Role of job burnout and work engagement in the relationship between mental health literacy and life satisfaction in Chinese Barefoot Social Workers: A serial mediation model based on the job demands-resources theory

doi:10.21203/rs.3.rs-5276819/v1

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Role of job burnout and work engagement in the relationship between mental health literacy and life satisfaction in Chinese Barefoot Social Workers: A serial mediation model based on the job demands-resources theory

https://doi.org/10.21203/rs.3.rs-5276819/v1

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Background

Barefoot social workers play an essential role in providing child welfare services, and their life satisfaction is critical but often ignored. Mental health literacy has been shown to be associated with life satisfaction, yet the mechanisms underlying such an association remain understudied. Guided by the job demands-resources (JD-R) theory, this study aimed to investigate the mediating effects of job burnout and work engagement in the relationship between Chinese barefoot social workers' mental health literacy and life satisfaction for the first time.

Methods

A retrospective cross-sectional study involving 1252 Chinese barefoot social workers was conducted from April to June 2023. Pearson's bivariate correlation analysis was conducted to identify correlations. The mediating effect was analyzed using SPSS PROCESS v.4.3.

Results

The correlation analysis results showed that mental health literacy (r = 0.12, p < 0.01), job burnout (r=-0.14, p < 0.01), and work engagement (r = 0.46, p < 0.01) were significantly associated with life satisfaction. Job burnout and work engagement serially and partially mediated the association between mental health literacy and life satisfaction, with a total indirect effect of 0.071 (95%CI:0.056 ~ 0.087).

Conclusion

Our findings support the potential mediating roles of job burnout and work engagement in the relationship between mental health literacy and life satisfaction. These findings hold significant implications for devising effective and targeted psychological intervention programs to improve life satisfaction among Barefoot social workers.

barefoot social workers

mental health literacy

job burnout

work engagement

life satisfaction

serial mediation model

Barefoot social workers are the main workforce engaged in child welfare services in grassroots communities in China, and they play an essential role in ensuring child wellbeing[1]. The Ministry of Civil Affairs of China has been scaling up the child protection model by recruiting barefoot social workers since 2010[2], and the number of barefoot social workers has reached over 0.67 million in 2022[3]. Barefoot social workers often take on multiple tasks, including identifying and reporting children with adverse childhood experiences, helping children in need to seek social services, and protecting children's physical and mental health[4, 5]. In addition, they also take on various roles, such as national policy implementers, vulnerable child protectors, and family prolocutors[3]. The work of barefoot social workers is complex, stressful, and emotionally demanding[6], which may lead to multiple adverse outcomes, such as high job burnout, low work engagement, and low life satisfaction[7, 8].

Among the multiple negative outcomes related to work stress, life satisfaction is one of the most critical but less reported issues in barefoot social workers. As an important part of subjective well-being, life satisfaction is the overall evaluation of an individual's feelings and attitudes toward life at a specific time[9, 10]. Studies have shown that compared with social workers in professional agencies, barefoot social workers experience lower life satisfaction because of lower wages and higher work stress[1, 7, 11]. Low life satisfaction not only negatively affects bare social workers' physical and mental health but also leads to poor work performance, which may directly affect the health and wellbeing of children[1, 10]. Identifying the upstream triggering factors of low life satisfaction among barefoot social workers is a critical initial step in designing effective and targeted interventions to improve their life satisfaction.

Increasing evidence has identified the critical role of mental health literacy in promoting subjective wellbeing and life satisfaction among various populations[12, 13]. Mental health literacy refers to the knowledge and beliefs that help people identify, manage, and prevent mental diseases[14]. It includes the ability to correctly identify different mental disorders, the understanding of the causes, risks, and treatment of mental diseases, and attitudes toward seeking professional assistance[15]. Studies among teachers, practicing counselors, and health management specialists have consistently demonstrated a significant positive correlation between mental health literacy and life satisfaction[16]. Furthermore, previous studies have reported that children in adversity have high rates of mental health problems, especially anxiety, depression, and non-suicidal self-injuries[17]. Barefoot social workers with better mental health literacy are more able to identify children's mental problems and provide timely interventions. However, the current state of mental health literacy in China is not encouraging, with only 12% of the national population having adequate mental health literacy in 2023[18]. People with low mental health literacy are more susceptible to mental illness, such as anxiety, depression, and suicidal ideation. They are less likely to seek professional help due to the high social stigma of mental illness, which may lead to decreased life satisfaction[19]. Therefore, low mental health literacy may be a modifiable risk factor for low life satisfaction among barefoot social workers.

