Skip to main content
Top
Published in: BMC Public Health 1/2012

Open Access 01-12-2012 | Research article

The mediating role of psychological capital on the association between occupational stress and depressive symptoms among Chinese physicians: a cross-sectional study

Authors: Li Liu, Ying Chang, Jialiang Fu, Jiana Wang, Lie Wang

Published in: BMC Public Health | Issue 1/2012

Login to get access

Abstract

Background

Although occupational stress is an identified predictor of depressive symptoms, the mechanism behind the association is not well understood. The purpose of this study was to examine how psychological capital (PsyCap), a positive psychological state, mediates the association between occupational stress and depressive symptoms among Chinese physicians.

Methods

A cross-sectional survey was conducted in Liaoning Province, China, during September–October 2010. Self-administered questionnaires including items on depressive symptoms assessed by the Center for Epidemiologic Studies Depression Scale, occupational stress assessed by the effort–reward imbalance scale and PsyCap estimated by a 24-item Psychological Capital Questionnaire, together with age, gender, marital status and education were distributed to 1300 physicians employed in large general hospitals. The final sample consisted of 998 participants. Asymptotic and resampling strategies were used to examine how PsyCap mediates the association between occupational stress and depressive symptoms.

Results

Both the effort/reward ratio (ERR) and overcommitment were significantly associated with depressive symptoms among male and female physicians. There was a gender difference in the mediating role of PsyCap on the occupational stress–depressive symptoms association. For male physicians, PsyCap did not mediate the association between occupational stress and depressive symptoms. For female physicians, ERR and overcommitment were negatively associated with PsyCap, and PsyCap was negatively associated with depressive symptoms. As a result, PsyCap significantly mediated the associations of ERR and overcommitment with depressive symptoms. The proportion of PsyCap mediation was 19.07% for ERR, and 24.29% for overcommitment.

