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The association between psychological strains and life satisfaction: Evidence from medical staff in China
Journal of Affective Disorders 260 (2020) 105–110
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Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad
Research paper
The association between psychological strains and life satisfaction: Evidence from medical staff in China
T
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Sibo Zhaoa,b, Jie Zhanga,c, , Yanzheng Liub, Haoyi Jib, Bob Lewb,d a
Department of Sociology, Central University of Finance & Economics, Beijing, China Shandong University, Center for Suicide Prevention Research, Shandong University, China c Department of Sociology, State University of New York at Buffalo State, United States d Independent Researcher, Asia Crux Limited, Malaysia b
A R T I C LE I N FO
A B S T R A C T
Keywords: Life satisfaction Psychological strains Medical staff
Background: Previous research on the relationship between life satisfaction and its influencing factors has mainly focused on the work domain. Psychological strains, which result from these stress-related outcomes, have not been paid enough attention to explain how it correlates negatively with life satisfaction. Method: A cross-sectional study was conducted, using questionnaires sent to selected medical staff in a public hospital in Shandong, China (N = 1012). Multiple regression analysis was used to investigate how psychological strains influencing life satisfactions among medical staff. Results: The findings indicate that aspiration strain and deprivation strain have significantly negative impact on medical staff's life satisfaction even with other variables controlled for. Weekly working hour was a significant predictor for life satisfaction. Family factors, such as marital status and kids in the family as well as social support were important factors in influencing individuals’ life satisfaction. Conclusion: The current study highlights the negative associations between aspiration strain, deprivation strain and life satisfaction. The result underlines the importance of actions taken to prevent and combat psychological strains. It also provides some evidence for policy makers to improve the work environment for medical staff, such as reduce weekly working hours and enhance social support in order to increase medical staff's life satisfaction.
1. Introduction
associated with patient satisfaction, the quality of medical care in general and the general relationship between doctors and patients (Haas et al., 2000; Kassirer 1998; Cong 2004), since medical staff is the direct provider of hospital services and key element in the development of health services. In China, the recent studies have paid increasing attention on the relationship between work stress and life satisfaction among medical professionals and nursing staff (Wang et al., 2017; Zhang 2013). However, these studies tend to either identify some mental health problem of medical staff or provide a glimpse of negative aspects that influence life satisfaction as a descriptive study. Few studies provide an accurate view on how those risk factors affect individuals’ life satisfaction (Yan et al., 2012; Wang 2013). Theoretical explanations are needed in this research field. According to the Strain Theory of Suicide, psychological issues arise from two or more conflicting or competing stressors or social experiences (Zhang 2005). The theory includes four types of strain that comes
Life satisfaction is referred to a person's evaluation of the extent to which they are satisfied with their life overall (Pavot and Diener 2008). The growing body of research on life satisfaction among medical staff has most focused on the work domain, suggesting that job stress, burnout and clinical depression are significantly associated with a low level of life satisfaction (Iacovides et al., 2003; Hakanen and Schaufeli 2012). Much of these research have proceeded along the inquiry through occupational perspective, indicating that medical staff are exposed to an important number of psychosocial risk factors as a consequence of the type of work, such as high intensity of workload, relative long working hours, violent, abusive or demanding patients, seriously ill patients and so on (Escribà-Agüir et al., 2006; Nylenna et al., 2005; Hesketh et al., 2012; Rodriguez et al., 1998). This is unfortunate because these risk factors not only are associated with work satisfaction and well-being for medical staff members, but also are
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Correspondence author at: Department of Sociology, State University of New York College at Buffalo, 1300 Elmwood Avenue, Buffalo, New York 14222, USA. E-mail address: zhangj@buffalostate.edu (J. Zhang).
https://doi.org/10.1016/j.jad.2019.09.006 Received 6 June 2019; Received in revised form 9 July 2019; Accepted 1 September 2019 Available online 02 September 2019 0165-0327/ © 2019 Elsevier B.V. All rights reserved.
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investigated medical staff was strictly protected by filling in the questionnaires anonymously.
from the following four conflicts: (1) differential values that resulting from two or more conflicting or competing internalized beliefs at a given situation, (2) discrepancy between aspiration or life goals and the reality of their inability to meet such lofty goals, (3) relative deprivation, which from the perception that others with a similar background or within a comparable social group have attained comparatively greater resources or lead a better life, and (4) lack of coping skills when an individual does not deal effectively with challenges and crises in life. The connection between psychological strains in the form of all the four sources and negative aspect of mental health, such as suicide and depression have been tested and supported with a number of studies in the United States (Zhang and Lester 2008; Zhang et al., 2013), as well as among different population groups in China (Zhang et al., 2011; Zhang and Zhao 2013). For example, one study indicated that young adults in rural China aged 25 to 34 years have an increased risk of suicide as a result of experiencing more psychological strains with age (Zhao and Zhang, 2015). Researchers have also identified the gender differences in experiencing psychological strain. Specifically, rural males have been found to experience greater aspiration strain and deprivation strain (Sun and Zhang, 2016; Zhang et al., 2009), whereas rural females are associated with higher levels of value strain (Sun and Zhang, 2016). Unfortunately, none of positive aspects of psychological well-being has been examined by the theory. To address this issue, we conducted a survey study of life satisfaction among a large sample of medical staff in China that included representation across most the specialty disciplines. The first aim of this study was to analyze the relationship between the psychological strains and life satisfaction among medical staff including doctors, nurses, medical technicians, and hospital administrators who are approved and given privileges to provide health care to patients in hospitals. It is hypothesized that value strain, aspiration strain, deprivation strain, and coping strain were negatively related to life satisfaction. The secondary aim was to determine how the association between psychological strains and life satisfaction may be different if Sociodemographic factors were considered in the context. This study contributes to our understanding of psychological strains as common and impactful stressors in medical staff's life satisfaction and emphasizes the importance of actions taken to prevent and combat those strains.