Although the association between mental health literacy and life satisfaction is well-established, the underlying mechanism of such an association remains unclear. Two work-related factors—job burnout and work engagement, may play an essential role in connecting mental health literacy and life satisfaction. Job burnout refers to the state of exhaustion caused by work pressure and load, which includes emotional exhaustion, depersonalization, and low personal accomplishment[20]. Numerous studies have documented the negative effects of job burnout in terms of physical, psychological, and occupational consequences, leading to decreased life satisfaction, especially among social workers in stressful work environments[21]. Furthermore, Xu et al found that burnout mediated the association between job stress and life satisfaction among university faculty members[22]. Work engagement refers to a positive state of high energy combined with deep dedication and a strong focus on work[23]. A plethora of studies have shown that work engagement is positively associated with life satisfaction in various populations[24]. In addition, a randomized controlled trial found that mental health literacy positively predicted work engagement[25]. Therefore, work engagement may mediate the association between mental health literacy and life satisfaction. However, no research has explored the mediation effect of job burnout and work engagement in the relationship between mental health literacy and life satisfaction among barefoot social workers.

To fill in the research gap, we conducted the current study to test a serial mediation model of job burnout and work engagement in the relationship between mental health literacy and life satisfaction based on the job demands-resources (JD-R) theory. According to the JD-R theory, job resources are resources that stimulate personal growth, learning, and development, which instigate a motivational process through motivation. On the other hand, job demands trigger a health impairment process through strain, leading to adverse outcomes, such as low life satisfaction[26]. Mental health literacy represents workers' ability to identify mental health knowledge and cope with psychological problems, thereby serving as a job resource. Job burnout serves as one of the most important and widely concerned strain factors to link job demands and life outcomes. When job demands increase, job burnout will rise, and the levels of performance and work engagement will decrease, leading to lower life satisfaction[27, 28].

Based on the JD-R theory, we proposed the following main hypotheses:

(H1) There were significant correlations among mental health literacy, job burnout, work engagement, and life satisfaction.

(H2) Job burnout mediated the relationship between mental health literacy and life satisfaction.

(H3) Work engagement mediated the relationship between mental health literacy and life satisfaction.

(H4) Job burnout and work engagement serially mediated the relationship between mental health literacy and life satisfaction.

Participants and procedures

This cross-sectional study was conducted in Changsha City, South-Central China, from April 2023 to July 2023. Based on the Gross Domestic Product (GDP) ranking of the regional statistics bureau and government website,[29] two districts were conveniently selected for the study: Yuhua District (ranking first in GDP; lies in the south of Changsha City) and Wangcheng District (ranking last in GRP; lies in the northwest of Changsha City).

Participants were recruited from an annual training workshop for barefoot social workers in Changsha City (N = 1324). Inclusion criteria were: (a) age ≥ 18; (b) child directors, child supervisors, or social workers working with children in Changsha City; (c) with basic understanding and communication skills; and (d) voluntary participation. Exclusion criteria were: (a) suffering from or had a history of mental illness; (2) receiving psychotherapy or a psychological intervention. Before data collection, the research team explained the study's purpose and procedure to participants on the homepage of the questionnaire, and those who were willing to participate signed an online informed consent form to participate in the formal survey. In total, 1296 barefoot social workers completed the survey, among whom 1252 (96.8%) were included in the final analysis (42 invalid questionnaires were excluded due to missing information, inaccurate records, or implausible responses). Monte Carlo efficacy analysis was used to estimate the sample size, and 267 participants were required to achieve at least 80% efficacy (95% CI)[30]. The study protocol and procedures were reviewed and approved by the Ethical Committee.

