Archives of Psychiatric Nursing 29 (2015) 6470

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Archives of Psychiatric Nursing

journal homepage: www.elsevier.com/locate/apnu

The Relationships Among Work Stress, Resourcefulness, and Depression

Level in Psychiatric Nurses
Shu Mi Wang a, Chien Yu Lai b,, Yong-Yuan Chang c, Chiung-Yu Huang d,
Jaclene A. Zauszniewski e, Ching-Yun Yu f
a

Department of Nursing, Shu-Zen Junior College of Medicine and Management, 452, Huanciou Rd. Lujhu Dist., Kaohsiung, Taiwan
School of Nursing, National Taipei University of Nursing and Health Sciences, 365, Ming-de Road, Peitou District, Taipei City, Taiwan
Department of Healthcare Administration and Medical Informatics, College of Health Science, Kaohsiung Medical University, 100 Shih Chuan 1st Rd. Sanmin District, Kaohsiung, Taiwan
d
Department of Nursing, College of Medicine, I-Shou University, 8, E-Da Rd., Yanchau District, Kaohsiung City, Taiwan
e
Community Health Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, 2120 Cornell Road, Cleveland, OH
f
College of Nursing, Kaohsiung Medical University, 100 Shih Chuan 1st Rd. Sanmin District, Kaohsiung, Taiwan
b
c

a b s t r a c t
Psychiatric nurses are exposed to highly stressful work environments that can lead to depression over time. This
study aimed to explore the relationships among work stress, resourcefulness, and depression levels of psychiatric
nurses. A cross-sectional design with randomized sampling was used; 154 psychiatric nurses were recruited
from six medical centers in Taiwan. Psychiatric nurses' work stress was found positively correlated with their
depression level, and negatively related to resourcefulness. Work stress signicantly predicted depression
level. These results suggest that the hospital administrative units may develop training courses about resourcefulness skills to reduce psychiatric nurses' work stress, and improve their mental health.
2014 Elsevier Inc. All rights reserved.

Nurses are the major work force in hospitals, and are often on
the front line of contact with patients. This is especially true for the
department of psychiatry, where patients often exhibit various types
of symptoms with behavioral problems such as violence, attacks, agitation, and suicide when hospitalized that can be stressful for the
healthcare team. Long-term exposure to such a stressful work environment can easily cause psychiatric nurses to suffer from stress responses
and depression symptoms (Letvak, Ruhm, & McCoy, 2012; Lim,
Bogossian, & Ahern, 2010; Lin, Probst, & Hsu, 2010). A study in China
found that up to 74.9% of nurses have mild depression symptoms
(Gao et al., 2012). A related study in Taiwan found that 17% to 28% of
psychiatric nurses suffered from depression and dysthymia (Tseng,
2004), suggesting that depression in nurses was cause for concern.
However, research has found that people with higher resourcefulness
are less depressed (Huang, Sousa, Tu, & Hwang, 2005; Huang et al.,
2010). In studies of resourcefulness, subjects including diabetic
patients (Huang, Perng, Chen, & Lai, 2008), patients with breast cancer
(Huang et al., 2010), depressed adults (Lai et al., 2014), caregivers
(Wang, Rong, Chen, Wei, & Lin, 2007), community seniors (Bekhet &

Corresponding Author: Chien Yu Lai, PhD, RN, Assistant Professor, School of Nursing,
National Taipei University of Nursing and Health Sciences 365, Ming-de Road, Peitou District, Taipei, 11219 Taiwan.
E-mail addresses: rice921@yahoo.com.tw (S.M. Wang), chienlai@ntunhs.edu.tw
(C.Y. Lai), m685001@kmu.edu.tw (Y.-Y. Chang), chyh@isu.edu.tw (C.-Y. Huang),
jaz@case.edu (J.A. Zauszniewski), cyyu@kmu.edu.tw (C.-Y. Yu).
http://dx.doi.org/10.1016/j.apnu.2014.10.002
0883-9417/ 2014 Elsevier Inc. All rights reserved.