2.2. Data collection During the recruitment process, a member of the medical staff was used to help contact potential participants from different departments in the hospital and to coordinate the administration of the study. We collected the data by using a structured questionnaire and asked participates to take the survey at a group meeting, guided by two welltrained investigators from Shandong University School of Public Health. To ensure the quality, the completed questionnaires were checked carefully by quality supervisors after participates handed in. The information collected of this study included demographic characteristics, such as gender, age, marital status, educational background, job position, and working hours. In addition, we also collected data about psychological strains, social support and, most importantly, life satisfaction, etc. 2.3. Measurements 2.3.1. Dependent variables Life satisfaction was assessed by the Satisfaction with Life Scale (Diener et al., 1985), which is a self-report questionnaire comprising five items, that is, (1) ‘In most ways my life is close to my ideal’; (2) ‘My life condition is very good’; (3) ‘I am satisfied with my life’, (4) ‘I have got the important things which I want in the life’ and (5) ‘If I had new life, I would enjoy it just as I do now’. All items are answered on a seven-point Likert scale ranging from 1(strongly disagree) to 7(strongly agree). The average score of the five items was calculated as the score of life satisfaction. Although the SWLS includes only five items, it has demonstrated good psychometric characteristics in both China and other western countries (Pavot and Diener 1993). In the present study, The Cronbach's coefficient alpha had an estimate of 0.85, which indicates good internal consistency reliability (Bland and Altman 1997). 2.3.2. Independent variables Psychological strains were measured by the Psychological Strain Scale (PSS), which is a 40-item scale designed to measure the psychological strains that have been experienced by the respondents (Zhang et al., 2014). The 40 items in each proposed strain scale were originally translated and back translated between English and Chinese a number of times by bilingual experts on Zhang's research team, until every single item in Chinese were satisfactorily fit to its corresponding item in the English version. It has been tested with good reliability and validity both in Chinese and English version. Detailed procedure of developing questionnaire and translation could be found in previous publications (Zhang et al., 2014). The PSS consists of 10 items in each of the four dimensions of the psychological strain: Value Strain, Aspiration Strain, Relative Deprivation Strain, and Coping Strain. An example of the items regarding value strain was: ``How much do you agree or disagree on the issue that women have to stay at home without working outside?” Aspiration strain is measured by questions such as ``I wish had a better job now, but I cannot realize it according to some reasons.” Relative deprivation is assessed by the question, for instance, ``My life is worse than others.” The coping skill criterion is measured by the item such as ``When I confront a crisis in life, I usually plan steps to successfully solve the problem.” The response was rated on the scale ranging from 1=``never, it's not me”, 2=``rarely, it's not me”, 3=``maybe, I'm not sure”, 4=``often, it's like me” to 5=``yes, it's exactly me”. Each of the four strains was analyzed by adding up their subscore. The higher the score, the higher is the individual's psychological strain. The Cronbach's coefficient of Value Strain, Aspiration Strain, Relative Deprivation Strain, and Coping Strain of this study were 0.899, 0.930, 0.928 and 0.926, respectively. Sociodemographic factors have also been considered in the analysis,
2. Method 2.1. Study population This is a cross-sectional study, which was conducted in Jinan, the capital city of Shandong province where located at the eastern part of China. The medical staff members were selected using purposive random sampling from a large government owned and operated public hospital in China. In each of the ten departments (i.e. Gynecology, Neurology, et.al.), 100 medical staff members, including doctors, nurses, medical technicians (personnel in pharmacy, clinical laboratory, and radiology department), as well as hospital administrators were randomly chosen and considered as subjects of the study. A total of 1050 medical staff members were investigated and 1012 valid answer sheets were returned, resulting in a response rate of 96.38%. The exclusion of the data was mainly due to incomplete demographics or inappropriate response patterns (e.g. repetitively reporting the same response to all questions). Shandong is a typical province in terms of population structure, social and culture life (Liu et al., 2017). Although the data was not a national representative sample, those medical staff members vary substantially in terms of professional features. This study protocol was approved by the Medical Ethical Committee of Qilu Hospital, the Ethics Committee of Shandong University, and the Ethics Committee of Central University of Finance and Economics where the Principal Investigator is affiliated. The medical staff was aware of this study and willing to participate. The privacy of the 106
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aspiration strain, deprivation strain and coping strain. As psychological strain comes from the interactions of the four dimensions, total PSS score is also negatively correlated with life satisfaction and social support level. What's more, all the associations mentioned above are statistically significant (p < 0.05) and most of their absolute values of correlation coefficient are located between 0.3 and 0.5, which means these associations are moderately correlated.
including individuals’ gender, age, education level, job position, marital status, kids in the family, and weekly working hours. Educational background was categorized by 0 (Junior college and below), 1 (Bachelor's degree), and 2 (Master's degree or above). Position consists of four categories, 0 (hospital administrators), 1 (doctors), 2 (nurse), and 3 (medical technician). We computed marital status into a dummy variable. The group of ``never married” included those young people who are not married while the group of ``ever married” covered those who are married and or married before but separated or divorced now. Kids in the family has three categories, 0 (no kids), 1(one kid) and 2 (more than one kid). Weekly working hours ranged from 1 to 5, indicating ``less than or equal to 40 h” to ``more than 70 h”. It was considered as a continuous variable in the current analysis. Multi-dimensional Scale of Perceived Social Support (MSPSS) (Zimet et al., 1990) was used to measure perceived social support. It was a 12-item scale and was used to measure degree of social support from three key sources: (1) Family (e.g., ``I get the emotional help and support I need from my family”); (2) Friends (e.g., ``My friends really try to help me”), and (3) Significant Others (e.g., ``There is a special person who is around when I am in need”). In the current study, the internal consistency coefficient of MSPSS was 0.956.
3.3. Assessment on the factors related to life satisfaction Multiple regressions were constructed to analyze the factors related to life satisfaction (see Table 3 and Table 4). Model 1 only included independent variable of psychological strains. The sociodemographic factors were added as control variables in Model 2. Model 3 included both independent variables and control variables. We further analyzed data by separating males and females in order to compare the results by gender (Model 4 and Model 5 in table 4). The analysis showed that the regression equation was, in general, significant and could explain 32.6% of the total variance (Adjusted R2 = 0.326; F = 21.440, p < 0.001) (see Model 3). The results in Model 2 showed that compared to individuals with junior college and below education level, those who have bachelor's degree and master's degree or above have reported higher life satisfaction (β1 = 1.281, p = 0.201, β2 = 1.530, p = 0.082). The P values of them were not statistically significant (p > 0.05), but the dimensions of life satisfaction existed marginal significant differences between individuals with junior college and below education level and individuals with master's degree and above. Comparing with administrators, the negative coefficients (β1 = −1.997, p = 0.014; β2 = −0.521, p = 0.461; β3 = −0.746, p = 0.544) showed that doctors, nurses, and medical technicians have lower life satisfaction, although the P values of nurse and medical technician were not statistically significan. Based on the beta estimates of Model 3, marital status, weekly working hours and social support are significantly related to life satisfaction. Compared to individuals who do not have kids in the family, the positive coefficients (β1 = 0.562, p = 0.328, β2 = 1.315, p = 0.083) indicated those who have kids in the family have reported higher life satisfaction, although the P values were not statistically significant (p > 0.05) in the model. As for the four dimensions of psychological strains, the statistically significant impacts show that higher aspiration strain and deprivation strain (β1 = −0.225, p < 0.001, β2 = −0.122, p = 0.010) were associated with lower life satisfaction level. Thus, aspiration strain and deprivation strain have significantly negative impact on life satisfaction even with other variables controlled for. In Table 4, we compared the finding above by separating males and females. It indicated that comparing to men, women who are married had significantly higher life satisfaction than women who never married. But this positive effect was not found among males. In addition, among women, more than one child significantly increased their life satisfaction and longer weekly working hours was significantly associated with lower life satisfaction. Deprivation strain is negatively related to the life satisfaction. These findings were not the case among men. But higher aspiration strain in both male and female sample (β1 = −0.442, p < 0.001, β2 = −0.152, p = 0.002) were associated with lower life satisfaction level.