Conclusions

PsyCap could be a positive resource for combating depressive symptoms in Chinese physicians. In addition to reducing occupational stress, PsyCap development should be included in depression prevention and treatment strategies, especially for female physicians.
Appendix
Available only for authorised users
Literature
1.
go back to reference Leykin Y, Roberts CS, Derubeis RJ: Decision-making and depressive symptomatology. Cognit Ther Res. 2011, 35: 333-341. 10.1007/s10608-010-9308-0.CrossRefPubMed Leykin Y, Roberts CS, Derubeis RJ: Decision-making and depressive symptomatology. Cognit Ther Res. 2011, 35: 333-341. 10.1007/s10608-010-9308-0.CrossRefPubMed
2.
go back to reference Elinson L, Houck P, Marcus SC, Pincus HA: Depression and the ability to work. Psychiatr Serv. 2004, 55: 29-34. 10.1176/appi.ps.55.1.29.CrossRefPubMed Elinson L, Houck P, Marcus SC, Pincus HA: Depression and the ability to work. Psychiatr Serv. 2004, 55: 29-34. 10.1176/appi.ps.55.1.29.CrossRefPubMed
3.
go back to reference Adler DA, McLaughlin TJ, Rogers WH, Chang H, Lapitsky L, Lerner D: Job performance deficits due to depression. Am J Psychiatry. 2006, 163: 1569-1576. 10.1176/appi.ajp.163.9.1569.CrossRefPubMedPubMedCentral Adler DA, McLaughlin TJ, Rogers WH, Chang H, Lapitsky L, Lerner D: Job performance deficits due to depression. Am J Psychiatry. 2006, 163: 1569-1576. 10.1176/appi.ajp.163.9.1569.CrossRefPubMedPubMedCentral
4.
go back to reference Stewart WF, Ricci JA, Chee E, Hahn SR, Morganstein D: Cost of lost productive work time among US workers with depression. JAMA. 2003, 289: 3135-3144. 10.1001/jama.289.23.3135.CrossRefPubMed Stewart WF, Ricci JA, Chee E, Hahn SR, Morganstein D: Cost of lost productive work time among US workers with depression. JAMA. 2003, 289: 3135-3144. 10.1001/jama.289.23.3135.CrossRefPubMed
5.
go back to reference Rusli BN, Edimansyah BA, Naing L: Working conditions, self-perceived stress, anxiety, depression and quality of life: a structural equation modelling approach. BMC Publ Health. 2008, 8: 48-10.1186/1471-2458-8-48.CrossRef Rusli BN, Edimansyah BA, Naing L: Working conditions, self-perceived stress, anxiety, depression and quality of life: a structural equation modelling approach. BMC Publ Health. 2008, 8: 48-10.1186/1471-2458-8-48.CrossRef
6.
go back to reference Tennant C: Work-related stress and depressive disorders. J Psychosom Res. 2001, 51: 697-704. 10.1016/S0022-3999(01)00255-0.CrossRefPubMed Tennant C: Work-related stress and depressive disorders. J Psychosom Res. 2001, 51: 697-704. 10.1016/S0022-3999(01)00255-0.CrossRefPubMed
7.
go back to reference Wang LJ, Chen CK, Hsu SC, Lee SY, Wang CS, Yeh WY: Active job, healthy job? Occupational stress and depression among hospital physicians in Taiwan. Ind Health. 2011, 49: 173-184. 10.2486/indhealth.MS1209.CrossRefPubMed Wang LJ, Chen CK, Hsu SC, Lee SY, Wang CS, Yeh WY: Active job, healthy job? Occupational stress and depression among hospital physicians in Taiwan. Ind Health. 2011, 49: 173-184. 10.2486/indhealth.MS1209.CrossRefPubMed
8.
go back to reference Wang JN, Sun W, Chi TS, Wu H, Wang L: Prevalence and associated factors of depressive symptoms among Chinese doctors: a cross-sectional survey. Int Arch Occup Environ Health. 2010, 83: 905-911. 10.1007/s00420-010-0508-4.CrossRefPubMed Wang JN, Sun W, Chi TS, Wu H, Wang L: Prevalence and associated factors of depressive symptoms among Chinese doctors: a cross-sectional survey. Int Arch Occup Environ Health. 2010, 83: 905-911. 10.1007/s00420-010-0508-4.CrossRefPubMed
9.
go back to reference Frank E, Dingle AD: Self-reported depression and suicide attempts among U.S. women physicians. Am J Psychiatry. 1999, 156: 1887-1894.PubMed Frank E, Dingle AD: Self-reported depression and suicide attempts among U.S. women physicians. Am J Psychiatry. 1999, 156: 1887-1894.PubMed
10.
