Health-related Quality of Life and Determinants of the Mental Dimension Among Tunisian Nurses in Public Hospitals

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Lamia Bouzgarrou
Irtyah Merchaoui
Amira Omrane
Nada Ameur
Salma Kammoun
Neila Chaari


Quality of life, mental health, Public hospitals, Nurses


Background: The health-related quality of life (HR-QoL) has been in­creasingly investigated in health sciences. The Objectives of this study are to evaluate the HR-QoL among nurses in Tunisian public hospitals and to identify the determinants of its mental dimension.

Methods: A cross-sectional, bi-centric study was conducted within a representative sample of the 1,179 nurses assigned to 28 departments of two Tunisian public hospitals. A structured inquiry (socio-professional characteristics, occupational perceived workload) and validated questionnaires (SF12, Job Content Questionnaire of Karasek, Work Ability Index) have been completed.

Results: Response rate was equal to 97.34%. The mean age of nurses was 42.60 ± 21 years. Nearly half of caregivers (49.07%) had a poor mental quality of life. The multivariate analysis concluded that mental HR-QoL was correlated with the female gender (0.010), obesity and the non-practice of regular physical activity (0.027), musculoskeletal diseases (<10-3), the low ability to work (<10-3). This deterioration of the mental HR-QoL dimension was also associated with the job tenure (0.002), the perceived workload (0.015), and conflictual relationships with colleagues (0.006) the feeling of insecurity at work (0.034), and the intention to leave the profession early (0.007)

Conclusion: The results of this study showed that a considerable number of nurses had a poor mental quality of life. This study also identified factors associated with this deterioration. Acting on these determining factors may improve the well-being and global health of nurses, as well as their work performance and quality of care provided.