2.4. Data analysis The data were double entered and checked using EpiData 6.04 and were analyzed by using SPSS 24.0. T-test was used to analyze the life satisfaction and other influencing conditions between male and female. We performed correlation analysis to check the continuous factors associated with life satisfaction. And then, multivariate linear regression was used to further assess the association between psychological strains and life satisfaction with other variables controlled for. 3. Results 3.1. Descriptive statistics The sample consisted of 237 males and 775 females. Although there was an excess of female respondents in our sample, it is in line with previous studies (Fang et al., 2015), as the general medical staff population in Chinese hospitals are mainly comprised of females. The mean (standard deviation) or frequency (percentage) of each variable and their gender difference comparison are shown in Table 1. As can be seen, the average score of life satisfaction for the whole sample was 20.36 (SD=6.28) and there was no significant difference between male and female medical staff (p = 0.764). Compared to males, females tended to have younger age (M = 33.28, SD=7.9) and less weekly working hours (M = 2.09, SD = 1.051) and these differences were statistically significant (p < 0.001). In our sample, most of participants has a bachelor's degree (60.3%) or master degree or above (26.6%). One reason could be in China, a medical staff member needs higher education level in order to undergo and pass a special qualification examination to get their professional title. In addition, nurse (58.0%) and doctor (21.9%) accounted for a higher proportion of the four types of job positions. Of the medical staff participating in the study, 69.6% (N = 536) reported having one child in the family. No statistically significant differences between genders were observed in value strain, aspiration strain, deprivation strain, coping strain, marital status, and social support. Table 2.
4. Discussion Although the relationship between work stress and life satisfaction among medical professional and nursing staff has been widely studied, the mechanisms that account for this relationship are not yet fully understood. This research focuses on the association between psychological strains and life satisfaction among medical staff in the context of China. The results show that marital status is a significant family factor that positively correlated with the level of life satisfaction. As known, in a
3.2. Correlation analysis between psychological strains and life satisfaction The result of bivariate correlation analysis indicates that higher life satisfaction level is significantly associated with lower value strain, aspiration strain, deprivation strain and coping strain. Stronger social support level has significantly corresponding to lower value strain, 107
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Table 1 Demographic characteristics of the sampled medical staff and distribution of the major variables for study with a gender comparison. Variable
Total (N = 1012) M ± SD/f (%)
Male (N = 237) M ± SD/f (%)
Female (N = 775) M ± SD/f (%)
t/χ2
p
Age Educational background Junior college and below (0) Bachelor's degree (1) Master's degree or above (2) Position Doctor Nurse Medical technician hospital administrators Marital status Ever married (1) Never married (0) Kids in the family none (0) one child (1) more than one (2) Weekly working hours Social support Value strain Aspiration strain Deprivation strain Coping strain Life satisfaction
33.89 ± 8.42
35.90 ± 9.70
33.28 ± 7.90
3.793 195.403
<0.001 <0.001
133 (13.2) 608 (60.3) 268 (26.6)
47 (20.1) 78 (33.3) 109 (46.6)
86 (11.1) 530 (68.4) 159 (20.5) 93.64
<0.001
222 (21.9) 587 (58.0) 36 (3.6) 167 (16.5)
104 (43.9) 45 (19.0) 13 (5.5) 75 (31.6)
118 (15.2) 542 (69.9) 23 (3.0) 92 (11.9) 0.949
0.330
774 (76.6) 237 (23.4)
187 (78.9) 50 (21.1)
587 (75.8) 187 (24.2)
131 (17.0) 536 (69.6) 103 (13.4) 2.21 ± 1.115 60.39 ± 10.07 24.93 ± 7.42 25.11 ± 8.11 24.45 ± 7.79 23.24 ± 7.08 20.36 ± 6.28
29 (15.8) 118 (64.5) 36 (19.7) 2.60 ± 1.226 60.31 ± 11.66 24.41 ± 7.78 24.37 ± 8.59 24.74 ± 8.50 22.51 ± 7.59 20.24 ± 6.98
102 (17.4) 418 (71.2) 67 (11.4) 2.09 ± 1.051 60.41 ± 9.54 25.08 ± 7.31 25.32 ± 7.95 24.36 ± 7.56 23.47 ± 6.91 20.40 ± 6.05
8.212
0.016
−5.75 −0.120 −1.182 −1.552 0.614 −1.820 −0.301
<0.001 0.904 0.238 0.121 0.540 0.069 0.764
deprivation strain are significantly and negatively associated with the level of life satisfaction while value strain and coping strain are not shown the same pattern. Aspiration strain comes from disparity between aspiration and reality. Compare to people in other professions, medical staff in China are facing a conflicting environment of lofty aspirations and lack of legitimate means for success or self-fulfillment. For example, Wang (2002) found that nurses were mostly dissatisfied with pay and job promotion, and most medical professionals have the ambition for promotion. However, the promotion system in some hospitals is based on scientific research evaluation rather than medical practice (Li 2014). In this way, the conflict between the desire of promotion and lack of time for research publication is more likely to develop aspiration strain for medical staff. Due to many circumstances like the one mentioned, the gap between an individual's desires/goals and the actual reality in which the person live may result in their aspiration strain, and further decrease their life satisfaction. According to the strain theory, deprivation strain is result from the discrepancy when comparing one's own status with others (Zhang et al., 2011). Medical professionals nowadays are facing a crucial fact: compared to other professionals in the same social class, they are experiencing relatively more work stress (i.e. long work hours and dissatisfied patient), earning less salary and having less spare time to be with their families and friends (Grembowski et al., 2005; Haas et al., 2000). Tzeng (2002) noted in his study that nurses believed indirect working environment (e.g. a hospital's policies, leisure activities, and vacation policy), salary and promotion were very important but strongly dissatisfying, which may results in their high levels of deprivation strain and then influence the overall life satisfaction.
