Structural Equation Model of Stress, Anxiety, and Depression Association with Musculoskeletal Disorders among Emergency Medical Personnel
-
Mohammad Khandan
,
Alireza Koohpaei
,
Seyed Abed Abedi
,
Mohammad Reza Azadeh
,
Ali Montazeri
,
Ali Ebrahimi
Abstract
Background: Emergency medical personnel play a crucial role in saving the lives of patients and injured individuals before they receive hospital services. Given their working conditions and environment, emergency medical service personnel are at risk for mental health issues and musculoskeletal disorders. Therefore, this study aimed to investigate the relationship between stress, anxiety, and depression with musculoskeletal disorders among emergency medical personnel in Qom Province.
Methods: This descriptive-analytical cross-sectional study was conducted among 177 emergency medical service personnel in Qom city, selected through simple random sampling. Data collection tools included demographic questionnaires, the Depression Anxiety Stress Scales (DASS), and a body map chart. Data analysis was performed using descriptive statistical tests and multivariate structural equation modeling techniques, as well as Cronbach’s alpha coefficients and average variance extracted (AVE) analysis, with the help of SPSS version 22 and AMOS version 20 software.
Results: The average age of the participants was 33.03 ± 7.48 years. Most participants (84%) reported symptoms of musculoskeletal disorders. The reliability and validity of the DASS questionnaire and its subscales were confirmed with acceptable Cronbach’s alpha coefficients (0.7) and average variance extracted (AVE) values (0.4). Levels of stress, anxiety, and depression were above average. No significant relationship was found between stress, anxiety, and depression and musculoskeletal disorders, and demographic variables did not moderate the relationship between these psychological factors and musculoskeletal disorders.
Conclusion: Given the high prevalence of musculoskeletal disorders and the elevated levels of stress, anxiety, and depression among emergency medical personnel—with no significant relationship found between these variables—it is essential to identify other influencing factors in this field. Implementing control measures to improve working conditions and the work environment is critical, especially considering the vital role of emergency medical personnel in the healthcare sector.
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2. Reichard AA, Marsh SM, Tonozzi TR, Konda S, Gormley MA. Occupational injuries and exposures among emergency medical services workers. Prehosp Emerg Care. 2017;21(4):420–31.
3. Bentley MA, Crawford JM, Wilkins JR, Fernandez AR, Studnek JR. An assessment of depression, anxiety, and stress among nationally certified EMS professionals. Prehosp Emerg Care. 2013;17(3):330–8.
4. Bahadori M, Ravangard R, Raadabadi M, Hosseini-Shokouh SM, Behzadnia MJ. Job stress and job burnout based on personality traits among emergency medical technicians. Trauma Mon. 2019;24(6):24–31.
5. Friedenberg R, Kalichman L, Ezra D, Wacht O, Alperovitch-Najenson D. Work-related musculoskeletal disorders and injuries among emergency medical technicians and paramedics: a comprehensive narrative review. Arch Environ Occup Health. 2022;77(1):9–17.
6. Austin CL, Pathak M, Thompson S. Secondary traumatic stress and resilience among EMS. J Paramed Pract. 2018;10(6):240–7.
7. Morrison LK. Coping techniques, world assumptions, and level of post-traumatic stress in emergency medical technicians. Mass Sch Prof Psychol. 2014.
8. Cash RE, Anderson SE, Lancaster KE, Lu B, Rivard MK, Camargo CA Jr, et al. Comparing the prevalence of poor sleep and stress metrics in basic versus advanced life support emergency medical services personnel. Prehosp Emerg Care. 2020;24(5):644–56.
9. Davison C, Cotrim TP, Gonçalves S. Perception of musculoskeletal symptoms and psychosocial risk factors among a sample of Portuguese emergency medical technicians. In: Proc Int Conf Healthc Ergon Patient Saf. Springer; 2019. p. 46–55.
10. Monteiro Fonseca S, Faria S, Cunha S, Silva M, Ramos MJ, Azevedo G, et al. Mental health patterns during COVID-19 in emergency medical services (EMS). Int J Emerg Serv. 2022;11(2):193–206.
11. Haydon T, Leko MM, Stevens D. Teacher stress: sources, effects, and protective factors. J Spec Educ Leadersh. 2018;31(2):69–80.
