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Volume 17, Issue 4 (2025)
3 2025, 17(4): 377-382 |
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Received: 2025/09/19 | Accepted: 2025/10/25 | Published: 2025/11/19
Received: 2025/09/19 | Accepted: 2025/10/25 | Published: 2025/11/19
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Samadi H, Razi M, Pourmodaresi E. Predictive Role of Perceived Physical Literacy in Depression and Anxiety among Veterans and Individuals with Disabilities. 3 2025; 17 (4) :377-382
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Introduction
Veterans and individuals living with war-related disabilities are considered one of the most vulnerable health groups in postwar societies and face a complex set of physical, psychological, and social consequences [1-5]. Epidemiological evidence indicates that the prevalence of depression in this population typically ranges between 20% and 23%, and the rates of suicidal thoughts or tendencies are reported to be markedly higher than those of the general population [6]. These disorders are often accompanied by chronic pain, functional limitations, impairments in social participation, and reduced access to physical activity [7-9], factors that synergistically undermine quality of life and impose a substantial burden on healthcare systems and families [5, 10]. Such conditions highlight the necessity of developing multidimensional and behavior-based approaches to support the mental health of these vulnerable groups.
Among psychological outcomes, depression and anxiety are considered the most common and disabling disorders among veterans and individuals with disabilities, and are directly associated with sedentary behavioral patterns, chronic fatigue, persistent pain, and reduced social participation. Abrantes et al. report that veterans with post-traumatic stress disorder experience higher levels of anxiety, depression, and behavioral avoidance [7]. Other studies have also shown that sedentary lifestyles, functional limitations, and environmental barriers play an important role in the exacerbation and persistence of depressive and anxiety symptoms in this population [6, 11]. The extensive public health literature indicates that cycles of movement avoidance, perceived disability, low motivation, and social isolation are key pathways in the persistence of mood disorders [12-15].
Depression and anxiety in postwar societies are not viewed merely as individual disorders but are recognized as chronic phenomena with broad social, economic, and functional consequences. Reports from the World Health Organization indicate that mood disorders in populations exposed to trauma and physical disability are often persistent in nature and are associated with reduced functional capacity, increased dependency, and the continuation of the disability cycle [16]. In veterans and individuals with disabilities, the co-occurrence of physical injury, chronic pain, unemployment, and restricted social participation intensifies the risk of chronic depression and anxiety and reduces the effectiveness of conventional therapeutic interventions [17]. Accordingly, recent research has focused on identifying behavioral and psychosocial protective factors that can mitigate this debilitating cycle.
Although regular physical activity is recognized as one of the most effective non-pharmacological strategies for reducing psychological distress and improving emotional functioning [12-15], evidence suggests that relying solely on recommendations to increase physical activity—particularly in populations with persistent physical and psychological limitations—is insufficient to produce long-term behavioral change. Studies have shown that many veterans and individuals with disabilities, despite awareness of the benefits of physical activity, face difficulties in maintaining sustained participation in such activities [10]. These findings indicate that without attention to the psychological prerequisites of movement—such as motivation, perceived competence, and the meaningfulness of the movement experience—physical activity-based interventions will have limited effectiveness.
In addition, conventional mental health approaches, including pharmacotherapy and psychotherapy, can be effective in reducing short-term symptoms of depression and anxiety, but often face challenges such as low adherence, limited accessibility, and poor durability of treatment effects in veteran populations [18]. In contrast, lifestyle-based approaches, particularly movement-based interventions, have received attention as low-cost and potentially sustainable complements. However, existing evidence indicates that the absence of empowering conceptual frameworks limits the effectiveness of these interventions in vulnerable populations [19].
In this context, physical literacy, as a multidimensional construct comprising motivation, confidence, movement competence, knowledge, and understanding related to lifelong participation in physical activity, has gained a prominent position in health research [20-23]. Unlike traditional approaches that consider physical activity merely as a measurable behavior, physical literacy emphasizes the individual’s lived experience of movement and dynamic interaction with the environment, and addresses the psychological and perceptual prerequisites of movement behavior [24-27]. Research has shown that higher levels of physical literacy are associated with more sustained participation in physical activity, greater positive emotions, and lower levels of psychological distress in non-clinical populations.