healthy marital relationship, spouses generally develop the ability to help each other with personal difficulties and provide everyday support for their partner (Bradbury and Karney 2004), which is likely to increase people's life satisfaction. Facing high intensity of workload, medical professionals who are married will be more likely to get social support from the family to resist risks or take responsibilities together. Thus, they will have higher life satisfaction than singled ones. In addition, although kids in the family did not show a statistically significant impact on individual's life satisfaction in the whole model, it does show the significant impact among women. The positive coefficients indicated those who have kids in the family have reported higher life satisfaction. Having kids is expected to have a positive effect on parents’ life satisfaction. As earlier study suggested, despite or maybe precisely because of the difficulty of raising children, for the arrival of a child tends to be seen as a blessing to a married couple. Our result indicated that weekly working hours is negatively associated with individual's life satisfaction, especially for women. A significant proportion of medical staff had marked psychological stress, and long weekly working hours made works even more unsatisfactory. For example, sources of stress are from dying patients’ excessive responsibility, rapid advances in technology, and excessive personal demands of patient and families (Escribà-Agüir et al., 2006; Nylenna et al., 2005; Hesketh et al., 2012; Rodriguez et al., 1998). The majority of staff had experienced difficulties in their personal lives which were directly linked to low life satisfaction (Molassiotis et al., 1995). The result also suggested that those who have received more social support are more likely to have a better life satisfaction, which is consistent with previous research (Zhang and Zhao 2017). In the current study, we have found that aspiration strain and
Table 2 Psychological strains, social support, and life satisfaction: Correlation matrix analyses. Scale/Variable
Value strain r
Aspiration strain r
Deprivation strain r
Coping strain r
Total PSS score r
Life satisfaction Weekly working hours Social support
−0.348 0.084 −0.342
−0.467 0.075 −0.348
−0.432 0.115 −0.350
−0.329 0.033 −0.405
−0.464 0.092 −0.425
Note. All P-values are <0.001. 108
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Table 3 Multiple regressions on association between psychological strains and life satisfaction with major covariates included. Variable
Gender (male) Age Bachelor's degree (Junior college and below) Master's degree or above (Junior college and below) Doctor (administrators) Nurse (administrators) Medical technician (administrators) Marital status (Never married) One child (No child) More than one child (No child) Value strain Aspiration strain Deprivation strain Coping strain Weekly working hours Social support Constant R2 Adjusted R2 Model Fit
Model 1 β
p
Model 2 β
t
p
−0.609 −6.142 −3.252 −0.249
0.543 <0.001 0.001 0.804
−0.568 0.054 1.002 1.530 −1.997 −0.521 −0.746 7.147 0.416 0.741 −0.020 −0.260 −0.134 0.001
−0.986 1.453 1.281 1.740 −2.466 −0.737 −0.607 2.536 0.693 0.940 −0.460 −5.562 −2.755 0.008
0.324 0.147 0.201 0.082 0.014 0.461 0.544 0.011 0.488 0.348 0.646 <0.001 0.006 0.994
30. 561 42.166 0.228 0.225 F = 66.797, p<0.001
<0.001
21.657 6.872 0.274 0.259 F = 18.002, p<0.001
<0.001
−0.023 −0.248 −0.131 −0.01
t
Model 3 β −0.459 0.049 0.632 1.268 −0.710 −0.168 −0.026 7.534 0.562 1.315 0.003 −0.225 −0.122 0.026 −0.573 0.167 9.590 0.342 0.326 F = 21.440,
t
p
−0.829 1.651 0.835 1.502 −0.861 −00.247 −0.022 2.795 0.979 1.734 0.069 −5.008 −2.578 0.586 −2.686 7.726 2.749
0.407 0.099 0.404 0.134 0.389 0.805 0.982 0.005 0.328 0.083 0.945 <0.001 0.010 0.558 0.007 <0.001 0.006
p<0.001
Table 4 Multiple regressions on association between psychological strains and life satisfaction with gender comparison. Variable
Gender (male) Age Bachelor's degree (Junior college and below) Master's degree or above (Junior college and below) Doctor (administrators) Nurse (administrators) Medical technician (administrators) Marital status (Never married) One child (No child) More than one child (No child) Value strain Aspiration strain Deprivation strain Coping strain Weekly working hours Social support Constant R2 Adjusted R2 Model Fit
Model 4 (Male) β
t
p
0.088 1.335 2.403 1.468 00.781 0.458 0.323 0.222 −2.588 −1.445 −1.721 −0.780 −6.548 −1.142 −1.135 −0.869 −0.951 −0.606 −0.193 −1.087 −0.442 −4.516 −0.160 −1.598 −0.224 −1.280 −0.457 −2.036 0.262 6.252 14.101 1.962 0.513 0.458 F = 9.402, p < 0.001
0.184 0.144 0.648 0.824 0.151 0.437 0.255 0.387 0.546 0.221 <0.001 0.112 0.176 0.302 <0.001 0.052
Model 5(Female) β
t
0.028 0.839 0.287 0.338 1.380 1.405 −1.379 −1.350 0.002 0.002 0.593 0.427 12.127 4.018 0.924 1.457 1.782 2.038 −0.039 −0.858 −0.152 −3.048 −0.115 −2.175 −0.046 −0.922 −0.549 −2.266 0.136 5.438 8.131 2.060 0.325 0.305 F = 16.418, p < 0.001
p
0.402 0.736 0.161 0.178 0.998 0.669 <0.001 0.146 0.042 0.391 0.002 0.030 0.357 0.024 <0.001 0.040
5. Limitation
6. Conclusion
The study contains several limitations. The major limitation of this study is the use of a cross-sectional design, which allows for the identification of statistical association but does not provide definitive evidence on whether the assumed cause precedes the assumed effect or whether the association between psychological strains and life satisfaction is caused by a third factor. Longitudinal study should be conducted in the future, so that the correlated factors can be explained more effectively and their effects can be predicted more precisely. Moreover, the sample comes from a large government owned and operated public hospital located in Jinan, Shandong province. Due to the sample restriction, we may not be able to generalize the result to the whole of medical staff, thus the result of the study may be affected by the data source. In addition, other social factors such as income, job specialties and social class should be taken into consideration, which might explain the differences in life satisfaction among different subgroups.
The findings of the current study highlight the negative associations between aspiration strain, deprivation strain and life satisfaction, even with other variables controlled for. The result underlines the importance of actions taken to prevent and combat psychological strains. Medical staff should be encouraged to establish reasonable career planning based on their own circumstance. It is more conducive to reduce aspiration strain by cognitive intervention so as to redirect individuals to a rational motivation and ambition level. The current study also provides evidences for policy makers to improve the work environment for medical staff members. For instance, hospital can reduce weekly working hours by implementing work shift schedule, which can increase the flexibility of working hours and thus provide medical staff more time to spend with their families. Enhancing social support is also important for medical staff to improve their life satisfaction. For example, government should ensure the continuous increase of social benefits such as providing childcare service and increasing in paid leave for medical staff. Additionally, regular psychological counseling should
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be provided in order to help medical staff members who have higher aspiration and deprivation strains.
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CRediT authorship contribution statement Sibo Zhao: Conceptualization, Formal analysis, Writing - original draft, Writing - review & editing. Jie Zhang: Conceptualization. Yanzheng Liu: Data curation. Haoyi Ji: Data curation. Bob Lew: Resources, Validation. Declaration of Competing Interest None. Role of the funding source The funding source had no role in the study design; in the collection, analysis and interpretation of data; in the writing of this report; and in the decision to submit the article for publication. Acknowledgments This research was supported by the grant from Beijing Psychosocial Services Promotion Center (2017BJXLS08) and the grant from The Education and Teaching Reform Fund of Central University of Finance and Economics (2018GRYBJG07). Supplementary materials Supplementary material associated with this article can be found, in the online version, at doi:10.1016/j.jad.2019.09.006. References Bland, J.M.&., Altman, D.G., 1997. Cronbach's alpha. BMJ 314 (7080), 572. Bradbury, T.N., Karney, B.R., 2004. Understanding and altering the longitudinal course of marriage. J. Marriage Family 66 (4), 862–879. Cong, Y., 2004. Doctor-family-patient relationship: the Chinese paradigm of informed consent. J. Med. Philos. 29 (2), 149–178. Diener, E., Emmons, R.A., Larsen, R.J., Griffin, S., 1985. The satisfaction with life scale. J. Pers. Assess. 49 (1), 71–75. Escribà-Agüir, V., Martín-Baena, D., Pérez-Hoyos, S., 2006. Psychosocial work environment and burnout among emergency medical and nursing staff. Int. Arch. Occup. Environ. Health 80 (2), 127–133. Fang, P., Luo, Z., Fang, Z., 2015. What is the job satisfaction and active participation of medical staff in public hospital reform: a study in Hubei province of China. Hum. Resour. Health 13 (1), 34. Grembowski, D., Paschane, D., Diehr, P., Katon, W., Martin, D., Patrick, D.L., 2005. Managed care, physician job satisfaction, and the quality of primary care. J. Gen. Intern. Med. 20 (3), 271–277. Haas, J.S., Cook, E.F., Puopolo, A.L., Burstin, H.R., Cleary, P.D., Brennan, T.A., 2000. Is the professional satisfaction of general internists associated with patient satisfaction? J. Gen. Intern. Med. 15 (2), 122–128. Hakanen, J.J., Schaufeli, W.B., 2012. Do burnout and work engagement predict depressive symptoms and life satisfaction? A three-wave seven-year prospective study. J.
