Formulation and Testing of a Model of the Relationship between Psychological Characteristics of Depression, Anxiety, and Stress, and Physical Complaints of the Staff of a Military Unit in Tabriz, Iran, with the Mediating Role of Chronic Fatigue


  • Mohammad Reza Sharbafchi Assistant Professor, Psychosomatic Research Center AND Department of Psychiatry, Isfahan University of Medical Sciences, Isfahan, Iran
  • Hamid Afshar-Zanjani Professor, Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
  • Hossein Rostami Assistant Professor, Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran



Psychological characteristics, Chronic fatigue, Physical complaints


Background: Employees of military units in their workplaces often complain of experiencing multiple physical and psychological symptoms that cannot be explained medically. The present study aimed to investigate the relationship between the psychological characteristics of depression, anxiety, and stress, and unexplained physical complaints of the staff of a military unit in the city of Tabriz, Iran, with the mediating role of chronic fatigue.

Methods: For this purpose, 300 employees of a military unit in the city of Tabriz were selected through cluster sampling method in 2019. To measure the variables, the participants completed the Depression, Anxiety, and Stress Scale (DASS-21)‎, Chalder Fatigue Questionnaire ‎‎(CFQ), and Symptom Checklist-90 (SCL-90)‎. Cronbach’s alpha was used to assess the validity and reliability of these scales and the results indicated the desirability of these scales. The data were analyzed using Amos software and bootstrapping test.

Results: The results showed that the total effect of psychological characteristics on chronic fatigue (β = 0.85 P < 0.001), chronic fatigue on physical complaints (β = 0.54; P < 0.001), and psychological characteristics on physical complaints (β = 0.30; P < 0.001) was statistically significant. Moreover, the indirect effect of chronic fatigue and psychological characteristics on physical complaints was significant (β = 0.096; P = 0.020).

Conclusion: The identification of psychological characteristics helps authorities to think about ways to provide counseling and treatment for mental disorders and chronic fatigue among the work force that can improve physical complaints among the personnel of military units.


