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. 2022 Dec 7:10.1002/casp.2666. Online ahead of print. doi: 10.1002/casp.2666

Mental health and intentions to quit among nurses in Iran during COVID‐19 Pandemic: A social identity approach

Huseyin Cakal 1, Saeed Keshavarzi 2, Ali Ruhani 3,✉, Golnoosh Dakhil‐Abbasi 3, Halime Ünver 1
PMCID: PMC9878192  PMID: 36718475

Abstract

The positive effects of social identification on mental health are well documented in the literature. However, most of this research has been conducted among small groups in WEIRD (Western Educated Industrialized Rich and Democratic Henrich, Heine, & Norenzayan, 2010, Behavioral and Brain Sciences, 33, 61) settings. Understanding how social identity as a psychological source can improve resilience and welfare among frontline healthcare workers in non‐WEIRD contexts can help to alleviate the negative impact of large‐scale epidemics overall, especially in resource‐poor settings and contribute towards improved welfare of key healthcare workers. The present research investigates whether identifying as a nurse could influence mental health and intentions to quit directly and indirectly via positive and negative emotions among a unique sample of Iranian nurses (N = 462) during a risky period, the COVID‐19 pandemic. Multiple regression results showed that identifying as a nurse was negatively associated with negative emotions which in turn were positively related to depressive symptoms. In a similar vein, identifying as a nurse was positively associated with positive emotions which, in turn, were negatively related to intentions to quit. Results also confirmed that risk perceptions related to COVID‐19 positively moderated the effect of social identification on negative emotions only. That is, identification as a nurse was associated with reduced negative emotions only when perceived risk was low. We discuss the theoretical and practical implications of the findings.

Keywords: COVID‐19, depressive symptoms, emotions, group identity, intentions to quit

Across the world, the raging COVID‐19 pandemic has brought frontline healthcare workers under great public and psychological pressure also exposing them to a high risk of infection (Mo et al., 2020; Shen et al., 2020). Understandably, recent research investigated how this exposure to psychological pressure influenced nurses' well‐being as well as their intentions to stay on the job (Huang et al., 2020; Mo et al., 2020; Shen et al., 2020) at a time when they are most needed. Research on social identity and well‐being, on the other hand, has demonstrated that a shared sense of identity can have beneficial effects on health and well‐being (Jetten et al., 2014). Integrative research on the topic shows that social identification exerts this positive impact on well‐being via several processes (Postmes et al., 2019). Identifying with a group provides access to sources of social support, satisfies individuals' basic needs of belonging and self‐esteem and enables individuals to locate themselves within a network of social relations providing them with a shared interpretation of the social and physical environment (Cruwys et al., 2014).

Social identification with a group can also empower people by improving their perceptions of efficacy (Drury et al., 2016); resilience (Alfadhli et al., 2019; Alfadhli & Drury, 2018); triggering positive emotions (Tewari et al., 2012); and more positive appraisal of coping resources (Isaksson et al., 2017). A shared sense of identity can also reduce depression (Cruwys et al., 2013) and improve self‐esteem (Schmitt et al., 2003).

In fact, more recent research shows that the potential beneficial effects of shared identities are not limited to facilitating access to psychological resources that protect the individual in difficult times such as the pandemic. For instance, shared identities can motivate individuals to engage in actions beneficial to the group such as actions aimed at maintaining or improving the conditions for the group (van Zomeren et al., 2008; van Zomeren et al., 2012); protecting the group by acting in solidarity (Saab et al., 2015); or by offering mutual help in emergencies (Drury et al., 2016), adhering to protective measures more strictly and prosocial acts of shopping for others (Vignoles et al., 2021). Accordingly, these psychological tools have the capacity to protect one's mental health and well‐being and promote resilience in the face of adversity.

These positive effects of social identification on well‐being notwithstanding, social identification with a group can also have negative effects on well‐being by influencing how individuals appraise symptoms and respond to them (Haslam et al., 2009). People report a higher level of hearing handicap when they identify as elderly (St Claire & He, 2009) or want to take more medication when they identify with those who suffer from colds (St Claire et al., 2008). More recent research suggests the way social identity influences mental welfare might be influenced by perceptions of uncertainty (Goldberg et al., 2010). For instance, people perceiving higher uncertainty, for example, having a higher risk of cancer reported experiencing more negative affect and more negative life satisfaction (Persoskie et al., 2014).

