The Impact of Self-Compassion on Enhancing the Professional Quality of Life for Healthcare Workers

Abstract

Emphasizing the importance of psychological experiences in professional roles, this study explored the relationship between self-compassion and professional quality of life (ProQOL) among healthcare workers (HCWs). Sociodemographic characteristics, depressive symptoms, self-compassion, and ProQOL were assessed by conducting an online survey with 371 HCWs on coronavirus disease 2019 dedicated teams. Our findings indicate that self-compassion contributes to a better ProQOL, enhancing compassion satisfaction while reducing burnout and secondary traumatic stress, even when controlling depressive symptoms. These results have important implications fostering self-compassion interventions for a better ProQOL in HCWs.

Graphical Abstract

Healthcare workers (HCWs) are classified as essential workers, as they bear the responsibility for the health of all members of society. Furthermore, HCWs are a vulnerable population in terms of mental health because their roles involve addressing urgency and existential fears. For example, during the coronavirus disease 2019 (COVID-19) pandemic, HCWs faced a greater risk of mental health issues, including depression, anxiety, fear, and helplessness.1,2,3 During that time HCWs’ mental health directly affected their ability to provide care and support the functioning of the healthcare system.4

For HCWs, failure to cope with mental health challenges may lead to poor professional quality of life (ProQOL). The ProQOL refers to the overall positive and negative aspects of an individual’s experience related to their work in a professional context. The ProQOL refers to how professionals navigate the successes and challenges they encounter in the workplace.5 It encompasses the emotional experiences of helping professionals in their work, highlighting the positive aspects (compassion satisfaction) as well as the negative elements (compassion fatigue). Compassion satisfaction refers to the key positive psychological experiences that HCWs have in their work. This experience is the fulfillment gained through the process of caring for individuals in need. Compassion fatigue refers to the secondary stress caused by witnessing traumatic events and burnout resulting from high-intensity workloads. In health care workers, excessive compassion fatigue can lead to reduced capacity in exhibiting empathy or bearing the suffering of clients. These two elements represent the internal and psychological quality of work life for HCWs.6 At the organizational level, poor ProQOL among HCWs may also lead to increased employee turnover, as well as decreased patient satisfaction and safety within facilities.7

Recently, in the field of mental health, self-compassion has emerged as an attitude that positively influences psychological well-being. Self-compassion refers to opening one’s awareness to failure and suffering and, rather than avoiding or disconnecting from them, acknowledging these experiences as a common part of human existence. Self-compassion embodies a kind, warm, and caring attitude toward oneself. This self-attitude helps individuals support and understand themselves in difficult situations.8 A perspective of self-compassion could nurture the view of failure as a valuable resource and facilitate an easier and more resilient approach to the process of pursuing goals within work domains.9,10 In the demanding work environment of HCWs, where high-intensity tasks are carried out based on empathy and compassion for others, self-compassion becomes even more critical. Through self-compassion, HCWs could manage workplace stress and challenges more effectively. Therefore, the healthy development of their self-identity and self-worth would be fostered, which would ultimately enhance their ProQOL.11,12 There is a growing recognition of the importance of self-compassion in organizational settings. However, research is still relatively limited as compared to other topics, with a specific focus on healthcare organizations being even scarcer. This study examined the relationship between self-compassion and ProQOL among HCWs and explored how self-compassion impacts ProQOL. Conducted within the pandemic context—a context that amplifies the occupation-specific stressors and complexities faced by HCWs (e.g., urgency, existential factors, uncertainty, high emotional labor, ongoing need for knowledge updates, etc.)—this study specifically addresses the gap in previous research by focusing on the dynamics of self-compassion tailored to HCWs.13 Furthermore, unlike other pandemic-related studies, our research controls depressive symptoms and demographic variables, thereby isolating the effect of self-compassion on ProQoL.14,15

This study analyzed the dataset of a survey investigating the negative psychological conditions of HCWs during COVID-19 pandemic. The survey was administered by the Mental Health Welfare Center in Jeju, Korea, with data collected in March 2022, two years into the pandemic. The participants included physicians, nurses, and healthcare assistants—who provide support in roles such as medical technology—working in dedicated COVID-19 hospitals and public health centers in Jeju, Korea. The survey was designed to be anonymous, ensuring that participants’ information remained confidential. It was an online questionnaire (Google Forms), and informed consent was confirmed at the beginning of the online questionnaire. A total of 371 HCWs participated voluntarily and were recruited through advertisements. There were no specific exclusion criteria applied for participant selection in this study.