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Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad
Research paper
The association between psychological strains and life satisfaction: Evidence from medical staff in China
T
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Sibo Zhaoa,b, Jie Zhanga,c, , Yanzheng Liub, Haoyi Jib, Bob Lewb,d a
Department of Sociology, Central University of Finance & Economics, Beijing, China Shandong University, Center for Suicide Prevention Research, Shandong University, China c Department of Sociology, State University of New York at Buffalo State, United States d Independent Researcher, Asia Crux Limited, Malaysia b
A R T I C LE I N FO
A B S T R A C T
Keywords: Life satisfaction Psychological strains Medical staff
Background: Previous research on the relationship between life satisfaction and its influencing factors has mainly focused on the work domain. Psychological strains, which result from these stress-related outcomes, have not been paid enough attention to explain how it correlates negatively with life satisfaction. Method: A cross-sectional study was conducted, using questionnaires sent to selected medical staff in a public hospital in Shandong, China (N = 1012). Multiple regression analysis was used to investigate how psychological strains influencing life satisfactions among medical staff. Results: The findings indicate that aspiration strain and deprivation strain have significantly negative impact on medical staff's life satisfaction even with other variables controlled for. Weekly working hour was a significant predictor for life satisfaction. Family factors, such as marital status and kids in the family as well as social support were important factors in influencing individuals’ life satisfaction. Conclusion: The current study highlights the negative associations between aspiration strain, deprivation strain and life satisfaction. The result underlines the importance of actions taken to prevent and combat psychological strains. It also provides some evidence for policy makers to improve the work environment for medical staff, such as reduce weekly working hours and enhance social support in order to increase medical staff's life satisfaction.
1. Introduction
associated with patient satisfaction, the quality of medical care in general and the general relationship between doctors and patients (Haas et al., 2000; Kassirer 1998; Cong 2004), since medical staff is the direct provider of hospital services and key element in the development of health services. In China, the recent studies have paid increasing attention on the relationship between work stress and life satisfaction among medical professionals and nursing staff (Wang et al., 2017; Zhang 2013). However, these studies tend to either identify some mental health problem of medical staff or provide a glimpse of negative aspects that influence life satisfaction as a descriptive study. Few studies provide an accurate view on how those risk factors affect individuals’ life satisfaction (Yan et al., 2012; Wang 2013). Theoretical explanations are needed in this research field. According to the Strain Theory of Suicide, psychological issues arise from two or more conflicting or competing stressors or social experiences (Zhang 2005). The theory includes four types of strain that comes
Life satisfaction is referred to a person's evaluation of the extent to which they are satisfied with their life overall (Pavot and Diener 2008). The growing body of research on life satisfaction among medical staff has most focused on the work domain, suggesting that job stress, burnout and clinical depression are significantly associated with a low level of life satisfaction (Iacovides et al., 2003; Hakanen and Schaufeli 2012). Much of these research have proceeded along the inquiry through occupational perspective, indicating that medical staff are exposed to an important number of psychosocial risk factors as a consequence of the type of work, such as high intensity of workload, relative long working hours, violent, abusive or demanding patients, seriously ill patients and so on (Escribà-Agüir et al., 2006; Nylenna et al., 2005; Hesketh et al., 2012; Rodriguez et al., 1998). This is unfortunate because these risk factors not only are associated with work satisfaction and well-being for medical staff members, but also are
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Correspondence author at: Department of Sociology, State University of New York College at Buffalo, 1300 Elmwood Avenue, Buffalo, New York 14222, USA. E-mail address: zhangj@buffalostate.edu (J. Zhang).
https://doi.org/10.1016/j.jad.2019.09.006 Received 6 June 2019; Received in revised form 9 July 2019; Accepted 1 September 2019 Available online 02 September 2019 0165-0327/ © 2019 Elsevier B.V. All rights reserved.
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investigated medical staff was strictly protected by filling in the questionnaires anonymously.
from the following four conflicts: (1) differential values that resulting from two or more conflicting or competing internalized beliefs at a given situation, (2) discrepancy between aspiration or life goals and the reality of their inability to meet such lofty goals, (3) relative deprivation, which from the perception that others with a similar background or within a comparable social group have attained comparatively greater resources or lead a better life, and (4) lack of coping skills when an individual does not deal effectively with challenges and crises in life. The connection between psychological strains in the form of all the four sources and negative aspect of mental health, such as suicide and depression have been tested and supported with a number of studies in the United States (Zhang and Lester 2008; Zhang et al., 2013), as well as among different population groups in China (Zhang et al., 2011; Zhang and Zhao 2013). For example, one study indicated that young adults in rural China aged 25 to 34 years have an increased risk of suicide as a result of experiencing more psychological strains with age (Zhao and Zhang, 2015). Researchers have also identified the gender differences in experiencing psychological strain. Specifically, rural males have been found to experience greater aspiration strain and deprivation strain (Sun and Zhang, 2016; Zhang et al., 2009), whereas rural females are associated with higher levels of value strain (Sun and Zhang, 2016). Unfortunately, none of positive aspects of psychological well-being has been examined by the theory. To address this issue, we conducted a survey study of life satisfaction among a large sample of medical staff in China that included representation across most the specialty disciplines. The first aim of this study was to analyze the relationship between the psychological strains and life satisfaction among medical staff including doctors, nurses, medical technicians, and hospital administrators who are approved and given privileges to provide health care to patients in hospitals. It is hypothesized that value strain, aspiration strain, deprivation strain, and coping strain were negatively related to life satisfaction. The secondary aim was to determine how the association between psychological strains and life satisfaction may be different if Sociodemographic factors were considered in the context. This study contributes to our understanding of psychological strains as common and impactful stressors in medical staff's life satisfaction and emphasizes the importance of actions taken to prevent and combat those strains.
