The Mediating Role of Resilience in the Relationship between Perceived Stress and Mental Health
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants, Procedures and Data Collection
2.2. Demographics and Measures
2.3. Statistical Analyses
3. Results
3.1. Correlation Analysis
3.2. Mediation Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Faggioni, M.P.; Gonzalez-Melado, F.J.; Di Pietro, M.L. National health system cuts and triage decisions during the COVID-19 pandemic in Italy and Spain: Ethical implications. J. Med. Ethics 2021, 47, 300–307. [Google Scholar] [CrossRef]
- Moreno-Torres, V.; de la Fuente, S.; Mills, P.; Munoz, A.; Munez, E.; Ramos, A.; Fernandez-Cruz, A.; Arias, A.; Pintos, I.; Vargas, J.A.; et al. Major determinants of death in patients hospitalized with COVID-19 during the first epidemic wave in Madrid, Spain. Medicine (Baltimore) 2021, 100, e25634. [Google Scholar] [CrossRef] [PubMed]
- Fernandez, R.; Lord, H.; Halcomb, E.; Moxham, L.; Middleton, R.; Alananzeh, I.; Ellwood, L. Implications for COVID-19: A systematic review of nurses’ experiences of working in acute care hospital settings during a respiratory pandemic. Int. J. Nurs. Stud. 2020, 111, 103637. [Google Scholar] [CrossRef] [PubMed]
- Raurell-Torreda, M.; Martinez-Estalella, G.; Frade-Mera, M.J.; Carrasco Rodriguez-Rey, L.F.; Romero de San Pio, E. Reflections arising from the COVID-19 pandemic. Enferm. Intensiva 2020, 31, 90–93. [Google Scholar] [CrossRef]
- Stocchetti, N.; Segre, G.; Zanier, E.R.; Zanetti, M.; Campi, R.; Scarpellini, F.; Clavenna, A.; Bonati, M. Burnout in Intensive Care Unit Workers during the Second Wave of the COVID-19 Pandemic: A Single Center Cross-Sectional Italian Study. Int. J. Environ. Res. Public Health 2021, 18, 6102. [Google Scholar] [CrossRef]
- De Pinho, L.G.; Sampaio, F.; Sequeira, C.; Teixeira, L.; Fonseca, C.; Lopes, M.J. Portuguese Nurses’ Stress, Anxiety, and Depression Reduction Strategies during the COVID-19 Outbreak. Int. J. Environ. Res. Public Health 2021, 18, 3490. [Google Scholar] [CrossRef]
- Kim, M.Y.; Yang, Y.Y. Mental Health Status and Its Influencing Factors: The Case of Nurses Working in COVID-19 Hospitals in South Korea. Int. J. Environ. Res. Public Health 2021, 18, 6531. [Google Scholar] [CrossRef]
- Varghese, A.; George, G.; Kondaguli, S.V.; Naser, A.Y.; Khakha, D.C.; Chatterji, R. Decline in the mental health of nurses across the globe during COVID-19: A systematic review and meta-analysis. J. Glob. Health 2021, 11, 05009. [Google Scholar] [CrossRef]
- Galehdar, N.; Kamran, A.; Toulabi, T.; Heydari, H. Exploring nurses’ experiences of psychological distress during care of patients with COVID-19: A qualitative study. BMC Psychiatry 2020, 20, 489. [Google Scholar] [CrossRef]
- Batra, K.; Singh, T.P.; Sharma, M.; Batra, R.; Schvaneveldt, N. Investigating the Psychological Impact of COVID-19 among Healthcare Workers: A Meta-Analysis. Int. J. Environ. Res. Public Health 2020, 17, 9096. [Google Scholar] [CrossRef] [PubMed]
- Al Maqbali, M.; Al Sinani, M.; Al-Lenjawi, B. Prevalence of stress, depression, anxiety and sleep disturbance among nurses during the COVID-19 pandemic: A systematic review and meta-analysis. J. Psychosom. Res. 2021, 141, 110343. [Google Scholar] [CrossRef] [PubMed]
- Cooper, A.L.; Brown, J.A.; Leslie, G.D. Nurse resilience for clinical practice: An integrative review. J. Adv. Nurs. 2021. [Google Scholar] [CrossRef] [PubMed]
- Aiena, B.J.; Baczwaski, B.J.; Schulenberg, S.E.; Buchanan, E.M. Measuring resilience with the RS-14: A tale of two samples. J. Personal. Assess. 2015, 97, 291–300. [Google Scholar] [CrossRef] [PubMed]