Sociodemographic data included age, gender, work position, healthcare work experience, and COVID-19 pandemic response work experience. Psychological variables were depressive symptoms, self-compassion, and ProQOL. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms. The PHQ-9 consists of nine items scored on a 4-point Likert scale, with scores ranging from 0 to 27, and the Korean version of the PHQ-9 has high internal consistency (Cronbach’s α = 0.86).16,17 The Self-Compassion Scale (SCS) was used for measuring the level of self-compassion. The SCS is a 26-item scale that assesses six different components of self-compassion: self-kindness, reduced self-judgement, common humanity, reduced isolation, mindfulness, and reduced over-identification. The Korean version of the SCS has high internal consistency (Cronbach’s α = 0.87).18,19 The ProQOL Scale 5 (ProQOL-5) assesses ProQOL through 30 items rated on a 5-point Likert scale. The ProQOL-5 includes three subscales: compassion satisfaction, burnout, and secondary traumatic stress. The Cronbach’s α of these subscales were 0.93, 0.79, and 0.84, respectively. Poor ProQOL may indicate a low level of compassion satisfaction as well as high levels of burnout and secondary traumatic stress.5,20

Categorical variables were compared using the χ² test while continuous variables were analyzed with independent t-test and analysis of variance (ANOVA). This study conducted Pearson’s correlation analysis to investigate the relationships among depressive symptoms, self-compassion, and ProQOL (compassion satisfaction, burnout, and secondary traumatic stress). Hierarchical regression analyses were conducted to examine the contribution of self-compassion (SCS scores) as an independent variable to ProQOL (ProQOL-5 scores), while controlling for the effects of depressive symptoms (PHQ-9 scores). The hierarchical regression analysis is a subtype of multiple regression that not only provides the final model but also adds independent variables step by step, showing how the explanatory power changes with each step. This approach helps to assess how much each independent variable contributes to the model’s overall explanatory power. In our study, The PHQ-9 scores were included as predictors in step 1 of the hierarchical linear regression analysis, and SCS scores were entered in step 2. All statistical analyses were conducted using SPSS software (version 25.0; SPSS Inc., Chicago, IL, USA), and P values less than 0.05 were considered statistically significant.

First, preliminary analysis was performed to examine basic demographic information. Other relevant variables were examined for subsequent analysis (Tables 1 and 2). The analysis suggested that higher age was associated with better ProQOL. This indicates that greater age serves as a protective factor, individuals in their 50s had higher compassion satisfaction (P < 0.001) and lower burnout (P = 0.002) when compared to those in their 20s and 30s. Years of work experience were found to have a statistically significant impact on ProQOL. The longer COVID-19 pandemic response work experience (≥ 1 year) group had higher burnout levels (P = 0.021) and secondary traumatic stress scores (P = 0.043) than the group with less experience (< 1 year). More severe depressive symptoms (higher score on the PHQ-9) were associated with poorer ProQOL (all P < 0.001). In contrast, greater self-compassion (higher SCS scores) was significantly associated with better ProQOL (all P < 0.001).

Table 1. Demographic characteristics associated with professional quality of life.

Demographic variables		No. of patients	Professional Quality of Life Scale-5
			Compassion satisfaction		Burnout		Secondary traumatic stress
			Mean ± SD	P value	Mean ± SD	P value	Mean ± SD	P value
Age group, yr				< 0.001***		0.002**		0.706
	< 40	160	29.0 ± 7.3		28.7 ± 6.0		23.6 ± 6.4
	In the 40s	129	30.7 ± 6.6		27.6 ± 5.5		23.1 ± 5.2
	≥ 50	82	32.6 ± 5.8		26.0 ± 4.8		23.2 ± 5.9
Gender				0.601		0.183		0.434
	Men	50	30.9 ± 7.4		26.7 ± 6.3		22.7 ± 5.3
	Women	321	30.3 ± 6.8		27.9 ± 5.6		23.4 ± 6.0
Work position				0.774		0.639		0.719
	Physicians and nurses	205	30.5 ± 7.0		27.8 ± 5.7		23.4 ± 5.6
	Healthcare assistants	166	30.3 ± 6.8		27.6 ± 5.7		23.2 ± 6.2
Healthcare work experience, yr				< 0.001***		< 0.001***		0.856
	< 3	83	30.7 ± 6.9		26.3 ± 5.1		22.9 ± 6.2
	≥ 3 and < 5	45	27.4 ± 6.9		29.6 ± 5.5		23.2 ± 6.3
	≥ 5 and <10	60	28.5 ± 7.1		29.9 ± 6.0		23.7 ± 6.0
	≥ 10	183	31.6 ± 6.5		27.2 ± 5.5		23.5 ± 5.6
COVID-19 pandemic response work experience, yr				0.478		0.021*		0.043*
	< 1	143	30.7 ± 6.8		26.9 ± 5.3		22.6 ± 5.6
	≥ 1	228	30.2 ± 7.0		28.3 ± 5.9		23.8 ± 6.0