2.2. Data collection During the recruitment process, a member of the medical staff was used to help contact potential participants from different departments in the hospital and to coordinate the administration of the study. We collected the data by using a structured questionnaire and asked participates to take the survey at a group meeting, guided by two welltrained investigators from Shandong University School of Public Health. To ensure the quality, the completed questionnaires were checked carefully by quality supervisors after participates handed in. The information collected of this study included demographic characteristics, such as gender, age, marital status, educational background, job position, and working hours. In addition, we also collected data about psychological strains, social support and, most importantly, life satisfaction, etc. 2.3. Measurements 2.3.1. Dependent variables Life satisfaction was assessed by the Satisfaction with Life Scale (Diener et al., 1985), which is a self-report questionnaire comprising five items, that is, (1) ‘In most ways my life is close to my ideal’; (2) ‘My life condition is very good’; (3) ‘I am satisfied with my life’, (4) ‘I have got the important things which I want in the life’ and (5) ‘If I had new life, I would enjoy it just as I do now’. All items are answered on a seven-point Likert scale ranging from 1(strongly disagree) to 7(strongly agree). The average score of the five items was calculated as the score of life satisfaction. Although the SWLS includes only five items, it has demonstrated good psychometric characteristics in both China and other western countries (Pavot and Diener 1993). In the present study, The Cronbach's coefficient alpha had an estimate of 0.85, which indicates good internal consistency reliability (Bland and Altman 1997). 2.3.2. Independent variables Psychological strains were measured by the Psychological Strain Scale (PSS), which is a 40-item scale designed to measure the psychological strains that have been experienced by the respondents (Zhang et al., 2014). The 40 items in each proposed strain scale were originally translated and back translated between English and Chinese a number of times by bilingual experts on Zhang's research team, until every single item in Chinese were satisfactorily fit to its corresponding item in the English version. It has been tested with good reliability and validity both in Chinese and English version. Detailed procedure of developing questionnaire and translation could be found in previous publications (Zhang et al., 2014). The PSS consists of 10 items in each of the four dimensions of the psychological strain: Value Strain, Aspiration Strain, Relative Deprivation Strain, and Coping Strain. An example of the items regarding value strain was: ``How much do you agree or disagree on the issue that women have to stay at home without working outside?” Aspiration strain is measured by questions such as ``I wish had a better job now, but I cannot realize it according to some reasons.” Relative deprivation is assessed by the question, for instance, ``My life is worse than others.” The coping skill criterion is measured by the item such as ``When I confront a crisis in life, I usually plan steps to successfully solve the problem.” The response was rated on the scale ranging from 1=``never, it's not me”, 2=``rarely, it's not me”, 3=``maybe, I'm not sure”, 4=``often, it's like me” to 5=``yes, it's exactly me”. Each of the four strains was analyzed by adding up their subscore. The higher the score, the higher is the individual's psychological strain. The Cronbach's coefficient of Value Strain, Aspiration Strain, Relative Deprivation Strain, and Coping Strain of this study were 0.899, 0.930, 0.928 and 0.926, respectively. Sociodemographic factors have also been considered in the analysis,
2. Method 2.1. Study population This is a cross-sectional study, which was conducted in Jinan, the capital city of Shandong province where located at the eastern part of China. The medical staff members were selected using purposive random sampling from a large government owned and operated public hospital in China. In each of the ten departments (i.e. Gynecology, Neurology, et.al.), 100 medical staff members, including doctors, nurses, medical technicians (personnel in pharmacy, clinical laboratory, and radiology department), as well as hospital administrators were randomly chosen and considered as subjects of the study. A total of 1050 medical staff members were investigated and 1012 valid answer sheets were returned, resulting in a response rate of 96.38%. The exclusion of the data was mainly due to incomplete demographics or inappropriate response patterns (e.g. repetitively reporting the same response to all questions). Shandong is a typical province in terms of population structure, social and culture life (Liu et al., 2017). Although the data was not a national representative sample, those medical staff members vary substantially in terms of professional features. This study protocol was approved by the Medical Ethical Committee of Qilu Hospital, the Ethics Committee of Shandong University, and the Ethics Committee of Central University of Finance and Economics where the Principal Investigator is affiliated. The medical staff was aware of this study and willing to participate. The privacy of the 106
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aspiration strain, deprivation strain and coping strain. As psychological strain comes from the interactions of the four dimensions, total PSS score is also negatively correlated with life satisfaction and social support level. What's more, all the associations mentioned above are statistically significant (p < 0.05) and most of their absolute values of correlation coefficient are located between 0.3 and 0.5, which means these associations are moderately correlated.
including individuals’ gender, age, education level, job position, marital status, kids in the family, and weekly working hours. Educational background was categorized by 0 (Junior college and below), 1 (Bachelor's degree), and 2 (Master's degree or above). Position consists of four categories, 0 (hospital administrators), 1 (doctors), 2 (nurse), and 3 (medical technician). We computed marital status into a dummy variable. The group of ``never married” included those young people who are not married while the group of ``ever married” covered those who are married and or married before but separated or divorced now. Kids in the family has three categories, 0 (no kids), 1(one kid) and 2 (more than one kid). Weekly working hours ranged from 1 to 5, indicating ``less than or equal to 40 h” to ``more than 70 h”. It was considered as a continuous variable in the current analysis. Multi-dimensional Scale of Perceived Social Support (MSPSS) (Zimet et al., 1990) was used to measure perceived social support. It was a 12-item scale and was used to measure degree of social support from three key sources: (1) Family (e.g., ``I get the emotional help and support I need from my family”); (2) Friends (e.g., ``My friends really try to help me”), and (3) Significant Others (e.g., ``There is a special person who is around when I am in need”). In the current study, the internal consistency coefficient of MSPSS was 0.956.
3.3. Assessment on the factors related to life satisfaction Multiple regressions were constructed to analyze the factors related to life satisfaction (see Table 3 and Table 4). Model 1 only included independent variable of psychological strains. The sociodemographic factors were added as control variables in Model 2. Model 3 included both independent variables and control variables. We further analyzed data by separating males and females in order to compare the results by gender (Model 4 and Model 5 in table 4). The analysis showed that the regression equation was, in general, significant and could explain 32.6% of the total variance (Adjusted R2 = 0.326; F = 21.440, p < 0.001) (see Model 3). The results in Model 2 showed that compared to individuals with junior college and below education level, those who have bachelor's degree and master's degree or above have reported higher life satisfaction (β1 = 1.281, p = 0.201, β2 = 1.530, p = 0.082). The P values of them were not statistically significant (p > 0.05), but the dimensions of life satisfaction existed marginal significant differences between individuals with junior college and below education level and individuals with master's degree and above. Comparing with administrators, the negative coefficients (β1 = −1.997, p = 0.014; β2 = −0.521, p = 0.461; β3 = −0.746, p = 0.544) showed that doctors, nurses, and medical technicians have lower life satisfaction, although the P values of nurse and medical technician were not statistically significan. Based on the beta estimates of Model 3, marital status, weekly working hours and social support are significantly related to life satisfaction. Compared to individuals who do not have kids in the family, the positive coefficients (β1 = 0.562, p = 0.328, β2 = 1.315, p = 0.083) indicated those who have kids in the family have reported higher life satisfaction, although the P values were not statistically significant (p > 0.05) in the model. As for the four dimensions of psychological strains, the statistically significant impacts show that higher aspiration strain and deprivation strain (β1 = −0.225, p < 0.001, β2 = −0.122, p = 0.010) were associated with lower life satisfaction level. Thus, aspiration strain and deprivation strain have significantly negative impact on life satisfaction even with other variables controlled for. In Table 4, we compared the finding above by separating males and females. It indicated that comparing to men, women who are married had significantly higher life satisfaction than women who never married. But this positive effect was not found among males. In addition, among women, more than one child significantly increased their life satisfaction and longer weekly working hours was significantly associated with lower life satisfaction. Deprivation strain is negatively related to the life satisfaction. These findings were not the case among men. But higher aspiration strain in both male and female sample (β1 = −0.442, p < 0.001, β2 = −0.152, p = 0.002) were associated with lower life satisfaction level.
