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had a confounding effect on the relationship between income and applying for cosmetic surgery and after adjusting these effects, the odds ratio increased (Table 2). 4. Discussion Heidarzadeh, A., et al. (2019). Body Image, Self-Esteem, and Psychological Problems. JPCP, 7(1), 33-42. 37 January 2019, Volume 7, Number 1 Based on the results, the mean score of self-image in non-applicants was higher than applicants of cosmetic surgery but the difference was not statistically significant. In this regard, the study results conducted by other researchers indicate no significant difference between the applicants and non-applicants of cosmetic surgery in terms of stress and body image (Hosseini et al., 2010; (Mohammadpanah et al., 2012). Nevertheless, Zuckerman and Abraham (2008) reported that dissatisfaction with breast and abdomen was the most important causes of cosmetic surgery in America. Results of another study showed a significant difference between the applicants and non-applicants of cosmetic surgery in terms of self-image, body mass index, general health, and self-concept (Pasha et al., 2008). Thus, although dissatisfaction with self-image can be a motivation for cosmetic surgery, it can partly explain cosmetic surgery and socio-cultural effects should be considered as well. Besides socio-cultural values, the bias of the society on the appearance, comparing individuals based on their appearance and giving value to beauty and complimenting beautiful people, feeling inferior by others (due to the appearances) may make people sensitive to their body images (Saba, 2012). According to our results, the mean score of self-esteem was not significantly different between the applicants and non-applicants of cosmetic surgery. In addition, the results of adjusted logistic regression indicate that by increasing self-esteem, applying for cosmetic surgery will reduce. According to Aliehyaii, Latifi, and Bakkhtiary (2013) low self-confidence and negative self-image were among the main causes of nose surgery. The results of Sadrosadatzadeh, Farahani, Kiamanesh, and Ramezani (2013) study indicate no significant difference between self-esteem and body image before and after the nose surgery. In contrast, Mackie et al. (2000) reported that cosmetic surgeries are mostly performed because of resolving dissatisfaction with appearance and for increasing self-esteem. According to Zamani and Fazilatpour (2013) cosmetic surgery can contribute to psychological changes such as higher self-esteem, feeling eligible, and improvement of negative self-image. Regarding such results, low self-esteem is associated with humility, being unvalued and self-inefficiency. Such people would try to cope with their perceived weakness and inefficiency. In other words, they feel that their inefficiency is due to their bad-looking appearances. Therefore, individuals with low self-esteem may choose cosmetic surgery to compensate for their defects (Sadrosadatzadeh et al., 2013). Those with low self-esteem feel that cosmetic surgery is a way to reach the standards of the society for their appearance; however, it seems that such people are not usually satisfied with their body even after the surgery (Tahmasbi, Tahmasbi, & Yaghmaie, 2014). Table 1. The comparison of body image, self-esteem, and psychological problems between the applicants and the non-applicants for cosmetic surgery (n=200) Variable Mean±SD Mann-Whitney U Test P Cosmetic Surgery Applicants Cosmetic Surgery Non-applicants Body image Evaluation of appearance. 38 January 2019, Volume 7, Number 1 In addition, the results related to the psychological problems indicate no significant difference between the applicants and non-applicants in terms of psychological problems. Contrary to our findings, Khanjani et al. (2012), reported a significant difference between the applicants and non-applicants of cosmetic surgery regarding nine dimensions of mental disorders except for paranoid thoughts and psychosis. Harris and Moss in 2009 found out that before cosmetic surgery, the level of anxiety and depression of applicants of surgery was 7.4 and 7.6, respectively compared to non-applicants (Moss & Harris, 2009). Such discrepancy may be due to the cultural or methodological factors such as research instruments and selected sample. Moreover, the results indicate that job and income have a significant relationship with applying for cosmetic surgery. Individuals who have jobs had a lower chance to apply for cosmetic surgery than students. Ching, Thoma, McCabe and Antony (2003) in their longitudinal study reported a relationship between atTable 2. The univariate and Multivariate logistic regression model of being a cosmetic surgery applicant Variable Univariate Logistic Regression
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