Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2023

Open Access 01-12-2023 | Burnout Syndrome | Research

Depression and burnout among Chinese nurses during COVID-19 pandemic: a mediation and moderation analysis model among frontline nurses and nonfrontline nurses caring for COVID-19 patients

Authors: Jingjun Wang, Xia Huang, Mengmeng Wang, Lei Huang, Ya Wang

Published in: BMC Psychiatry | Issue 1/2023

Login to get access

Abstract

Background

During the COVID-19 pandemic, nurses' workload increased dramatically, and nurses faced the risk of infection and multiple ethical dilemmas. In such a situation, nurse burnout was elevated, which tended to exacerbate depression in nurses. Although previous studies have demonstrated the relationship between burnout and depression among nurses, the exact mechanisms remain unclear. Furthermore, environmental factors are also essential to a person's psychological health. Therefore, this study intended to investigate the potential mechanisms of depression caused by nurse burnout and whether burnout among frontline nurses during the COVID-19 pandemic exacerbated its effect on depression in nurses as an environmental factor.

Methods

A total of 4517 nurses were enrolled in this study. A moderated mediation model was established to investigate the relationship between burnout and positive coping styles, interpersonal relationships, and depression utilizing the SPSS PROCESS 3.3 macro. The direct effect of burnout on depression was also investigated with the moderated mediation model.

Results

The indirect effects of positive coping styles (β = 0.04, 95% CI: 0.03 to 0.04) and interpersonal relationships (β = 0.12, 95% CI: 0.10 to 0.13) were revealed. Being a frontline nurse caring for COVID-19 patients moderated the direct effect of burnout on depression (β = 0.12, 95% CI: 0.08 to 0.16).

