Causal relationship between Depression and Health-related quality of life through chain mediation of Chronic Fatigue and Treatment Adherence in women with uterine cancer

Document Type : Original Article


1 Department of Health Psychology, Khoramshahr International Branch, Islamic Azad University, Khoramshahr, Iran

2 Department of Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran


Aim: The aim of the present study was to investigate the causal relationship between depression and health-related quality of life through the chain mediation of chronic fatigue and adherence to treatment in women with uterine cancer. Method: In this descriptive correlational study, the statistical population consisted of all women diagnosed with uterine cancer in Mashhad in the year 2021, and 261 people were selected as a sample by purposive sampling. In this study, Health-related quality of life of Weber (1992), Depression of Beck (1996), Chronic fatigue of Chalder et al (1993), Treatment Adherence of Seyyed Fatemi, Rafiei, Hajizadeh & Madanlo (2018) were used for data collection in this study. The data were analyzed using Pearson's correlation coefficient and path analysis model with the help of SPSS-27 and AMOS-25 software. Results: The findings showed the relationship between depression and health-related quality of life; between depression and chronic fatigue; between chronic fatigue and adherence to treatment; There was a significant relationship between adherence to treatment and health-related quality of life (p<0.01); Also, the indirect path of depression with health-related quality of life with the mediating role of chronic fatigue and adherence to treatment were significant (p<0.01). Conclusion: Based on the results of this research, the proposed model had a favorable fit and is considered an important step in the direction of knowing the factors affecting the quality of life related to the health of women with uterine cancer.


