Serial Multiple Mediation Model of Depression, Anxiety and Sleep Quality Between Perceived Stress and Life Satisfaction
-
Amir Hoseinpour
,
Parvin Akbariasbagh
,
Fatemeh Mohammadzadeh
,
Esfandiar Azad
,
Mohsen Saberi Isfeedvajani
Abstract
Life satisfaction can both affect and be affected by occupational factors in military personnel. Perceived stress is considered an important predictor of life satisfaction. The objective of this study is to evaluate the direct and indirect effects of perceived stress on life satisfaction and the mediating role of depression, anxiety, and sleep quality among Iranian military personnel. In this cross-sectional study, a total of 301 military personnel were investigated by using standard self-report questionnaires, consisting of the Revised Symptom Checklist-90 (SCL-90-R), Pittsburgh Sleep Quality Index (PSQI), Perceived Stress Scale (PSS), and Satisfaction with Life Scale (SWLS) in our study. Data analysis was conducted using descriptive statistics, the Pearson correlation coefficient, ordinary least square regression, and the bootstrap method. The direct effect of perceived stress on life satisfaction was significant. Perceived stress also affects life satisfaction indirectly through single mediation of sleep quality; serial multiple mediations of anxiety as the first and sleep quality as the second mediator; and the serial multiple mediations of depression, anxiety, and sleep quality, as the first to the third mediator, respectively. Lower levels of perceived stress, depression, and anxiety, along with better sleep quality, are correlated to higher levels of life satisfaction in military personnel. There are several points of prevention and intervention in order to increase the life satisfaction of military personnel, which can improve their quality of life and occupational efficiency.
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2. Koivumaa-Honkanen H, Koskenvuo M, Honkanen RJ, Viinamäki H, Heikkilä K, Kaprio J. Life dissatisfaction and subsequent work disability in an 11-year follow-up. Psychol Med 2004;34:221-8.
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5. Lee J, Kim E, Wachholtz A. The effect of perceived stress on life satisfaction : The mediating effect of self-efficacy. Chongsonyonhak Yongu 2016;23:29-47.
6. Shi M, Wang X, Bian Y, Wang L. The mediating role of resilience in the relationship between stress and life satisfaction among Chinese medical students: a cross-sectional study. BMC Med Educ 2015;15:16.
7. Siddiqi FA, Azim ME, Babur MN, Osama M, Waheed A, Memon AR. Psychological Stress and Satisfaction with Life among Physical Therapy Students of Rawalpindi / Islamabad, Pakistan. J Pak Med Assoc 2019;69:973-5.
8. Darling CA, Senatore N, Strachan J. Fathers of children with disabilities: stress and life satisfaction. Stress Health 2012;28:269-78.
9. Mroczek DK, Spiro A, 3rd. Change in life satisfaction during adulthood: findings from the veterans affairs normative aging study. J Pers Soc Psychol 2005;88:189-202.
10. Lambert EG, Jiang S, Liu J, Zhang J, Choi E. A Happy Life: Exploring How Job Stress, Job Involvement, and Job Satisfaction Are Related to the Life Satisfaction of Chinese Prison Staff. Psychiatr Psychol Law 2018;25:619-36.
11. Yazdanshenas Ghazwin M, Kavian M, Ahmadloo M, Jarchi A, Golchin Javadi S, Latifi S, Tavakoli SA, Ghajarzadeh M. The Association between Life Satisfaction and the Extent of Depression, Anxiety and Stress among Iranian Nurses: A Multicenter Survey. Iran J Psychiatry 2016;11:120-7.
12. Yu M, Qiu T, Liu C, Cui Q, Wu H. The mediating role of perceived social support between anxiety symptoms and life satisfaction in pregnant women: a cross-sectional study. Health Qual Life Outcomes 2020;18:223.
13. Seidl JN, Pastorek NJ, Lillie R, Rosenblatt A, Troyanskaya M, Miller BI, et al. Factors related to satisfaction with life in veterans with mild traumatic brain injury. Rehabil Psychol 2015;60:335-43.