Conclusion

This study offers strong evidence for the mediating role of positive coping styles and interpersonal relationships in the relationship between nurse burnout and depression, in addition to illustrating the need for more psychological support for frontline nurses caring for COVID-19 patients.
Literature
1.
Yoruk S, Guler D. The relationship between psychological resilience, burnout, stress, and sociodemographic factors with depression in nurses and midwives during the COVID-19 pandemic: a cross-sectional study in Turkey. Perspect Psychiatr Care. 2021;57(1):390–8.PubMed
2.
Organization WH: Weekly epidemiological update on COVID-19 - 5 23 November 2022. In.; 2022.
3.
Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, Wu J, Du H, Chen T, Li R, et al. Factors associated with mental health outcomes among health care workers exposed to Coronavirus Disease 2019. Jama Network Open. 2020;3(3):e203976.PubMedPubMedCentral
4.
de Pablo GS, Vaquerizo-Serrano J, Catalan A, Arango C, Moreno C, Ferre F, Shin JI, Sullivan S, Brondino N, Solmi M, et al. Impact of coronavirus syndromes on physical and mental health of health care workers: systematic review and meta-analysis. J Affect Disord. 2020;275:48–57.
5.
Tosun A, Tosun H, Ozkaya BO, Erdogan Z, Gul A: "Sleep Quality and Depression Level in Nurses in COVID-19 Pandemic". Omega-Journal of Death and Dying 2022.
6.
Doo E-Y, Kim M, Lee S, Lee SY, Lee KY. Influence of anxiety and resilience on depression among hospital nurses: a comparison of nurses working with confirmed and suspected patients in the COVID-19 and non-COVID-19 units. J Clin Nurs. 2021;30(13–14):1990–2000.PubMedPubMedCentral
7.
Maslach C, Leiter MP. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry. 2016;15(2):103–11.PubMedPubMedCentral
8.
McManus IC, Winder BC, Gordon D. The causal links between stress and burnout in a longitudinal study of UK doctors. Lancet. 2002;359(9323):2089–90.PubMed
9.
Brown SD, Goske MJ, Johnson CM. Beyond substance abuse: stress, burnout, and depression as causes of physician impairment and disruptive behavior. Journal of the American College of Radiology : JACR. 2009;6(7):479–85.PubMed
10.
de Vasconcelos EM. Figueiredo de Martino MM, de Souza Franca SP: burnout and depressive symptoms in intensive care nurses: relationship analysis. Rev Bras Enferm. 2018;71(1):135–41.PubMed
11.
Quintas S, Queiros C, Marques A, Orvalho V. Nurses and their health at work: the relationship between depression and burnout. International Journal on Working Conditions. 2017;13:1–20.
12.
Tokur ME, Ergan B, Aydin K, Caliskan T, Savran Y, Yaka E, Koca U, Comert B, Gokmen N. Depression and burnout frequency in nurses working in tertiary intensive care units. Journal of Medical and Surgical Intensive Care Medicine. 2018;9(2):25–33.
13.
Chen C, Meier ST: Burnout and depression in nurses - a systematic review and meta-analysis (vol 124, 104099, 2021). Int J Nurs Stud. 2022, 127.
14.
Leiter MP, Durup J. The discriminant validity of burnout and depression - a confirmatory factor-analytic study. Anxiety Stress Coping. 1994;7(4):357–73.
15.
Stelnicki AM, Jamshidi L, Angehrn A, Hadjistavropoulos HD, Carleton RN. Associations between burnout and mental disorder symptoms among nurses in Canada. Canadian Journal of Nursing Research. 2021;53(3):254–63.
16.
Happell B, Dwyer T, Reid-Searl K, Burke KJ, Caperchione CM, Gaskin CJ. Nurses and stress: recognizing causes and seeking solutions. J Nurs Manag. 2013;21(4):638–47.PubMed
17.
Yoshizawa K, Sugawara N, Yasui-Furukori N, Danjo K, Furukori H, Sato Y, Tomita T, Fujii A, Nakagam T, Sasaki M, et al. Relationship between occupational stress and depression among psychiatric nurses in Japan. Arch Environ Occup Health. 2016;71(1):10–5.PubMed
18.
Folkman S, Lazarus RS, Gruen RJ, Delongis A. Appraisal, coping, health-status, and psychological symptoms. J Pers Soc Psychol. 1986;50(3):571–9.PubMed
19.
Chen J, Li J, Cao B, Wang F, Luo L, Xu J. Mediating effects of self-efficacy, coping, burnout, and social support between job stress and mental health among young Chinese nurses. J Adv Nurs. 2020;76(1):163–73.PubMed
20.
Garcia-Arroyo JA, Osca Segovia A: Work overload and emotional exhaustion in university teachers: moderating effects of coping styles. Universitas Psychologica 2019, 18(2).