go back to reference Schwenk TL, Gorenflo DW, Leja LM: A survey on the impact of being depressed on the professional status and mental health care of physicians. J Clin Psychiatry. 2008, 69: 617-620. 10.4088/JCP.v69n0414.CrossRefPubMed Schwenk TL, Gorenflo DW, Leja LM: A survey on the impact of being depressed on the professional status and mental health care of physicians. J Clin Psychiatry. 2008, 69: 617-620. 10.4088/JCP.v69n0414.CrossRefPubMed
11.
go back to reference Fahrenkopf AM, Sectish TC, Barger LK, Sharek PJ, Lewin D, Chiang VW, Edwards S, Wiedermann BL, Landrigan CP: Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. 2008, 336: 488-491. 10.1136/bmj.39469.763218.BE.CrossRefPubMedPubMedCentral Fahrenkopf AM, Sectish TC, Barger LK, Sharek PJ, Lewin D, Chiang VW, Edwards S, Wiedermann BL, Landrigan CP: Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. 2008, 336: 488-491. 10.1136/bmj.39469.763218.BE.CrossRefPubMedPubMedCentral
12.
go back to reference Tomioka K, Morita N, Saeki K, Okamoto N, Kurumatani N: Working hours, occupational stress and depression among physicians. Occup Med (Lond). 2011, 61: 163-170. 10.1093/occmed/kqr004.CrossRef Tomioka K, Morita N, Saeki K, Okamoto N, Kurumatani N: Working hours, occupational stress and depression among physicians. Occup Med (Lond). 2011, 61: 163-170. 10.1093/occmed/kqr004.CrossRef
13.
go back to reference Center C, Davis M, Detre T, Ford DE, Hansbrough W, Hendin H, Laszlo J, Litts DA, Mann J, Mansky PA, Michels R, Miles SH, Proujansky R, Reynolds CF, Silverman MM: Confronting depression and suicide in physicians: a consensus statement. JAMA. 2003, 289: 3161-3166. 10.1001/jama.289.23.3161.CrossRefPubMed Center C, Davis M, Detre T, Ford DE, Hansbrough W, Hendin H, Laszlo J, Litts DA, Mann J, Mansky PA, Michels R, Miles SH, Proujansky R, Reynolds CF, Silverman MM: Confronting depression and suicide in physicians: a consensus statement. JAMA. 2003, 289: 3161-3166. 10.1001/jama.289.23.3161.CrossRefPubMed
14.
go back to reference Cho JJ, Kim JY, Chang SJ, Fiedler N, Koh SB, Crabtree BF, Kang DM, Kim YK, Choi YH: Occupational stress and depression in Korean employees. Int Arch Occup Environ Health. 2008, 82: 47-57. 10.1007/s00420-008-0306-4.CrossRefPubMed Cho JJ, Kim JY, Chang SJ, Fiedler N, Koh SB, Crabtree BF, Kang DM, Kim YK, Choi YH: Occupational stress and depression in Korean employees. Int Arch Occup Environ Health. 2008, 82: 47-57. 10.1007/s00420-008-0306-4.CrossRefPubMed
15.
go back to reference Wu H, Zhao Y, Wang JN, Wang L: Factors associated with occupational stress among Chinese doctors: a cross-sectional survey. Int Arch Occup Environ Health. 2010, 83: 155-164. 10.1007/s00420-009-0456-z.CrossRefPubMed Wu H, Zhao Y, Wang JN, Wang L: Factors associated with occupational stress among Chinese doctors: a cross-sectional survey. Int Arch Occup Environ Health. 2010, 83: 155-164. 10.1007/s00420-009-0456-z.CrossRefPubMed
16.
go back to reference Ahola K, Hakanen J: Job strain, burnout, and depressive symptoms: a prospective study among dentists. J Affect Disord. 2007, 104: 103-110. 10.1016/j.jad.2007.03.004.CrossRefPubMed Ahola K, Hakanen J: Job strain, burnout, and depressive symptoms: a prospective study among dentists. J Affect Disord. 2007, 104: 103-110. 10.1016/j.jad.2007.03.004.CrossRefPubMed
17.
go back to reference Wu H, Ge CX, Sun W, Wang JN, Wang L: Depressive symptoms and occupational stress among Chinese female nurses: the mediating effects of social support and rational coping. Res Nurs Health. 2011, 34: 401-407. 10.1002/nur.20449.CrossRefPubMed Wu H, Ge CX, Sun W, Wang JN, Wang L: Depressive symptoms and occupational stress among Chinese female nurses: the mediating effects of social support and rational coping. Res Nurs Health. 2011, 34: 401-407. 10.1002/nur.20449.CrossRefPubMed
18.