We observe at least three gaps in this literature. First, most of this research has been conducted in WEIRD (Western Educated Industrialized Rich and Democratic Henrich et al., 2010) contexts. Second, majority of these studies focus on either small interactive groups or social categorical groups such as ethnic groups or gender (Postmes et al., 2019). Thus, there is very little research on social identity and well‐being among non‐WEIRD populations in applied settings (see Steffens et al., 2017). Third, there is very little, research known to us that investigates how perceived uncertainty imposed by the prolonged pandemic affects the relationship between social identity and well‐being and work‐related outcomes. Understanding how psychological sources can improve resilience and welfare among frontline healthcare workers in non‐WEIRD contexts can help to alleviate the negative impact of large‐scale epidemics overall, especially in resource‐poor settings and contribute towards improved provision of health support and services during a period of emergency (Billings et al., 2021). In the present research, we address this gap by focusing on nurses' well‐being and their intentions to quit during the pandemic in a unique sample of nurses in Iran. More specifically, we investigate whether identifying as a nurse is associated with decreased mental distress and intentions to quit the job via increased positive emotions and decreased negative emotions. In doing so, we explore whether a shared sense of identity as a nurse in a challenging environment is associated with positive feelings and/or decreased negative emotions that nurses might experience as a result of external challenges. Hence, we test these hypotheses among a group of frontline nurses during periods of intensive work in an under‐researched context, Iran.

1. SOCIAL IDENTITY AND COLLECTIVE EXPERIENCE

Social identity provides a basis for a shared understanding and experience of the social world. Cumulative work on appraisal and coping suggest that emotions are triggered to the extent of self‐relevance (Mackie & Smith, 2008) and defining oneself in terms of shared identity can empower individuals who now perceive themselves as having the capacity to change their physical and social environment accompanied by intense positive affect, that is, “emotional transformation” (Neville & Reicher, 2011). Research on collective behaviour and emotional experiences for instance shows that individuals experience positive emotions when they perceive themselves and others around them in terms of a certain category that is, group and adopt a framework based on values and norms of this category (Hopkins et al., 2016). This consensual perspective of the world then serves as a basis upon which the social world and the external events are evaluated in terms of their relevance to the group (Ray et al., 2014). A shared identity rooted in self‐categorization of oneself into a particular group whose members are socially cohesive, and being in close company with these members is then associated with intensive positive feelings (Wlodarczyk et al., 2020).

In a similar vein, a salient social identity also emphasizes the experience of negative emotions as a result of group‐based disadvantages (van Zomeren et al., 2012). Stronger identification with a disadvantaged group connects the individual with the disadvantage making the disadvantage relevant to the self and reinforcing the attributions of responsibility to external actors which in turn triggers negative emotions, for example, anger. Surprisingly, most research on collective positive emotions has mainly focused on the association between shared identity (Hopkins et al., 2016; Neville & Reicher, 2011) and positive feelings within crowds, collective gatherings and rituals, whereas most research on social identity and negative emotions investigated anger and motivations to engage in social change (van Zomeren et al., 2008). Below we elaborate on how experiencing positive and negative emotions might connect with mental health and well‐being, and motivate or demotivate nurses to stay on the job despite the adversities they face.

2. EMOTIONS AND WELL‐BEING

Extant research demonstrates that identifying as a member of a group has important consequences for how individuals experience affect (see Steffens et al., 2017 for a review). This is mainly because individuals' appraisal of social objects and events, and their responses to these are determined by the relevancy of the social objects and events to the group individuals identify with (Levine & Reicher, 1996). Thus, when a group of individuals interacts in a social environment (Neville & Reicher, 2011) their interpretations of the environment, social objects in this environment and their emotional reactions to this social environment are determined by their social identifications embedded in that social environment. Stronger identification with a particular group of nurses will elicit stronger, positive or negative, affect related to the nursing environment.

According to the broaden‐and‐built theory of positive emotions (Fredrickson, 2004), positive emotions increase and broaden cognition, trigger broader coping mechanisms and therefore improve emotional well‐being. The availability of psychological, physical and social sources in turn triggers creativity, exploration and resilience (Cohn et al., 2009; Gloria & Steinhardt, 2016). Research has also shown that positive emotions are also directly and positively associated with coping (Folkman, 2008; Folkman & Moskowitz, 2000; Gloria & Steinhardt, 2016), and could mediate the effect of resilience on emotional well‐being. Research by Tugade and her colleagues (Tugade et al., 2004; Tugade & Fredrickson, 2004) shows that trait resilience is associated with positive emotions which in turn accelerates cardiovascular recovery from negative emotional arousal and finding positive meaning in negative circumstances. (Kuppens & Yzerbyt, 2012). When combined with mutual care and concern, and involving both behavioural and biological synchrony, positive emotions can lead to improved well‐being (Major et al., 2018).