However, systematic reviews of the literature indicate that the concept of physical literacy has largely been overlooked in clinical or vulnerable populations, particularly veterans and individuals with disabilities. Even in extensive research within military contexts that emphasizes the role of physical activity in mental health, physical literacy has not been incorporated as an independent construct in mental health models [6, 10]. This research gap suggests that although the benefits of physical activity are well documented, the psychological and experiential prerequisites of sustained engagement in movement—especially in populations with physical limitations—have received less attention.
From this perspective, physical literacy may provide a comprehensive conceptual framework for explaining the link between movement, behavior, and mental health in vulnerable populations. The focus of this construct on motivation, movement confidence, and the meaningfulness of movement experiences offers the potential to reduce psychological barriers to movement participation and consequently moderate symptoms of depression and anxiety [20-25]. Despite this theoretical potential, empirical evidence regarding the role of physical literacy in the mental health of clinical populations remains limited.
In response to this conceptual gap, the present study was designed to examine the predictive role of perceived physical literacy in depression and anxiety among veterans and individuals with disabilities. This study sought to contribute empirical evidence to the expansion of mental health conceptual frameworks in special populations and to provide a basis for designing physical literacy-based rehabilitation interventions.
Instrument and Methods
Design and sample
This descriptive-correlational study, conducted between August and September 2025, used a survey method to collect data and was performed on 110 participants (12 veterans and 98 individuals with disabilities) in Yazd City, selected using convenience sampling. The sample size was determined using G*Power software, considering a medium effect size, a type I error of 0.05, and a power of 0.95. Inclusion criteria included not using psychiatric medications, absence of intellectual disability, absence of very severe physical disabilities or disorders, absence of genetic disability, and provision of informed consent. The exclusion criterion was unwillingness to complete the questionnaires.
To collect background information, a researcher-made demographic questionnaire was used. This questionnaire included a set of basic questions assessing demographic characteristics and physical condition, including height, weight, age, presence of physical or mental illness, education level, marital status, and history of sports or therapeutic activities.
The Perceived Physical Literacy Assessment Scale (PLAS) was used to assess the level of physical literacy in adults. This instrument was developed by Naylor et al. in 2024 [15] and is considered one of the newest psychometric scales in the field of physical activity and health. The PLAS consists of 23 items categorized into six main components: motivational-psychological, social, confidence, physical-coordination, physical-strength, and knowledge. To calculate the total physical literacy score, the mean score of each subscale is first calculated, and then the sum of these means is taken as the final score. Higher scores indicate higher levels of perceived physical literacy. In Iran, the validity and reliability of the Persian version of this questionnaire were examined and confirmed by Samadi et al. [28]. The reliability of the questionnaire in our study was obtained as 0.83 using Cronbach's alpha coefficient.
We used the Depression, Anxiety and Stress Scales (DASS) to assess the participants’ levels of depression and anxiety. This instrument was developed by Lovibond and Lovibond in 1995 and is regarded as a valid and standardized psychometric tool in the field of mental health. The short version of the questionnaire comprises 21 self-report items. Responses to each item are rated on a four-point Likert scale (from “did not apply to me at all” to “applied to me very much”). Due to its simple structure and established reliability and validity, this instrument is widely used in psychological and clinical research. In Iran, the validity and reliability of the DASS have been examined by various researchers. In the study by Asghari Moghadam et al., Cronbach’s alpha coefficients of 0.77 for depression, 0.79 for anxiety, and 0.78 for stress were reported [29]. The reliability of the questionnaire in our study was obtained as 0.74 using Cronbach's alpha coefficient.
