Coping with Epidemic-Related Job Stressors in Healthcare Workers During the Late Stage of the COVID-19 Pandemic: Effects of Reflective Functioning and Cognitive Emotion Regulation

BACKGROUND: Healthcare workers encountered novel job stressors during the late stage of the COVID-19 pandemic. These stressors possessed potential deleterious effects on mental health outcomes, yet the underlying mediating and moderating mechanisms remained relatively unexplored. OBJECTIVE: The current study aimed to examine the role of cognitive emotion regulation as a mediator in the association between pandemic-related job stressors and the psychological symptoms of healthcare professionals in the late stage of the COVID-19 pandemic, and the role of reflective functioning as a resilience factor moderating both the associations of pandemic-related job stressors and cognitive emotion regulation, as well as psychological symptoms. METHODS: This cross-sectional survey conducted in October 2020 included 2393 healthcare professionals working in departments with a high risk of exposure to COVID-19 from 22 hospitals in Beijing, China. Participants were asked to complete questionnaires measuring pandemic-related job stressors, anxiety, depression, reflective functioning, and cognitive emotion regulation strategies. Path analyses were performed to examine the hypothesized model. RESULTS: Epidemic-related job stressors had significant direct effects on depression (β=0.31, p<0.001) and anxiety symptoms (β=0.29, p<0.001) and the indirect effects through mediation of maladaptive cognitive regulation were also significant (for depression, indirect effect=0.06, SE=0.01, CI=[0.04, 0.07]; for anxiety, indirect effect=0.06, SE=0.01, CI=[0.04, 0.08]). The dimension of certainty about mental states in the reflective functioning questionnaire (RFQc) moderated the direct effect of pandemic-related job stressors on depression (β=−0.05, p<0.001) and moderated the effect of job stressors on maladaptive cognitive regulation (β=0.06, p<0.001). CONCLUSION: The results shed light on the roles of cognitive emotion regulation and reflective functioning in coping with pandemic-related job stressors in frontline healthcare workers in periods of dealing with major infectious diseases. The findings have implications for developing interventions for healthcare workers in need.