The Mediating Role of Cumulative Fatigue on the Association between Occupational Stress and Depressive Symptoms: A Cross-Sectional Study among 1327 Chinese Primary Healthcare Professionals
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Basic Investigation
2.3. Measurement of Occupational Stress
2.4. Measurement of Depressive Systems
2.5. Measurement of Cumulative Fatigue
2.6. Statistic Analysis
3. Results
3.1. Basic Information of Participants
3.2. Factors of Occupational Stress, Cumulative Fatigue, and Depressive Symptoms
3.3. Correlation of Occupational Stress, Cumulative Fatigue, and Depressive Symptoms
3.4. Stratified Regression Analysis on Cumulative Fatigue, Occupational Stress, and Depressive Symptoms
3.5. Mediation of Cumulative Fatigue between Occupational Stress and Depressive Symptoms
4. Discussion
4.1. Effect of Occupational Stress on Depressive Symptoms
4.2. The Mediating Role of Cumulative Fatigue
5. Conclusions and Prospects
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Number of Items | Factor 1 | Factor 2 | Factor 3 | Factor 4 |
---|---|---|---|---|
C7 Job–education commensurability | 0.839 | |||
C8 Effort–performance mismatch | 0.821 | |||
C9 Unnecessary changes to the job | 0.789 | |||
C6 Effort–respect mismatch | 0.736 | |||
C11 Hierarchical department | 0.432 | |||
C10 Cannot bear shift work | ||||
C1 Get along well with leaders | 0.853 | |||
C2 Get along well with colleagues | 0.838 | |||
C3 The department is well-coordinated | 0.819 | |||
C4 Leader is helpful for work | 0.817 | |||
C5 Family supports my work | 0.722 | |||
C13 The job requires a quick pace | −0.834 | |||
C15 Require to work extra hours | −0.829 | |||
C12 Time is insufficient due to workload | −0.828 | |||
C14 Job demands are getting higher | −0.773 | |||
C16 Free to choose what to do at work | 0.920 | |||
C17 Free to choose how to do at work | 0.911 |
Number of Items | Factor 1 |
---|---|
D4 Feeling tired and bored | 0.788 |
D2 Feeling bad, unhappy | 0.764 |
D6 Feeling like a failure | 0.745 |
D3 Can’t sleep or sleep too much | 0.720 |
D8 Slowness or restlessness | 0.713 |
D5 Poor appetite or eating too much | 0.701 |
D1 Little or no interest in doing things | 0.689 |
D7 Difficult in concentrating | 0.688 |
D9 Thoughts of suicide or self-harm | 0.542 |
Number of Items | Factor 1 | Factor 2 | Factor 3 |
---|---|---|---|
G2 Disturbed | 0.852 | ||
G3 Restless | 0.837 | ||
G4 Feeling depressed | 0.728 | ||
G1 Irritable | 0.697 | ||
G5 Insomnia | 0.627 | ||
G7 Inattention | 0.422 | ||
G6 Poor health | 0.414 | ||
G14 Overtime in the past month | 0.740 | ||
G15 Irregular working hours | 0.729 | ||
G20 Physical burden of work | 0.703 | ||
G17 Burden of night shift | 0.679 | ||
G19 Mental burden of work | 0.665 | ||
G16 Burden of business trips | 0.470 | ||
G18 Rest time and facilities | 0.439 | ||
G9 Sleepy at work | −0.809 | ||
G10 Not motivated | −0.768 | ||
G12 Feeling tired in the morning | −0.691 | ||
G11 Exhausted | −0.657 | ||
G8 Error-prone | −0.623 | ||
G13 More fatigue than before | −0.600 |
Variables | Amount | Occupational Stress | Cumulative Fatigue | Depression | ||||||