Procedure
This study was conducted following coordination with the Martyrs and Veterans Affairs Foundation and the Disabled and Veterans Sports Board of Yazd County. After coordinating with eligible individuals, an orientation session was held for them. In this session, the research objectives and procedures were fully explained, with emphasis placed on data confidentiality, the voluntary nature of participation, and the right to withdraw at any stage. Subsequently, a written informed consent form was given to each participant, and after any ambiguities were clarified, it was signed. In the next phase, the questionnaire package was completed by the participants in a calm and private setting. Before beginning, participants were informed that there were no right or wrong answers and that the results would be reported only in aggregate and anonymously to reduce response bias. If any ambiguity arose during questionnaire completion, the researcher was available to provide clarification. Finally, participants’ cooperation was acknowledged, and they were promised that a summary of the overall research findings would be sent to them upon request.
Statistical analysis
After verifying normality, the data were analyzed using Pearson’s correlation coefficient to assess the relationships between parameters, and simple regression analysis was used to predict parameters based on levels of perceived physical literacy. A significance level of α=0.05 was maintained for all statistical tests. Data were analyzed using SPSS 26 software. To check the normality of the data, the Kolmogorov-Smirnov test was used, which showed that all parameters had a normal distribution.
Findings
There was a significant cognitive relationship between perceived physical literacy and depression (p<0.05, r=-0.34), as well as a significant negative relationship between perceived physical literacy and anxiety (p<0.05, r=-0.21).
Approximately 12% of the variance in depression was predicted based on perceived physical literacy. In other words, perceived physical literacy negatively and significantly predicted depression among veterans and individuals with disabilities (p<0.001). Similarly, over 4.5% of the variance in anxiety was predicted by perceived physical literacy, showing a significant negative predictive relationship (p<0.025; Table 1).
Table 1. Regression analysis predicting depression and anxiety based on perceived physical literacy
Discussion
The purpose of the present study was to examine the predictive role of perceived physical literacy in symptoms of depression and anxiety among veterans and individuals with disabilities. Physical literacy had a significant negative relationship with both depression and anxiety, such that higher perceived levels of physical literacy components—including motivation, bodily confidence, movement competence, social interaction, and knowledge related to physical activity—were associated with reduced severity of psychological symptoms. Thus, physical literacy can function as a multidimensional protective factor in the mental health of these vulnerable groups.
The relationship between physical literacy and depression was of moderate strength, whereas its association with anxiety was weaker but still significant. Regression analysis also showed that physical literacy explained approximately 11.5% of the variance in depression and 4.5% of the variance in anxiety; a finding consistent with previous studies in non-clinical populations and indicating that although physical literacy is only one of the factors influencing mental health, its contribution—particularly to depression—is considerable [19].
Our findings are consistent with existing evidence in the literature on physical literacy and mental health. Shanshan et al. report that higher levels of physical literacy among adolescents are associated with increased positive emotions and reduced negative emotions [12]. Likewise, Leung et al., in a systematic review, show that perceived physical literacy among university students is associated with reduced depression, anxiety, and stress, as well as increased quality of life and life satisfaction [14]. On the other hand, Fortnum et al., emphasizing the multidimensional nature of physical literacy, identify it as a fundamental determinant of health, the effects of which are exerted through increased motivation, competence, and sustained participation in physical activity [30]. However, these authors also point to the lack of evidence in clinical and vulnerable populations—a gap that the present study seeks to partially address by focusing on veterans and individuals with disabilities.
Several theoretical mechanisms can explain the observed relationship between physical literacy and symptoms of depression and anxiety. First, the motivational–emotional components of physical literacy can enhance feelings of competence, personal control, and social belonging—factors recognized in contemporary mental health models as protective buffers against depression and anxiety [25]. Second, there is strong evidence that regular participation in physical activity—an expected outcome of higher levels of physical literacy—is associated with reduced symptoms of depression and anxiety and with improved emotional functioning [19]. Third, increased movement participation can reduce social isolation and provide opportunities for positive social interaction, particularly for individuals with physical limitations, a factor directly associated with improved psychological well-being.
In the context of veterans and injured populations, the findings of Abrantes et al. also indicate that physical activity in individuals with PTSD can be associated with reduced emotional symptoms, increased perceptions of controllability, and improved quality of life [7]. Although the present study did not directly measure PTSD, the mechanisms proposed in that research can provide a theoretical explanation for the protective role of physical literacy in reducing psychological distress in the studied population.