2.4. Data analysis The data were double entered and checked using EpiData 6.04 and were analyzed by using SPSS 24.0. T-test was used to analyze the life satisfaction and other influencing conditions between male and female. We performed correlation analysis to check the continuous factors associated with life satisfaction. And then, multivariate linear regression was used to further assess the association between psychological strains and life satisfaction with other variables controlled for. 3. Results 3.1. Descriptive statistics The sample consisted of 237 males and 775 females. Although there was an excess of female respondents in our sample, it is in line with previous studies (Fang et al., 2015), as the general medical staff population in Chinese hospitals are mainly comprised of females. The mean (standard deviation) or frequency (percentage) of each variable and their gender difference comparison are shown in Table 1. As can be seen, the average score of life satisfaction for the whole sample was 20.36 (SD=6.28) and there was no significant difference between male and female medical staff (p = 0.764). Compared to males, females tended to have younger age (M = 33.28, SD=7.9) and less weekly working hours (M = 2.09, SD = 1.051) and these differences were statistically significant (p < 0.001). In our sample, most of participants has a bachelor's degree (60.3%) or master degree or above (26.6%). One reason could be in China, a medical staff member needs higher education level in order to undergo and pass a special qualification examination to get their professional title. In addition, nurse (58.0%) and doctor (21.9%) accounted for a higher proportion of the four types of job positions. Of the medical staff participating in the study, 69.6% (N = 536) reported having one child in the family. No statistically significant differences between genders were observed in value strain, aspiration strain, deprivation strain, coping strain, marital status, and social support. Table 2.
4. Discussion Although the relationship between work stress and life satisfaction among medical professional and nursing staff has been widely studied, the mechanisms that account for this relationship are not yet fully understood. This research focuses on the association between psychological strains and life satisfaction among medical staff in the context of China. The results show that marital status is a significant family factor that positively correlated with the level of life satisfaction. As known, in a
3.2. Correlation analysis between psychological strains and life satisfaction The result of bivariate correlation analysis indicates that higher life satisfaction level is significantly associated with lower value strain, aspiration strain, deprivation strain and coping strain. Stronger social support level has significantly corresponding to lower value strain, 107
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Table 1 Demographic characteristics of the sampled medical staff and distribution of the major variables for study with a gender comparison. Variable
Total (N = 1012) M ± SD/f (%)
Male (N = 237) M ± SD/f (%)
Female (N = 775) M ± SD/f (%)
t/χ2
p
Age Educational background Junior college and below (0) Bachelor's degree (1) Master's degree or above (2) Position Doctor Nurse Medical technician hospital administrators Marital status Ever married (1) Never married (0) Kids in the family none (0) one child (1) more than one (2) Weekly working hours Social support Value strain Aspiration strain Deprivation strain Coping strain Life satisfaction
33.89 ± 8.42
35.90 ± 9.70
33.28 ± 7.90
3.793 195.403
<0.001 <0.001
133 (13.2) 608 (60.3) 268 (26.6)
47 (20.1) 78 (33.3) 109 (46.6)
86 (11.1) 530 (68.4) 159 (20.5) 93.64
<0.001
222 (21.9) 587 (58.0) 36 (3.6) 167 (16.5)
104 (43.9) 45 (19.0) 13 (5.5) 75 (31.6)
118 (15.2) 542 (69.9) 23 (3.0) 92 (11.9) 0.949
0.330
774 (76.6) 237 (23.4)
187 (78.9) 50 (21.1)
587 (75.8) 187 (24.2)
131 (17.0) 536 (69.6) 103 (13.4) 2.21 ± 1.115 60.39 ± 10.07 24.93 ± 7.42 25.11 ± 8.11 24.45 ± 7.79 23.24 ± 7.08 20.36 ± 6.28
29 (15.8) 118 (64.5) 36 (19.7) 2.60 ± 1.226 60.31 ± 11.66 24.41 ± 7.78 24.37 ± 8.59 24.74 ± 8.50 22.51 ± 7.59 20.24 ± 6.98
102 (17.4) 418 (71.2) 67 (11.4) 2.09 ± 1.051 60.41 ± 9.54 25.08 ± 7.31 25.32 ± 7.95 24.36 ± 7.56 23.47 ± 6.91 20.40 ± 6.05
8.212
0.016
−5.75 −0.120 −1.182 −1.552 0.614 −1.820 −0.301
<0.001 0.904 0.238 0.121 0.540 0.069 0.764
deprivation strain are significantly and negatively associated with the level of life satisfaction while value strain and coping strain are not shown the same pattern. Aspiration strain comes from disparity between aspiration and reality. Compare to people in other professions, medical staff in China are facing a conflicting environment of lofty aspirations and lack of legitimate means for success or self-fulfillment. For example, Wang (2002) found that nurses were mostly dissatisfied with pay and job promotion, and most medical professionals have the ambition for promotion. However, the promotion system in some hospitals is based on scientific research evaluation rather than medical practice (Li 2014). In this way, the conflict between the desire of promotion and lack of time for research publication is more likely to develop aspiration strain for medical staff. Due to many circumstances like the one mentioned, the gap between an individual's desires/goals and the actual reality in which the person live may result in their aspiration strain, and further decrease their life satisfaction. According to the strain theory, deprivation strain is result from the discrepancy when comparing one's own status with others (Zhang et al., 2011). Medical professionals nowadays are facing a crucial fact: compared to other professionals in the same social class, they are experiencing relatively more work stress (i.e. long work hours and dissatisfied patient), earning less salary and having less spare time to be with their families and friends (Grembowski et al., 2005; Haas et al., 2000). Tzeng (2002) noted in his study that nurses believed indirect working environment (e.g. a hospital's policies, leisure activities, and vacation policy), salary and promotion were very important but strongly dissatisfying, which may results in their high levels of deprivation strain and then influence the overall life satisfaction.
healthy marital relationship, spouses generally develop the ability to help each other with personal difficulties and provide everyday support for their partner (Bradbury and Karney 2004), which is likely to increase people's life satisfaction. Facing high intensity of workload, medical professionals who are married will be more likely to get social support from the family to resist risks or take responsibilities together. Thus, they will have higher life satisfaction than singled ones. In addition, although kids in the family did not show a statistically significant impact on individual's life satisfaction in the whole model, it does show the significant impact among women. The positive coefficients indicated those who have kids in the family have reported higher life satisfaction. Having kids is expected to have a positive effect on parents’ life satisfaction. As earlier study suggested, despite or maybe precisely because of the difficulty of raising children, for the arrival of a child tends to be seen as a blessing to a married couple. Our result indicated that weekly working hours is negatively associated with individual's life satisfaction, especially for women. A significant proportion of medical staff had marked psychological stress, and long weekly working hours made works even more unsatisfactory. For example, sources of stress are from dying patients’ excessive responsibility, rapid advances in technology, and excessive personal demands of patient and families (Escribà-Agüir et al., 2006; Nylenna et al., 2005; Hesketh et al., 2012; Rodriguez et al., 1998). The majority of staff had experienced difficulties in their personal lives which were directly linked to low life satisfaction (Molassiotis et al., 1995). The result also suggested that those who have received more social support are more likely to have a better life satisfaction, which is consistent with previous research (Zhang and Zhao 2017). In the current study, we have found that aspiration strain and