Aggarwal, V. R., McBeth, J., Zakrzewska, J. M., Lunt, M., & Macfarlane, G. J. (2006). The epidemiology of chronic syndromes that are frequently unexplained: do they have common associated factors? Int J Epidemiol., 35(2), 468-476. doi:dyi265 [pii];10.1093/ije/dyi265 [doi]. Retrieved from PM:16303810
Aghaei, A., Jalali, D., Aslan, Z., & Hasanzadeh, R. (2011). Prediction of role ambiguity and conflict, job burnout and four dimensions of stress spillover on Isfahan’ counsellors based on their demographic characteristics. New Findings in Psychology, 6(20), 69-88.
Ahmadi, A., Mohammadi Sartang, M., Nooraliee, P., Veisi, M., & Rasouli, J. (2013). Prevalence of anxiety and it's relationship with consumption of snacks in high school students in Shiraz. J Shahrekord Univ Med Sci, 15(1), 83-90.
Arnow, B. A., Blasey, C. M., Constantino, M. J., Robinson, R., Hunkeler, E., Lee, J. et al. (2011). Catastrophizing, depression and pain-related disability. Gen.Hosp.Psychiatry, 33(2), 150-156. doi:S0163-8343(11)00006-5 [pii];10.1016/j.genhosppsych.2010.12.008 [doi]. Retrieved from PM:21596208
Baker, S. (1997). The relationships of self-care agency and self-care actions to caregiver strain as perceived by female family caregivers of elderly parents. J N.Y.State.Nurses.Assoc, 28(1), 7-11. Retrieved from PM:9165809
Carruthers, B. M., Jain, A. K., De Meirleir, K. L., Peterson, D. L., Klimas, N. G., Lerner, A. M. et al. (2003). Myalgic encephalomyelitis/chronic fatigue syndrome. Journal of Chronic Fatigue Syndrome, 11(1), 7-115.
Chalder, T., Berelowitz, G., Pawlikowska, T., Watts, L., Wessely, S., Wright, D. et al. (1993). Development of a fatigue scale. J Psychosom.Res, 37(2), 147-153. doi:10.1016/0022-3999(93)90081-p [doi]. Retrieved from PM:8463991
Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Board on the Health of Select Populations, & Institute of Medicine. (2015). Beyond myalgic encephalomyelitis/chronic fatigue syndrome: Redefining an illness. Washington, DC: National Academies Press.
Demyttenaere, K., Bruffaerts, R., Posada-Villa, J., Gasquet, I., Kovess, V., Lepine, J. P. et al. (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA, 291(21), 2581-2590. doi:10.1001/jama.291.21.2581 [doi];291/21/2581 [pii]. Retrieved from PM:15173149
Derogatis, L. R., Lipman, R. S., & Covi, L. (1973). SCL-90: An outpatient psychiatric rating scale--preliminary report. Psychopharmacol.Bull., 9(1), 13-28. Retrieved from PM:4682398
Farhadi, M. E. H. R., Yarmohamadi Vasel, M. O. S. A., Zoghi Paidar, M. R., & Chegini, A. A. (2017). The efficacy of hypnotherapy based on ego strengthening on treatment of major depression in female-headed households. Journal of Psychological Achievements, 23(1), 63-78.
Gadermann, A. M., Engel, C. C., Naifeh, J. A., Nock, M. K., Petukhova, M., Santiago, P. N. et al. (2012). Prevalence of DSM-IV major depression among U.S. military personnel: meta-analysis and simulation. Mil.Med, 177(8 Suppl), 47-59. doi:10.7205/milmed-d-12-00103 [doi]. Retrieved from PM:22953441
Ghaddar, A., Mateo, I., & Sanchez, P. (2008). Occupational stress and mental health among correctional officers: a cross-sectional study. J Occup Health, 50(1), 92-98. doi:JST.JSTAGE/joh/50.92 [pii];10.1539/joh.50.92 [doi]. Retrieved from PM:18285652
Golparvar M, & Sadeghi E. (2016). Relationship between Work-Family Conflict and Spillover with Psychosomatic Complaints. Journal of Psychology, 20(2), 102-119.
Haddadi, M., Zakerian, A., Mahmoodi, M., Nasl seraji, J., Parsa Yekta, Z., & Ali yari, A. (2014). Investigation of Chronic Fatigue Syndrome Questionnaire Validity and Reliability CFS (DSQ Revised). J Sch Public Health Inst Public Health Res, 12(1), 75-84.
Haftgoli, N., Favrat, B., Verdon, F., Vaucher, P., Bischoff, T., Burnand, B. et al. (2010). Patients presenting with somatic complaints in general practice: depression, anxiety and somatoform disorders are frequent and associated with psychosocial stressors. BMC.Fam.Pract., 11, 67. doi:1471-2296-11-67 [pii];10.1186/1471-2296-11-67 [doi]. Retrieved from PM:20843358
Hekmat Ravan, R., Samsam Shariat, M. R., Khani, F., Khademi, M. J. (; 2012 Oct 17-19). The relationship between anxiety and depression on physical complaints in the blind of Isfahan. 4th International Congress on Psychosomatic, Isfahan, Iran.