One of the main innovations of this study is its focus on a population that has been largely neglected in the physical literacy literature. Most previous research on physical literacy has focused on children, adolescents, university students, and healthy populations [1, 6], while little evidence exists regarding the role of this construct among veterans or individuals with disabilities. Therefore, by providing preliminary data from a vulnerable group, the present study opens a new pathway for expanding the application of physical literacy in the fields of mental health and rehabilitation.
From a practical perspective, the results suggest that promoting physical literacy can be considered a complementary component of physical and psychological rehabilitation programs for veterans and individuals with disabilities. Because physical literacy encompasses not only the amount of physical activity but also motivational, cognitive, and social dimensions, interventions based on this construct can lead to increased participation, reduced movement-related anxiety, and improved perceptions of personal competence [25]. Such an approach, alongside medical and psychotherapeutic treatments, could contribute to the sustainable promotion of mental health in this population.
Despite these findings, the limitations of the study should be considered. The cross-sectional design limits causal inference. In addition, the use of self-report instruments may be associated with response bias. Given that the majority of participants were individuals with disabilities compared to veterans, caution should be exercised in generalizing the findings. Furthermore, parameters such as PTSD, severity of chronic pain, or actual levels of physical activity were not measured, which may have mediated or moderated the observed relationships. Future studies using longitudinal or interventional designs and examining these parameters may provide a deeper understanding of the mechanisms through which physical literacy influences mental health.
Conclusion
A higher level of perceived physical literacy is associated with lower levels of psychological distress, particularly symptoms of anxiety and depression, among veterans and individuals with disabilities.
Acknowledgments: We would like to express our appreciation and gratitude to the respected officials of the Foundation of Martyrs and Veterans’ Affairs of Yazd Province, and to all the veterans and people with disabilities who cooperated in the research.
Ethical Permissions: This study received the ethics code IR.YAZD.REC.1401.018.
Conflicts of Interests: There are no conflicts of interests.
Authors' Contribution: Samadi H (First Author), Introduction Writer/Main Researcher/Statistical Analyst (40%); Razi MJ (Second Author), Methodologist/Assistant Researcher/Discussion Writer (40%); Pourmodaresi E (Third Author), Assistant Researcher/Statistical Analyst (20%)
Funding/Support: The present study was not financially supported.
Veterans and individuals living with war-related disabilities are considered one of the most vulnerable health groups in postwar societies and face a complex set of physical, psychological, and social consequences [1-5]. Epidemiological evidence indicates that the prevalence of depression in this population typically ranges between 20% and 23%, and the rates of suicidal thoughts or tendencies are reported to be markedly higher than those of the general population [6]. These disorders are often accompanied by chronic pain, functional limitations, impairments in social participation, and reduced access to physical activity [7-9], factors that synergistically undermine quality of life and impose a substantial burden on healthcare systems and families [5, 10]. Such conditions highlight the necessity of developing multidimensional and behavior-based approaches to support the mental health of these vulnerable groups.
Among psychological outcomes, depression and anxiety are considered the most common and disabling disorders among veterans and individuals with disabilities, and are directly associated with sedentary behavioral patterns, chronic fatigue, persistent pain, and reduced social participation. Abrantes et al. report that veterans with post-traumatic stress disorder experience higher levels of anxiety, depression, and behavioral avoidance [7]. Other studies have also shown that sedentary lifestyles, functional limitations, and environmental barriers play an important role in the exacerbation and persistence of depressive and anxiety symptoms in this population [6, 11]. The extensive public health literature indicates that cycles of movement avoidance, perceived disability, low motivation, and social isolation are key pathways in the persistence of mood disorders [12-15].
Depression and anxiety in postwar societies are not viewed merely as individual disorders but are recognized as chronic phenomena with broad social, economic, and functional consequences. Reports from the World Health Organization indicate that mood disorders in populations exposed to trauma and physical disability are often persistent in nature and are associated with reduced functional capacity, increased dependency, and the continuation of the disability cycle [16]. In veterans and individuals with disabilities, the co-occurrence of physical injury, chronic pain, unemployment, and restricted social participation intensifies the risk of chronic depression and anxiety and reduces the effectiveness of conventional therapeutic interventions [17]. Accordingly, recent research has focused on identifying behavioral and psychosocial protective factors that can mitigate this debilitating cycle.