12. Mahdizadeh M, Jaberi AA, Bonabi TN. Massage therapy in management of occupational stress in emergency medical services staffs: a randomized controlled trial. Int J Ther Massage Bodywork. 2019;12(1):16–23.
13. Bergen-Cico D, Lane S, Thompson M, Wozny S, Zajdel M, Barduhn M, et al. The impact of post-traumatic stress on first responders: analysis of cortisol, anxiety, depression, sleep impairment and pain. Int Paramed Pract. 2015;5(3):78–87.
14. Aljerian N, Alshehri S, Masudi E, Albawardi AM, Alzahrani F, Alanazi R. The prevalence of musculoskeletal disorders among EMS personnel in Saudi Arabia, Riyadh. Egypt J Hosp Med. 2018;73(1):5777–82.
15. Chan VC, Ross GB, Clouthier AL, Fischer SL, Graham RB. The role of machine learning in the primary prevention of work-related musculoskeletal disorders: a scoping review. Appl Ergon. 2022;98:103574.
16. Lietz J, Kozak A, Nienhaus A. Prevalence and occupational risk factors of musculoskeletal diseases and pain among dental professionals in Western countries: a systematic literature review and meta-analysis. PLoS One. 2018;13(12):e0208628.
17. Deros BM, Daruis DD, Thiruchelvam S, Othman R, Ismail D, Rabani NF, et al. Evaluation on ambulance design and musculoskeletal disorders risk factors among ambulance emergency medical service personnel. Iran J Public Health. 2016;45(Suppl 1):52–60.
18. Broniecki M, Esterman A, May E, Grantham H. Musculoskeletal disorder prevalence and risk factors in ambulance officers. J Back Musculoskelet Rehabil. 2010;23(4):165–74.
19. Hossain MD, Aftab A, Al Imam MH, Mahmud I, Chowdhury IA, Kabir RI, et al. Prevalence of work-related musculoskeletal disorders and ergonomic risk assessment among readymade garment workers of Bangladesh: a cross-sectional study. PLoS One. 2018;13(7):e0200122.
20. Ng YM, Voo P, Maakip I. Psychosocial factors, depression, and musculoskeletal disorders among teachers. BMC Public Health. 2019;19(1):731.
21. Ekpenyong CE, Daniel NE, Aribo EO. Associations between academic stressors, reaction to stress, coping strategies and musculoskeletal disorders among college students. Ethiop J Health Sci. 2013;23(2):98–112.
22. Ghanbary Sartang A, Ashnagar ME, Habibi E, Sadeghi S. The association of anxiety and depression with musculoskeletal disorders among military personnel in 2016. J Occup Health Epidemiol. 2016;5(2):98–104.
23. Babazadeh T, Sarkhoshi R, Bahadori F, Moradi F, Shariat F. Prevalence of depression, anxiety and stress disorders in elderly people residing in Khoy, Iran (2014–2015). J Res Clin Med. 2016;4(2):122–8.
24. Asghari A, Saed F, Dibajnia P. Psychometric properties of the Depression Anxiety Stress Scales-21 (DASS-21) in a non-clinical Iranian sample. Int J Psychol. 2008;2(2):82–102.
25. Sahebi A, Asghari MJ, Salari RS. Validation of depression anxiety and stress scale (DASS-21) for an Iranian population. J Iran Psychol. 2005;1(4):299–313.
26. Alimoradi H, Fallah Madavari R, Nazari MN, Jafarinodoshan R, Zaresakhvidi MJ, Ajdani A. The relationship of Depression Anxiety and Stress Scale and Harmon Jones with noise in Isfahan Steel Industry Workers. Occup Health Health Promot. 2021;4(4):351–66.
27. Le MT, Tran TD, Holton S, Nguyen HT, Wolfe R, Fisher J. Reliability, convergent validity and factor structure of the DASS-21 in a sample of Vietnamese adolescents. PLoS One. 2017;12(7):e0180557.
28. Gong X, Xie XY, Xu R, Luo YJ. Psychometric properties of the Chinese versions of DASS-21 in Chinese college students. Chin J Clin Psychol. 2010;18(4):443–6.