Zauszniewski, 2013), and college students (Goff, 2011) have been

involved, but few studies have focused on nurses, specically on psychiatric nurses. Therefore, the purpose of this study was to (a) examine
levels of work stress, depression, and resourcefulness in psychiatric
nurses and (b) explore potential relationships among these variables.
LITERATURE REVIEW
Work Stress in Psychiatric Nurses
Following the rapid development and changes in medical science,
and expansion of the work scope of nursing, clinical nursing has become
a highly stressful professional occupation. However, in order to reduce
the cost of personnel, a continuous reduction in the nursing workforce
in medical institutions has caused an increase in work pressure.
Therefore, the work of nursing is considered as one of the most
challenging and stressful occupations (Lim et al., 2010; Moustsks &
Constantinidis, 2010). Studies have found that the main stressors in
nursing work include excessive workload, lack of respect, incompetency,
conicts in relationships with other colleagues, unfriendly management
style of the supervisor, lack of control in work, lack of executive support,
the need to respond to the emotions of patients and their families, facing
patients death, rotating working shifts, and lack of reward (McVicar,
2003; Moustsks & Constantinidis, 2010). In addition to the problems described above, psychiatric nurses encounter unique situations that may
bring about high levels of stress. For example, psychiatric patients frequently encounter danger to themselves with high potential for violence
or suicide. Thus, there is an ever-present need to take care of patients

S.M. Wang et al. / Archives of Psychiatric Nursing 29 (2015) 6470

with violent behaviors, which is likely to increase their workloads

(Tuvesson, Eklund, & Wann-Hansson, 2012). As a result, for the personal
responses, such high work stress might lead these nurses to seeing
themselves negatively (Gao et al., 2012; Smith, Segal, & Segal, 2013);
additionally, physical symptoms such as diarrhea or constipation, nausea, dizziness, chest pain, or rapid heartbeat would come along with
these work stress (Smith et al., 2013). For the working issues in hospitals,
overloaded work stress might cause high attrition rates, high absence
rates, high occupational hazard rates, medical negligence, and strikes
(Milliken, Clement, & Tillman, 2007; Simpson, 2002) among the
psychiatric nurses. Furthermore, the impact caused by high attrition
rates includes a loss of experienced nurses, high need for recruitment,
and ongoing training of new employees. These situations not only affect
the morale of other nurses and increase hospital costs, they also have
considerably worse effects on the nursing quality for patients and exert
negative effects on the health care system (Moustsks & Constantinidis,
2010; Simpson, 2002). Hence, the high work stress of nurses deserves
further attention.
Resourcefulness
Rosenbaum (1990) developed a self-control model, in which
learned resourcefulness was dened as a set of cognitive and behavioral skills, which an individual accumulates over time through formal
or informal learning processes, events, or experiences, and then applies
the skills in coping with stress when confronted by adverse situations.
These skills include inner self-control, self-direction, and self-efcacy
as coping strategies to deal with stressful situations or stimuli
(Rosenbaum, 1990). However, Zauszniewski (2012) uses the term personal resourcefulness to contrast these skills, which are self-help skills
performed independently; while, equally important skills that involve
seeking help from others, which she calls social resourcefulness.
Therefore, personal resourcefulness and social resourcefulness constitute Resourcefulness (Zauszniewski, 2012). A highly resourceful person can use resourcefulness skills (e.g., positive self-talk, active
problem solving strategies, or seeking help from others) to effectively
reduce or eliminate the harms caused by stress, and to control negative
thoughts and feelings; thus, he/she may successfully attain the goal of
mental health (Rosenbaum, 1990; Zauszniewski, 2012). Consequently,
highly resourceful individuals should have better adaptability, greater
ability to independently carry out tasks in daily living, better functioning in social roles, and greater life-satisfaction (Huang et al., 2008; Lai
et al., 2014). Indeed, research has shown that individuals who use
both sets of skills, personal and social resourcefulness, have the best
health outcomes (Zauszniewski, 2012). Therefore, the ability to use
personal and/or social resources is essential for improving and maintaining
physical and mental health.
Depression
Depression has been a global issue and is the leading cause of disease
burden especially for women in worldwide countries (World Health
Organization, 2013). In nursing professional that comprises majority
of women, approximately 50% of nurses in Taiwan have been suffering
from mild-to-moderate depressive symptoms (Chang, Wang, Li, & Liu,
2011). Depression is a complex emotional syndrome that disturbs
affection, cognition, behavior, and interpersonal relationships (Flynn,
Kecmanovic, & Alloy, 2010). Individuals with depression usually describe their emotional symptoms including depressed mood or sadness;
cognitive symptoms involving feelings of worthlessness, inappropriate
guilt, poor attention, or suicidal ideas (American Psychiatric Association,
2013). Physical changes are also observed, such as decreased appetite,
insomnia, weight loss or gain, or reduced energy resulting in fatigue;
nally, several behaviors like social withdrawal, psychomotor retardation/agitation, or suicidal behaviors would be noticed (American Psychiatric Association, 2013). These symptoms might cause impaired