Although regular physical activity is recognized as one of the most effective non-pharmacological strategies for reducing psychological distress and improving emotional functioning [12-15], evidence suggests that relying solely on recommendations to increase physical activity—particularly in populations with persistent physical and psychological limitations—is insufficient to produce long-term behavioral change. Studies have shown that many veterans and individuals with disabilities, despite awareness of the benefits of physical activity, face difficulties in maintaining sustained participation in such activities [10]. These findings indicate that without attention to the psychological prerequisites of movement—such as motivation, perceived competence, and the meaningfulness of the movement experience—physical activity-based interventions will have limited effectiveness.
In addition, conventional mental health approaches, including pharmacotherapy and psychotherapy, can be effective in reducing short-term symptoms of depression and anxiety, but often face challenges such as low adherence, limited accessibility, and poor durability of treatment effects in veteran populations [18]. In contrast, lifestyle-based approaches, particularly movement-based interventions, have received attention as low-cost and potentially sustainable complements. However, existing evidence indicates that the absence of empowering conceptual frameworks limits the effectiveness of these interventions in vulnerable populations [19].
In this context, physical literacy, as a multidimensional construct comprising motivation, confidence, movement competence, knowledge, and understanding related to lifelong participation in physical activity, has gained a prominent position in health research [20-23]. Unlike traditional approaches that consider physical activity merely as a measurable behavior, physical literacy emphasizes the individual’s lived experience of movement and dynamic interaction with the environment, and addresses the psychological and perceptual prerequisites of movement behavior [24-27]. Research has shown that higher levels of physical literacy are associated with more sustained participation in physical activity, greater positive emotions, and lower levels of psychological distress in non-clinical populations.
However, systematic reviews of the literature indicate that the concept of physical literacy has largely been overlooked in clinical or vulnerable populations, particularly veterans and individuals with disabilities. Even in extensive research within military contexts that emphasizes the role of physical activity in mental health, physical literacy has not been incorporated as an independent construct in mental health models [6, 10]. This research gap suggests that although the benefits of physical activity are well documented, the psychological and experiential prerequisites of sustained engagement in movement—especially in populations with physical limitations—have received less attention.
From this perspective, physical literacy may provide a comprehensive conceptual framework for explaining the link between movement, behavior, and mental health in vulnerable populations. The focus of this construct on motivation, movement confidence, and the meaningfulness of movement experiences offers the potential to reduce psychological barriers to movement participation and consequently moderate symptoms of depression and anxiety [20-25]. Despite this theoretical potential, empirical evidence regarding the role of physical literacy in the mental health of clinical populations remains limited.
In response to this conceptual gap, the present study was designed to examine the predictive role of perceived physical literacy in depression and anxiety among veterans and individuals with disabilities. This study sought to contribute empirical evidence to the expansion of mental health conceptual frameworks in special populations and to provide a basis for designing physical literacy-based rehabilitation interventions.
Instrument and Methods
Design and sample
This descriptive-correlational study, conducted between August and September 2025, used a survey method to collect data and was performed on 110 participants (12 veterans and 98 individuals with disabilities) in Yazd City, selected using convenience sampling. The sample size was determined using G*Power software, considering a medium effect size, a type I error of 0.05, and a power of 0.95. Inclusion criteria included not using psychiatric medications, absence of intellectual disability, absence of very severe physical disabilities or disorders, absence of genetic disability, and provision of informed consent. The exclusion criterion was unwillingness to complete the questionnaires.
To collect background information, a researcher-made demographic questionnaire was used. This questionnaire included a set of basic questions assessing demographic characteristics and physical condition, including height, weight, age, presence of physical or mental illness, education level, marital status, and history of sports or therapeutic activities.