29. Sariçam H. The psychometric properties of Turkish version of Depression Anxiety Stress Scale-21 (DASS-21) in health control and clinical samples. J Cogn Behav Psychother Res. 2018;7(1):19–25.
30. Kakemam E, Navvabi E, Albelbeisi AH, Saeedikia F, Rouhi A, Majidi S. Psychometric properties of the Persian version of Depression Anxiety Stress Scale-21 items (DASS-21) in a sample of health professionals: a cross-sectional study. BMC Health Serv Res. 2022;22(1):877.
31. Moshashaei P, Nazari J. The relationship between musculoskeletal disorders and general health among employees of a soft drinks industry. J Occup Health Epidemiol. 2017;4(1):45–55.
32. Stanton NA. Human factors and ergonomics methods. In: Handbook of Human Factors and Ergonomics Methods. CRC Press; 2004. p. 27–38.
33. Vinzi VE, Chin WW, Henseler J, Wang H, editors. Handbook of Partial Least Squares: Concepts, Methods and Applications. Springer; 2010.
34. Broniecki M, Esterman A, May E, Grantham H. Musculoskeletal disorder prevalence and risk factors in ambulance officers. J Back Musculoskelet Rehabil. 2010;23(4):165–74.
35. Davis KG, Kotowski SE. Prevalence of musculoskeletal disorders for nurses in hospitals, long-term care facilities, and home health care: a comprehensive review. Hum Factors. 2015;57(5):754–92.
36. Taleghani E, Noroozi M, Hadavi M. Prevalence of stress, anxiety and depression among nursing staff in intensive care units of Ali Ebn-e Abitaleb Hospital in Rafsanjan in 2017. J Rafsanjan Univ Med Sci. 2018;12(2):11–21.
37. Choobineh AR, Rajaifard AR, Niqab M. Perceived demands and musculoskeletal disorders among hospital nurses. Hakim. 2007;10(2):70–75.
38. Johnson JV, Hall EM, Theorell T. Combined effects of job strain and social isolation on cardiovascular disease morbidity and mortality in a random sample of the Swedish male working population. Scand J Work Environ Health. 1989;15(4):271–9.
39. Crill MT, Hostler D. Back strength and flexibility of EMS providers in practicing prehospital providers. J Occup Rehabil. 2005;15(2):105–11.
40. López-González MJ, González-Menéndez E, González S, Torrano F. Study of the interrelationships between musculoskeletal disorders and psychosocial risk factors in occupational health and safety technicians. Int J Occup Saf Ergon. 2021;27(2):361–9.
41. Imani A, Borna J, Alami A, Khosravan S, Hasankhani H, Zende MB. Prevalence of low back pain and its related factors among pre-hospital emergency personnel in Iran. J Emerg Pract Trauma. 2019;5(1):8–13.
42. Smith DR, Wei N, Kang L, Wang RS. Musculoskeletal disorders among professional nurses in mainland China. J Prof Nurs. 2004;20(6):390–5.
43. Soylar P, Ozer A. Evaluation of the prevalence of musculoskeletal disorders in nurses: a systematic review. Med Sci. 2018;7(3):479–85.
44. Dropkin J, Moline J, Power PM, Kim H. A qualitative study of health problems, risk factors, and prevention among emergency medical service workers. Work. 2015;52(4):935–51.
45. Soltaninejad M, Aminizadeh M, Saberinia A. Investigation of the relationship between trauma, anxiety, depression and stress in Kerman Emergency Medical and Emergency Center 115. J Pharm Res Int. 2020;32(1):25–31.
46. Hulland J. Use of partial least squares (PLS) in strategic management research: a review of four recent studies. Strateg Manag J. 1999;20(2):195–204.
47. Talwar P, Othman MK, Othman AE, Mustaffa MS, Mughal YH. Socio-demographic determinants and prevalence of depression, anxiety, and stress among Malaysian university students. J Indian Acad Appl Psychol. 2017;43(2):296–304.
48. Bayram N, Bilgel N. The prevalence and socio-demographic correlations of depression, anxiety and stress among a group of university students. Soc Psychiatry Psychiatr Epidemiol. 2008;43(8):667–72.