65

social, occupational, or educational functioning (American Psychiatric

Association, 2013). Furthermore, previous studies have found that marriage (Chang et al., 2011) and job stress (Chiang & Chang, 2012; Lin
et al., 2010) were associated with depression in nurses. These variables
were what we concerned in the current study.
The Relationships Among Work Stress, Resourcefulness and Depression
Concerning the relationship between work stress and depression,
when facing work stress, an individual may become emotionally agitated,
feel frustrated and experience feelings of burnout, which might lead to
depression (Pinikahana & Happel, 2004). Clinical nurses are exposed to
a work environment that is extremely energy-consuming, both physically
and mentally, and thus, at risk for depression (Gao et al., 2012). Previous
studies have found that individuals with high work stress, who had less
control, less support, or had to work on weekends, had worse physical
and mental health, and were more depressed (Blackmore et al., 2007;
Kopp, Stauder, Purebl, Janszky, & Skrabski, 2007). Studies focused on
stress and depression in nurses found that the nurses tension was
positively correlated to their depression levels (Chiang & Chang, 2012;
Lee & Kim, 2006; Tang, Chen, Chen, Chang, & Lin, 2005). Lin et al.
(2010) reported similar ndings (r = .61, P b .001) in psychiatric nurses.
Another prior study suggested that work stress was a signicant predictor
of depression (Tseng, 2004). Thus, higher work stress appears to result in
a higher incidence rate and level of depression.
Regarding the relationship between resourcefulness and depression,
studies have been conducted across a number of populations, including
community-dwelling older adults (Bekhet & Zauszniewski, 2013), teenagers (Huang & Guo, 2009; Huang et al., 2005), pregnant women
(Boonpongmanee, Zauszniewski, & Morris, 2003), patients with diabetes
mellitus (Huang et al., 2007), and patients with breast cancer (Huang
et al., 2010). In these studies, personal resourcefulness has been signicantly and negatively correlated with depression, providing evidence
supporting that individuals with higher personal resourcefulness have
lower depression levels. Moreover, Huang et al. (2005) found that personal resourcefulness was a predictor of depression ( = .32,
p b .001) in a sample of 404 female adolescents. However, there is only
one known study of the relationship between stress and resourcefulness
(Wang et al., 2007), which found that stressful life events were negatively correlated with resourcefulness (r = .35, p b .001) among caregivers
of schizophrenic adolescents. Thus, individuals with higher resourcefulness might be more likely to effectively reduce or eliminate the harms
caused by stress, resulting in a lower perceived level of stress.
As suggested by the literature reviewed above, work stress may contribute to depression; additionally, individuals with higher resourcefulness are
more capable of effectively using problem-solving abilities, controlling negative thoughts, and therefore had lower levels of depression. On the other
hand, the connections between work stress and resourcefulness still remain
unknown. Moreover, the relationships among work stress, resourcefulness,
and depression level specically in psychiatric nurses have not been simultaneously explored in previous studies. Hence, in this study, psychiatric
nurses were recruited as subjects to investigate the correlations of work
stress, resourcefulness, and depression level. Fig. 1 represents the research
model for this study. The research questions were presented, such as
Is work stress correlated with depression level in psychiatric nurses?, Is
resourcefulness correlated with depression level in psychiatric nurses?,
What is the relationship between work stress and resourcefulness in
psychiatric nurses?, and Are work stress and resourcefulness predictors
of depression level in psychiatric nurses?
METHODS
Study Design and Sampling
A cross-sectional study design, randomized sampling and structured
questionnaires were used to collect data. Research sites were 18

