study, the target population was all the cosmetic surgery applicants (who referred to Rafsanjan hospitals) and their relatives. The inclusion criteria were being definitely the candidates for cosmetic surgery within the next 15 days, lacking any medical cause for cosmetic surgery, and undergoing cosmetic surgery in an operating room and not at an outpatient clinic (Klassen et al., 1996). The exclusion criteria were having a history of cosmetic surgery for the applicants and tendency toward cosmetic surgery in future for nonapplicants (Khanjani et al., 2012). Non-applicants were relatives of the applicants. A self-report questionnaire was distributed to subjects to complete it. Sampling was conducted from April 2013 to September 2013. The obtained data were analyzed in SPSS version 18. The participants’ characteristics were described by descriptive statistics (frequency, percentage, mean and standard deviation). As the data lacked the normal distribution, the Mann-Whitney U test was used to compare body image, self-confidence, and psychological problems between cosmetic surgery applicants and non-applicants. Univariate and multivariate logistic regression were used to determine the relationship between socio-demographic characteristics and being an applicant for cosmetic surgery. The significance level was considered at 0.05. 3. Results Socio-demographic characteristics Totally, 200 citizens of Rafsanjan participated in the study. Twenty subjects refused to continue the study, therefore the response rate was 90.9%. The Mean±SD ages of the applicants and the non-applicants for cosmetic surgery were 25.07±5.74 and 27.74±8 years, respectively. In both groups, more than half of the participants were women and more than 70% of the applicants and more than 60% of the non-applicants were single. The educational degree of more than half of the subjects was higher than diploma. About 65% of the applicants and 42% of the non-applicants were students. In both groups, 28% of the participants were earning more than 10 million IRR monthly ($1=35000 IRR). Among different cosmetic surgeries, 79% were associated with nose surgery (Rhinoplasty), 7% with suction, 6% with breast surgery and 8% with Botox injection. Body image, self-confidence, and psychological problems Table 1 presents the mean scores of body image, selfconfidence, and psychological problems of the applicants and the non-applicants for cosmetic surgery. Our data analysis showed that although the mean scores of mental body image and self-confidence were higher in the non-applicants of cosmetic surgery than the applicants, these differences were not statistically significant (P>0.05). In addition, no significant difference was seen between the applicants and non-applicants in terms of psychological problems. Logistic regression was used to study the relationship between all the study variables and being an applicant for cosmetic surgery. Results of the adjusted logistic regression analysis indicate that for each unit increase in selfconfidence, the chance for being an applicant for cosmetic surgery multiplies by 0.92. Therefore, the increase in self-confidence will reduce the level of applying for cosmetic surgery. Moreover, applying for cosmetic surgery will be 0.88 by increasing the score of psychological problems by one. Therefore, by increase in psychological problems, the demand for cosmetic surgery will reduce. Nevertheless, our data analysis indicated that out of demographic variables, job and income had a significant relationship with applying for cosmetic surgery. Employed people had a lower chance of being an applicant for cosmetic surgery than students. The chance of cosmetic surgery among individuals with monthly income of 5,000,000 IRR was 13.93 times more than individuals with monthly income lower than 5,000,000 IRR. Regarding the income variable, the great difference between the raw and adjusted values of the odd ratio shows that the relationship between income and applying for cosmetic surgery is affected by confounding factors. Testing several three-variable models indicated that the two variables of age and job
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