49. Tan KC, Chan GC, Hoo E, Maria AI, Norliza MJ, Oun BH, et al. Depression, anxiety and stress among patients with diabetes in primary care: a cross-sectional study. Malays Fam Physician. 2015;10(2):9.
50. Nia RG. Evaluating the degree of stress, anxiety, and depression among the emergency personnel in Kerman University of Medical Sciences. Sci Res Essays. 2016;2(1):1–6.
51. Sabbaghi M, Miri K, Kahi R, Nia MN. Investigation of stress, anxiety, and depression levels of pre-hospital emergency medicine personnel in eastern Iran during the Covid-19 pandemic. BMC Emerg Med. 2022;22(1):83.
52. Stankevitz K, Schoenfisch A, de Silva V, Tharindra H, Stroo M, Ostbye T. Prevalence and risk factors of musculoskeletal disorders among Sri Lankan rubber tappers. Int J Occup Environ Health. 2016;22(2):91–8.
53. Barzideh M, Choobineh AR, Tabatabai SH. Job stress dimensions and their relationship to musculoskeletal disorders in nurses. Health Sci Rep. 2013;8(7):1365–75.
54. Hendi OM, Alturkistani LH, Bajaber AS, Alhamoud MA, Mahfouz ME. Prevalence of musculoskeletal disorder and its relation to stress among medical students at Taif University, Saudi Arabia. Int J Prev Med. 2021;12(1):6.
55. Azari G, Davudian Talab A, Mahmudabad EM, Mofidi A. Complaint of pain in the upper limbs and its relationship with job stress in office workers. Tabibgaran. 2013;12(3):149–60.
56. Yazdi M, Feizi A, Keshteli AH, Afshar H, Adibi P. A classification analysis of musculoskeletal complaints and its association with anxiety, depression and psychological distress: results from a large-scale cross-sectional study of adult Iranian population. Adv Hum Biol. 2018;8(3):180.
57. Ashnagar M, Habibi E, Rezaei N. Relationship between anxiety and depression with musculoskeletal disorders in military personnel. Mil Caring Sci J. 2017;4(2):95–101.
58. Soteriades ES, Psalta L, Leka S, Spanoudis G. Occupational stress and musculoskeletal symptoms in firefighters. Int J Occup Med Environ Health. 2019;32(3):307–17.
59. Dehdashti A, Mehralizadeh S, Mahjoubi Z. Workplace stresses and musculoskeletal disorders among nurses: a cross-sectional study. Middle East J Rehabil Health Stud. 2017;4(3):e57492.
60. Heikkinen J, Honkanen R, Williams L, Leung J, Rauma P, Quirk S, et al. Depressive disorders, anxiety disorders and subjective mental health in common musculoskeletal diseases: a review. Maturitas. 2019;127:18–25.
61. Kerr MS, Frank JW, Shannon HS, et al. Biomechanical and psychological risk factors for low back pain at work. Am J Public Health. 2001;91(7):1069–75.
2. Reichard AA, Marsh SM, Tonozzi TR, Konda S, Gormley MA. Occupational injuries and exposures among emergency medical services workers. Prehosp Emerg Care. 2017;21(4):420–31.
3. Bentley MA, Crawford JM, Wilkins JR, Fernandez AR, Studnek JR. An assessment of depression, anxiety, and stress among nationally certified EMS professionals. Prehosp Emerg Care. 2013;17(3):330–8.
4. Bahadori M, Ravangard R, Raadabadi M, Hosseini-Shokouh SM, Behzadnia MJ. Job stress and job burnout based on personality traits among emergency medical technicians. Trauma Mon. 2019;24(6):24–31.
5. Friedenberg R, Kalichman L, Ezra D, Wacht O, Alperovitch-Najenson D. Work-related musculoskeletal disorders and injuries among emergency medical technicians and paramedics: a comprehensive narrative review. Arch Environ Occup Health. 2022;77(1):9–17.
6. Austin CL, Pathak M, Thompson S. Secondary traumatic stress and resilience among EMS. J Paramed Pract. 2018;10(6):240–7.
7. Morrison LK. Coping techniques, world assumptions, and level of post-traumatic stress in emergency medical technicians. Mass Sch Prof Psychol. 2014.