3. NEGATIVE EMOTIONS

Whereas research shows a consistent link between positive emotions and well‐being, evidence of the association between negative emotions and well‐being is less conclusive. Experiencing worry about things that might happen in the future for instance is negatively associated with subsequent well‐being (Kramer et al., 2021). Conversely, suppression of negative emotions was not associated with improved well‐being or reduced stress (Katana et al., 2019). Findings from cross‐cultural research on effect and well‐being also suggest that these inconsistencies might be due to cultural differences (Wirtz et al., 2010) or gender (Fujita et al., 1991). Wirtz and his colleagues for instance found that while western cultures put more emphasis on positive affect and its role in improving well‐being, eastern cultures emphasize the lack of negative affect in promoting well‐being. In a similar vein, Fujita et al. (1991) showed that while women experience more negative affect, they express positive affect more intensely, and this, in turn, mitigates the impact of a stronger negative effect on well‐being.

4. EMOTIONS IN ORGANIZATIONAL SETTINGS

Positive emotions are considered as a key component of employee well‐being (Diener et al., 2019; Sonnentag, 2015) and most research focused on emotions within organizational settings has investigated emotion regulation, that is, emotional labour. Other research that conceptualizes emotions as affective states, processes and functions shows that positive emotions are associated with collaboration and cooperation (Baron, 1990; Doorn et al., 2012). When displayed openly, positive emotions can also function as social information spreading to others and inducing a general sense of positivity at the workplace (van Kleef, 2009), and thus can buffer the effect of negative experiences on job satisfaction (Dimotakis et al., 2011). Various lines of research also show that positive emotions can lead to decreased turnover intentions by increasing motivations to invest effort in work, enhancing dedication and commitment to one's tasks, and reinforcing absorption in work (Siu et al., 2015). Thus, we hypothesize that positive emotions triggered by a sense of shared identity can simultaneously improve well‐being and motivate staying on the job.

Among healthcare professionals, emotions in general can influence decision making (Heyhoe et al., 2016). Negative emotions like agitation (Erickson & Grove, 2007); fear and anxiety (Hu et al., 2020) can be associated with burnout and lower job satisfaction. In a similar vein, experiencing negative affect (e.g., nervousness and concern) can trigger discriminatory attitudes and temporal distancing from patients and work (Harris et al., 2020). Emergent research in the context of pandemic shows that physical proximity to known COVID‐19 outbreak zone is associated with sadness, worry and anger which in turn are associated with problem and emotion‐focused coping (Huang et al., 2020). Conversely, experiencing discreet emotions of fear, guilt and sadness were not related to negative behaviour towards patients (Jalil et al., 2017).

5. THE PRESENT STUDY

Official statistics confirm that the first cases of COVID‐19 were detected on 19 February 2020 in Iran while unofficial reports argue that the infected existed for at least 45 days before official confirmation. In the middle of June (2020), when we collected data, the infected cases were reported 182,545 people while 2 months later the number almost doubled (equal to 343,203 people; Worldometers, 2021). At the time of writing the present research (24 August 2021), the cumulative count of infected Iranians is more than 4.7 million, while more than 103,000 died. It is hence not difficult to imagine how nurses have been under pressure during the period after contagion. According to statistics, of 145,000 employed nurses, 60,000 were infected by COVID‐19 and 100 of them died until 17 Dec of 2020 (Isna, 2021). Nowadays, administrative hospitals and health institutions relentlessly express their concerns about the negative consequences of such heavy pressures on nurses while demands for immediate recruitment of new nurses (Mehrnews, 2021). The outlined situation questions the capacity of hospitals and healthcare professionals to provide suitable care to all who need urgent medical attention.

In this study, we aimed to test the conceptual model presented in Figure 1. As shown, we hypothesised that identifying as a nurse would be directly and negatively associated with both depressive symptoms and intentions to quit (Hypothesis 1a: H1a). In addition, identification as a nurse would be positively associated with positive emotions and negatively with negative emotions (Hypothesis 1b: H1b). In turn, positive emotions would be negatively associated with intentions to quit and depressive symptoms (Hypothesis 2a: H2a), and negative emotions would be positively associated with intentions to quit and depressive symptoms (Hypothesis 2b: H2b). As a result, identification as a nurse would be also negatively and indirectly associated with depressive symptoms via increased positive emotions and decreased negative emotions (Hypothesis 3; H3). In a similar vein, identification as a nurse would be also negatively and indirectly associated with intentions to quit via increased positive emotions and decreased negative emotions (Hypothesis 4; H4). We expect that risk perceptions would moderate these associations. More specifically, among those who perceive the risk of COVID‐19 contagion as higher, identification as a nurse would be more strongly associated with intentions to quit and depressive symptoms (Hypothesis 4: H4). Moreover, identification as a nurse would be associated less strongly with positive emotions and more strongly with negative emotions among those who perceive the risk of COVID‐19 contagion as higher (Hypothesis 5: H5). Similarly, positive emotions would be less strong and negative emotions would be more strongly associated with intentions to quit and depressive symptoms among those who perceive the risk of COVID‐19 contagion as higher (Hypothesis 5: H5). As a result, indirect associations of identification as a nurse with depressive symptoms and intentions to quit would be moderated by risk perceptions (moderated mediation). Among those who perceive higher risk of COVID‐19 contagion, identification as a nurse would be less strongly and indirectly associated with depressive symptoms via positive emotions (Hypothesis 6a: H6a); it would also be more strongly and indirectly associated with intentions to quit via negative emotions (Hypothesis 6b: H6b). Finally, identification as a nurse would be less strongly and indirectly associated with depressive symptoms via positive emotions (Hypothesis 7a: H7a); it would also be more strongly and indirectly associated with intentions to quit via negative emotions (Hypothesis 7b: H7b).