go back to reference Takaki J, Taniguchi T, Fukuoka E, Fujii Y, Tsutsumi A, Nakajima K, Hirokawa K: Workplace bullying could play important roles in the relationships between job strain and symptoms of depression and sleep disturbance. J Occup Health. 2010, 52: 367-374. 10.1539/joh.L10081.CrossRefPubMed Takaki J, Taniguchi T, Fukuoka E, Fujii Y, Tsutsumi A, Nakajima K, Hirokawa K: Workplace bullying could play important roles in the relationships between job strain and symptoms of depression and sleep disturbance. J Occup Health. 2010, 52: 367-374. 10.1539/joh.L10081.CrossRefPubMed
19.
go back to reference Luthans F, Youssef CM: Human, social and now positive psychological capital management: investing in people for competitive advantage. Organ Dyn. 2004, 33: 143-160. 10.1016/j.orgdyn.2004.01.003.CrossRef Luthans F, Youssef CM: Human, social and now positive psychological capital management: investing in people for competitive advantage. Organ Dyn. 2004, 33: 143-160. 10.1016/j.orgdyn.2004.01.003.CrossRef
20.
go back to reference Luthans F, Avolio BJ, Avey JB, Norman SM: Positive psychological capital: measurement and relationship with performance and satisfaction. Pers Psychol. 2007, 60: 541-572. 10.1111/j.1744-6570.2007.00083.x.CrossRef Luthans F, Avolio BJ, Avey JB, Norman SM: Positive psychological capital: measurement and relationship with performance and satisfaction. Pers Psychol. 2007, 60: 541-572. 10.1111/j.1744-6570.2007.00083.x.CrossRef
21.
go back to reference Luthans F, Avey JB, Clapp-Smith R, Li WX: More evidence on the value of Chinese workers’ psychological capital: a potentially unlimited competitive resource?. Int J Hum Resour Man. 2008, 19: 818-827. 10.1080/09585190801991194.CrossRef Luthans F, Avey JB, Clapp-Smith R, Li WX: More evidence on the value of Chinese workers’ psychological capital: a potentially unlimited competitive resource?. Int J Hum Resour Man. 2008, 19: 818-827. 10.1080/09585190801991194.CrossRef
22.
go back to reference Sun T, Zhao XW, Yang LB, Fan LH: The impact of psychological capital on job embeddedness and job performance among nurses: a structural equation approach. J Adv Nurs. 2012, 68: 69-79. 10.1111/j.1365-2648.2011.05715.x.CrossRefPubMed Sun T, Zhao XW, Yang LB, Fan LH: The impact of psychological capital on job embeddedness and job performance among nurses: a structural equation approach. J Adv Nurs. 2012, 68: 69-79. 10.1111/j.1365-2648.2011.05715.x.CrossRefPubMed
23.
go back to reference Zhong LF: Effects of psychological capital on employees’ job performance, organizational commitment, and organizational citizenship behavior. Acta Psychologica Sinica. 2007, 39: 328-334. (in Chinese) Zhong LF: Effects of psychological capital on employees’ job performance, organizational commitment, and organizational citizenship behavior. Acta Psychologica Sinica. 2007, 39: 328-334. (in Chinese)
24.
go back to reference Avey JB, Luthans F, Smith RM, Palmer NF: Impact of positive psychological capital on employee well-being over time. J Occup Health Psychol. 2010, 15: 17-28.CrossRefPubMed Avey JB, Luthans F, Smith RM, Palmer NF: Impact of positive psychological capital on employee well-being over time. J Occup Health Psychol. 2010, 15: 17-28.CrossRefPubMed
25.
go back to reference Avey JB, Luthans F, Jensen SM: Psychological Capital: a positive resource for combating employee stress and turnover. Hum Resour Manage. 2009, 48: 677-693. 10.1002/hrm.20294.CrossRef Avey JB, Luthans F, Jensen SM: Psychological Capital: a positive resource for combating employee stress and turnover. Hum Resour Manage. 2009, 48: 677-693. 10.1002/hrm.20294.CrossRef
26.
go back to reference Luthans F, Norman SM, Avolio BJ, Avey JB: The mediating role of psychological capital in the supportive organizational climate—employee performance relationship. J Organ Behav. 2008, 29: 219-238. 10.1002/job.507.CrossRef Luthans F, Norman SM, Avolio BJ, Avey JB: The mediating role of psychological capital in the supportive organizational climate—employee performance relationship. J Organ Behav. 2008, 29: 219-238. 10.1002/job.507.CrossRef