8. Cash RE, Anderson SE, Lancaster KE, Lu B, Rivard MK, Camargo CA Jr, et al. Comparing the prevalence of poor sleep and stress metrics in basic versus advanced life support emergency medical services personnel. Prehosp Emerg Care. 2020;24(5):644–56.
9. Davison C, Cotrim TP, Gonçalves S. Perception of musculoskeletal symptoms and psychosocial risk factors among a sample of Portuguese emergency medical technicians. In: Proc Int Conf Healthc Ergon Patient Saf. Springer; 2019. p. 46–55.
10. Monteiro Fonseca S, Faria S, Cunha S, Silva M, Ramos MJ, Azevedo G, et al. Mental health patterns during COVID-19 in emergency medical services (EMS). Int J Emerg Serv. 2022;11(2):193–206.
11. Haydon T, Leko MM, Stevens D. Teacher stress: sources, effects, and protective factors. J Spec Educ Leadersh. 2018;31(2):69–80.
12. Mahdizadeh M, Jaberi AA, Bonabi TN. Massage therapy in management of occupational stress in emergency medical services staffs: a randomized controlled trial. Int J Ther Massage Bodywork. 2019;12(1):16–23.
13. Bergen-Cico D, Lane S, Thompson M, Wozny S, Zajdel M, Barduhn M, et al. The impact of post-traumatic stress on first responders: analysis of cortisol, anxiety, depression, sleep impairment and pain. Int Paramed Pract. 2015;5(3):78–87.
14. Aljerian N, Alshehri S, Masudi E, Albawardi AM, Alzahrani F, Alanazi R. The prevalence of musculoskeletal disorders among EMS personnel in Saudi Arabia, Riyadh. Egypt J Hosp Med. 2018;73(1):5777–82.
15. Chan VC, Ross GB, Clouthier AL, Fischer SL, Graham RB. The role of machine learning in the primary prevention of work-related musculoskeletal disorders: a scoping review. Appl Ergon. 2022;98:103574.
16. Lietz J, Kozak A, Nienhaus A. Prevalence and occupational risk factors of musculoskeletal diseases and pain among dental professionals in Western countries: a systematic literature review and meta-analysis. PLoS One. 2018;13(12):e0208628.
17. Deros BM, Daruis DD, Thiruchelvam S, Othman R, Ismail D, Rabani NF, et al. Evaluation on ambulance design and musculoskeletal disorders risk factors among ambulance emergency medical service personnel. Iran J Public Health. 2016;45(Suppl 1):52–60.
18. Broniecki M, Esterman A, May E, Grantham H. Musculoskeletal disorder prevalence and risk factors in ambulance officers. J Back Musculoskelet Rehabil. 2010;23(4):165–74.
19. Hossain MD, Aftab A, Al Imam MH, Mahmud I, Chowdhury IA, Kabir RI, et al. Prevalence of work-related musculoskeletal disorders and ergonomic risk assessment among readymade garment workers of Bangladesh: a cross-sectional study. PLoS One. 2018;13(7):e0200122.
20. Ng YM, Voo P, Maakip I. Psychosocial factors, depression, and musculoskeletal disorders among teachers. BMC Public Health. 2019;19(1):731.
21. Ekpenyong CE, Daniel NE, Aribo EO. Associations between academic stressors, reaction to stress, coping strategies and musculoskeletal disorders among college students. Ethiop J Health Sci. 2013;23(2):98–112.
22. Ghanbary Sartang A, Ashnagar ME, Habibi E, Sadeghi S. The association of anxiety and depression with musculoskeletal disorders among military personnel in 2016. J Occup Health Epidemiol. 2016;5(2):98–104.
23. Babazadeh T, Sarkhoshi R, Bahadori F, Moradi F, Shariat F. Prevalence of depression, anxiety and stress disorders in elderly people residing in Khoy, Iran (2014–2015). J Res Clin Med. 2016;4(2):122–8.
24. Asghari A, Saed F, Dibajnia P. Psychometric properties of the Depression Anxiety Stress Scales-21 (DASS-21) in a non-clinical Iranian sample. Int J Psychol. 2008;2(2):82–102.
25. Sahebi A, Asghari MJ, Salari RS. Validation of depression anxiety and stress scale (DASS-21) for an Iranian population. J Iran Psychol. 2005;1(4):299–313.