FIGURE 1.

FIGURE 1

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The conceptual model: The direct and indirect effects (via positive and negative emotions independently) of identification as a nurse on intentions to quit and depressive symptoms

6. METHOD

6.1. Participants

For the current study, we analysed the data collected from a cross‐sectional study carried out from 12 June to 16 August 2020 in Iran. Ethical approval was obtained from Yazd University Central Research Ethics Committee. All research activities comply with the 1964 Helsinki Human Rights Declaration. The data reported in this manuscript were collected as part of a larger data collection. One variable intention to quit has been used in another publication that reports the impact of internal and external workplace violence on intentions to quit via job satisfaction (Cakal et al., 2021). Here we consider how identifying as a nurse affects mental health and intentions to quit via positive and negative emotions and whether risk perception influences these associations. We invited nurses who were on active duty to participate in a study “on difficulties faced by nurses during the pandemic”. Those who were interested were directed to the study link and completed the survey upon their consent. Overall, 462 Iranian nurses across the country participated in the study (M age = 31.6 SD = 8.78). The sample included 313 females (67.7%) and 132 males (28.6%), while 17 ones (3.7%) chose not to express their gender. This Noting that the high proportion of females seems not problematic to our sampling method, as according to the latest statistics, 78% of the net population of Iranian nurses has been female (Fardanews, 2018) which is not too far from the proportion in our sample. All respondents held university degrees; including 85% with a bachelor, 14% with a master's or PhD degree and four participants did not answer the question. Moreover, nearly 40% of our respondents were expected to contact frequently with COVID‐19‐positive cases due to their working sections, for example, emergency, infection control, or newly established sections exclusively for COVID‐19 patients. Other participants belonged to units, for example, neonatal and oncology, at risk of COVID‐19 infection, possibly at lower levels than the former group. We did not have any missing data.

6.2. Measures

All items were measured on a 7‐point Likert‐type scale anchored from 1 not at all to 7 very much (See the Appendix 1 for a full list of the items).

6.2.1. Identification as a nurse

Was measured by four items (α = .83) adapted from (van Stekelenburg et al., 2011). We asked our participants to respond to statements on different dimensions (emotional commitment, significance of being a nurse, shared sense of ‘we’, involvement) of their sense of belongingness to the nurse group (e.g., I am happy to be a member of the nurses' team).

6.2.2. Positive emotions

Participants were asked to think about their job regarding the COVID‐19 pandemic and then to indicate the extent that they feel the following emotions: hope, happiness and excitement (α = .82).

6.2.3. Negative emotions

Participants reported the extent that they experience worry, desperation and fear (α = .82).

6.2.4. Depressive symptoms

Was measured by three items adapted from Goldberg et al. (2010) with modification. A sample question read as “Have you been feeling unhappy and depressed?” (α = .82).

6.2.5. Intentions to quit

We used four items to measure the nurses' willingness to quit their job. Thus, a sample item reads “If an opportunity comes up, I am ready to leave my job”. (α = .91).

6.2.6. Risk perception

Was measured by eight items adapted from (Wu et al., 2009). The respondents were asked to indicate their agreement with the items. A sample item read as “I am afraid of falling ill with the coronavirus” (α = .77).

7. RESULTS

In Table 1, we report descriptive statistics and correlations between our variables of interest. Results show that the respondents had a strong sense of belongingness to the nurse group. They also perceived the risk frequently and felt worried about their situation at work. The mean level of depressive symptoms demonstrates widespread prevalence of depressive symptoms among nurses at the time of COVID‐19 contagion. As shown in Table 1, collective identity and experiencing positive emotions negatively, and experiencing negative emotions and perception of risk correlated positively with our dependent variables.

TABLE 1.