27.
go back to reference Luo H, Hao ZH: The relationships among psychological capital, job burnout and turnover intention in 466 nurses. Chin J Nurs. 2010, 45: 933-935. in Chinese Luo H, Hao ZH: The relationships among psychological capital, job burnout and turnover intention in 466 nurses. Chin J Nurs. 2010, 45: 933-935. in Chinese
28.
go back to reference Radloff LS: The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Measure. 1977, 1: 385-401. 10.1177/014662167700100306.CrossRef Radloff LS: The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Measure. 1977, 1: 385-401. 10.1177/014662167700100306.CrossRef
29.
go back to reference Liu XC, Tang MQ: The comparison of SDS and CES-D on college students’ depressive symptoms. Chin Ment Health J. 1995, 9: 19-21. (in Chinese) Liu XC, Tang MQ: The comparison of SDS and CES-D on college students’ depressive symptoms. Chin Ment Health J. 1995, 9: 19-21. (in Chinese)
30.
go back to reference Li XY, Guo YS, Lu WJ, Wang SJ, Chen K: Associations between social psychological factors and depressive symptoms among healthcare workers. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2006, 24: 454-457. (in Chinese)PubMed Li XY, Guo YS, Lu WJ, Wang SJ, Chen K: Associations between social psychological factors and depressive symptoms among healthcare workers. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2006, 24: 454-457. (in Chinese)PubMed
31.
go back to reference Siegrist J: Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol. 1996, 1: 27-41.CrossRefPubMed Siegrist J: Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol. 1996, 1: 27-41.CrossRefPubMed
32.
go back to reference Xu W, Zhao Y, Guo L, Guo Y, Gao W: The association between effort-reward imbalance and coronary atherosclerosis in a Chinese sample. Am J Ind Med. 2010, 53: 655-661.PubMed Xu W, Zhao Y, Guo L, Guo Y, Gao W: The association between effort-reward imbalance and coronary atherosclerosis in a Chinese sample. Am J Ind Med. 2010, 53: 655-661.PubMed
33.
go back to reference Li J, Yang W, Cho SI: Gender differences in job strain, effort-reward imbalance, and health functioning among Chinese physicians. Soc Sci Med. 2006, 62: 1066-1077. 10.1016/j.socscimed.2005.07.011.CrossRefPubMed Li J, Yang W, Cho SI: Gender differences in job strain, effort-reward imbalance, and health functioning among Chinese physicians. Soc Sci Med. 2006, 62: 1066-1077. 10.1016/j.socscimed.2005.07.011.CrossRefPubMed
34.
go back to reference Yang WJ, Li J: Measurement of psychosocial factors in work environment: application of two models of occupational stress. Zhong hua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2004, 22: 422-426. (in Chinese) Yang WJ, Li J: Measurement of psychosocial factors in work environment: application of two models of occupational stress. Zhong hua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2004, 22: 422-426. (in Chinese)
35.
go back to reference Xu W, Yu H, Gao W, Guo L, Zeng L, Zhao Y: When job stress threatens Chinese workers: combination of job stress models can improve the risk estimation for coronary heart disease–the BADCAR study. J Occup Environ Med. 2011, 53: 771-775. 10.1097/JOM.0b013e318222b0b5.CrossRefPubMed Xu W, Yu H, Gao W, Guo L, Zeng L, Zhao Y: When job stress threatens Chinese workers: combination of job stress models can improve the risk estimation for coronary heart disease–the BADCAR study. J Occup Environ Med. 2011, 53: 771-775. 10.1097/JOM.0b013e318222b0b5.CrossRefPubMed
36.
go back to reference Wen L, Qi SS, Zhang YZ: A preliminary revision of Luthans psychological capital questionnaire. Chin J Clin Psychol. 2009, 17: 148-150. (in Chinese) Wen L, Qi SS, Zhang YZ: A preliminary revision of Luthans psychological capital questionnaire. Chin J Clin Psychol. 2009, 17: 148-150. (in Chinese)