Table 2 Psychological strains, social support, and life satisfaction: Correlation matrix analyses. Scale/Variable
Value strain r
Aspiration strain r
Deprivation strain r
Coping strain r
Total PSS score r
Life satisfaction Weekly working hours Social support
−0.348 0.084 −0.342
−0.467 0.075 −0.348
−0.432 0.115 −0.350
−0.329 0.033 −0.405
−0.464 0.092 −0.425
Note. All P-values are <0.001. 108
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Table 3 Multiple regressions on association between psychological strains and life satisfaction with major covariates included. Variable
Gender (male) Age Bachelor's degree (Junior college and below) Master's degree or above (Junior college and below) Doctor (administrators) Nurse (administrators) Medical technician (administrators) Marital status (Never married) One child (No child) More than one child (No child) Value strain Aspiration strain Deprivation strain Coping strain Weekly working hours Social support Constant R2 Adjusted R2 Model Fit
Model 1 β
p
Model 2 β
t
p
−0.609 −6.142 −3.252 −0.249
0.543 <0.001 0.001 0.804
−0.568 0.054 1.002 1.530 −1.997 −0.521 −0.746 7.147 0.416 0.741 −0.020 −0.260 −0.134 0.001
−0.986 1.453 1.281 1.740 −2.466 −0.737 −0.607 2.536 0.693 0.940 −0.460 −5.562 −2.755 0.008
0.324 0.147 0.201 0.082 0.014 0.461 0.544 0.011 0.488 0.348 0.646 <0.001 0.006 0.994
30. 561 42.166 0.228 0.225 F = 66.797, p<0.001
<0.001
21.657 6.872 0.274 0.259 F = 18.002, p<0.001
<0.001
−0.023 −0.248 −0.131 −0.01
t
Model 3 β −0.459 0.049 0.632 1.268 −0.710 −0.168 −0.026 7.534 0.562 1.315 0.003 −0.225 −0.122 0.026 −0.573 0.167 9.590 0.342 0.326 F = 21.440,
t
p
−0.829 1.651 0.835 1.502 −0.861 −00.247 −0.022 2.795 0.979 1.734 0.069 −5.008 −2.578 0.586 −2.686 7.726 2.749
0.407 0.099 0.404 0.134 0.389 0.805 0.982 0.005 0.328 0.083 0.945 <0.001 0.010 0.558 0.007 <0.001 0.006
p<0.001
Table 4 Multiple regressions on association between psychological strains and life satisfaction with gender comparison. Variable
Gender (male) Age Bachelor's degree (Junior college and below) Master's degree or above (Junior college and below) Doctor (administrators) Nurse (administrators) Medical technician (administrators) Marital status (Never married) One child (No child) More than one child (No child) Value strain Aspiration strain Deprivation strain Coping strain Weekly working hours Social support Constant R2 Adjusted R2 Model Fit
Model 4 (Male) β
t
p
0.088 1.335 2.403 1.468 00.781 0.458 0.323 0.222 −2.588 −1.445 −1.721 −0.780 −6.548 −1.142 −1.135 −0.869 −0.951 −0.606 −0.193 −1.087 −0.442 −4.516 −0.160 −1.598 −0.224 −1.280 −0.457 −2.036 0.262 6.252 14.101 1.962 0.513 0.458 F = 9.402, p < 0.001
0.184 0.144 0.648 0.824 0.151 0.437 0.255 0.387 0.546 0.221 <0.001 0.112 0.176 0.302 <0.001 0.052
Model 5(Female) β
t
0.028 0.839 0.287 0.338 1.380 1.405 −1.379 −1.350 0.002 0.002 0.593 0.427 12.127 4.018 0.924 1.457 1.782 2.038 −0.039 −0.858 −0.152 −3.048 −0.115 −2.175 −0.046 −0.922 −0.549 −2.266 0.136 5.438 8.131 2.060 0.325 0.305 F = 16.418, p < 0.001
p
0.402 0.736 0.161 0.178 0.998 0.669 <0.001 0.146 0.042 0.391 0.002 0.030 0.357 0.024 <0.001 0.040
5. Limitation
6. Conclusion
The study contains several limitations. The major limitation of this study is the use of a cross-sectional design, which allows for the identification of statistical association but does not provide definitive evidence on whether the assumed cause precedes the assumed effect or whether the association between psychological strains and life satisfaction is caused by a third factor. Longitudinal study should be conducted in the future, so that the correlated factors can be explained more effectively and their effects can be predicted more precisely. Moreover, the sample comes from a large government owned and operated public hospital located in Jinan, Shandong province. Due to the sample restriction, we may not be able to generalize the result to the whole of medical staff, thus the result of the study may be affected by the data source. In addition, other social factors such as income, job specialties and social class should be taken into consideration, which might explain the differences in life satisfaction among different subgroups.
The findings of the current study highlight the negative associations between aspiration strain, deprivation strain and life satisfaction, even with other variables controlled for. The result underlines the importance of actions taken to prevent and combat psychological strains. Medical staff should be encouraged to establish reasonable career planning based on their own circumstance. It is more conducive to reduce aspiration strain by cognitive intervention so as to redirect individuals to a rational motivation and ambition level. The current study also provides evidences for policy makers to improve the work environment for medical staff members. For instance, hospital can reduce weekly working hours by implementing work shift schedule, which can increase the flexibility of working hours and thus provide medical staff more time to spend with their families. Enhancing social support is also important for medical staff to improve their life satisfaction. For example, government should ensure the continuous increase of social benefits such as providing childcare service and increasing in paid leave for medical staff. Additionally, regular psychological counseling should
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be provided in order to help medical staff members who have higher aspiration and deprivation strains.
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CRediT authorship contribution statement Sibo Zhao: Conceptualization, Formal analysis, Writing - original draft, Writing - review & editing. Jie Zhang: Conceptualization. Yanzheng Liu: Data curation. Haoyi Ji: Data curation. Bob Lew: Resources, Validation. Declaration of Competing Interest None. Role of the funding source The funding source had no role in the study design; in the collection, analysis and interpretation of data; in the writing of this report; and in the decision to submit the article for publication. Acknowledgments This research was supported by the grant from Beijing Psychosocial Services Promotion Center (2017BJXLS08) and the grant from The Education and Teaching Reform Fund of Central University of Finance and Economics (2018GRYBJG07). Supplementary materials Supplementary material associated with this article can be found, in the online version, at doi:10.1016/j.jad.2019.09.006. References Bland, J.M.&., Altman, D.G., 1997. Cronbach's alpha. BMJ 314 (7080), 572. Bradbury, T.N., Karney, B.R., 2004. Understanding and altering the longitudinal course of marriage. J. Marriage Family 66 (4), 862–879. Cong, Y., 2004. Doctor-family-patient relationship: the Chinese paradigm of informed consent. J. Med. Philos. 29 (2), 149–178. Diener, E., Emmons, R.A., Larsen, R.J., Griffin, S., 1985. The satisfaction with life scale. J. Pers. Assess. 49 (1), 71–75. Escribà-Agüir, V., Martín-Baena, D., Pérez-Hoyos, S., 2006. Psychosocial work environment and burnout among emergency medical and nursing staff. Int. Arch. Occup. Environ. Health 80 (2), 127–133. Fang, P., Luo, Z., Fang, Z., 2015. What is the job satisfaction and active participation of medical staff in public hospital reform: a study in Hubei province of China. Hum. Resour. Health 13 (1), 34. Grembowski, D., Paschane, D., Diehr, P., Katon, W., Martin, D., Patrick, D.L., 2005. Managed care, physician job satisfaction, and the quality of primary care. J. Gen. Intern. Med. 20 (3), 271–277. Haas, J.S., Cook, E.F., Puopolo, A.L., Burstin, H.R., Cleary, P.D., Brennan, T.A., 2000. Is the professional satisfaction of general internists associated with patient satisfaction? J. Gen. Intern. Med. 15 (2), 122–128. Hakanen, J.J., Schaufeli, W.B., 2012. Do burnout and work engagement predict depressive symptoms and life satisfaction? A three-wave seven-year prospective study. J.
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