Means, standard deviations and correlations between main variables

Variables 1 2 3 4 5 6
1 collective identity
2 risk perception 0.01ns
3 positive emotions .53*** −.10***
4 negative emotions −.28*** −.33*** −.44***
5 depressive symptoms −.28*** .52*** −.42*** .48***
6 intentions to quit −.56*** .14*** −.57*** .48*** .37***
M 5.59 4.37 4.00 4.84 4.10 4.12
SD 1.20 1.11 1.42 1.44 1.05 1.89
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Note: Valid N (listwise) 462. The scale ranges from 1 to 7 for all measures. *p < 0.05, **p < 0.01, ***p < 0.001, one‐tailed.

In line with our hypotheses, we first tested the indirect effects via Model 4 in PROCESS (Hayes, 2018) first. We then used Model 59 to test the full moderated mediation model. As PROCESS does not allow testing two outcome variables at the same time, we entered the outcome variable that is not being tested as a co‐variant to control for any effect it might have in the model. Thus, we first entered identification as a nurse as a predictor, positive and negative emotions as parallel mediators, risk perception as moderator, intentions to quit our outcome variable, and depressive symptoms as co‐variant. Next, we entered depressive symptoms as our outcome variable and intentions to quit as co‐variant. Below, we report the full regression results including direct, indirect and moderating effects. Accordingly, we tested whether our independent variable, identifying as a nurse, would be associated with reduced depressive symptoms and reduced intentions to quit via our mediating variables, positive emotions and negative emotions. We then proceeded to test whether these associations, if any, would be moderated by risk perception. The effects are significant when the calculated confidence interval does not include zero (Hayes, 2018).

We report the effect sizes of all significant paths in Figure 2 and Table 2. Overall, our model explained 66% and 43% of variance in our mediating variables, positive and negative emotions, respectively, and 51% and 47% of variance of our dependent variables, intentions to quit and depressive symptoms, respectively. Confirming H1a results showed that identifying as a nurse was directly and negatively associated with depressive symptoms (B = −0.23, 95% CI [−0.48, −0.02]) and intentions to quit (B = −0.69, 95% CI [−1.14, −0.24]). In a similar vein and confirming H1b identification as a nurse was associated with positive emotions (B = 0.42, 95% CI [0.11, 0.73]) and negatively with negative emotions (B = −0.43, 95% CI [−0.76, −0.09]). Partially confirming H2a, positive emotions were only associated with intentions to quit (B = −0.45, 95% CI [−0.89, −0.00]).In a similar vein, Negative emotions were positively associated with depressive symptoms (B = 0.24, 95% CI [−0.03, 0.44]) but not with intentions to quit ergo, H2b was only partially confirmed.

FIGURE 2.

FIGURE 2

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The effects of identifying as a Nurse on Intentions to Quit and Depressive Symptoms via Positive and Negative Emotions

TABLE 2.

Full regression models predicting depressive symptoms and intentions to quit

Predictors Positive emotions Negative emotions Depressive symptoms Intentions to quit
B SE 95% CI B SE 95% CI B SE 95% CI B SE 95% CI
IN 0.42** 0.15 (0.11, 0.73) −0.43** 0.16 (−0.76, −0.09) −0.23* 0.09 (−0.48, −0.02) −0.69*** 0.22 (−1.14, −0.24)
PR −0.01 0.17 (−0.35, 0.34) 0.35 0.19 (−0.44, 0.31) 0.36 0.22 (−0.06, 0.78) −0.40 0.38 (−1.15, 0.34)
IN × PR −0.01 0.03 (−0.07, 0.05) 0.08** 0.03 (0.09, 0.14) 0.03 0.03 [−0.02, 0.08) 0.03 0.05 (−0.06, 0.12)
Positive emotions −0.16 0.12 (−0.41, 0.08) −0.45* 0.22 (−0.89, −0.01)
Positive emotions × PR −0.01 0.03 (−0.05, 0.06) 0.02 (−0.07, 0.11]
Negative emotions 0.24** 0.10 (0.03, 0.44) 0.13 (−0.22, 0.50)
Negative emotions × PR −.02 0.02 (−0.07, 0.02) 0.04 (−0.04, 0.11)
F F(4,457) = 66.17*** F(4,457) = 43.43*** F(8,453) = 47.44*** F(8,453) = 51.11***
R 2 0.36 0.47 0.27 0.45 0.47
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Abbreviations: IN, identification as a nurse; PR, perceived risk.

*

p < 0.05.

**

p < 0.01.

***

p < 0.001.