Measures

Demographic characteristics

A researcher-designed General Information Questionnaire was used to collect participants' sociodemographic information, including age, sex, education level, marital status, workplace, annual income, parenthood status, years of working with vulnerable children, previous training on children's work, and self-rated physical health.

Mental health literacy

Mental health literacy was assessed using the Chinese version of the Mental Health Literacy Scale (C-MHLS), which was developed for the Chinese population by Ma[31]. The C-MHLS consists of 35 items under six domains: identification of common mental illness, attitudes toward cognition improvement and self-help, knowledge of self-treatment for mental disease patients, knowledge of disease risk and access to professional treatment, knowledge of how to access mental health information, and knowledge about common treatment methods. The total score ranges from 35 to 160, with a higher total score indicating better mental health literacy. In this study, the C-MHLS demonstrated good internal consistency, with a Cronbach's alpha of 0.824.

Job burnout

Job burnout was assessed using the Maslach Burnout Inventory (MBI)[32]. The scale includes a total of 15 items under three domains: emotional exhaustion, depersonalization, and low personal accomplishment. Each item is rated on a 7-point Likert-type frequency scale ranging from 1 (totally inconsistent) to 7 (completely consistent). The total score ranges from 15 to 105, with a higher score indicating a higher degree of job burnout. The MBI has been well-validated in the Chinese population. In the current study, the MBI also demonstrated good internal consistency, with a Cronbach's alpha of 0.701.

Work engagement

Work engagement was assessed using the Utrecht Work Engagement Scale (UWES)[33]. The scale includes 9 items under three dimensions: vitality, dedication, and concentration. Each item is scored on a 7-point Likert-type frequency scale ranging from 0 (never) to 6 (always). The total score ranges from 0 to 54, with a higher score indicating a higher level of work engagement. The UWES has been well-validated in the Chinese population[34]. In the current study, the UWES also demonstrated good internal consistency, with a Cronbach's alpha of 0.924.

Life satisfaction

Life satisfaction was assessed using the life satisfaction scale developed by Diener et al[10]. The scale consisted of 5 items. Each item is scored on a 7-point Likert-type frequency scale ranging from 1 (strongly disagree) to 7 (strongly agree). The total score ranges from 1 to 35, with a higher score indicating a higher level of life satisfaction. The scale has been well-validated in the Chinese population[35]. In the current study, the life satisfaction scale also demonstrated good internal consistency, with a Cronbach's alpha of 0.868.

Statistical analysis

SPSS version 26.0 was used for the data analysis. First, descriptive analysis was used to describe the demographics of the barefoot social workers. Second, Pearson's bivariate correlation analysis was used to identify correlations between mental health literacy, job burnout, work engagement, and life satisfaction. Finally, the SPSS macro PROCESS program (Model 6) designed by Hayes was used to test the serial mediation model of job burnout and work engagement in the association between mental health literacy and life satisfaction36. A P value of 0.05 was considered to indicate statistical significance. We set the bootstrap confidence interval (CI) to 95% and the bootstrap sample size to 5000. A significant mediation effect was indicated if the 95% CI did not include 0.

Sample characteristics

Table 1 shows a summary of the demographic characteristics of the 1252 barefoot social workers (mean age = 38.6 years, standard deviation = 8.1). Most of the participants were female (81.6%), had a high school education (68.3%), married (91.3%), being a parent (92.2%), working in rural areas (72.3%), and with an annual personal income< RMB 50,000 (65.9%). Most of the participants had been working with vulnerable children for less than five years (93.4%), and only half of them had received training on children's work (53.0%). Almost all participants considered themselves to be in good health (88.4%).