14. Zhi TF, Sun XM, Li SJ, Wang QS, Cai J, Li LZ, et al. Associations of sleep duration and sleep quality with life satisfaction in elderly Chinese: The mediating role of depression. Arch Gerontol Geriatr 2016;65:211-7.
15. Wang L, Xu B, Gu Y, Zhu J, Liang Y. The mediating and moderating effects of resilience on the relationship between perceived stress and depression in heroin addicts. J Community Psychol 2019;47:495-503.
16. Liu Y, Li T, Guo L, Zhang R, Feng X, Liu K. The mediating role of sleep quality on the relationship between perceived stress and depression among the elderly in urban communities: a cross-sectional study. Public Health 2017;149:21-7.
17. Lee JS, Joo EJ, Choi KS. Perceived stress and self-esteem mediate the effects of work-related stress on depression. Stress Health 2013;29:75-81.
18. Li M, Wang L. The Associations of Psychological Stress with Depressive and Anxiety Symptoms among Chinese Bladder and Renal Cancer Patients: The Mediating Role of Resilience. PLoS One 2016;11:e0154729.
19. Peplińska A, Jeżewska M, Leszczyńska I, Połomski P. Stress and the level of perceived anxiety among mariners: the mediating role of marital satisfaction. Int Marit Health 2013;64:221-5.
20. Aanes MM, Hetland J, Pallesen S, Mittelmark MB. Does loneliness mediate the stress-sleep quality relation? The Hordaland Health Study. Int Psychogeriatr 2011;23:994-1002.
21. Zhang QJ, Zhang QL, Sun XY, Zhang LY, Zhang SY, Yao GF, et al. Relationship between acute stress and sleep disorder in grass-root military personnel: mediating effect of social support. Mil Med Res 2014;1:3.
22. Ypsilanti A, Lazuras L, Robson A, Akram U. Anxiety and depression mediate the relationship between self-disgust and insomnia disorder. Sleep Health 2018;4:349-51.
23. Lacruz ME, Schmidt-Pokrzywniak A, Dragano N, Moebus S, Deutrich SE, Möhlenkamp S, et al. Depressive symptoms, life satisfaction and prevalence of sleep disturbances in the general population of Germany: results from the Heinz Nixdorf Recall study. BMJ Open 2016;6:e007919.
24. Bergman BP, Mackay DF, Smith DJ, Pell JP. Long-term mental health outcomes of military service: national linkage study of 57,000 veterans and 173,000 matched nonveterans. J Clin Psychiatry 2016;77:793-8.
25. Ikin JF, Sim MR, McKenzie DP, Horsley KW, Wilson EJ, Harrex WK, et al. Life satisfaction and quality in Korean War veterans five decades after the war. J Epidemiol Community Health 2009;63:359-65.
26. Derogatis LR, Cleary PA. Confirmation of the dimensional structure of the SCL‐90: A study in construct validation. J Clin Psycol 1977;33:981-9.
27. Bahrami H. Mental Disorders in Male Prisoners as Compared to Normal Population. Iran J Psychiatry Behav Sci 1999;5:37-45.
28. Afkham Ebrahimi A, Bandi G, Salehi M, Tafti K, Vakili Y, Farsi A. Sleep parameters and the factors affecting the quality of sleep in patients attending selected clinics of Rasoul-e-Akram hospital. Razi J Med Sci 2008;15:31-8.
29. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24:385-96.
30. Bayani AA, Koocheky AM, Goodarzi H. The reliability and validity of the satisfaction with life scale. Sci J Manag Syst 2007;3:259-65.
31. Hayes A. PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling 1. Psychology 2012.
32. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach: Guilford publications, 2017.
33. Pflanz S, Sonnek S. Work stress in the military: prevalence, causes, and relationship to emotional health. Mil Med 2002;167:877-82.
34. Shilling S, Brackbill RM. Occupational health and safety risks and potential health consequences perceived by US workers, 1985. Public Health Rep 1987;102:36-46.
35. Marin MF, Lord C, Andrews J, Juster RP, Sindi S, Arsenault-Lapierre G, et al. Chronic stress, cognitive functioning and mental health. Neurobiol Learn Mem 2011;96:583-95.