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1. Watkinson RE, Sutton M, Turner AJ. Ethnic inequalities in health-related quality of life among older adults in England: secondary analysis of a national cross-sectional survey. Lancet Public Health. 2021;6:e145-54.
2. Mooney A. Quality of life: questionnaires and questions. J Health Commun. 2006;11:327-341.
3. Symeou M, Efstathiou A, Charalambous G, et al. Assessing the Health-Related Quality of Life of Nurses in the Public Sector of Cyprus. Int J Caring Sci. 2018;11(1):100-107.
4. Wu SY, Li HY, Tian J, et al. Health-related Quality of Life and Its Main Related Factors among Nurses in China. Ind Health. 2011;49:158-165.
5. Ware JE, Kosinski M, Keller SD. SF-12: How to Score the SF-12 Physical and Mental Health Summary Scales. Boston (M.A.): The Health Institute, New England Medical Center, Second edition, 1995.
6. Swapnil B, Harshali R, Snehal C. Prevalence of low mental health among nurses in medical intensive care units Int J Contemp Med Res. 2016;3(8):2444-2447.
7. Hall LH, Johnson J, Watt I, et al. Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review. PLoS ON. 2016;11(7):1-12e0159015.
8. Gandek B, Ware JE, Aaronson NK, et al. Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assess-ment. J Clin Epidemiol. 1998;51:1171-1178.
9. Younsi M, Chakroun M. Measuring health-related quality of life: psychometric evaluation of the Tuni-sian version of the SF-12 health survey. Qual Life Res. 2014;23:2047-2054.
10. Steenstrup T, Pedersen OB, Hjelmborg J, Skytthe A, Kyvik KO. Heritability of health-related quality of life: SF-12 summary scores in a population-based nationwide twin cohort. Twin. Res Hum Genet. 2013 Jun;16(3):670-8.
11. Vilagut G, Forero CG, Pinto-Meza A, et al: The Mental Component of the Short-Form12 Health Survey (SF-12) As a Measure of Depressive Disorders in the General Population: Results with Three Alterna-tive Scoring Methods. Value Health. 2013;16(4):564-573.
12. Niedhammer I. Psychometric properties of the French version of the Karasek Job Content Question-naire: a study of the scales of decision latitude, psychological demands, social support, and physical demands in the GAZEL cohort. Int Arch Occup Environ Health. 2002;75(3):129-44.
13. Karasek R, Brisson C, Kawakami N, Houtman I, Bongers P, Amick B. The Job Content Questionnaire (JCQ): An Instrument for Internationally Comparative Assessments of Psychosocial Job Characteristics. J Occup Health Psychol. 1998;3(4):322-355.
14. Silva Junior SHA, Vasconcelos AG, Griep RH, Rotenberg L. Test-retest reliability of the Work Ability In-dex (WAI) in nursing workers. Rev Bras Epidemiol. 2013;16(1):202-209.
15. Ilmarinen J. The Work Ability Index (WAI). Occup Med. 2007;57(2):160.
16. Arsalani N, Fallahi-khoshknab M, Josephson M, Lagerstroemia M. Iranian nursing staff's self-reported general and mental health-related to working conditions and family situation. Int Nurs Rev. 2012;59(3):416-423.
17. Coons SJ, Rao S, Keininger DL, Hays RD. A Comparative Review of Generic Quality-of-Life Instruments. Pharmacoeconomics. 2000;17(1),13-35.
18. Karimi M, Brazier J. Health, Health-Related Quality of Life, and Quality of Life: What is the Difference?. Pharmacoeconomics. 2016;34(7):645-649.
19. Ware JE, Kosinski, M, Gandek B, et al. The Factor Structure of the SF-36 Health Survey in 10 Countries. J Clin Epidemiol. 1998;51(11):1159-1165.
20. Sarafis P, Rousaki, E, Tsounis A, et al. The impact of occupational stress on nurses' caring behaviors and their health-related quality of life. BMC nursing. 2016;15(1):1-9.
21. Oyama Y, Fukahori H. A literature review of factors related to hospital nurses' health‐related quality of life. J Nurs Manag. 2015;23(5):661-673.
22. Schluter PJ, Turner C, Huntington AD, et al. Work/life balance and health: the Nurses and Midwives e-cohort study. International Nursing Review. 2011;58(1),28-36.
23. Al-Ameri MHI. Shift and its Impact upon the Quality of Life of Nurses Working at the Teaching Hospi-tals of the Medical City Complex in Baghdad City, Iraq. J Nurs Care. 2017;6:4:1-5.
24. Ioannou P, Katsikavali V, Galanis P, et al. Impact of Job Satisfaction on Greek Nurses’ Health-Related Quality of Life. Saf Health Work. 2015;6 (4):324-328.
25. Yang X, Hao Y, Marlah SG, Wang L. Factors associated with health-related quality of life among Chi-nese caregivers of the older adults living in the community: a cross-sectional study. Health Qual Life Outcomes. 2012;10(143):1-12.
26. Ruiz-Fernández MD, Ortega-Galán ÁM, Fernández-Sola C, Hernández-Padilla JM, Granero-Molina J, Ramos-Pichardo JD. Occupational factors associated with health-related quality of life in nursing professionals: A multi-centre study. Int J Environ Res Public Health. 2020;17(3);982.
27. Abbasi M, Zakerian A, Akbarzade A, et al. Investigation of the Relationship between Work Ability and Work-related Quality of Life in Nurses. Iran J Public Health. 2017;46(10):1404-1412.
28. Chiu MC, Wang MJ, Lu CW, et al. Evaluating work ability and quality of life for clinical nurses in Tai-wan. Nurs Outlook. 2007;55(6):318-326.
29. Milosevic M, Golubic R, Knezevic B, et al. Work ability as a major determinant of clinical nurses' quality of life. J Clin Nurs. 2011;20:2931-2938.
30. Apple R, Samuels LR, Fonnesbeck C, et al. Body mass index and health-related quality of life. Obes Sci Pract. 2018;4(5):417-426.
31. Busutil R, Espallardo O, Torres A, et al. The impact of obesity on health-related quality of life in Spain. Health Qual Life Outcomes. 2017;15(197) 1-11.
32. Nigatu YT, Reijneveld SA, de Jonge P, et al. The Combined Effects of Obesity, Abdominal Obesity and Major Depression/ Anxiety on Health-Related Quality of Life: the Life Lines Cohort Study. PLoS ONE. 11(2):1-15e0148871.
33. Hart PD, Minsoo K. Physical Inactivity and Health-Related Quality of Life among U.S. Adult Men and Women. J Women's Health Care. 2014;3(6):201-206.
34. Wang J, Sereika SM, Styn MA, Burke LE. Factors associated with health-related quality of life among overweight or obese adults. J Clin Nurs. 2013;22(15-16):2172-2182.
35. Levandoski G, Pilatti LA, Zannin PHT. Quality of Life, Physical Activity and Risk Behaviors: A Case Study in Mechanical Engineering Students. Open J Soc Sci. 2016;4,19-27.
36. Saulle R, Bernardi M, Chiarini M, et al. Shift work, overweight and obesity in health professionals: a systematic review and meta-analysis. Clin Ter. 2018; 169 (4):189-197.
37. Joslin L, Davis CR, Dolan P, Clark EM. Clark. Quality of life and neck pain in nurses. International. Int J Occup Med Environ Health. 2014;27(2):236-242.
38. Yan P, Yang Y, Zhang L, et al. Correlation analysis between work-related musculoskeletal disorders and the nursing practice environment, quality of life, and social support in the nursing professionals. Medicine (Baltimore). 2018;97(9):1-6.
39. Ellapen TJ, Narsigan S. Work Related Musculoskeletal Disorders among Nurses: Systematic Review. J Ergonomics. 2014;S4:1-6.
40. MacPhee M, Susan Dahinten V, Havaei F. The Impact of Heavy Perceived Nurse Workloads on Patient and Nurse. Outcomes Adm Sci. 2017;7(7):1-17.
41. Hamaideh SH, Mrayyan MT, Mudallal R, et al. Jordanian nurses’ job stressors and social support. Int Nurs Rev. 2008; 55(1):40-7.
42. Altuntaş S. Factors affecting the job satisfaction levels and quit intentions of academic nurses. Nurse Educ Today. 2014;34 (4):513-519.
43. Honda A, Date Y, Abe Y, et al. Work-related Stress, Caregiver Role, and Depressive Symptoms among Japanese Workers. Saf Health Work. 2014; 5(1):7-12.
44. Leineweber C, Chungkham HS, Lindqvist R, et al. Nurses’ practice environment and satisfaction with schedule flexibility is related to intention to leave due to dissatisfaction: A multi-country, multilevel study. Int J Nurs Stud. 2016;58:47-58.
45. Antigoni F, Pediaditaki O, Dimitrios T. Nursing staff under heavy stress: focus on Greece/A critical re-view. Int. J. Caring Sci.. 2011;4(1):11-20.
46. Adriaenssens J, De Gucht V, Maes S. Causes and consequences of occupational stress in emergency nurses, a longitudinal study. J Nurs Manag. 2013;23(3):346-358.
47. Priano SM, Hong OS, Chen JL. Lifestyles and Health-Related Outcomes of U.S. Hospital Nurses: A Sys-tematic Review. Nurs Outlook. 2018;66(1):66-76.