The Perceived Physical Literacy Assessment Scale (PLAS) was used to assess the level of physical literacy in adults. This instrument was developed by Naylor et al. in 2024 [15] and is considered one of the newest psychometric scales in the field of physical activity and health. The PLAS consists of 23 items categorized into six main components: motivational-psychological, social, confidence, physical-coordination, physical-strength, and knowledge. To calculate the total physical literacy score, the mean score of each subscale is first calculated, and then the sum of these means is taken as the final score. Higher scores indicate higher levels of perceived physical literacy. In Iran, the validity and reliability of the Persian version of this questionnaire were examined and confirmed by Samadi et al. [28]. The reliability of the questionnaire in our study was obtained as 0.83 using Cronbach's alpha coefficient.
We used the Depression, Anxiety and Stress Scales (DASS) to assess the participants’ levels of depression and anxiety. This instrument was developed by Lovibond and Lovibond in 1995 and is regarded as a valid and standardized psychometric tool in the field of mental health. The short version of the questionnaire comprises 21 self-report items. Responses to each item are rated on a four-point Likert scale (from “did not apply to me at all” to “applied to me very much”). Due to its simple structure and established reliability and validity, this instrument is widely used in psychological and clinical research. In Iran, the validity and reliability of the DASS have been examined by various researchers. In the study by Asghari Moghadam et al., Cronbach’s alpha coefficients of 0.77 for depression, 0.79 for anxiety, and 0.78 for stress were reported [29]. The reliability of the questionnaire in our study was obtained as 0.74 using Cronbach's alpha coefficient.
Procedure
This study was conducted following coordination with the Martyrs and Veterans Affairs Foundation and the Disabled and Veterans Sports Board of Yazd County. After coordinating with eligible individuals, an orientation session was held for them. In this session, the research objectives and procedures were fully explained, with emphasis placed on data confidentiality, the voluntary nature of participation, and the right to withdraw at any stage. Subsequently, a written informed consent form was given to each participant, and after any ambiguities were clarified, it was signed. In the next phase, the questionnaire package was completed by the participants in a calm and private setting. Before beginning, participants were informed that there were no right or wrong answers and that the results would be reported only in aggregate and anonymously to reduce response bias. If any ambiguity arose during questionnaire completion, the researcher was available to provide clarification. Finally, participants’ cooperation was acknowledged, and they were promised that a summary of the overall research findings would be sent to them upon request.
Statistical analysis
After verifying normality, the data were analyzed using Pearson’s correlation coefficient to assess the relationships between parameters, and simple regression analysis was used to predict parameters based on levels of perceived physical literacy. A significance level of α=0.05 was maintained for all statistical tests. Data were analyzed using SPSS 26 software. To check the normality of the data, the Kolmogorov-Smirnov test was used, which showed that all parameters had a normal distribution.
Findings
There was a significant cognitive relationship between perceived physical literacy and depression (p<0.05, r=-0.34), as well as a significant negative relationship between perceived physical literacy and anxiety (p<0.05, r=-0.21).
Approximately 12% of the variance in depression was predicted based on perceived physical literacy. In other words, perceived physical literacy negatively and significantly predicted depression among veterans and individuals with disabilities (p<0.001). Similarly, over 4.5% of the variance in anxiety was predicted by perceived physical literacy, showing a significant negative predictive relationship (p<0.025; Table 1).
Table 1. Regression analysis predicting depression and anxiety based on perceived physical literacy
Discussion
The purpose of the present study was to examine the predictive role of perceived physical literacy in symptoms of depression and anxiety among veterans and individuals with disabilities. Physical literacy had a significant negative relationship with both depression and anxiety, such that higher perceived levels of physical literacy components—including motivation, bodily confidence, movement competence, social interaction, and knowledge related to physical activity—were associated with reduced severity of psychological symptoms. Thus, physical literacy can function as a multidimensional protective factor in the mental health of these vulnerable groups.
The relationship between physical literacy and depression was of moderate strength, whereas its association with anxiety was weaker but still significant. Regression analysis also showed that physical literacy explained approximately 11.5% of the variance in depression and 4.5% of the variance in anxiety; a finding consistent with previous studies in non-clinical populations and indicating that although physical literacy is only one of the factors influencing mental health, its contribution—particularly to depression—is considerable [19].