36. Van Laethem M, Beckers DG, van Hooff ML, Dijksterhuis A, Geurts SA. Day-to-day relations between stress and sleep and the mediating role of perseverative cognition. Sleep Med 2016;24:71-9.
37. Loizou M, Petkari E. Do male university students sleep well when they feel well? Exploring the role of depression and anxiety as mediators. Psychol Health Med 2019;24:951-61.
38. Yang SJ, Cha HS. Retrospective cohort study on Korean adolescents' sleep, depression, school adjustment, and life satisfaction. Nurs Health Sci 2018;20:422-30.
39. Calderon C, Carmona-Bayonas A, Hernandez R, Castelo B, Varma S, Donnay O, et al. Incidence of sleep problems and their mediating role on depression and anxious preoccupation in patients with resected, non-advanced cancer: data from NEOcoping study. Clin Transl Oncol 2019;21:1104-7.
40. Wang T, Li M, Xu S, Jiang C, Gao D, Wu T, et al. The Factorial Structure of Trait Anxiety and Its Mediating Effect Between Mindfulness and Depression. Front Psychiatry 2018;9:514.
41. Huang HM, Lai JH, Huang TW. Mediating effects of depression on anxiety and leisure constraints in patients with breast cancer. BMC Womens Health 2019;19:141.
42. Soltani MA, Karaminia R, Hashemian SA. Prediction of war veteran's mental health based on spiritual well-being, social support and self-efficacy variables: The mediating role of life satisfaction. J Edu Health Promot 2014;3:57.
43. Samaranayake CB, Arroll B, Fernando AT, 3rd. Sleep disorders, depression, anxiety and satisfaction with life among young adults: a survey of university students in Auckland, New Zealand. N Z Med J 2014;127:13-22.
44. Zhang H, Zhang Q, Gao T, Kong Y, Qin Z, Hu Y, et al. Relations between Stress and Quality of Life among Women in Late Pregnancy: The Parallel Mediating Role of Depressive Symptoms and Sleep Quality. Psychiatry Investig 2019;16:363-9.
45. Brand S, Beck J, Hatzinger M, Harbaugh A, Ruch W, Holsboer-Trachsler E. Associations between satisfaction with life, burnout-related emotional and physical exhaustion, and sleep complaints. World J Biol Psychiatry 2010;11:744-54.
2. Koivumaa-Honkanen H, Koskenvuo M, Honkanen RJ, Viinamäki H, Heikkilä K, Kaprio J. Life dissatisfaction and subsequent work disability in an 11-year follow-up. Psychol Med 2004;34:221-8.
3. Koivumaa-Honkanen H, Honkanen R, Antikainen R, Hintikka J, Laukkanen E, Honkalampi K, et al. Self-reported life satisfaction and recovery from depression in a 1-year prospective study. Acta Psychiatr Scand 2001;103:38-44.
4. Koivumaa-Honkanen H, Honkanen R, Viinamäki H, Heikkilä K, Kaprio J, Koskenvuo M. Self-reported life satisfaction and 20-year mortality in healthy Finnish adults. Am J Epidemiol 2000;152:983-91.
5. Lee J, Kim E, Wachholtz A. The effect of perceived stress on life satisfaction : The mediating effect of self-efficacy. Chongsonyonhak Yongu 2016;23:29-47.
6. Shi M, Wang X, Bian Y, Wang L. The mediating role of resilience in the relationship between stress and life satisfaction among Chinese medical students: a cross-sectional study. BMC Med Educ 2015;15:16.
7. Siddiqi FA, Azim ME, Babur MN, Osama M, Waheed A, Memon AR. Psychological Stress and Satisfaction with Life among Physical Therapy Students of Rawalpindi / Islamabad, Pakistan. J Pak Med Assoc 2019;69:973-5.
8. Darling CA, Senatore N, Strachan J. Fathers of children with disabilities: stress and life satisfaction. Stress Health 2012;28:269-78.
9. Mroczek DK, Spiro A, 3rd. Change in life satisfaction during adulthood: findings from the veterans affairs normative aging study. J Pers Soc Psychol 2005;88:189-202.