26. Alimoradi H, Fallah Madavari R, Nazari MN, Jafarinodoshan R, Zaresakhvidi MJ, Ajdani A. The relationship of Depression Anxiety and Stress Scale and Harmon Jones with noise in Isfahan Steel Industry Workers. Occup Health Health Promot. 2021;4(4):351–66.
27. Le MT, Tran TD, Holton S, Nguyen HT, Wolfe R, Fisher J. Reliability, convergent validity and factor structure of the DASS-21 in a sample of Vietnamese adolescents. PLoS One. 2017;12(7):e0180557.
28. Gong X, Xie XY, Xu R, Luo YJ. Psychometric properties of the Chinese versions of DASS-21 in Chinese college students. Chin J Clin Psychol. 2010;18(4):443–6.
29. Sariçam H. The psychometric properties of Turkish version of Depression Anxiety Stress Scale-21 (DASS-21) in health control and clinical samples. J Cogn Behav Psychother Res. 2018;7(1):19–25.
30. Kakemam E, Navvabi E, Albelbeisi AH, Saeedikia F, Rouhi A, Majidi S. Psychometric properties of the Persian version of Depression Anxiety Stress Scale-21 items (DASS-21) in a sample of health professionals: a cross-sectional study. BMC Health Serv Res. 2022;22(1):877.
31. Moshashaei P, Nazari J. The relationship between musculoskeletal disorders and general health among employees of a soft drinks industry. J Occup Health Epidemiol. 2017;4(1):45–55.
32. Stanton NA. Human factors and ergonomics methods. In: Handbook of Human Factors and Ergonomics Methods. CRC Press; 2004. p. 27–38.
33. Vinzi VE, Chin WW, Henseler J, Wang H, editors. Handbook of Partial Least Squares: Concepts, Methods and Applications. Springer; 2010.
34. Broniecki M, Esterman A, May E, Grantham H. Musculoskeletal disorder prevalence and risk factors in ambulance officers. J Back Musculoskelet Rehabil. 2010;23(4):165–74.
35. Davis KG, Kotowski SE. Prevalence of musculoskeletal disorders for nurses in hospitals, long-term care facilities, and home health care: a comprehensive review. Hum Factors. 2015;57(5):754–92.
36. Taleghani E, Noroozi M, Hadavi M. Prevalence of stress, anxiety and depression among nursing staff in intensive care units of Ali Ebn-e Abitaleb Hospital in Rafsanjan in 2017. J Rafsanjan Univ Med Sci. 2018;12(2):11–21.
37. Choobineh AR, Rajaifard AR, Niqab M. Perceived demands and musculoskeletal disorders among hospital nurses. Hakim. 2007;10(2):70–75.
38. Johnson JV, Hall EM, Theorell T. Combined effects of job strain and social isolation on cardiovascular disease morbidity and mortality in a random sample of the Swedish male working population. Scand J Work Environ Health. 1989;15(4):271–9.
39. Crill MT, Hostler D. Back strength and flexibility of EMS providers in practicing prehospital providers. J Occup Rehabil. 2005;15(2):105–11.
40. López-González MJ, González-Menéndez E, González S, Torrano F. Study of the interrelationships between musculoskeletal disorders and psychosocial risk factors in occupational health and safety technicians. Int J Occup Saf Ergon. 2021;27(2):361–9.
41. Imani A, Borna J, Alami A, Khosravan S, Hasankhani H, Zende MB. Prevalence of low back pain and its related factors among pre-hospital emergency personnel in Iran. J Emerg Pract Trauma. 2019;5(1):8–13.
42. Smith DR, Wei N, Kang L, Wang RS. Musculoskeletal disorders among professional nurses in mainland China. J Prof Nurs. 2004;20(6):390–5.
43. Soylar P, Ozer A. Evaluation of the prevalence of musculoskeletal disorders in nurses: a systematic review. Med Sci. 2018;7(3):479–85.
44. Dropkin J, Moline J, Power PM, Kim H. A qualitative study of health problems, risk factors, and prevention among emergency medical service workers. Work. 2015;52(4):935–51.
45. Soltaninejad M, Aminizadeh M, Saberinia A. Investigation of the relationship between trauma, anxiety, depression and stress in Kerman Emergency Medical and Emergency Center 115. J Pharm Res Int. 2020;32(1):25–31.
