COVID | Free Full-Text | A Mediation Model of Self-Efficacy and Depression between Burnout and Alcohol Consumption among Health Workers during the COVID-19 Pandemic
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1. Introduction
To better understand the relationship among work demands, individual resources and their consequences at the emotional and behavioral levels, an analytical model was established in which the COVID-19 pandemic (generalized demand) put health workers under immense stress, leading them to experience burnout (personal demand), with a consequent increase in the probability of consuming alcohol (personal outcome); self-efficacy and depression (a personal resource and a personal lack of resources, respectively) act as mediators of this relationship.
1.1. Job Demands and Resources Model
1.2. Alcohol Consumption
Therefore, the purpose of the present study was to test an analytical model in which the COVID-19 pandemic (generalized demand) has put health workers under immense stress and led them to experience burnout (personal demand), with a consequent increase in the probability of consuming alcohol (personal outcome), where self-efficacy and depression (a personal resource and a personal lack of resources, respectively) mediate the relationship.
2. Materials and Methods
We conducted data collection during the 2nd and 3rd COVID-19 waves in Mexico as a part of a psychoeducational intervention organized by the Mexico City Health Ministry and the Labor Union of the Mexican Social Security Institute. The courses and participation in the cross-sectional study were offered to all affiliated workers, including physicians, nurses, administrators, pharmacists, security workers, etc. throughout the COVID-19 pandemic. Enrollment in the intervention program and taking the survey were both voluntary and anonymous processes. At the beginning of the online survey, the participants gave their consent to start responding. Participants needed to be active workers and to give their consent to participate in the study; they also needed to have an active email account to which the invitation to participate in the research could be sent. No exclusion criteria were established, and the only elimination criteria were incomplete data in the sociodemographic section and more than 20% missing data in the complete survey.
2.1. Participants
2.2. Instruments
The survey was part of a larger applied study on the mental health of health workers with a pilot intervention program aimed at ameliorating the potential distress suffered by health workers during the COVID-19 pandemic. The survey was conceived as a screening tool for the participants to enroll in a series of online free courses. Participation in the online courses and the screening test were completely voluntary and anonymous, and the participants signed an informed consent form before enrolling.
In the current study, we focused on the responses on four scales included in the survey, which were presented to each participant in the same order. In the sociodemographic section, the participants were asked to indicate their gender, age, marital status, educational level and main area of work. Immediately thereafter, the participants were presented with the following psychological scales in the subsequent order:
2.2.1. Burnout Scale
2.2.2. Depression Scale
2.2.3. Self-Efficacy Index
2.2.4. Alcohol Consumption
2.3. Procedure
Before the course videos were presented, a pop-up window asked the participants whether they would be interested in participating in a survey. If the participant agreed to participate, then an informed consent form was displayed. After providing informed consent, the participants could start the survey and could pause or drop out at any time, and the participants had the option to go directly to the online course material instead. When the participants finalized the survey, they received feedback on the results, and if their scores were high, they were shown an informative note directing them to seek psychological services. The participants were redirected to the online courses after they finished the survey. The survey lasted approximately 25 min.
2.4. Data Analyses
3. Results
Two hundred and seventy-nine participants were enrolled in clinical and medical care (53.9%), 1081 were working in administrative positions (28%), 69 were collaborating in clinical and laboratory analyses (1.8%) and 627 worked in general services (e.g., security and IT; 16.3%). Of the total sample, 2884 identified themselves as women (74.8%), and 972 identified as men (25.2%), with an age range from 20 to 66 years old (Mage = 38.29 years; S.D. age = 9.5 years); 1892 reported being single or divorced (49.1%), 1964 were married or in a free union (50.9%), 815 had a secondary level of education (years 7 to 12; 21.1%), 1832 had a bachelor’s diploma (47.5%) and 1209 had a postgraduate degree (medical specialization, master’s and doctoral degrees; 31.4%).
Based on these results, we can partially support the assertion that burnout directly predicts alcohol consumption. Emotional exhaustion and achievement dissatisfaction did not have a direct significant effect on alcohol consumption, and only depersonalization had a significant positive effect on alcohol consumption. Self-efficacy and depression significantly predicted alcohol consumption, and the latter had the greatest effect.
4. Discussion
One limitation of the current study is that random sampling procedures were not used for the survey, which limits the generalizability of the findings. All of the participants voluntarily agreed to complete the survey, which may have led to a self-selection bias. The survey was distributed online, which prevented potential participants with restricted access to electronic infrastructure (e.g., concierges and security guards) from being included.
5. Conclusions
The severe effects of burnout, such as depression and increased alcohol consumption, can be prevented by fostering a sense of self-efficacy. Strengthening a sense of competence and reducing institutional stressors (e.g., providing sufficient work materials and relevant and adequate rest and recreation space) will reduce the probability of engaging in unhealthy coping strategies, such as alcohol consumption, among health workers.