37.
go back to reference Zhao J, Zhang XC: Work stress and job burnout: the moderating effects of psychological capital. Journal of Henan Normal University (Natural Science). 2010, 38: 139-143. (in Chinese) Zhao J, Zhang XC: Work stress and job burnout: the moderating effects of psychological capital. Journal of Henan Normal University (Natural Science). 2010, 38: 139-143. (in Chinese)
38.
go back to reference Pan QQ, Zhou ZK: Relationships among psychological capital, coping style and mental health of impoverished college students. China Journal of Health Psychology. 2009, 17: 844-846. (in Chinese) Pan QQ, Zhou ZK: Relationships among psychological capital, coping style and mental health of impoverished college students. China Journal of Health Psychology. 2009, 17: 844-846. (in Chinese)
39.
go back to reference Preacher KJ, Hayes AF: Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Meth. 2008, 40: 879-891. 10.3758/BRM.40.3.879.CrossRef Preacher KJ, Hayes AF: Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Meth. 2008, 40: 879-891. 10.3758/BRM.40.3.879.CrossRef
40.
go back to reference Arnetz BB: Psychosocial challenges facing physicians of today. Soc Sci Med. 2001, 52: 203-213. 10.1016/S0277-9536(00)00220-3.CrossRefPubMed Arnetz BB: Psychosocial challenges facing physicians of today. Soc Sci Med. 2001, 52: 203-213. 10.1016/S0277-9536(00)00220-3.CrossRefPubMed
41.
go back to reference Sakata Y, Wada K, Tsutsumi A, Ishikawa H, Aratake Y, Watanabe M, Katoh N, Aizawa Y, Tanaka K: Effort-reward imbalance and depression in Japanese medical residents. J Occup Health. 2008, 50: 498-504. 10.1539/joh.L8043.CrossRefPubMed Sakata Y, Wada K, Tsutsumi A, Ishikawa H, Aratake Y, Watanabe M, Katoh N, Aizawa Y, Tanaka K: Effort-reward imbalance and depression in Japanese medical residents. J Occup Health. 2008, 50: 498-504. 10.1539/joh.L8043.CrossRefPubMed
42.
go back to reference Roxburgh S: Gender differences in work and well-being: effects of exposure and vulnerability. J Health Soc Behav. 1996, 37: 265-277. 10.2307/2137296.CrossRefPubMed Roxburgh S: Gender differences in work and well-being: effects of exposure and vulnerability. J Health Soc Behav. 1996, 37: 265-277. 10.2307/2137296.CrossRefPubMed
44.
go back to reference Luthans F, Avey JB, Patera JL: Experimental analysis of a web-based training intervention to develop positive psychological capital. Acad Manag Learn Educ. 2008, 7: 209-221. 10.5465/AMLE.2008.32712618.CrossRef Luthans F, Avey JB, Patera JL: Experimental analysis of a web-based training intervention to develop positive psychological capital. Acad Manag Learn Educ. 2008, 7: 209-221. 10.5465/AMLE.2008.32712618.CrossRef
45.
go back to reference Luthans F, Avey JB, Avolio BJ, Norman SM, Combs GM: Psychological capital development: toward a micro-intervention. J Organ Behav. 2006, 27: 387-393. 10.1002/job.373.CrossRef Luthans F, Avey JB, Avolio BJ, Norman SM, Combs GM: Psychological capital development: toward a micro-intervention. J Organ Behav. 2006, 27: 387-393. 10.1002/job.373.CrossRef
46.
go back to reference Chen FG, Li J: A study of social psychology in physician depression. Chin J Behavioral Med Sci. 2006, 15: 1103-1105. (in Chinese) Chen FG, Li J: A study of social psychology in physician depression. Chin J Behavioral Med Sci. 2006, 15: 1103-1105. (in Chinese)
Metadata
Title
The mediating role of psychological capital on the association between occupational stress and depressive symptoms among Chinese physicians: a cross-sectional study
Authors
Li Liu
Ying Chang
Jialiang Fu
Jiana Wang
Lie Wang
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2012
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-12-219

Other articles of this Issue 1/2012

BMC Public Health 1/2012 Go to the issue