21.
Pedro Martinez J, Mendez I, Ruiz-Esteban C, Fernandez-Sogorb A, Manuel Garcia-Fernandez J. Profiles of burnout, coping strategies and depressive symptomatology. Front Psychol. 2020;11:591.
22.
Shao R, He P, Ling B, Tan L, Xu L, Hou Y, Kong L, Yang Y. Prevalence of depression and anxiety and correlations between depression, anxiety, family functioning, social support and coping styles among Chinese medical students. BMC Psychol. 2020;8(1):38.PubMedPubMedCentral
23.
Bakker AB, Schaufeli WB, Sixma HJ, Bosveld W, Van Dierendonck D. Patient demands, lack of reciprocity, and burnout: a five-year longitudinal study among general practitioners. J Organ Behav. 2000;21(4):425–41.
24.
Khanji MY, Maniero C, Ng S, Siddiqui I, Gupta J, Crosby L, Antoniou S, Khan R, Kapil V, Gupta A. Early and mid-term implications of the COVID-19 pandemic on the physical, behavioral and mental health of healthcare professionals: The CoPE-HCP study protocol. Front Psychol. 2021;12:616280.PubMedPubMedCentral
25.
Yoon HS, Kim G-H, Kim J. Effectiveness of an interpersonal relationship program on interpersonal relationships, self-esteem, and depression in nursing students. J Korean Acad Nurs. 2011;41(6):805–13.PubMed
26.
Zlotnick C, Kohn R, Keitner G, Della Grotta SA. The relationship between quality of interpersonal relationships and major depressive disorder: findings from the National Comorbidity Survey. J Affect Disord. 2000;59(3):205–15.PubMed
27.
Bolatov AK, Seisembekov TZ, Smailova DS, Hosseini H. Burnout syndrome among medical students in Kazakhstan. BMC Psychol. 2022;10(1):193.PubMedPubMedCentral
28.
Puto G, Jurzec M, Leja-Szpak A, Bonior J, Muszalik M, Gniadek A. Stress and coping strategies of nurses working with patients infected with and not infected with SARS-CoV-2 Virus. Int J Environ Res Public Health. 2022;19(1):195.
29.
Thobane KF, Mulaudzi FM, Moagi MM. Improvement of the psychosocial support for frontline nurses in public hospitals during COVID-19 pandemic. J Nurs Manag. 2022;30(7):2461–9.PubMed
30.
Li J, Su Q, Li X, Peng Y, Liu Y. COVID-19 negatively impacts on psychological and somatic status in frontline nurses. J Affect Disord. 2021;294:279–85.PubMedPubMedCentral
31.
Johns G: Advances in the Treatment of Context in Organizational Research. In: Annual Review of Organizational Psychology and Organizational Behavior, Vol 5. Volume 5, edn. Edited by Morgeson F; 2018: 21–46.
32.
Thinh-Van V, Vo-Thanh T, Chi H, Nguyen Phong N, Van Duy N, Zaman M. The role of perceived workplace safety practices and mindfulness in maintaining calm in employees during times of crisis. Hum Resour Manage. 2022;61(3):315–33.
33.
Zakeri MA, Rahiminezhad E, Salehi F, Ganjeh H, Dehghan M. Burnout, anxiety, stress, and depression among iranian nurses: before and during the first wave of the COVID-19 pandemic. Front Psychol. 2021;12:789737.PubMedPubMedCentral
34.
Mao X, Lin X, Liu P, Zhang J, Deng W, Li Z, Hou T, Dong W. Impact of Insomnia on burnout among chinese nurses under the regular COVID-19 epidemic prevention and control: parallel mediating effects of anxiety and depression. Int J Public Health. 2023;68:1605688–1605688.PubMedPubMedCentral
35.
Kim HJ, Lee GH. A comparative study of the psychological impacts of tasks related and unrelated to COVID-19 on nurses: a cross-sectional study. Journal of Yeungnam medical science. 2022;39(3):216–22.PubMed
36.
Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP. Psychometric properties of the 42-item and 21-item versions of the depression anxiety stress scales in clinical groups and a community sample. Psychol Assess. 1998;10(2):176–81.
37.
Lovibond PF, Lovibond SH. The structure of negative emotional states - comparison of the depression anxiety stress scales (DASS) with the beck depression and anxiety inventories. Behav Res Ther. 1995;33(3):335–43.PubMed
38.
Schutte N, Toppinen S, Kalimo R, Schaufeli W. The factorial validity of the maslach burnout inventory-general Survey (MBI-GS) across occupational groups and nations. J Occup Organ Psychol. 2000;73:53–66.
39.
ChaoPing Li KS. The impact of distributive and procedural fairness on job burnout. Acta Psychol Sin. 2003;35(05):677–84.