- Cooper, A.L.; Brown, J.A.; Rees, C.S.; Leslie, G.D. Nurse resilience: A concept analysis. Int. J. Ment. Health Nurs. 2020, 29, 553–575. [Google Scholar] [CrossRef] [PubMed]
- Mirosevic, S.; Klemenc-Ketis, Z.; Selic, P. The 14-item Resilience scale as a potential screening tool for depression/anxiety and quality of life assessment: A systematic review of current research. Fam. Pract. 2019, 36, 262–268. [Google Scholar] [CrossRef]
- Zager Kocjan, G.; Kavcic, T.; Avsec, A. Resilience matters: Explaining the association between personality and psychological functioning during the COVID-19 pandemic. Int. J. Clin. Health Psychol. 2021, 21, 100198. [Google Scholar] [CrossRef]
- Labrague, L.J. Pandemic fatigue and clinical nurses’ mental health, sleep quality and job contentment during the covid-19 pandemic: The mediating role of resilience. J. Nurs. Manag. 2021. [Google Scholar] [CrossRef]
- Jung, H.S.; Baek, E. A structural equation model analysis of the effects of emotional labor and job stress on depression among nurses with long working hours: Focusing on the mediating effects of resilience and social support. Work 2020, 66, 561–568. [Google Scholar] [CrossRef]
- Yildirim, M. Mediating Role of Resilience in the Relationships Between Fear of Happiness and Affect Balance, Satisfaction With Life, and Flourishing. Eur. J. Psychol. 2019, 15, 183–198. [Google Scholar] [CrossRef][Green Version]
- Sánchez-Teruel, D.; Robles-Bello, M.A. Escala de Resiliencia 14 ítems (RS-14): Propiedades Psicométricas de la Versión en Español. Rev. Iberoam. Diagnóstico Evaluación-e Avaliação Psicológica 2015, 2, 103–113. [Google Scholar]
- Lara-Cabrera, M.L.; Mundal, I.P.; De Las Cuevas, C. Patient-reported well-being: Psychometric properties of the world health organization well-being index in specialised community mental health settings. Psychiatry Res. 2020, 291, 113268. [Google Scholar] [CrossRef]
- Topp, C.W.; Ostergaard, S.D.; Sondergaard, S.; Bech, P. The WHO-5 Well-Being Index: A systematic review of the literature. Psychother. Psychosom. 2015, 84, 167–176. [Google Scholar] [CrossRef]
- Vallejo, M.A.; Vallejo-Slocker, L.; Fernandez-Abascal, E.G.; Mananes, G. Determining Factors for Stress Perception Assessed with the Perceived Stress Scale (PSS-4) in Spanish and Other European Samples. Front. Psychol 2018, 9, 37. [Google Scholar] [CrossRef]
- Cohen, S.; Kamarck, T.; Mermelstein, R. A Global Measure of Perceived Stress. J. Health Soc. Behav. 1983, 24, 385–396. [Google Scholar] [CrossRef]
- Kroenke, K.; Spitzer, R.L.; Williams, J.B. The Patient Health Questionnaire-2: Validity of a two-item depression screener. Med. Care 2003, 41, 1284–1292. [Google Scholar] [CrossRef]
- Kroenke, K.; Spitzer, R.L.; Williams, J.B.; Lowe, B. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: A systematic review. Gen. Hosp. Psychiatry 2010, 32, 345–359. [Google Scholar] [CrossRef] [PubMed]
- Kroenke, K.; Spitzer, R.L.; Williams, J.B.; Monahan, P.O.; Lowe, B. Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Ann. Intern. Med. 2007, 146, 317–325. [Google Scholar] [CrossRef] [PubMed]
- Kroenke, K.; Spitzer, R.L.; Williams, J.B.; Lowe, B. An ultra-brief screening scale for anxiety and depression: The PHQ-4. Psychosomatics 2009, 50, 613–621. [Google Scholar] [CrossRef] [PubMed]
- Mills, S.D.; Fox, R.S.; Pan, T.M.; Malcarne, V.L.; Roesch, S.C.; Sadler, G.R. Psychometric Evaluation of the Patient Health Questionnaire-4 in Hispanic Americans. Hisp. J. Behav. Sci. 2015, 37, 560–571. [Google Scholar] [CrossRef][Green Version]
- Rosseel, Y. An R Package for Structural Equation Modeling. J. Stat. Softw. 2021, 48, 1–36. [Google Scholar] [CrossRef][Green Version]
- Preacher, K.J.; Hayes, A.F. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav. Res. Methods 2008, 40, 879–891. [Google Scholar] [CrossRef]