---|---|---|---|---|---|---|---|---|---|---|
(Ratio/%) | Total/Score | Z/H | p | Total/Score | Z/H | p | Total/Score | Z/H | p | |
Gender | −0.365 | 0.715 | −1.633 | 0.102 | −1.483 | 0.138 | ||||
Male | 378 (28.5) | 44.5 (39.0,50.0) | 2.0 (0.0,4.0) | 8.0 (6.0,10.3) | ||||||
Female | 949 (71.5) | 45.0 (40.0,50.0) | 2.0 (0.0,4.0) | 8.0 (5.0,10.0) | ||||||
Age/Year | 4.301 | 0.116 | 19.806 | <0.001 | 13.732 | 0.001 | ||||
≤30 | 416 (31.3) | 45.0 (39.0,50.0) | 2.0 (0.0,4.0) | 8.0 (6.0,11.0) | ||||||
31–40 | 484 (36.5) | 45.0 (40.0,51.0) | 2.0 (0.0,4.0) | 8.0 (5.0,10.0) | ||||||
≥41 | 427 (33.2) | 44.0 (39.0,49.0) | 1.0 (0.0,4.0) | 7.0 (5.0,10.0) | ||||||
Education level | −0.760 | 0.448 | −3.721 | <0.001 | −1.250 | 0.211 | ||||
Junior college or below | 634 (47.1) | 45.0 (40.0,50.0) | 2.0 (0.0,4.0) | 7.5 (5.0,10.0) | ||||||
Bachelor or above | 693 (52.9) | 44.0 (39.0,50.0) | 2.0 (0.0,4.0) | 8.0 (5.0,10.0) | ||||||
Marital status | −0.492 | 0.623 | −1.142 | 0.149 | −4.122 | <0.001 | ||||
Unmarried | 329 (24.8) | 45.0 (39.0,50.0) | 2.0 (0.0,4.0) | 8.0 (6.0,12.0) | ||||||
Married | 998 (75.2) | 45.0 (40.0,50.0) | 2.0 (0.0,4.0) | 8.0 (5.0,10.0) | ||||||
Monthly income/USD | 17.406 | <0.001 | 1.053 | 0.591 | 10.254 | 0.006 | ||||
≤700 | 488 (36.8) | 46.0 (41.0,51.0) | 2.0 (0.0,4.0) | 8.0 (6.0,11.0) | ||||||
701–999 | 412 (31.0) | 45.0 (40.0,50.0) | 2.0 (0.0,4.0) | 7.0 (5.0,10.0) | ||||||
≥1000 | 427 (32.2) | 43.0 (38.0,49.0) | 2.0 (0.0,4.0) | 8.0 (5.0,10.0) | ||||||
Occupation | 10.574 | 0.005 | 20.079 | <0.001 | 10.158 | 0.006 | ||||
Doctor | 428 (32.3) | 46.0 (40.0,51.8) | 2.0 (0.3,4.0) | 8.0 (6.0,11.0) | ||||||
Nurse | 548 (41.3) | 45.0 (40.0,50.0) | 2.0 (0.0,4.0) | 8.0 (5.0,10.0) | ||||||
Medical technician | 351 (26.4) | 44.0 (39.0,49.0) | 1.0 (0.0,4.0) | 8.0 (5.0,10.0) | ||||||
Weekly working hours/h | 57.928 | <0.001 | 149.455 | <0.001 | 29.919 | <0.001 | ||||
≤40 | 290 (21.9) | 43.0 (39.0,49.0) | 0.0 (0.0,2.0) | 7.0 (5.0,9.0) | ||||||
41–48 | 595 (41.8) | 44.0 (38.0,49.0) | 2.0 (0.0,4.0) | 8.0 (5.0,10.0) | ||||||
≥49 | 442 (36.3) | 47.0 (42.0,52.0) | 4.0 (2.0,5.0) | 8.0 (6.0,11.3) | ||||||
Shift or not | −4.644 | <0.001 | −4.642 | <0.001 | −0.572 | <0.001 | ||||
No | 745 (56.1) | 44.0 (39.0,49.0) | 2.0 (0.0,4.0) | 8.0 (5.0,10.0) | ||||||
Yes | 582 (43.9) | 46.0 (40.0,51.0) | 2.5 (0.0,4.0) | 8.0 (5.0,10.0) | ||||||
Night shift | −4.606 | <0.001 | −9.112 | <0.001 | −3.572 | <0.001 | ||||
No | 777 (58.6) | 44.0 (39.0,49.0) | 1.0 (0.0,4.0) | 7.0 (5.0,10.0) | ||||||
Yes | 550 (41.4) | 46.0 (40.0,51.0) | 3.0 (1.0,4.3) | 8.0 (6.0,10.0) |
Variables | COSS | Social Support | Organization and Reward | Demand and Effort | Autonomy | Cumulative Fatigue | Depression |
---|---|---|---|---|---|---|---|
COSS | 1.000 | ||||||
Social support | −0.661 ** | 1.000 | |||||
Organization and reward | 0.788 ** | −0.351 ** | 1.000 | ||||
Demand and effort | 0.644 ** | −0.132 ** | 0.382 ** | 1.000 | |||
Autonomy | −0.296 ** | 0.204 ** | −0.078 ** | −0.020 | 1.000 | ||
Cumulative fatigue | 0.546 ** | −0.339 ** | 0.348 ** | 0.526 ** | −0.107 ** | 1.000 | |