Our findings are consistent with existing evidence in the literature on physical literacy and mental health. Shanshan et al. report that higher levels of physical literacy among adolescents are associated with increased positive emotions and reduced negative emotions [12]. Likewise, Leung et al., in a systematic review, show that perceived physical literacy among university students is associated with reduced depression, anxiety, and stress, as well as increased quality of life and life satisfaction [14]. On the other hand, Fortnum et al., emphasizing the multidimensional nature of physical literacy, identify it as a fundamental determinant of health, the effects of which are exerted through increased motivation, competence, and sustained participation in physical activity [30]. However, these authors also point to the lack of evidence in clinical and vulnerable populations—a gap that the present study seeks to partially address by focusing on veterans and individuals with disabilities.
Several theoretical mechanisms can explain the observed relationship between physical literacy and symptoms of depression and anxiety. First, the motivational–emotional components of physical literacy can enhance feelings of competence, personal control, and social belonging—factors recognized in contemporary mental health models as protective buffers against depression and anxiety [25]. Second, there is strong evidence that regular participation in physical activity—an expected outcome of higher levels of physical literacy—is associated with reduced symptoms of depression and anxiety and with improved emotional functioning [19]. Third, increased movement participation can reduce social isolation and provide opportunities for positive social interaction, particularly for individuals with physical limitations, a factor directly associated with improved psychological well-being.
In the context of veterans and injured populations, the findings of Abrantes et al. also indicate that physical activity in individuals with PTSD can be associated with reduced emotional symptoms, increased perceptions of controllability, and improved quality of life [7]. Although the present study did not directly measure PTSD, the mechanisms proposed in that research can provide a theoretical explanation for the protective role of physical literacy in reducing psychological distress in the studied population.
One of the main innovations of this study is its focus on a population that has been largely neglected in the physical literacy literature. Most previous research on physical literacy has focused on children, adolescents, university students, and healthy populations [1, 6], while little evidence exists regarding the role of this construct among veterans or individuals with disabilities. Therefore, by providing preliminary data from a vulnerable group, the present study opens a new pathway for expanding the application of physical literacy in the fields of mental health and rehabilitation.
From a practical perspective, the results suggest that promoting physical literacy can be considered a complementary component of physical and psychological rehabilitation programs for veterans and individuals with disabilities. Because physical literacy encompasses not only the amount of physical activity but also motivational, cognitive, and social dimensions, interventions based on this construct can lead to increased participation, reduced movement-related anxiety, and improved perceptions of personal competence [25]. Such an approach, alongside medical and psychotherapeutic treatments, could contribute to the sustainable promotion of mental health in this population.
Despite these findings, the limitations of the study should be considered. The cross-sectional design limits causal inference. In addition, the use of self-report instruments may be associated with response bias. Given that the majority of participants were individuals with disabilities compared to veterans, caution should be exercised in generalizing the findings. Furthermore, parameters such as PTSD, severity of chronic pain, or actual levels of physical activity were not measured, which may have mediated or moderated the observed relationships. Future studies using longitudinal or interventional designs and examining these parameters may provide a deeper understanding of the mechanisms through which physical literacy influences mental health.
Conclusion
A higher level of perceived physical literacy is associated with lower levels of psychological distress, particularly symptoms of anxiety and depression, among veterans and individuals with disabilities.
Acknowledgments: We would like to express our appreciation and gratitude to the respected officials of the Foundation of Martyrs and Veterans’ Affairs of Yazd Province, and to all the veterans and people with disabilities who cooperated in the research.
Ethical Permissions: This study received the ethics code IR.YAZD.REC.1401.018.
Conflicts of Interests: There are no conflicts of interests.
Authors' Contribution: Samadi H (First Author), Introduction Writer/Main Researcher/Statistical Analyst (40%); Razi MJ (Second Author), Methodologist/Assistant Researcher/Discussion Writer (40%); Pourmodaresi E (Third Author), Assistant Researcher/Statistical Analyst (20%)
Funding/Support: The present study was not financially supported.
Keywords:
Anxiety [MeSH], Depression [MeSH], Individuals with Disabilities [MeSH], Mental Health [MeSH], Veterans [MeSH]
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