Table 1

Demographic Information of Barefoot Social Workers in China
Variables	Groups	N	%
Age (Mean ± SD)	—	38.6 ± 8.1
Sex (n%)	Male	230	18.4
	Female	1022	81.6
Education level (n%)	Below high school	41	3.3
	High school	855	68.3
	Above high school	356	28.4
Marital status (n%)	Not in marriage	109	8.7
	In marriage	1143	91.3
Workplace (n%)	Rural area	905	72.3
	Urban area	347	27.7
Annual personal income (n%)	< RMB 50,000	825	65.9
	≥RMB 500,000	427	34.1
Being a parent (n%)	Yes	1154	92.2
	No	98	7.8
Years of working with vulnerable children (n%)	< 5 years	1169	93.4
	5–10 years	55	4.4
	> 10 years	28	2.2
Previous training on children's work (n%)	Yes	664	53.0
	No	588	47.0
Self-rated physical health (n%)	Poor	5	0.4
	Normal	140	11.2
	Good	1107	88.4

Correlation analysis

Table 2 shows the descriptive statistics and correlations among key variables. There were significant correlations among mental health literacy, job burnout, work engagement, and life satisfaction. Mental health literacy was negatively correlated with job burnout (r=-0.18, p < 0.01) and positively correlated with work engagement (r = 0.30, p < 0.01) and life satisfaction (r = 0.12, p < 0.01). Life satisfaction was negatively correlated with job burnout (r=-0.14, p < 0.01) and positively correlated with work engagement (r = 0.47, p < 0.01). Besides, the two mediators— job burnout and work engagement also showed a significant negative correlation (r=-0.16, p < 0.01). Therefore, H1 was supported.

Table 2

Descriptive Statistics and Correlations among Key Variables
Variables	Mean	SD	1	2	3	4
1. Mental Health Literacy	112.21	11.47	1
2. Job burnout	53.90	9.12	-0.18**	1
3. Work Engagement	34.71	8.88	0.29**	-0.16**	1
4. Life Satisfaction	23.16	5.60	0.12**	-0.14**	0.46**	1

Mediation Analysis

Model 6 in the PROCESS macro was used to test the mediating effect of job burnout and work engagement in the association between mental health literacy and life satisfaction after controlling for demographic variables, and there were significant differences in five paths, as shown in Table 3 and Fig. 1. Mental health literacy was significantly associated with job burnout (direct effect β=-0.15, 95% CI[-0.19, -0.10], p < 0.01) and work engagement (direct effect = 0.22, 95% CI[0.18, 0.26], p < 0.01), and that job burnout(direct effect β=-0.03, 95%[-0.06, -0.001], p < 0.01) and work engagement(direct effect β = 0.26, 95% CI[0.23, 0.29], p < 0.01) were significantly associated with life satisfaction. Additionally, job burnout was significantly associated with work engagement (direct effect β=-0.07, 95% CI [-0.12, -0.02], p < 0.001), and mental health literacy was not significantly associated with life satisfaction (direct effect β = 0.01, 95% CI [-0.02, 0.03], p > 0.05).

Table 3

Regression Analysis among Variables in the Serial Mediation Model
Outcome variable	Predictor variable	R	R²	F-value	β	t-value
JB	MHL	0.25	0.07	7.79***	-0.15	-6.52**
WE	MHL	0.46	0.21	27.50***	0.22	10.69**
	JB				-0.07	-2.79**
LS	MHL	0.52	0.27	35.84***	0.01	0.43
	JB				-0.03	-2.02*
	WE				0.26	15.12**

The serial mediation model was tested using the bias-corrected nonparametric percentile bootstrap method with 5000 replications, and the results are shown in Table 4. A significant correlation was found between mental health literacy and life satisfaction (total effect c = 0.070, 95% CI = 0.044 to 0.097), indicating that higher mental health literacy was associated with higher life satisfaction. However, such an association became nonsignificant with the inclusion of mediators (direct effect: 0.006, 95% CI = -0.020 to 0.031), signifying complete mediation. Specifically, job burnout played a mediating role in the relationship between mental health literacy and life satisfaction (β = 0.005, 95%CI [0.000,0.010]), supporting hypothesis 2. Work engagement played a mediating role in the relationship between mental health literacy and life satisfaction (β = 0.057, 95%CI [0.045,0.071]), supporting hypothesis 3. Job burnout and work engagement (β = 0.003, 95%CI [0.000,0.005]) acted as serial mediators in the relationship between mental health literacy and life satisfaction, substantiating Hypothesis 4.