SD = standard deviation, COVID-19 = coronavirus disease 2019.

^*P < 0.05, ^**P < 0.01, ^***P < 0.001.

Table 2. Psychological characteristics associated with professional quality of life.

Psychological variables	r	P value	r	P value	r	P value
Depressive symptoms (PHQ-9 score)	−0.424	< 0.001***	0.693	< 0.001***	0.442	< 0.001***
Self-compassion (SCS score)	0.498	< 0.001***	−0.646	< 0.001***	−0.302	< 0.001***

PHQ-9 = The Patient Health Questionnaire-9, SCS = Self-Compassion Scale.

^***P < 0.001.

To test our hypothesis, a hierarchical multiple regression model was utilized to assess the contribution of self-compassion as an independent variable to ProQOL, while controlling the effects of depressive symptoms (Table 3). In our study, depressive symptoms (PHQ-9) were entered simultaneously into the ProQOL-5 regression model after controlling relevant factors (age group, gender, work position, healthcare work experience, and COVID-19 pandemic response work experience) (step 1). Depressive symptoms were positively associated with poor ProQOL. When entered in the final regression analysis after the covariates of relevant factors, self-compassion (SCS) was positively associated with better ProQOL (a high level of compassion satisfaction and low levels of burnout and secondary traumatic stress). This finding indicates that self-compassion positively influences HCWs’ ProQOL, this model (step 2) revealed an additional 9.9% of the variance in compassion satisfaction, 12.8% of the variance in burn out, and 1.4% of the variance in secondary traumatic stress, even when accounting for the effects of depressive symptoms.

Table 3. Hierarchical regression analysis of factors associated with professional quality of life.

Professional quality of life		Step 1a			Step 2a
		B	β	t	B	β	t
Compassion satisfaction
	Depressive symptoms	−0.440	−0.400	−8.182**	−0.261	−0.237	−4.635**
	Self-compassion				0.178	0.369	7.154**
	Adjusted R2	0.184			0.283
	Adjusted R2 change	0.148			0.099
	F	14.905**			21.848**
Burnout
	Depressive symptoms	0.610	0.674	17.288**	0.443	0.490	12.961**
	Self-compassion				−0.167	-0.419	−11.000**
	Adjusted R2	0.480			0.609
	Adjusted R2 change	0.420			0.128
	F	57.944**			83.324***
Secondary traumatic stress
	Depressive symptoms	0.415	0.444	9.086**	0.358	0.382	7.059**
	Self-compassion				−0.058	−0.140	−2.563*
	Adjusted R2	0.185			0.198
	Adjusted R2 change	0.182			0.014
	F	15.036**			14.024**

^aAdjustment for age group, gender, work position, healthcare work experience, and coronavirus disease 2019 pandemic response work experience.

^*P < 0.05, ^**P < 0.01, ^***P < 0.001.

These results shed light on the characteristics of HCWs during COVID-19 pandemic with poorer ProQOL, as well as the association between depressive symptoms, self-compassion, and ProQOL. Similar to previous studies, our results showed that HCWs with longer COVID-19 pandemic response work experiences had more severe burnout and secondary traumatic stress.1,3 Our findings further indicate that higher levels of depressive symptoms were significantly associated with poorer ProQOL. Associated with being sympathetic to people who are suffering, the excessive emotional load of HCWs can be a risk factor for depression. HCWs may have also experienced trauma-related symptoms, such as depression or anxiety, after being indirectly exposed to traumatic incidents during the COVID-19 pandemic.21,22,23 However, further research is needed to determine whether depression leads to decreased ProQOL or whether poor ProQOL contributes to increased depressive symptoms.