In line with our hypotheses, we then tested whether ingroup identification is indirectly associated with depressive symptoms and intentions to quit. Here, we first report the indirect effects. We then report the results of moderated mediation tests in the following section. Partially confirming H3 identification as a nurse was also negatively and indirectly associated with depressive symptoms via increased positive emotions (B = −0.06, 95% CI [−0.11, −0.02]) but not via decreased negative emotions. Fully confirming H4, identification as a nurse was negatively and indirectly associated with intentions to quit via increased positive emotions (B = −0.19, 95% CI [−0.26, −0.02]) and decreased negative emotions (B = −0.08, 95% CI [−0.13, −0.04]).

8. TESTS OF MODERATION AND MODERATED MEDIATION

In line with our predictions (H4‐H7b), we also tested whether any direct or indirect effects of our independent variable, identification as a nurse, on our criterion variables, depressive symptoms and intentions to quit, via our mediating variables, positive and negative feelings, would be moderated by risk perception. To do so, we used PROCESS Macro (Model 59, Hayes, 2018). Contrary to our expectations, none of the direct paths from our independent variable, identification as a nurse, to our criterion variables, intentions to quit and depressive symptoms was moderated by risk perceptions. The paths from our mediation variables, positive and negative emotions to our criterion variables did not also change at different levels of risk perception. We only detected evidence partially confirming H5 and H7b. Perceived risk of COVID‐19 contagion moderated the association between identification as a nurse and negative emotions. (B = .08, 95% CI [0.09, 0.14]). When perceived risk was low (−1 SD) the association between identification as a nurse and negative emotions was negative (B = −0.17, 95% CI [−0.31, −0.03.]), When perceived risk was at mean, this association decreased and became non‐significant (B = −0.10, 95% CI [−0.21, 0.01.]). The association changed direction but remained non‐significant (B = .001, 95% CI [−0.13, 0.13.]) when the perceived risk was high (+1SD). Accordingly, and partially confirming H7b, the indirect effect of identification as a nurse on depressive symptoms was negative (B = −.03, 95% CI [−0.05, −0.01]) when perceived risk was low (−1SD); decreased and became non‐significant (B = −.01, 95% CI [−0.03, 0.01]) when perceived risk was at mean; and became positive but remained non‐significant (B = .01, 95% CI [−0.01, 0.01]) when perceived risk was high (+1SD) (Table 3).

TABLE 3.

Conditional direct and indirect effects of identification as a nurse on depressive symptoms and intentions to quit at different levels of perceived risk

Direct effects B SE 95% CI
IN‐depressive symptoms
(−1SD) 3.33 −0.12 0.05 (−0.22, −0.02)
(Mean) 4.22 −0.09 0.04 (−0.17, −0.01)
(+1SD) 5.55 −0.05 0.05 (−0.14, 0.05)
IN‐intentions to quit
(−1SD) 3.33 −0.59 0.09 (−0.76, −0.41)
(Mean) 4.22 −0.56 0.07 (−0.69, −0.43)
(+1SD) 5.55 −0.51 0.08 (−0.67, −035)
Indirect effects B SE 95% CI
IN‐positive emotions ‐depressive symptoms
(−1SD) 3.33 −0.06 0.02 (−0.11, −0.02)
(Mean) 4.22 −0.06 0.02 [−0.10, −0.03)
(+1SD) 5.55 −0.06 0.02 (−0.11, −0.02)
IN‐negative emotions ‐depressive symptoms
(−1SD) 3.33 −0.03 0.01 (−0.05, −0.01)
(Mean) 4.22 ‐0.01 0.01 (−0.03, 0.01)
(+1SD) 5.55 0.01 0.02 (−0.01, 0.01)
IN‐positive emotions –intentions to quit
(−1SD) 3.33 −0.19 0.05 (−0.30, −0.11)
(Mean) 4.22 −0.19 0.04 (−0.26, −0.02)
(+1SD) 5.55 −0.17 0.05 (−0.27, −0.09]
IN‐negative emotions –intentions to quit
(−1SD) 3.33 −0.08 0.03 (−0.15, −0.03)
(Mean) 4.22 −0.08 0.02 (−0.12, −0.04)
(+1SD) 5.55 −0.06 0.03 (−0.11, −0.01)
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Thus, these results partially supported H5 and H7a that risk perception would moderate the direct effect of identification as a nurse on negative emotions and the indirect effect of identifying as a nurse on depressive symptoms via negative emotions.

9. DISCUSSION

The aim of present study was to examine the effects of group identity on depressive symptoms and intentions to quit among nurses during the COVID‐19 contagion in Iran. We argued that a sense of belongingness as a nurse would be related to positive and negative emotions which in turn would be associated with reduced depressive symptoms and intentions to quit. We also hypothesized that these associations would be moderated by perceived risk of being infected with COVID‐19.