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S.M. Wang et al. / Archives of Psychiatric Nursing 29 (2015) 6470

indicating incomplete personal activities as arranged in daily living,

such as no time to do the laundry because of delay from the work.
These four sub-scales covered the consequences of interaction between
nurses and the environment, ability of evaluation toward medical
environment, professional competence, and physical and psychological
responses when faced with difculties (Benoliel et al., 1990). This
checklist was scored using a 9-point (08) Likert-type scale with total
scores ranging from 0376. The higher scores indicated higher work
stress in nursing practice. Factor analysis and internal consistency analysis were applied to test validity and reliability of the Chinese version of
NSC. The result of factor analysis indicated that 80.1% of the stress in
nursing could be explained by the four factors (Tsai & Chen, 1996).
The Cronbachs coefcient of the total scale of the Chinese version of
NSC was .96; and Cronbachs for each subscales was between .85
and .96 in the current study, referring to a good reliability of the Chinese
version of NSC.

Fig. 1. The research framework for this study.

medical centers in Taiwan. Most of these medical centers are situated in

the western part of Taiwan since the Central Mountain Range is located
in the middle and runs from the north to the south of the island
(Taiwan). Of these 18 medical centers, we randomly picked six medical
centers, two of them are just respectively located in the northern and
southern parts of Taiwan; and one of them are just respectively located
in the central and eastern parts of Taiwan. Nurses who were working in
the psychiatric departments of these six medical centers during the
period of data collection, and who had had three or more months
experience of clinical nursing in the psychiatric unit were all eligible
for the study. According to G-power analysis (Faul, Erdfelder, Buchner,
& Lang, 2009), a sample size of 84 subjects was required based on
estimation of an alpha level of .05, a medium effect size ( 2) of .30,
and a power of .80 for correlation and regression analysis to detect the
statistical signicance. All eligible participants (190 nurses) in the six
medical centers were recruited. 154 completed and valid questionnaires
were collected back, which accounted for a response rate of 81%.
Measurements
Demographic Characteristics
Age, gender, religion, educational level, marital status, work unit,
working shift, psychiatric nursing seniority, and total nursing seniority
were included.
Nurse Stress Checklist (NSC)
The Chinese version of NSC was initially translated by Tsai and Chen
(1996) from the checklist developed by Benoliel, McCorkle, Georgiadou,
Denton, and Pitzer (1990). It comprises 47 items in four subscales as follows. Personal responses (17 items), referring physical and psychological
responses caused by stress from various situational events at work.
Work concerns (13 items), i.e., perception about work stress. Competency
(11 items), implying the capability of a nurse who can nish work
effectively within the predicted period of time, who is satised with
displaying professional autonomy in ones own specialties. And the
nal subscale, incompleteness of personal arrangement (6 items),

Resourcefulness Scale (RS)