In contrast, self-compassion acts as a protective factor for ProQOL. Extensive research has demonstrated that self-compassion is linked to psychological well-being and strength, such as happiness, optimism, resilience, and wisdom.24,25 Self-compassion is a potentially important skill for HCWs because it allows them to view the distress experienced in healthcare settings with kindness, connection, and mindfulness, which can improve their ProQOL.12,26 Previous studies have reported that HCWs with high levels of self-compassion were more likely to be confident in their ability to provide compassionate care to others and have greater work engagement, psychological well-being, and ProQOL (less burnout and greater satisfaction with professional life).27,28

Specifically, regarding the three subcomponents of ProQOL, one possible mechanisms underlying the effect of self-compassion on compassion satisfaction could be as follows: by genuinely understanding the sense of common humanity, which includes recognizing human flaws and imperfections, it increases the likelihood of identifying others’ vulnerabilities and needs, thereby enhancing the opportunity to provide care and compassion satisfaction.29 Next is the relationship between self-compassion and secondary traumatic stress. Self-compassion can help alleviate self-related emotions associated with posttraumatic stress disorder, such as shame and guilt, as well as ineffective coping strategies like avoidance and rumination. Trauma often involves pathological responses such as avoidance, rumination, guilt, and shame. Self-compassion, by fostering emotional acceptance and embracing pain as part of the human experience, reduces ineffective coping strategies like avoidance and rumination.30,31 Through self-kindness, it also alleviates emotions such as guilt and shame, which are central to trauma-related distress.32 Last is the relationship between self-compassion and burnout. Self-compassion provides a new perspective on the challenging aspects of our work experience by encouraging us to face our struggles with kindness and understanding instead of skepticism. Even in difficult environments, self-compassion can foster intrinsic motivation. This change in outlook can help lessen the emotional burden and decrease the chances of experiencing burnout.33

Notably, self-compassion is a skill that can be developed with practical interventions. A recent meta-analysis for the efficacy of self-compassion interventions demonstrated not only moderate and significant improvement in self-compassion, but reductions in various psychopathologies with moderate to large effect.34 Previous studies have shown that intervention programs, such as Mindfulness-Based Stress Reduction (MBSR), Compassion Cultivation Training (CCT), and Mindful Self-Compassion (MSC), can increase self-compassion, enhance well-being, and reduce burnout among HCWs.35,36,37,38,39,40,41 Given the low mental health levels of HCWs in Korea compared to other professional groups,42,43,44 there is a pressing need for social and structural support. Considering these findings, practical policy recommendations include implementing group psychotherapy programs for HCWs based on MBSR, CCT, and MSC, incorporating self-compassion training into ongoing professional development, and introducing self-compassion-focused mental health education. These initiatives could provide essential support to HCWs, ultimately enhancing their well-being, resilience, and ProQOL.

This study had a few limitations. First, these findings have limited applicability to the broader population of HCWs. The study was limited to a single province in Korea, and bias may be introduced by the voluntary participation. Second, the establishment of causal relationships among depressive symptoms, ProQOL, and self-compassion was prevented by the study’s cross-sectional design. Longitudinal or experimental studies are needed to better understand the cause-and-effect dynamics. Third, while this study focuses on self-compassion’s impact on ProQOL, it does not account for other critical variables that might also influence ProQOL, such as job stress, organizational support, and leadership styles. To provide a more comprehensive understanding, future studies should include these factors. Lastly, while depressive symptoms were controlled for in the analysis, other mental health factors like previous psychiatric history, anxiety, and perceived stress were not considered. These factors may also play significant roles in shaping ProQOL. In future research, expanding the scope of mental health variables would provide a more nuanced understanding of the impact of self-compassion on ProQOL.

In conclusion, this study emphasized the modulatory role of self-compassion in the relationships among various factors associated with poorer ProQOL among HCWs, including depressive symptoms. Self-compassion could offer a promising solution for addressing the chronic job-related stress HCWs experience. Interventions to cultivate self-compassion for HCWs are crucial for their well-being, job satisfaction, and ability to provide effective care. Various studies and discussion are needed in the future to examine the role of self-compassion in enhancing the ProQOL of workers in healthcare settings.

Ethics statement

All protocols were approved by the Institutional Review Board (IRB) of Jeju National University Hospital and the requirement for informed consent was waived (IRB No. JEJUNUH 2022-07-009).