Depression | 0.514 ** | −0.394 ** | 0.365 ** | 0.362 ** | −0.135 ** | 0.566 ** | 1.000 |
Variables | Block 1 | Block 2 | Block 3 | |||
---|---|---|---|---|---|---|
β | VIF | β | VIF | β | VIF | |
Marital status (unmarried as reference) | ||||||
Married | −1.060 ** | 1.060 | −1.319 ** | 1.076 | −0.955 ** | 1.087 |
Monthly income/USD (≤700 as reference) | ||||||
701–999 | −0.774 ** | 1.328 | −0.489 | 1.346 | −0.385 | 1.347 |
≥1000 | −0.98 ** | 1.414 | −0.296 | 1.489 | −0.396 | 1.490 |
Occupation (doctor as reference) | ||||||
Nurse | −0.700 * | 1.425 | −0.491 * | 1.440 | −0.505 * | 1.440 |
Medical technician | −0.954 ** | 1.428 | −0.417 | 1.447 | −0.295 | 1.449 |
Weekly working hours/h (≤40 as reference) | ||||||
41–48 | 0.340 | 1.720 | 0.231 | 1.749 | −0.170 | 1.767 |
≥49 | 1.425 ** | 1.731 | 0.344 | 1.874 | −0.597 * | 1.963 |
Occupational stress | ||||||
Social support | −0.329 ** | 1.180 | −0.209 ** | 1.257 | ||
Organization and reward | 0.182 ** | 1.322 | 0.140 ** | 1.335 | ||
Demand and effort | 0.321 ** | 1.331 | 0.088 * | 1.614 | ||
Autonomy | −0.265 ** | 1.077 | −0.185 ** | 1.085 | ||
Cumulative fatigue | 0.889 ** | 1.663 | ||||
F | 9.651 | 112.953 | 257.540 | |||
Adjusted R² | 0.044 | 0.286 | 0.403 | |||
ΔR² | 0.049 | 0.243 | 0.116 |
X Variables | c | a | b | c′ | ab (95% CI) | Mediation Effect Percentage |
---|---|---|---|---|---|---|
Social support | −0.460 *** | −0.197 *** | 1.040 *** | −0.255 *** | −0.204(−0.245~−0.166) | 44.46 |
Organization and reward | 0.369 *** | 0.169 *** | 1.061 *** | 0.190 *** | 0.179(0.143~0.218) | 48.58 |
Demand and effort | 0.467 *** | 0.309 *** | 1.076 *** | 0.134 *** | 0.333(0.283~0.385) | 71.26 |
Autonomy | −0.459 *** | −0.183 *** | 1.148 *** | −0.249 *** | −0.210(−0.292~−0.132) | 45.80 |
COSS | 0.266 *** | 0.133 *** | 0.869 *** | 0.150 *** | 0.116(0.096~0.135) | 43.56 |
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Lu, Y.; Li, Z.; Fan, Y.; Wang, J.; Zhong, T.; Wang, L.; Xiao, Y.; Zhang, D.; Chen, Q.; Yu, X. The Mediating Role of Cumulative Fatigue on the Association between Occupational Stress and Depressive Symptoms: A Cross-Sectional Study among 1327 Chinese Primary Healthcare Professionals. Int. J. Environ. Res. Public Health 2022, 19, 15477. https://doi.org/10.3390/ijerph192315477
Lu Y, Li Z, Fan Y, Wang J, Zhong T, Wang L, Xiao Y, Zhang D, Chen Q, Yu X. The Mediating Role of Cumulative Fatigue on the Association between Occupational Stress and Depressive Symptoms: A Cross-Sectional Study among 1327 Chinese Primary Healthcare Professionals. International Journal of Environmental Research and Public Health. 2022; 19(23):15477. https://doi.org/10.3390/ijerph192315477
Chicago/Turabian StyleLu, Yushi, Zhi Li, Yuting Fan, Jin Wang, Tian Zhong, Ling Wang, Ying Xiao, Dongmei Zhang, Qingsong Chen, and Xi Yu. 2022. "The Mediating Role of Cumulative Fatigue on the Association between Occupational Stress and Depressive Symptoms: A Cross-Sectional Study among 1327 Chinese Primary Healthcare Professionals" International Journal of Environmental Research and Public Health 19, no. 23: 15477. https://doi.org/10.3390/ijerph192315477