The Chinese version of RS was translated with a back-translation
method from the original scale developed by Zauszniewski, Lai, and
Tithiphontumrong (2006). The RS comprises 28 items in total, including
personal resourcefulness (16 items) and social resourcefulness (12
items). The RS was scored according to a 6-point (05) Likert-type
scale, where 0 refers to not at all like me and 5 refers to very much
like me. The total score ranges from 0 to 140, where higher scores
imply a higher level of resourcefulness (Zauszniewski et al., 2006). For
internal consistency, Cronbachs coefcient of the Chinese version of
RS was .93 (Hsu, 2010). In this study, the total Cronbachs of this
scale was .86, whereas .74 to .86 for subscales; the item-total correlation
of each item was all located above .3, indicating acceptable reliability
and validity.
Taiwanese Depression Questionnaire (TDQ)
The Taiwanese Depression Questionnaire (Lee, Yang, Lai, Chiu, &
Chau, 2000) was developed to examine Taiwaneses depression level.
The questionnaire comprises 18 items, and is scored according to a
4-point Likert-type scale, dened from never or seldom (0) to usually
or always (3), based on frequency. The score ranges from 0 to 54 with a
cutoff score of 19. For the classication of depression level, a mean score
below 8 indicates mood status is stable without depression; mean score
of 914 indicates that mood status is uctuating; 1518 indicates that
mood status has reached a borderline to depression; 1928 indicates
mood status has reached depression, suggesting that the subject should
seek help from psychiatric and mental health professional; 29 or above
indicates that mood status is already in severe depression, suggesting
that immediate treatment from psychiatric professional is needed
(Tseng, 2004). Both reliability and validity of the TDQ are quite satisfactory. The Cronbachs coefcient of the internal consistency was .90
(Lee et al., 2000); .93 was for the current study; the area under the
receiver operating characteristic (ROC) curves referring concurrent
validity was .92 (Lee et al., 2000).
Data Collection and Analysis
Data were collected following the approval of the Institutional
Review Board (IRB) in the six randomly selected medical centers
(TSGHIRB-097-05-085, VGHIRB-97-07-38A, CSH-CMCTC-97-005,
ER97-063, KMUH-IRB-970116 & ACTIRB-097-13). The data collector
initiated contacts with head nurses in the psychiatric units of these six
hospitals, and explained the objectives and contents of this study to potential participants. The self-administered questionnaires were distributed to the subjects only if they signed informed consents. The data
collector then gathered those questionnaires right after they were
nished by the subjects and rechecked if the questionnaires were lled
out completely.

S.M. Wang et al. / Archives of Psychiatric Nursing 29 (2015) 6470

There was no missing data in the collection. The SPSS (17.0) statistical
software was performed to analyze research data. Descriptive statistics,
including frequencies, percentages, means, and standard deviations;
inferential statistics, such as Pearsons correlation, individual t-test,
one-way ANOVA, and multiple regression analysis were used after
conrming the statistical assumptions of normal distribution and homoscedasticity were met (Munro, 2005).

RESULTS
Subjects Demographic Characteristics
The subjects were aged from 21 to 53 years, with an average of
32 years (SD = 6.77). In terms of gender, there were 143 females
(92.9%) and 11 males (7.1%). Most of the subjects were single (59.7%)
and had a bachelors degree (63.6%). Regarding their work unit in the
psychiatric department, 127 subjects (82.5%) were working at acute
units, and 27 subjects (17.5%) were working in non-acute units, such
as day care or home care units. The majority of subjects (75.3%) needed
to undertake shift work. In terms of seniority in psychiatric nursing, the
average seniority was 85.45 months (SD = 66.32), or approximately
7.12 years. The average total seniority in nursing was 117.97 months
(SD = 80.36) or approximately 9.83 years.
There was a signicant difference in depression levels based on marital status (t = 2.14, p b .01); currently single nurses depression level
was signicantly higher than the level of those who were married. Depression levels of nurses working in different units were also signicantly different (t = 5.79, p b .001); nurses working in acute units had
signicantly higher depression levels than those working in non-acute
units. Whether or not the psychiatric nurses need to work in shift also
exhibited signicant difference in depression levels (t = 2.50, p b .05);
the depression level of psychiatric nurses who undertook working shifts
was signicantly higher than those who did not work in shifts (Table 1).
Using Pearson's correlation analysis on the correlations between depression level and subjects demographic characteristics including age,
total nursing seniority, and psychiatric nursing seniority, no signicant
correlations were found with depression.