Table 4

Bootstrap Analysis of the Mediating Effect of Mental Health Literacy and Life Satisfaction
Effect	Pathways	SE	LLCI	ULCI	Effect size, %
Total effect		0.070	0.044	0.097	100%
Direct effect	MHL→ LS	0.006	-0.020	0.031	8.57%
Indirect effect	MHL→ JB→ LS	0.005	0.000	0.010	7.14%
	MHL→ WE→ LS	0.057	0.045	0.071	81.43%
	MHL→ JB→ WE→ LS	0.003	0.000	0.005	4.29%
Total indirect effect		0.065	0.051	0.080	92.86%

To the best of our knowledge, this was the first study to explore the relationship between mental health literacy, job burnout, work engagement, and life satisfaction among barefoot social workers using a serial mediation model based on the JD-R theory. Our results revealed a significant correlation between mental health literacy and life satisfaction, which was fully mediated by job burnout and work engagement sequentially. Moreover, work engagement accounted for the largest proportion of the total indirect effect of mental health literacy on life satisfaction. These findings offer a comprehensive and deeper insight into the underlying mechanisms of factors influencing barefoot social workers' life satisfaction and provide helpful guidance in the future development of psychosocial interventions to improve their life satisfaction.

This study showed that there were significant correlations among the variables of mental health literacy, job burnout, work engagement, and life satisfaction. First, mental health literacy had a significant positive correlation with life satisfaction and work engagement, and had a significant negative correlation with job burnout. These findings were consistent with past research showing that individuals with higher mental health literacy were less likely to have job burnout and more likely to engage in work to achieve better performance and life satisfaction[36–39]. Second, the significant correlations among job burnout, work engagement, and life satisfaction in our study were consistent with previous studies showing job burnout was negatively correlated with work engagement and life satisfaction[40, 41]. Barefoot social workers, facing huge work pressure, are more likely to experience a low sense of professional identity and job accomplishment,[1] which leads to a reduction in their work enthusiasm and aggravation of their job burnout. Moreover, problems caused by job burnout further increase the life burden and lead to a decrease in life satisfaction[42, 43]. In addition, the finding that work engagement was positively associated with life satisfaction also corroborated previous research. For instance, Morales et al 's study showed that employees with high work engagement had more work enthusiasm, positive emotions, and optimistic attitudes, which contributed to higher life satisfaction[44].

In this study, job burnout and work engagement played mediating roles in the relationship between mental health literacy and life satisfaction, which was similar to previous studies. For example, Kai et al 's study showed that mental health literacy indirectly affected life satisfaction through mental health and proactive work behavior among primary and secondary school principals[45]. The mediating effect of job burnout and work engagement in the relationship between mental health literacy and life satisfaction may be explained by the JD-R theory[46]. Job demands and resources can stimulate emotional and psychological responses through the strain represented by job burnout and the motivation represented by work engagement, which can affect individuals' life satisfaction. Mental health literacy, known as a personal ability, is a job resource that includes knowledge, attitudes, and behavior habits to maintain and promote the mental health of oneself and others[47]. Individuals with good mental health literacy are more likely to possess the ability to manage and cope with work strain effectively, thus reducing the occurrence of job burnout. People with less job burnout are inclined to put more energy and enthusiasm into work, namely higher work engagement, which contributes to better job performance and higher life satisfaction. This finding is also consistent with the biopsychosocial model, which suggests that biological, psychological, and social factors interact to influence health and well-being. Job burnout and work engagement indicate the long-term occupational mental health of workers. According to the biopsychosocial model, individuals' mental health literacy can affect life satisfaction through the synergy of occupational mental health elements, such as job burnout and work engagement.