- Shrout, P.E. Commentary: Mediation Analysis, Causal Process, and Cross-Sectional Data. Multivar. Behav. Res. 2011, 46, 852–860. [Google Scholar] [CrossRef]
- Chigwedere, O.C.; Sadath, A.; Kabir, Z.; Arensman, E. The Impact of Epidemics and Pandemics on the Mental Health of Healthcare Workers: A Systematic Review. Int. J. Environ. Res. Public Health 2021, 18, 6695. [Google Scholar] [CrossRef] [PubMed]
- Fan, J.; Senthanar, S.; Macpherson, R.A.; Sharpe, K.; Peters, C.E.; Koehoorn, M.; McLeod, C.B. An Umbrella Review of the Work and Health Impacts of Working in an Epidemic/Pandemic Environment. Int. J. Environ. Res. Public Health 2021, 18, 6828. [Google Scholar] [CrossRef]
- Franklin, P.; Gkiouleka, A. A Scoping Review of Psychosocial Risks to Health Workers during the Covid-19 Pandemic. Int. J. Environ. Res. Public Health 2021, 18, 2453. [Google Scholar] [CrossRef]
- Croghan, I.T.; Chesak, S.S.; Adusumalli, J.; Fischer, K.M.; Beck, E.W.; Patel, S.R.; Ghosh, K.; Schroeder, D.R.; Bhagra, A. Stress, Resilience, and Coping of Healthcare Workers during the COVID-19 Pandemic. J. Prim. Care Community Health 2021, 12, 21501327211008448. [Google Scholar] [CrossRef] [PubMed]
- Dosil, M.; Ozamiz-Etxebarria, N.; Redondo, I.; Picaza, M.; Jaureguizar, J. Psychological Symptoms in Health Professionals in Spain After the First Wave of the COVID-19 Pandemic. Front. Psychol. 2020, 11, 606121. [Google Scholar] [CrossRef]
- Hesselink, G.; Straten, L.; Gallee, L.; Brants, A.; Holkenborg, J.; Barten, D.G.; Schoon, Y. Holding the frontline: A cross-sectional survey of emergency department staff well-being and psychological distress in the course of the COVID-19 outbreak. BMC Health Serv. Res. 2021, 21, 525. [Google Scholar] [CrossRef]
- Zeike, S.; Ansmann, L.; Lindert, L.; Samel, C.; Kowalski, C.; Pfaff, H. Identifying cut-off scores for job demands and job control in nursing professionals: A cross-sectional survey in Germany. BMJ Open 2018, 8, e021366. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Doo, E.Y.; Kim, M.; Lee, S.; Lee, S.Y.; Lee, K.Y. 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, 1990–2000. [Google Scholar] [CrossRef]
- Roberts, N.J.; McAloney-Kocaman, K.; Lippiett, K.; Ray, E.; Welch, L.; Kelly, C. Levels of resilience, anxiety and depression in nurses working in respiratory clinical areas during the COVID pandemic. Respir. Med. 2021, 176, 106219. [Google Scholar] [CrossRef] [PubMed]
- Zou, G.; Shen, X.; Tian, X.; Liu, C.; Li, G.; Kong, L.; Li, P. Correlates of psychological distress, burnout, and resilience among Chinese female nurses. Ind. Health 2016, 54, 389–395. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Miguel, A.Q.C.; Tempski, P.; Kobayasi, R.; Mayer, F.B.; Martins, M.A. Predictive factors of quality of life among medical students: Results from a multicentric study. BMC Psychol. 2021, 9, 36. [Google Scholar] [CrossRef] [PubMed]
- Yildirim, M.; Arslan, G.; Ozaslan, A. Perceived Risk and Mental Health Problems among Healthcare Professionals during COVID-19 Pandemic: Exploring the Mediating Effects of Resilience and Coronavirus Fear. Int. J. Ment. Health. Addict. 2020. [Google Scholar] [CrossRef] [PubMed]
Characteristics | Global (N = 214) |
---|---|
Female, n (%) | 164 (76.6) |
Mean age (SD 1) | 40.3 (11.6) |
Living arrangement, n (%) | |
Alone | 25 (11.7) |
With other adults | 141 (65.9) |
With their children | 42 (19.6) |
With people with chronic diseases | 32 (15.0) |
With the elderly | 28 (13.1) |
Beliefs about coronavirus COVID-19, n (%) I feel confident in my abilities to handle this COVID-19 crisis | |
Never | 3 (1.4) |
Some days | 40 (18.7) |
More than half the days | 83 (38.8) |
Almost every day | 80 (37.4) |