Table 1
Demographic Data and Their Relationships With Depression Level (N = 154).
Demographics
Age (years)
Psychiatric nursing
seniority (months)
Total nursing
seniority (months)
Gender
Male
Female
Marital status
Single
Married
Religion
Yes
No
Education level
Junior college
Bachelor
Master
Work unit
Acute ward
Non-acute ward
Working shift
Yes
No

M SD

p value

r = .14
r = .13

.082
.117

117.97 80.36

r = .11

.163

t = .401

.689

t = 2.14

.034

t = 1.663

.098

F = .545

.581

11
143

7.1
92.9

11.73 13.42
10.65 8.12

92
62

59.7
40.3

11.92 8.95
8.95 7.65

76
78

49.4
50.6

11.88 9.10
9.60 7.88

44
98
12

28.6
63.6
7.8

11.41 9.27
10.69 8.48
8.50 6.23

127
27

82.5
17.5

11.89 8.78
5.26 4.36

116
38

75.3
24.7

11.70 8.48
7.76 8.16

P b .05; P b .01; P b .001.

r, t, F value

32.10 6.77
85.45 66.32

67

Work Stress, Resourcefulness, and Depression Level of Psychiatric Nurses

The mean score of nurses work stress in this study was 134.09
(SD = 56.77), indicating the stress level of psychiatric nurses in this
study approached to a moderate level. Among the four subscales of
the Nurse Stress Checklist, personal responses had the highest mean
score (M = 48.45, SD = 28.60), which indicated that when psychiatric
nurses felt stressful in work, the level of negative physical and psychological responses would be presented most. This was followed by competency (M = 35.17, SD = 17.27), which meant that psychiatric nurses
perceived if they may competently nish their work as the second
most stressful factor. Lastly, incompleteness of personal arrangement
was the factor with the lowest stress level (M = 19.32, SD = 19.18),
referring that the inuence of work stress perceived by the psychiatric
nurses on the completion of daily living activities was little.
Concerning resourcefulness, the mean score of nurses resourcefulness in this study was 91.21 (SD = 12.11) indicating a moderate level
of resourcefulness in the psychiatric nurses. For the subscales of the resourcefulness, the mean score of personal resourcefulness was 55.08
(SD = 8.19) with an index score of 68.85 (index score = [mean/total
score of scale] 100), while social resourcefulness was 36.13 (SD =
6.29) with an index score of 60.21, indicating psychiatric nurses in this
study were more accustomed to using their personal resourcefulness.
Regarding psychiatric nurses depression level, study results showed
the level of depression in psychiatric nurses (M = 10.73, SD = 8.55) was
not as high as anticipated. However, 15.6% of the psychiatric nurses had
distinctly depressed mood by using the average score 19 as the cut point
(Lee et al., 2000). This percentage of psychiatric nurses in depression
mood was notable.
The Relationships Among Work Stress, Resourcefulness, and Depression
Level in Psychiatric Nurses
Depression level and work stress in the psychiatric nurses were signicantly and positively related (r = .70, p b .001). The similar relationships in the same direction were found in all subscales of the Nurse
Stress Checklist with depression level (Table 2). This was especially
true for personal responses which had the highest correlation with
depression level (r = .69, p b .001), indicating that individuals with
high depression levels usually display physiological and psychological
responses most.
In terms of the relationship between resourcefulness and depression
in the psychiatric nurses, the results showed that the correlation between total resourcefulness and depression levels approached signicance (r = .15, p = .05). However, personal resourcefulness was
signicantly and negatively correlated with depression level (r =
.17, p b .05). This indicates that when psychiatric nurses have a higher
level of personal resourcefulness, they may be using their internal
resources, and thereby experience a lower level of depression (Table 2).
As for the relationship between resourcefulness and work stress in
psychiatric nurses, a signicant and negative correlation (r = .20,
p b .05) was found. Moreover, further analysis showed that personal
resourcefulness was signicantly and negatively correlated with work

Table 2
Relationships Among Work Stress, Resourcefulness, and Depression Level (N = 154).

t = 5.788

.000

t = 2.504

.013

Relationships (r)

Depression level

Work stress

Work stress
Personal responses
Work concerns
Competency
Incompleteness of personal arrangement
Resourcefulness
Personal resourcefulness
Social resourcefulness

.70
.69
.57
.22
.56

.20
.26
.04

P b .05; P b .01; P b .001.