40.
Deng R. Psychological diagnosis of college students. Shandong: Shandong Education Publishing Company; 1999.
41.
Xie Y. A preliminary study of the reliability and validity of the simplified coping style questionnaire. Chin J Clin Psychol. 1998;6(2):114–5.
42.
Wang Y, Wang P. Perceived stress and psychological distress among chinese physicians the mediating role of coping style. Medicine. 2019;98(23):e15950.PubMedPubMedCentral
43.
Wang Y, Xiao H, Zhang X, Wang L. The role of active coping in the relationship between learning burnout and sleep quality among college students in China. Front Psychol. 2020;11:647.PubMedPubMedCentral
44.
Zhou J, Yang Y, Qiu X, Yang X, Pan H, Ban B, Qiao Z, Wang L, Wang W. Relationship between anxiety and burnout among chinese physicians: a moderated mediation model. Plos One. 2016;11(8):e0157013.PubMedPubMedCentral
45.
Hobfoll SE. Conservation of resources - a new attempt at conceptualizing stress. Am Psychol. 1989;44(3):513–24.PubMed
46.
Loh JMI, Saleh A: Lashing out: emotional exhaustion triggers retaliatory incivility in the workplace. Heliyon 2022, 8(1).
47.
Lee EJ. 신승화: The Effect of Health Promotion Behavior on Fatigue and Depression among Shift Nurses. Journal of Korea Academia-Industrial cooperation Society. 2014;15(4):2256–64.
48.
Sun BH. hae kk, Lee D-G: the relationships among anger expression, interpersonal relationship, and depression in nursing students. Journal of Korea Academia-Industrial cooperation Society. 2020;21(4):91–9.
49.
Starr LR, Davila J. Excessive reassurance seeking, depression, and interpersonal rejection: a meta-analytic review. J Abnorm Psychol. 2008;117(4):762–75.PubMed
50.
Eberhart NK, Hammen CL. Interpersonal predictors of onset of depression during the transition to adulthood. Pers Relat. 2006;13(2):195–206.
51.
Fagan K. Understanding human behavior and the social environment. Community Dev. 2017;48(4):601–2.
52.
Shin M, Kemps E. Media multitasking as an avoidance coping strategy against emotionally negative stimuli. Anxiety Stress Coping. 2020;33(4):440–51.PubMed
53.
Fitzpatrick S, Khoury JE, Krantz L, Zeifman R, Kuo JR. Next-day effects of dysfunctional and functional emotion regulation and the moderating role of experiential avoidance. J Contextual Behav Sci. 2019;12:22–8.
54.
Connolly RD, Noel V, Mezo PG. Self-evaluation as a mediating variable between substance abuse and stress. Int J Ment Heal Addict. 2017;15(5):1055–63.
55.
Lee H. Changes in workplace practices during the COVID-19 pandemic: the roles of emotion, psychological safety and organisation support. Journal of Organizational Effectiveness-People and Performance. 2021;8(1):97–128.
56.
Trougakos JP, Chawla N, McCarthy JM. Working in a pandemic: exploring the impact of COVID-19 health anxiety on work, family, and health outcomes. J Appl Psychol. 2020;105(11):1234–45.PubMed
Metadata
Title
Depression and burnout among Chinese nurses during COVID-19 pandemic: a mediation and moderation analysis model among frontline nurses and nonfrontline nurses caring for COVID-19 patients
Authors
Jingjun Wang
Xia Huang
Mengmeng Wang
Lei Huang
Ya Wang
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2023
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-023-05006-1

Other articles of this Issue 1/2023

BMC Psychiatry 1/2023 Go to the issue

Research

Prevalence and clinical correlates of psychotic symptoms in first-episode untreated female chinese patients with major depressive disorder

Research

Hypnotic prescription trends and patterns for the treatment of insomnia in Japan: analysis of a nationwide Japanese claims database

Research

Mapping associations between anxiety and sleep problems among outpatients in high-altitude areas: a network analysis

Study Protocol

Cognitive Remediation in Bipolar (CRiB2): study protocol for a randomised controlled trial assessing efficacy and mechanisms of cognitive remediation therapy compared to treatment as usual

Research

The effect of web-based educational interventions on mental health literacy, stigma and help-seeking intentions/attitudes in young people: systematic review and meta-analysis

Research

CASP3 gene expression and the role of caspase 3 in the pathogenesis of depressive disorders