10. Lambert EG, Jiang S, Liu J, Zhang J, Choi E. A Happy Life: Exploring How Job Stress, Job Involvement, and Job Satisfaction Are Related to the Life Satisfaction of Chinese Prison Staff. Psychiatr Psychol Law 2018;25:619-36.
11. Yazdanshenas Ghazwin M, Kavian M, Ahmadloo M, Jarchi A, Golchin Javadi S, Latifi S, Tavakoli SA, Ghajarzadeh M. The Association between Life Satisfaction and the Extent of Depression, Anxiety and Stress among Iranian Nurses: A Multicenter Survey. Iran J Psychiatry 2016;11:120-7.
12. Yu M, Qiu T, Liu C, Cui Q, Wu H. The mediating role of perceived social support between anxiety symptoms and life satisfaction in pregnant women: a cross-sectional study. Health Qual Life Outcomes 2020;18:223.
13. Seidl JN, Pastorek NJ, Lillie R, Rosenblatt A, Troyanskaya M, Miller BI, et al. Factors related to satisfaction with life in veterans with mild traumatic brain injury. Rehabil Psychol 2015;60:335-43.
14. Zhi TF, Sun XM, Li SJ, Wang QS, Cai J, Li LZ, et al. Associations of sleep duration and sleep quality with life satisfaction in elderly Chinese: The mediating role of depression. Arch Gerontol Geriatr 2016;65:211-7.
15. Wang L, Xu B, Gu Y, Zhu J, Liang Y. The mediating and moderating effects of resilience on the relationship between perceived stress and depression in heroin addicts. J Community Psychol 2019;47:495-503.
16. Liu Y, Li T, Guo L, Zhang R, Feng X, Liu K. The mediating role of sleep quality on the relationship between perceived stress and depression among the elderly in urban communities: a cross-sectional study. Public Health 2017;149:21-7.
17. Lee JS, Joo EJ, Choi KS. Perceived stress and self-esteem mediate the effects of work-related stress on depression. Stress Health 2013;29:75-81.
18. Li M, Wang L. The Associations of Psychological Stress with Depressive and Anxiety Symptoms among Chinese Bladder and Renal Cancer Patients: The Mediating Role of Resilience. PLoS One 2016;11:e0154729.
19. Peplińska A, Jeżewska M, Leszczyńska I, Połomski P. Stress and the level of perceived anxiety among mariners: the mediating role of marital satisfaction. Int Marit Health 2013;64:221-5.
20. Aanes MM, Hetland J, Pallesen S, Mittelmark MB. Does loneliness mediate the stress-sleep quality relation? The Hordaland Health Study. Int Psychogeriatr 2011;23:994-1002.
21. Zhang QJ, Zhang QL, Sun XY, Zhang LY, Zhang SY, Yao GF, et al. Relationship between acute stress and sleep disorder in grass-root military personnel: mediating effect of social support. Mil Med Res 2014;1:3.
22. Ypsilanti A, Lazuras L, Robson A, Akram U. Anxiety and depression mediate the relationship between self-disgust and insomnia disorder. Sleep Health 2018;4:349-51.
23. Lacruz ME, Schmidt-Pokrzywniak A, Dragano N, Moebus S, Deutrich SE, Möhlenkamp S, et al. Depressive symptoms, life satisfaction and prevalence of sleep disturbances in the general population of Germany: results from the Heinz Nixdorf Recall study. BMJ Open 2016;6:e007919.
24. Bergman BP, Mackay DF, Smith DJ, Pell JP. Long-term mental health outcomes of military service: national linkage study of 57,000 veterans and 173,000 matched nonveterans. J Clin Psychiatry 2016;77:793-8.
25. Ikin JF, Sim MR, McKenzie DP, Horsley KW, Wilson EJ, Harrex WK, et al. Life satisfaction and quality in Korean War veterans five decades after the war. J Epidemiol Community Health 2009;63:359-65.
26. Derogatis LR, Cleary PA. Confirmation of the dimensional structure of the SCL‐90: A study in construct validation. J Clin Psycol 1977;33:981-9.