.15
.17
.06

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S.M. Wang et al. / Archives of Psychiatric Nursing 29 (2015) 6470

stress (r = .26, p b .001), whereas social resourcefulness had no signicant relationship with work stress (r = .04, p = .59) (Table 2).
This indicates that psychiatric nurses who had greater resourcefulness
may have used internal and external resources in order to minimize
their stress.
Predictive Factors of Psychiatric nurses Depression
Demographic variables related to depression, including marital
status, work unit, and working shift were further processed with
dummy coding, and multiple regression was employed to analyze the
predictive factors of depression in psychiatric nurses. The results
showed that work stress (B = .10, = .68, t = 11.49, p b .001) and
work unit (B = 5.45, = .24, t = 2.73, p b .01) were predictors of
depression while controlling for marital status and working shift; 51%
of variance has been accounted for depression (adjusted R 2 = .51,
F = 40.37, p b .001) (Table 3). As expected, working in an acute unit
was found to affect the depression level of the psychiatric nurses. Finally,
the important inuence of work stress on the depression of psychiatric
nurses was conrmed in this study.
DISCUSSION
Relationships Between Marital Status, Work Unit, Working Shift,
and Depression
The results of this study revealed that single psychiatric nurses had
signicantly higher depression levels than currently married nurses
(t = 2.14, p b .05); additionally, the depression levels of nurses working
in acute units was signicantly higher than in those working in nonacute units (t = 5.79, p b .001). Similar ndings were reported in
Chus (2009) study, which found that psychiatric nurses without
spouses or working in acute units had worse physical and mental health
conditions, such as depression. Especially for marital status, AkhtarDanesh and Landeen (2007), and Chang et al. (2011), also found that
single individuals had signicantly higher depression levels than married ones. In addition, it was found in this study that nurses who needed
to work in shifts had signicantly higher depression levels than those
who did not (t = 2.50, p b .05). The results of Hung et al.s (2007)
study similarly presented that the physical and mental health conditions of nurses who needed to work in shifts were worse than nurses
who did not have shift work. Similar results have also been demonstrated in previous studies, suggesting that nurses needing to undertake
working shifts have signicantly more severe psychological and depression problems than those who do not (Driesen, Jansen, van Amelsvoort,
& Kant, 2011; Shimizu, 2012).
Relationships Among Work Stress, Resourcefulness, and Depression Level
There was a signicant and strong positive correlation (r = .70,
p b .001) between work stress and depression level of psychiatric nurses
in this study, implying that the higher levels of work stress psychiatric
nurses had, the higher levels of depression they felt. This nding is similar to the results of previous studies (Blackmore et al., 2007; Kopp et al.,
2007) that showed that when individuals encountered greater work
stress, they felt more depressed, and had worse physical and mental

Table 3
Regression Analyses for Predicting Psychiatric Nurses Depression Level (N = 154).
Predictors

Adjusted R2

Work stress
Marital status
Work unit
Working shift

.103
.552
5.447
2.447

.681
.032
.243
.124

11.489***
.492
2.734**
1.353

.51

40.37***

P b .01; P b .001.