These findings provided a new idea for improving life satisfaction from the perspective of mental health literacy among barefoot social workers. First, primary medical institutions can regularly provide widespread knowledge of mental health to barefoot social workers, whether in the form of face-to-face, video, or paper materials[48]. Second, managers can focus on reforming and maintaining the workplace of child welfare work, combining mental health literacy with professional competence training and cooperating with social organizations to ensure the integrity and professionalism of child welfare services[49]. Moreover, the World Health Organization encourages mental health literacy training for workers to improve their understanding of mental health and reduce the stigma of psychological problems at work[50]. All these measures are crucial for reducing job burnout, improving work engagement, and enhancing the life satisfaction of barefoot social workers, which will help ensure the effective implementation of child welfare work.

However, several limitations should be considered when interpreting the results. First, the bootstrap analysis of the mediating effects of job burnout on work engagement revealed that although there may be masking effects, the total effect was smaller than the total indirect effect. Second, the sample of this study was recruited from Changsha City and may not represent barefoot social workers in other parts of China. Further research may consider using a large sample from different areas to test our study hypotheses further. In addition, the cross-sectional design of this study cannot establish causal relationships. Future longitudinal research is needed to validate our findings further. Finally, the participants involved in this study varied greatly in age and work experience. The younger generation may have greater demands on quality of life and job resources, while the older generation may place more emphasis on basic job security. Future research can further segment the participants, explore intergenerational differences, and analyze in detail the mechanisms of their impact on life satisfaction.

In summary, our study showed that among barefoot social workers, mental health literacy was positively associated with life satisfaction both directly and indirectly through job burnout and work engagement sequentially. The present study recommends focusing on mental health literacy to create an intervention for barefoot social workers, which has policy implications for the Healthy China initiative. Considering the importance and potential for interventions in mental health literacy, primary health care managers can design mental health literacy intervention programs for barefoot social workers based on the JD-R theory to help barefoot social workers cope with the challenges brought by work-related to vulnerable children. Interventions to reduce job burnout and improve work engagement are also helpful in enhancing life satisfaction.

Acknowledgments

We warmly thank all the participants of the study for their time and effort. Additionally, we express our appreciation to Xiangya School of Nursing of Central South University for their invaluable support in facilitating the ethical review process.

Author Contributions

Each author made significant contributions to this study, including involvement in the conception, study design, data acquisition, data analysis and interpretation, or other critical aspects of the study. Jia Yang implemented and completed the study design, and supervised and participated in the writing and revising of the paper. Yang Chen involved in the research conception and analyzed the data and interpretation, and wrote the paper. Ping Mao provided help in the data collection and study design. Lianhua Peng provided help in research design and paper revision. Ya Zou, Jingjing Liu and Lang Mao provided help with the data collection and interpretation. All authors read and approved the final manuscript. Furthermore, all authors have mutually agreed on the choice of the journal for submission and have committed to be accountable for all aspects of this work.

Funding

This work is supported by Hunan Provincial Education Planning Project (Interim research result), the Education Department of Hunan Province of China No: XJK24CXX002.

Availability of data and materials

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Ethics approval and consent to participate

The studies were reviewed and approved by the Ethics Committee of Xiangya School of Nursing of Central South University, with the ethics approval number E2023119, and have been executed consistent with ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The participants provided their informed consent to participate in this study.

Consent for publication

Not applicable.

Competing interests

The authors report no conflicts of interest in this work. The authors declare that the present study was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Role of job burnout and work engagement in the relationship between mental health literacy and life satisfaction in Chinese Barefoot Social Workers: A serial mediation model based on the job demands-resources theory

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Introduction

Methods

Participants and procedures

Measures

Demographic characteristics

Mental health literacy

Job burnout

Work engagement

Life satisfaction

Statistical analysis

Results

Sample characteristics

Correlation analysis

Mediation Analysis

Discussion

Conclusion

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References

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