In line with our expectations, our results underlined the crucial role of social identification as a nurse in reducing depression and intentions to quit during a period of duress. In line with previous studies, we addressed the role of emotions in alleviating work‐related challenges (Folkman, 2008; Folkman & Moskowitz, 2000; Gloria & Steinhardt, 2016; Major et al., 2018). In our sample, we did not find a significant effect of positive emotions on well‐This might be due to contextual effects imposed by the pandemic. Previous research showed that socio‐cultural context can suppress or incite emotion regulation strategies (Snyder et al., 2013). Alternatively, this might be purely the result of direct effects of social identification on depressive symptoms as the simple negative correlation between positive emotions and depressive symptoms disappeared in the model.

Consistent with the literature (Hoeve et al., 2020; Kramer et al., 2021), our findings also show that undesirable feelings experienced by employees have a detrimental impact on their well‐being and could lead them to leave their jobs. As expected, our results confirm the role of emotions in mediating the impact of identification as a nurse on intentions to quit. Contrary to our expectations, however, negative emotions did not mediate the association between identification as a nurse and depressive symptoms. Broadly speaking, these results support the findings from extant research on the topic (Mackie & Smith, 2008; Yzerbyt et al., 2003) evincing that a sense of shared identity is related to experiencing positive and negative emotions which are in turn related to mental health and job‐related outcomes.

It is somewhat surprising that among all proposed associations, risk perception only moderated the association between identification as a nurse and negative emotions. As expected, the mitigating effects of shared sense of identifying negative emotions disappeared when nurses experience a high risk of being infected. This finding highlights the important role of contextual factors in identity outcomes (Ding et al., 2020; Trifiletti et al., 2021). What is surprising is that risk perceptions did not moderate any other path, that is, the effects of identification as a nurse on positive emotions and in turn emotions on well‐being and intentions to quit were independent of risk perceptions and not significantly different at various levels of risky conditions.

Risk perception only buffered the indirect effects of group identification on depressive symptoms but not intentions to leave. This means that when employees experience the risk of being infected at high levels, the positive outcomes of shared identity on employees' well‐being are not significant. This is good news for at least two reasons. First, the direct and indirect, via positive emotions, effects of identifying as a nurse on depressive symptoms are consistent and remain unaltered across different levels of perceived risk. These findings suggest that in a negative socio‐cultural context risk perceptions have limited impact on how social identity modulates mental health and well‐being, for example, suppressing the mitigating effect of social identity on negative emotions. By the same logic, future research could explore whether a positive socio‐cultural context would boost the positive effects of social identity on positive feelings. Second, the positive direct and indirect effects of social identity on intentions to quit appear to be independent of risk perceptions. This means that negative sociocultural context does not impact the retainer effects of social identity.

One of the issues that emerge from these findings is developing the possibility of linking social identity and emotional literature. This study, to our knowledge, is one of the first that brings together research on emotions and social identity to identify the psychological consequences of the COVID‐19 pandemic among healthcare workers, that is, nurses in an underrepresented context, Iran. Our findings once more underscore the importance of identity‐based mechanisms in response to the COVID‐19 pandemic.

10. THEORETICAL AND PRACTICAL IMPLICATIONS

We believe these results are important both theoretically but also for practical reasons.

Most research investigating the positive effects of social identification on mental health is limited in the sense that it has focused on small interactive groups and/or on social categorical groups such as ethnic groups or gender. Here we extend this research by investigating the positive effects of social identification among a non‐WEIRD sample in an applied setting (see Steffens et al., 2017). These results, in line with previous research by Vignoles and his colleagues (Vignoles, Jaser, Taylor, & Ntontis, 2021) show, how shared identities can provide a sense of direction and keep people motivated even in risky contexts as well as promote resilience in the face of adversity.

These results provide additional evidence on the protective effects of social identification in organizational settings (Steffens et al., 2017). by showing that these positive effects are (a) partially independent of perceived risk triggered by the context; and (b) extend to organizational outcomes, that is, intentions to quit. Last but not least, our results also underline the positive effects of social identity on health and applied outcomes are both direct and also via positive emotional experiences thus calling for more research on other alternative intermediary processes.

As for the practical implications, our findings suggest that social identification in organizational settings can be harnessed to keep employees resilient and on task. Both of these consequences are equally important in difficult times especially when the employees provide services and support essential for public health. Thus, organizations providing such services should pay particular attention. Measures could focus on reinforcing job‐related identification and providing safer environments that could improve positive emotional experiences while decreasing negative emotional experiences. Given that the positive effects of social identification are mainly direct and via positive emotions, future interventions could focus on these processes.