Supplementary Materials
Author Contributions
Conceptualization, A.d.C.D.-E., F.L.S., A.M.P.V. and G.P.H.; data curation, A.d.C.D.-E.; formal analysis, A.d.C.D.-E.; writing—original draft, A.d.C.D.-E. and F.L.S. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
The review of the ethical aspects of the screening test were supervised by the researchers at the Iberoamerican University and the authorities of the Mexico City Ministry of Health and the Mexican Social Security Institute Labor Union in strict adherence to the Helsinki Declaration and the Regulation of the General Health Law on Research for Health for Mexico.
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement
Acknowledgments
We thank the staff from the Direction for Training and Self-actualization and Research of the Secretary of Health of Mexico City and the Secretary of Women’s Action of the National Union of Social Security Workers for helping to collect the data. We also thank the Continuing Education Office from the Iberoamerican University for their support in launching the survey on the online platform. We also would like to thank Tonathiu Salcedo for helping upload the questionnaire to the online platform.
Conflicts of Interest
The authors declare no conflict of interest.
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Figure 1.
Mediation model of self-efficacy and depression between burnout and alcohol consumption. Latent constructs are shown in circles, and observable variables and error terms are not shown; double-headed arrows represent covariances, and single arrows represent direct effects. EE = Emotional Exhaustion; D = Depersonalization; AD = Achievement Dissatisfaction; SE = Self-Efficacy; Dp = Depression; AC = Alcohol Consumption.
Figure 1.
Mediation model of self-efficacy and depression between burnout and alcohol consumption. Latent constructs are shown in circles, and observable variables and error terms are not shown; double-headed arrows represent covariances, and single arrows represent direct effects. EE = Emotional Exhaustion; D = Depersonalization; AD = Achievement Dissatisfaction; SE = Self-Efficacy; Dp = Depression; AC = Alcohol Consumption.
Table 1.
Structural equation model of burnout predicting alcohol consumption.
Table 1.
Structural equation model of burnout predicting alcohol consumption.
Relationships | B | S.E. | C.R. | β | p |
---|---|---|---|---|---|
Emotional Exhaustion → | |||||
Self-Efficacy at Work | −0.20 | 0.03 | −7.07 | −0.18 | <0.001 |
Depression | 0.60 | 0.03 | 24.59 | 0.54 | <0.001 |
Alcohol Consumption | −0.02 | 0.02 | −1.08 | −0.04 | 0.279 |
Depersonalization → | |||||
Self-Efficacy at Work | −0.21 | 0.03 | −6.25 | −0.15 | <0.001 |
Depression | 0.14 | 0.03 | 5.33 | 0.10 | <0.001 |
Alcohol Consumption | 0.10 | 0.02 | 5.89 | 0.15 | <0.001 |
Achievement Dissatisfaction → | |||||
Self-Efficacy at Work | −0.19 | 0.04 | −4.86 | −0.12 | <0.001 |
Depression | 0.18 | 0.03 | 5.79 | 0.12 | <0.001 |
Alcohol Consumption | 0.00 | 0.02 | 0.21 | 0.01 | 0.835 |
Self-Efficacy at Work → | |||||
Depression | −0.11 | 0.02 | −7.53 | −0.11 | <0.001 |
Alcohol Consumption | −0.02 | 0.01 | −2.19 | −0.04 | 0.029 |
Depression → | |||||
Alcohol Consumption | 0.08 | 0.01 | 6.19 | 0.18 | <0.001 |
Table 2.
Indirect effects of burnout and self-efficacy on alcohol consumption.
Table 2.
Indirect effects of burnout and self-efficacy on alcohol consumption.
B | Confidence Interval | p | ||
---|---|---|---|---|
Low | High | |||
EE -> D -> AC | 0.049 | 0.035 | 0.066 | 0.006 |
EE -> SE -> AC | 0.004 | 0.001 | 0.007 | 0.030 |
EE -> SE -> D -> AC | 0.002 | 0.001 | 0.003 | 0.004 |
DEP -> D -> AC | 0.011 | 0.007 | 0.017 | 0.012 |
DEP -> SE -> AC | 0.004 | 0.002 | 0.009 | 0.014 |
DEP -> SE -> D -> AC | 0.002 | 0.001 | 0.003 | 0.004 |
AD -> D -> AC | 0.014 | 0.009 | 0.020 | 0.008 |
AD -> SE ->AC | 0.004 | 0.001 | 0.009 | 0.013 |
AD -> SE -> D -> AC | 0.002 | 0.001 | 0.003 | 0.002 |
SE-> D ->AC | −0.009 | −0.013 | −0.006 | 0.004 |
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