Role stress and psychological distress among Chinese nurses: a moderated mediation model of social support and burnout in a cross-sectional online survey (Preprint)

BACKGROUND Nurses are at high risk of psychological distress including stress, depression, and anxiety due to low personnel density and high work demand. Despite mounting evidence showing that role stress is a risk factor for nurses’ psychological distress, the mediating and moderating mechanisms underlying this relationship are less known. OBJECTIVE This study tests the mediation effect of burnout in the association between role stress and psychological distress, and whether this mediation is moderated by social support. METHODS A sample of 623 Chinese nurses was recruited from all hepatological surgery departments in Hunan Province and filled out online questionnaire through Sojum (a most commonly used professional online survey tool) to collect data on socio-demographics, role stress, burnout, psychological distress, and social support. Mediation and moderation analyses were carried out in SPSS macro-PROCESS. RESULTS Burnout partially mediated the positive association between role stress and psychological distress. Social support moderated the indirect effect of role stress on psychological distress via burnout, with the effect being stronger for nurses with low social support than those with high social support. CONCLUSIONS These findings demonstrated how role stress contributed to nurses’ psychological distress both directly and indirectly through burnout, and how this indirect effect was moderated by social support. The results provide important practical implications for future prevention and intervention programs to improve nurses’ mental health from multiple aspects such as decreasing role stress and burnout while increasing social support.