Beath, S. V., & Wray, J. (2020). Health‐Related Quality of Life and Cognitive Functioning in Pediatric Liver Transplant Recipients. Liver Transplantation, 26(1), 9-11.
Beck, A. T., & Alford, B. A. (2009). Depression: Causes and treatment. University of Pennsylvania Press.‏
Behzadi, E., & Asgari, P. (2018). The effectiveness of cognitive-behavioral therapy on chronic fatigue and feelings of distress in working women. Women and Culture Scientific Research Quarterly, 9(36), 75-85.
Chen, F., Bailey, C. E., Alvarez, R. D., Shu, X. O., & Zheng, W. (2021). Adherence to treatment guidelines as a major determinant of survival disparities between black and white patients with ovarian cancer. Gynecologic oncology, 160(1), 10-15.‏
Clayton, E. W. (2015). Beyond myalgic encephalomyelitis/chronic fatigue syndrome: an IOM report on redefining an illness. Jama, 313(11), 1101-1102.
Dappa, E., Elger, T., Hasenburg, A., Düber, C., Battista, M. J., & Hötker, A. M. (2017). The value of advanced MRI techniques in the assessment of cervical cancer: a review. Insights into imaging, 8(5), 471-481.‏
Dasari, S., Wudayagiri, R., & Valluru, L. (2015). Cervical cancer: Biomarkers for diagnosis and treatment. Clinica chimica acta, 445, 7-11.‏
Dean, J., & Keshavan, M. (2017). The neurobiology of depression: An integrated view. Asian journal of psychiatry, 27, 101-111.‏
D'Iuso, D. A., Dobson, K. S., Beaulieu, L., & Drapeau, M. (2018). Coping and interpersonal functioning in depression. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement, 50(4), 248.‏
Gilbert, P. (2016). Depression: The evolution of powerlessness. Routledge.‏
Hinman, A. R., & Orenstein, W. A. (2021). Elimination of cervical cancer: Lessons learned from polio and earlier eradication programs. Preventive Medicine, 144, 106325.‏
Hordijk, J., Verbruggen, S., Vanhorebeek, I., Van den Berghe, G., Utens, E., Joosten, K., & Dulfer, K. (2020). Health-related quality of life of children and their parents 6 months after children’s critical illness. Quality of Life Research, 29(1), 179-189.
Jim, H. S., Hyland, K. A., Nelson, A. M., Pinilla‐Ibarz, J., Sweet, K., Gielissen, M., ... & Knoop, H. (2020). Internet‐assisted cognitive behavioral intervention for targeted therapy–related fatigue in chronic myeloid leukemia: Results from a pilot randomized trial. Cancer, 126(1), 174-180.
Kołtuniuk, A., & Rosińczuk, J. (2021). The Levels of Depression, Anxiety, Acceptance of Illness, and Medication Adherence in Patients with Multiple Sclerosis-Descriptive and Correlational Study. International journal of medical sciences, 18(1), 216.‏
Mirzaei, M., & Nik-Amal, M. (2020). Investigating the relationship between anthropometric indicators and quality of life with depression in female employees aged 25 to 40 in Yazd. Scientific Research Journal of Shahid Sadoughi University of Medical Sciences, Yazd, 28 (4), 2573-2564.
Moghadam Tabrizi, F., Najarzadeh, M., & Reyesi, F. Z. (2016). Investigating the relationship between fatigue and sleep quality with health quality of life in people with MS. Journal of Urmia School of Nursing and Midwifery, 14(1), 78-87.
Mohammadi, R., Doran, B., Rabiei, M., & Salimi, S. H. (2017). The effectiveness of treatment based on acceptance and commitment on the quality of life of students of a military center. Journal of Law Enforcement Medicine, 6(1), 21-30.
Montazeri A, GOSHTASBI A, Vahdaninia M. (2006). Theshort form health survey (SF-36): Translation andValidation Studyof the IranianVersion.
Nasri, S., Najarian, B., Mehrabizadeh Honarmand, M., & Shokrkon, H. (2002). Comparison of the effectiveness of two psychological treatment methods in reducing the symptoms of chronic fatigue syndrome in female nurses in Tehran. Journal of Educational Sciences and Psychology, 9(2-1), 53-88.
Omranifard, V., Ebrahimi, A., Basti, T., Sherbafchi, M., Sajadieh, Sh., & Mortazavi, M. (2016). Investigating the relationship between adherence to treatment and depression, anxiety and coping strategies in kidney transplant patients. Journal of Isfahan Medical School, 34(409), 1430-1438.
Ormstad, H., Simonsen, C. S., Broch, L., Maes, M., Anderson, G., & Celius, E. (2020). Chronic fatigue and depression due to multiple sclerosis: Immune-inflammatory pathways, tryptophan catabolites and the gut-brain axis as possible shared pathways. Multiple Sclerosis and Related Disorders, 102533.‏
Park, H. Y., Jeon, H. J., Bang, Y. R., & Yoon, I. Y. (2019). Multidimensional Comparison of Cancer-Related Fatigue and Chronic Fatigue Syndrome: The Role of Psychophysiological Markers. Psychiatry investigation, 16(1), 71.
Parpa, E., Tsilika, E., Gennimata, V., & Mystakidou, K. (2015). Elderly cancer patients’ psychopathology: a systematic review: aging and mental health. Archives of gerontology and geriatrics, 60(1), 9-15.‏
Pasek, M., Suchocka, L., Osuch-Pęcak, G., Muzykiewicz, K., Iwańska, E., Kaducakowa, H., ... & Goździalska, M. (2021). Longitudinal Health-Related Quality of Life Study among Cervical Cancer Patients Treated with Radiotherapy. Journal of Clinical Medicine, 10(2), 226.‏
Razavi, R.; Yaghoubi, H., Ganji, K., & Khajevand Khoshli, A. (2021). Modeling the relationship between cancer coping self-efficacy and treatment adherence in women with breast cancer: the mediating role of social support. Journal of Urmia School of Nursing and Midwifery, 19(2), 158-168.
Roberts, D. (2018). Chronic fatigue syndrome and quality of life. Patient related outcome measures, 9, 253.‏
Sadoughi, M., Mehrzad, V., & Mohammad Salehi, Z. (2017). The relationship between anxiety and depression with the quality of life of women with breast cancer referred to Seyed al-Shohdai Hospital in Isfahan in 2015: the moderating role of resilience. Journal of Rafsanjan University of Medical Sciences, 16 (5): 408-395.
Salehi, Z., Nowrozi Tabrizi, K., Hosseini, M. A., Sedghi Goy Aghaj, N., & Reza Soltani, P. (2017). Investigating the relationship between medication regimen adherence and quality of life in patients with rheumatoid arthritis. Clinical Journal of Nursing and Midwifery, 6(2), 1-13.
Similä, W. A., Halsteinli, V., Helland, I. B., Suvatne, C., Elmi, H., & Rø, T. B. (2020). Health-related quality of life in Norwegian adolescents living with chronic fatigue syndrome. Health and Quality of Life Outcomes, 18, 1-11.‏
Steur, L. M., Kaspers, G. J., Van Someren, E. J., Van Eijkelenburg, N. K., Van der Sluis, I. M., Dors, N., ... & Van Litsenburg, R. R. (2020). Sleep–wake rhythm disruption is associated with cancer-related fatigue in pediatric acute lymphoblastic leukemia. Sleep, 43(6), zsz320.‏
Trikkalinou, A., Papazafiropoulou, A. K., & Melidonis, A. (2017). Type 2 diabetes and quality of life. World journal of diabetes, 8(4), 120.
Vodermaier, A., & Linden, W. (2019). Social support buffers against anxiety and depressive symptoms in patients with cancer only if support is wanted: a large sample replication. Supportive Care in Cancer, 27(7), 2345-2347.‏
Yamano, E., Sugimoto, M., Hirayama, A., Kume, S., Yamato, M., Jin, G., ... & Kataoka, Y. (2016). Index markers of chronic fatigue syndrome with dysfunction of TCA and urea cycles. Scientific reports, 6(1), 1-9.‏