health conditions. For the clinical nurses, prior research showed parallel
results suggesting that the stress experienced by nurses had a signicant and positive relation with depression level (Chiang & Chang,
2012; Lee & Kim, 2006; Lin et al., 2010). The relationship between
work stress and depression level was again veried in the current
study. Apparently, strategies for reducing work stress are very
important for mental health and should not be ignored. It is necessary
to reduce work stress, diminish the occurrence of depression, so that
workers can maintain or improve their mental health.
Personal resourcefulness and depression level of psychiatric nurses
in medical centers were found to be negatively correlated. Similar ndings were found in adolescent females (r = .37, p b .01) (Huang et al.,
2005), breast cancer patients (r = .57, p b .01) (Huang et al., 2010),
adult diabetic patients (r = .50, p b .01) (Huang et al., 2007), nurses
in a medical center (r = .20, p b .001) (Chung et al., 2012), and homebound older adults (r = .30, p b .01)(Choi, Marti, Bruce, & Hegel,
2013). Therefore, even for subjects of different ages or from different
populations, a consistently negative relationship between personal resourcefulness and depression exists. Individuals with higher personal
resourcefulness are more capable of applying positive thinking,
strengthening their self-efcacy, rejecting negative thinking, coping
with stressful life events, and promoting adaptive functioning, and
thus to reduce depressive emotions (Chang et al., 2011).
As for the relationship between work stress and resourcefulness, a
special result was found that psychiatric nurses with greater resourcefulness experienced less work stress. Very few studies have explored
the connection between work stress and resourcefulness, only one
study conducted by Wang et al. (2007) on the primary caregivers of adolescents with schizophrenia had a similar nding, showing that stressful life events were signicantly and negatively correlated with learned
resourcefulness (r = .35, p b .001). Rosenbaum (1990) pointed out
that if individuals could apply positive self-dialogue, strategies about
problem solving, self-control, and delayed gratication of immediate
needs, they can eliminate negative thoughts and hold on to their belief
that they are able to effectively cope with stressful situations and difculties.
Therefore, individuals with high resourcefulness might not perceive such
stressful situations. The results of this study are consistent with both the
theory and relevant literature showing that those who are more capable
of using personal and social resources will know how to effectively adapt
to their stress and improve their mental health (Rosenbaum, 1990;
Zauszniewski, 2012; Zauszniewski, Chung, & Krafcik, 2001).

Predictors of Depression in Psychiatric Nurses

Work stress was conrmed again to serve as a predictive factor of
depression in this study. This is consistent with the results of studies
that investigated nurses in Taiwan (Lin et al., 2010; Tang et al., 2005;
Tseng, 2004). Wangs (2005) longitudinal study investigating a
Canadian working population also found that work stress was a risk
factor of major depressive disorder. The results were also similar to
those of former studies (Blackmore et al., 2007; Melchior et al., 2007;
Panz & Ogle, 2006). Moreover, it was found in this study that whether
or not psychiatric nurses were working in the acute units of the
psychiatric department could signicantly predict their depression
level. Psychiatric nurses are usually confronted with the challenges of
violence, suicide, or the sudden occurrence of psychotic symptoms
while working in acute units, therefore, the factors inuence on
depression level is conceivable. This result is similar to the study
conducted by Virtanen et al. (2012) which concluded that psychiatric
staffs working at acute units had higher odds of depression than those
working at other units. Although different populations and various
work elds have been studied, work stress has been shown to have an
important inuence on depression in individuals. The ndings derived
from the current study worth to get policy makers attention for reducing workers work stress and promoting their mental health.

S.M. Wang et al. / Archives of Psychiatric Nursing 29 (2015) 6470

CONCLUSION
Psychiatric nurses who were single, who worked in acute units, and
who undertook shift work had signicantly higher depression levels
than those who were married, worked in non-acute units, and did not
undertake work in shifts. Higher stress levels and lower personal
resourcefulness in psychiatric nurses were correlated with higher
depression levels. Additionally, greater resourcefulness was associated
with lower work stress. Finally, work stress was found to be a signicant
predictor for depression in these psychiatric nurses.

Limitations and Implications

If the target population of psychiatric nurses were recruited from all
community medical facilities, rather than limited in medical centers, or
the geographical area of the study could have been enlarged further,
the generalization of outcomes would be less limited. Since a crosssectional design was used in this study, only relationships among variables of interest could be explored, while causal inferences were limited.
According the ndings of the current study, suggestions and implications for nursing professional were offered as follow. Regarding nursing
administration and practice, it is suggested that hospital administrative
units may establish formal counseling access, such as counseling or
mentoring services specically for nurses, so that they can get help
when they are facing stressful situations. In addition, creating various
supportive groups for nurses is recommended for improving emotional
communication among nurses, sharing nursing experiences, and easing
their work stress through the group activities. For nursing education, it is
suggested that initiating training courses about resourcefulness skills for
psychiatric nurses can help them deal with their work stress and then
further reduce depression levels. For future nursing research, we suggest
conducting studies to explore the mediating or moderating effect of resourcefulness on the relationship between work stress and depression.
Furthermore, intervention studies could be conducted in the future to
see if the new interventions constituting resourcefulness skills may offer
more care of practicing in-patient psychiatric mental health nurses.

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