Kiani, F., & Khodabakhsh, M. R. (2015). Predictive power of physical and psychological symptoms by employees' attitude toward safety issues in Isfahan Steel Company. Iran Occup Health, 12(1), 77-86.
Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav.Res Ther, 33(3), 335-343. doi:0005-7967(94)00075-U [pii];10.1016/0005-7967(94)00075-u [doi]. Retrieved from PM:7726811
Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annu.Rev.Psychol., 52, 397-422. doi:doi:10.1146/annurev.psych.52.1.397.
Mehdad, A., Rahimi, R., & Atashpour, S. H. (2011). Comparison of occupational stress and occupational accidents frequency among off shore and onshore oil industry employees. New Findings in Psychology, 6(19), 53-63.
Mofidirad, A., & Shareh, H. (2014). The psychological status of staff members in prisons of Khorasan Razavi province. J Fundam Ment Health, 16(61), 61-69.
Mohammadi, S. (2018). The Mediating Role of Psychological Symptoms in the Relationship between Resilience and Pain Coping Strategies with Pain Perception and Pain Disaster in Patients with Spinal Pain [PhD Thesis]. Karaj, Iran: Islamic Azad University.
Morton, E., Michalak, E. E., & Murray, G. (2017). What does quality of life refer to in bipolar disorders research? A systematic review of the construct's definition, usage and measurement. J Affect.Disord., 212, 128-137. doi:S0165-0327(16)31892-4 [pii];10.1016/j.jad.2017.01.026 [doi]. Retrieved from PM:28160685
Nakao, M. (2010). Work-related stress and psychosomatic medicine. BioPsychoSocial Medicine, 4(1), 4. Retrieved from
Navidian, A., Salar, A. R., Hashemi Nia, A., & Keikhaei, A. (2001). Study of mental exhaustion experienced by family caregivers of patients with mental disorders, Zahedan Psychiatric Hospital, 2000. J Babol Univ Med Sci, 3(4), 33-38.
Nemati.S.H, Babazadeh, A. R., & Fakhri, A. (2013). The Effect of Conflict Resolution Skills Training on Aggression Reduction in Meshkin Shahr Prisoners. Eslah va Tarbiat, 11(137), 39-41.
Nielsen, M. B., & Einarsen, S. (2012). Outcomes of exposure to workplace bullying: A meta-analytic review. Work & Stress, 26(4), 309-332. doi: 10.1080/02678373.2012.734709.
Rollings, K. A., Wells, N. M., Evans, G. W., Bednarz, A., & Yang, Y. (2017). Housing and neighborhood physical quality: Children's mental health and motivation. J Environ Psychol, 50, 17-23.
Sadock, B. J., & Sadock, V. A. (2010). Comprehensive textbook of psychiatry. Philadelphia, PA: Lippincott Williams & Wilkins.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry. Philadelphia, PA: Lippincott Williams and Wilkins.
Saeedi Dhaghani, S., Babapoor, J., & Esmaeelpoor, K. (2014). The role of meta-cognition in predicting cognitive, physical and social fatigue, based on Brown’s model. Journal of Cognitive Psychology, 2(1), 33-40.
Shahhosseini, M., & Vaez Mousavi, S. M. K. (2017). Comparing job burnout and quality of life in physically active and inactive military personnel. J Mil Med., 19(2), 158-168.
Shakoor, A., Shafqat, F., Mehmud, T., Akram, M., Riaz, S., Iqbal, Z. et al. (2010). Frequency of depression and somatic symptoms in patients on interferon alpha/ribavirin for chronic hepatitis C. J Ayub.Med Coll Abbottabad., 22(4), 6-9. Retrieved from PM:22455250
Sharpe, M. (1997). Chronic fatigue. In D. M. Clark, & C. G. Fairburn (Eds.). Science and practice of cognitive behavior therapy (pp. 380-414): Oxford, UK: Oxford University Press.
Taheri, S., & Sajjadian, I. (2018). Effectiveness of mindfulness based cognitive therapy on fatigue, anxiety and depression among staff with chronic fatigue syndrome. Journal of Psychological Achievements, 25(2), 129-150.
Tyrer, P. (1976). The role of bodily feelings in anxiety. Maudsley Monograph no. 23. Oxford, UK: Oxford University Press.
van Hooren, S. A. H., Vermeiren, J., & Bolman, C. (2008). The relationship between coping styles, depressive symptoms and somatic complaints among depressive inpatients. Neth.J.Psychol., 64(2), 78-86.




How to Cite

Sharbafchi, M. R., Afshar-Zanjani, H., & Rostami, H. (2020). Formulation and Testing of a Model of the Relationship between Psychological Characteristics of Depression, Anxiety, and Stress, and Physical Complaints of the Staff of a Military Unit in Tabriz, Iran, with the Mediating Role of Chronic Fatigue. International Journal of Body, Mind and Culture, 7(2), 51-61.



Quantitative Study(ies)

Most read articles by the same author(s)