46. Hulland J. Use of partial least squares (PLS) in strategic management research: a review of four recent studies. Strateg Manag J. 1999;20(2):195–204.
47. Talwar P, Othman MK, Othman AE, Mustaffa MS, Mughal YH. Socio-demographic determinants and prevalence of depression, anxiety, and stress among Malaysian university students. J Indian Acad Appl Psychol. 2017;43(2):296–304.
48. Bayram N, Bilgel N. The prevalence and socio-demographic correlations of depression, anxiety and stress among a group of university students. Soc Psychiatry Psychiatr Epidemiol. 2008;43(8):667–72.
49. Tan KC, Chan GC, Hoo E, Maria AI, Norliza MJ, Oun BH, et al. Depression, anxiety and stress among patients with diabetes in primary care: a cross-sectional study. Malays Fam Physician. 2015;10(2):9.
50. Nia RG. Evaluating the degree of stress, anxiety, and depression among the emergency personnel in Kerman University of Medical Sciences. Sci Res Essays. 2016;2(1):1–6.
51. Sabbaghi M, Miri K, Kahi R, Nia MN. Investigation of stress, anxiety, and depression levels of pre-hospital emergency medicine personnel in eastern Iran during the Covid-19 pandemic. BMC Emerg Med. 2022;22(1):83.
52. Stankevitz K, Schoenfisch A, de Silva V, Tharindra H, Stroo M, Ostbye T. Prevalence and risk factors of musculoskeletal disorders among Sri Lankan rubber tappers. Int J Occup Environ Health. 2016;22(2):91–8.
53. Barzideh M, Choobineh AR, Tabatabai SH. Job stress dimensions and their relationship to musculoskeletal disorders in nurses. Health Sci Rep. 2013;8(7):1365–75.
54. Hendi OM, Alturkistani LH, Bajaber AS, Alhamoud MA, Mahfouz ME. Prevalence of musculoskeletal disorder and its relation to stress among medical students at Taif University, Saudi Arabia. Int J Prev Med. 2021;12(1):6.
55. Azari G, Davudian Talab A, Mahmudabad EM, Mofidi A. Complaint of pain in the upper limbs and its relationship with job stress in office workers. Tabibgaran. 2013;12(3):149–60.
56. Yazdi M, Feizi A, Keshteli AH, Afshar H, Adibi P. A classification analysis of musculoskeletal complaints and its association with anxiety, depression and psychological distress: results from a large-scale cross-sectional study of adult Iranian population. Adv Hum Biol. 2018;8(3):180.
57. Ashnagar M, Habibi E, Rezaei N. Relationship between anxiety and depression with musculoskeletal disorders in military personnel. Mil Caring Sci J. 2017;4(2):95–101.
58. Soteriades ES, Psalta L, Leka S, Spanoudis G. Occupational stress and musculoskeletal symptoms in firefighters. Int J Occup Med Environ Health. 2019;32(3):307–17.
59. Dehdashti A, Mehralizadeh S, Mahjoubi Z. Workplace stresses and musculoskeletal disorders among nurses: a cross-sectional study. Middle East J Rehabil Health Stud. 2017;4(3):e57492.
60. Heikkinen J, Honkanen R, Williams L, Leung J, Rauma P, Quirk S, et al. Depressive disorders, anxiety disorders and subjective mental health in common musculoskeletal diseases: a review. Maturitas. 2019;127:18–25.
61. Kerr MS, Frank JW, Shannon HS, et al. Biomechanical and psychological risk factors for low back pain at work. Am J Public Health. 2001;91(7):1069–75.
| Files | ||
| Issue | Vol 16 No 3 (2024) | |
| Section | Original Article(s) | |
| Published | 2025-08-30 | |
| Keywords | ||
| Stress, Anxiety, Depression, Emergency Medical Services, Musculoskeletal Disorders. | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Khandan M, Koohpaei A, Abedi SA, Azadeh MR, Montazeri A, Ebrahimi A. Structural Equation Model of Stress, Anxiety, and Depression Association with Musculoskeletal Disorders among Emergency Medical Personnel. Int J Occup Hyg. 2025;16(3):35-44.