11. IMPLICATIONS FOR FUTURE RESEARCH AND LIMITATION OF THE PRESENT STUDY

We acknowledge some limitations. First, our data is correlational data hence our causal claims should be taken with a pinch of salt. Longitudinal and experimental data is needed to support our findings. Second, since the data for this study was collected online, all limitations and biases of such studies are to be acknowledged here. For instance, it is likely that those nurses with limited access to the internet have been excluded. In a similar vein, some of the nurses we approached declined to participate due to their high and stressful workload. Third, we conducted this study in a highly stressful context, that is, during COVID‐19 pandemic in Iran. Hence, the full generalizability of such findings to other periods and contexts should be applied with caution. Future research could investigate whether these results would apply to other service personnel (aid workers, security forces and firefighters to name a few). Fourth, we operationalized emotions at the personal level. One could argue that there is a mismatch between our focus, group‐level emotions and our measures of emotions at the individual level. Because we ask our participants to report their emotions regarding their work environment, we think our operationalization is still valid. However, a task for future research would be to replicate these results by improving the measures and emotions at the group level. Given the strong associations between identification as a nurse and emotions in the current study, we do not think that the results will deviate. Lastly, in this study, our focus was on the negative and positive feelings experienced by nurses. Still, there is abundant room for further progress in determining the effects of emotion in organizational settings, particularly when compared with not‐so‐high stressful work conditions.

These limitations notwithstanding, we believe we contribute to research on social identity and well‐being in an applied setting. Most research to date has investigated social identification and related positive or negative processes among the patients or general public. Thus, by focusing on mental health and well‐being in an applied setting, healthcare delivery during the pandemic, we contribute towards a more social understanding of healthcare and well‐being from the supplier, nurse, point of view (Jetten, 2012). Future research could investigate other processes such as resilience or norms in similarly applied settings from the supply side of healthcare.

Our data comes from Iran, one of the least researched contexts globally. The present research then joins the ranks of a handful number of studies conducted in this less‐known context. Thus, we add to the expanding research in non‐WEIRD (Henrich et al., 2010) populations.

CONFLICT OF INTEREST

The authors declare no conflict of interest.

ACKNOWLEDGEMENTS

The authors are most grateful to the two anonymous reviewers and the editor for their constructive feedback and supportive review process. The authors also appreciate the nurses who participated in this study during the stressful period of the COVID‐19 pandemic.

APPENDIX 1.

Identity (Strongly Disagree 1 Strongly Agree 7).

  1. I'm happy to be a member of the nurses’ team.

  2. Committed to the goals of nurses.

  3. I feel belonging to the group of nurses.

  4. I have a lot in common with other nurses.

Emotions (Never 1 Always 7).

When you think about your job during the pandemic, how much of each of the following emotions do you experience?

  1. Hope.

  2. Happiness.

  3. Excitement.

  4. Frustration.

  5. Desperation.

  6. Worry.

  7. Fear.

Depressive Symptoms (Never 1 Always 7).

Taking into account everything this outbreak has implied.

  1. Have you been able to concentrate? R.

  2. Have you had any kind of loss of sleep over worry?

  3. Have you felt constantly under strain?

  4. Have you been able to face problems? R.

  5. Have you been feeling unhappy and depressed?

  6. Considering all the circumstances, are you reasonably happy? R.

Risk perception (Never 1 Always7).

  1. I feel I have little control over whether I would get infected or not.

  2. I think I would be unlikely to survive if I were to get the coronavirus.

  3. I am afraid I would pass it on to others.

  4. Because I want to help the coronavirus patients, I am willing to accept the risks involved R.

  5. I am worried about losing my job and/or a close one as a result of COVID‐19.

  6. I am worried about having more conflicts with someone in my household as a result of COVID‐19.

  7. I am afraid of falling ill with the coronavirus.

  8. I am worried about suffering violence from someone in my household (e.g., partner, spouse, relative, etc.) as a result of COVID‐19.

Intentions to quit (Strongly Disagree 1 Strongly Agree 7).

  1. If an opportunity arises, I am ready to leave my job.

  2. If I have the financial ability, I will take my job.

  3. Those who left this job in recent years acted logically.

  4. The best option these days is to say goodbye to nursing.

Cakal, H. , Keshavarzi, S. , Ruhani, A. , Dakhil‐Abbasi, G. , & Ünver, H. (2022). Mental health and intentions to quit among nurses in Iran during COVID‐19 Pandemic: A social identity approach. Journal of Community & Applied Social Psychology, 1–18. 10.1002/casp.2666

Huseyin Cakal and Saeed Keshavarzi contributed equally to this work.

DATA AVAILABILITY STATEMENT

Full dataset is available from the authors upon request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

Full dataset is available from the authors upon request.

Articles from Journal of Community & Applied Social Psychology are provided here courtesy of Wiley

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