27. Bahrami H. Mental Disorders in Male Prisoners as Compared to Normal Population. Iran J Psychiatry Behav Sci 1999;5:37-45.
28. Afkham Ebrahimi A, Bandi G, Salehi M, Tafti K, Vakili Y, Farsi A. Sleep parameters and the factors affecting the quality of sleep in patients attending selected clinics of Rasoul-e-Akram hospital. Razi J Med Sci 2008;15:31-8.
29. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24:385-96.
30. Bayani AA, Koocheky AM, Goodarzi H. The reliability and validity of the satisfaction with life scale. Sci J Manag Syst 2007;3:259-65.
31. Hayes A. PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling 1. Psychology 2012.
32. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach: Guilford publications, 2017.
33. Pflanz S, Sonnek S. Work stress in the military: prevalence, causes, and relationship to emotional health. Mil Med 2002;167:877-82.
34. Shilling S, Brackbill RM. Occupational health and safety risks and potential health consequences perceived by US workers, 1985. Public Health Rep 1987;102:36-46.
35. Marin MF, Lord C, Andrews J, Juster RP, Sindi S, Arsenault-Lapierre G, et al. Chronic stress, cognitive functioning and mental health. Neurobiol Learn Mem 2011;96:583-95.
36. Van Laethem M, Beckers DG, van Hooff ML, Dijksterhuis A, Geurts SA. Day-to-day relations between stress and sleep and the mediating role of perseverative cognition. Sleep Med 2016;24:71-9.
37. Loizou M, Petkari E. Do male university students sleep well when they feel well? Exploring the role of depression and anxiety as mediators. Psychol Health Med 2019;24:951-61.
38. Yang SJ, Cha HS. Retrospective cohort study on Korean adolescents' sleep, depression, school adjustment, and life satisfaction. Nurs Health Sci 2018;20:422-30.
39. Calderon C, Carmona-Bayonas A, Hernandez R, Castelo B, Varma S, Donnay O, et al. Incidence of sleep problems and their mediating role on depression and anxious preoccupation in patients with resected, non-advanced cancer: data from NEOcoping study. Clin Transl Oncol 2019;21:1104-7.
40. Wang T, Li M, Xu S, Jiang C, Gao D, Wu T, et al. The Factorial Structure of Trait Anxiety and Its Mediating Effect Between Mindfulness and Depression. Front Psychiatry 2018;9:514.
41. Huang HM, Lai JH, Huang TW. Mediating effects of depression on anxiety and leisure constraints in patients with breast cancer. BMC Womens Health 2019;19:141.
42. Soltani MA, Karaminia R, Hashemian SA. Prediction of war veteran's mental health based on spiritual well-being, social support and self-efficacy variables: The mediating role of life satisfaction. J Edu Health Promot 2014;3:57.
43. Samaranayake CB, Arroll B, Fernando AT, 3rd. Sleep disorders, depression, anxiety and satisfaction with life among young adults: a survey of university students in Auckland, New Zealand. N Z Med J 2014;127:13-22.
44. Zhang H, Zhang Q, Gao T, Kong Y, Qin Z, Hu Y, et al. Relations between Stress and Quality of Life among Women in Late Pregnancy: The Parallel Mediating Role of Depressive Symptoms and Sleep Quality. Psychiatry Investig 2019;16:363-9.
45. Brand S, Beck J, Hatzinger M, Harbaugh A, Ruch W, Holsboer-Trachsler E. Associations between satisfaction with life, burnout-related emotional and physical exhaustion, and sleep complaints. World J Biol Psychiatry 2010;11:744-54.
| Files | ||
| Issue | Vol 59, No 4 (2021) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/acta.v59i4.6219 | |
| Keywords | ||
| Anxiety Depression Life satisfaction Military Perceived stress Sleep quality | ||
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How to Cite
1.
Hoseinpour A, Akbariasbagh P, Mohammadzadeh F, Azad E, Saberi Isfeedvajani M. Serial Multiple Mediation Model of Depression, Anxiety and Sleep Quality Between Perceived Stress and Life Satisfaction. Acta Med Iran. 2021;59(4):208-216.