Missing | 8 (3.7) |
The concern of acquiring the coronavirus has increased my stress level | |
Never | 24 (11.2) |
Some days | 92 (43.0) |
More than half the days | 32 (15.0) |
Almost every day | 58 (27.1) |
Missing | 8 (3.7) |
Perceived stress (PSS-4), total score, mean (SD) Low (0–5) Moderate (6–10) High (11–16) | 5.8 (3.2) 48.6% 43.9% 7.5% |
Resilience (RS-14), mean (SD) Low (14–64) Moderate (65–81) High (82–98) | 77.7 (12.6) 15.9% 40.7% 43.5% |
Wellbeing (WHO-5), total score, mean (SD) Poor wellbeing (0–12) Adequate wellbeing (13–25) | 12.4 (4.9) 50.5% 49.5% |
Anxiety (GAD-2), mean (SD) Depression (PHQ-2), mean (SD) | 2.5 (1.6) 2.1 (1.6) |
Psychologcal distress (PHQ-4), mean (SD) | 4.6 (3.0) |
None (0–2) | 25.2% |
Mild (3–5) | 43.9% |
Moderate (6–8) | 19.2% |
Severe (9–12) | 11.7% |
Variables | M | SD | Min | Max | 1 | 2 | 3 | 4 | 5 | 6 |
---|---|---|---|---|---|---|---|---|---|---|
1. Stress (PSS-4) | 5.8 | 3.2 | 0 | 15 | (0.70) | |||||
2. Resilience (RS-14) | 77.7 | 12.6 | 42 | 98 | −0.62 *** | (0.88) | ||||
3. Wellbeing (raw score WHO-5) | 12.4 | 4.9 | 0 | 22 | −0.60 ** | 0.494 *** | (0.88) | |||
4. Anxiety (GAD-2) | 2.5 | 1.6 | 0 | 6 | 0.62 ** | −0.499 ** | −0.670 *** | (0.79) | ||
5. Depression (PHQ-2) | 2.1 | 1.6 | 0 | 6 | 0.65 ** | −0.564 ** | −0.708 ** | 0.621 *** | (0.83) | |
6. Psychological distress (PHQ-4) | 4.6 | 2.9 | 0 | 12 | 0.71 ** | −0.59 ** | −0.76 ** | 0.90 ** | 0.90 *** | (0.84) |
Variables | Estimate | Std. Error | t-Value | p (>|t|) | R2 adj. |
---|---|---|---|---|---|
Model I | |||||
Intercept | 3.2788 | 0.7864 | 4.1692 | 0.001 | 0.46 |
Resilience (RS-14) | −0.0342 | 0.0084 | −4.0799 | 0.001 | |
PST Total | 0.2474 | 0.0325 | 7.6226 | 0.001 | |
Model II | |||||
Intercept | 2.915 | 0.825 | 3.535 | 0.001 | |
Resilience (RS-14) | −0.024 | 0.009 | −2.722 | 0.001 | 0.403 |
PST Total | 0.257 | 0.034 | 7.555 | 0.001 | |
Model III | |||||
Intercept | 6.1938 | 1.3151 | 4.7098 | 0.001 | 0.53 |
Resilience (RS-14) | −0.0581 | 0.0140 | −4.1467 | 0.001 | |
PST Total | 0.5046 | 0.0543 | 9.2959 | 0.001 |
Variables | Estimate | 95% CI Lower | 95% CI Upper | p-Value |
---|---|---|---|---|
Model I | ||||
ACME | 0.0816 | 0.0421 | 0.12 | 0.001 |
ADE | 0.2496 | 0.1847 | 0.31 | 0.001 |
Total Effect | 0.3312 | 0.2792 | 0.38 | 0.001 |
Prop. Mediated | 0.2437 | 0.1227 | 0.39 | 0.001 |
Model II | ||||
ACME | 0.0567 | 0.0162 | 0.1 | 0.001 |
ADE | 0.259 | 0.1964 | 0.33 | 0.001 |
Total Effect | 0.3157 | 0.2657 | 0.37 | 0.001 |
Prop. Mediated | 0.1793 | 0.0499 | 0.32 | 0.001 |
Model III | ||||
ACME | 0.14030 | 0.07240 | 0.22 | 0.001 |
ADE | 0.50370 | 0.39640 | 0.61 | 0.001 |
Total Effect | 0.64400 | 0.55530 | 0.73 | 0.001 |
Prop. Mediated | 0.21960 | 0.11100 | 0.34 | 0.001 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Lara-Cabrera, M.L.; Betancort, M.; Muñoz-Rubilar, C.A.; Rodríguez Novo, N.; De las Cuevas, C. The Mediating Role of Resilience in the Relationship between Perceived Stress and Mental Health. Int. J. Environ. Res. Public Health 2021, 18, 9762. https://doi.org/10.3390/ijerph18189762
Lara-Cabrera ML, Betancort M, Muñoz-Rubilar CA, Rodríguez Novo N, De las Cuevas C. The Mediating Role of Resilience in the Relationship between Perceived Stress and Mental Health. International Journal of Environmental Research and Public Health. 2021; 18(18):9762. https://doi.org/10.3390/ijerph18189762
Chicago/Turabian StyleLara-Cabrera, Mariela Loreto, Moisés Betancort, C. Amparo Muñoz-Rubilar, Natalia Rodríguez Novo, and Carlos De las Cuevas. 2021. "The Mediating Role of Resilience in the Relationship between Perceived Stress and Mental Health" International Journal of Environmental Research and Public Health 18, no. 18: 9762. https://doi.org/10.3390/ijerph18189762