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. 2023 Feb 8;327:416–424. doi: 10.1016/j.jad.2023.02.029

The relationship between personal-job fit and physical and mental health among medical staff during the two years after COVID-19 pandemic: Emotional labor and burnout as mediators

Jing Wen a,1,2, Li Zou b,1,2, Ying Wang c, Yifang Liu a, Wenjing Li a, Zewei Liu a, Qian Ma a, Yang Fei a, Jing Mao a,3,⁎, Wenning Fu a,3,⁎
PMCID: PMC9907793  PMID: 36758870

Abstract

Background

In the context of the Corona Virus Disease 2019 (COVID-19) pandemic, research on personal-job fit and physical and mental health was inadequate. We aimed to explore the relationship between personal-job fit and physical and mental health among medical staff during the two years after COVID-19 pandemic and verify emotional labor and burnout as mediators.

Methods

A total of 2868 medical staff from two general hospitals, were included from July 3 to July 27, 2022, in Wuhan, China. SPSS was used for statistical description, and AMOS was used for structural equation modeling (SEM) to analyze the mediating effect of emotional labor and burnout.

Results

In the SEM, the total effect of personal-job fit on physical and mental health was significant (β = 0.855, 95 % CI: 0.748–0.972). The mediating effect of surface acting between personal-job fit and physical and mental health was significant (β = 0.078, 95 % CI: 0.053–0.110). The mediating effect of burnout was significant (β = 0.220, 95 % CI: 0.175–0.274), but the mediating effect of deep acting was not significant (β = 0.006, 95 % CI: −0.013–0.025). The chain mediating effect of surface acting or deep acting and burnout between personal-job fit and physical and mental health was significant (β = 0.082, 95 % CI: 0.059–0.108; β = 0.049, 95 % CI: 0.038–0.063).

Limitations

Owing to the cross-sectional study, causal relationship, and direction of effects among variables could not be determined.

Conclusions

Personal-job fit has significant direct and indirect effects on physical and mental health. Monitoring and intervening in personal-job fit, emotional labor, and burnout might be effective ways to promoting physical and mental health among medical staff during the COVID-19 pandemic.

Keywords: COVID-19, Personal-job fit, Emotional labor, Burnout, Health, Medical staff

1. Introduction

The Corona Virus Disease 2019 (COVID-19) pandemic has produced a global public health emergency, which has changed the culture of medical and posed unique challenges. During the COVID-19 pandemic, some previous studies confirmed that medical staff were exposed to multiple stressors from social, work, and personal sources that negatively affected their physical and mental health, a major public health event that needed to be addressed urgently (Khorasanee et al., 2021; Secosan et al., 2021; Yuan et al., 2022). According to job demands and resources model (JD-R model), personal-job fit could affect final outcomes of individuals and organizations (Demerouti and Bakker, 2011). In addition, physical and mental health among medical staff has been proved closely related to their job stress, organizational and personal resources, emotional labor, and burnout among previous surveys (Buruck and Haitsch, 2021; White et al., 2019; Zhang et al., 2020; Zhang et al., 2021). However, few studies have focus on the impact of personal-job fit on physical and mental health among medical staff as complex individuals with social attributes and explore the mechanisms and pathways in the context of major public health emergencies. Therefore, the present study aimed to explore the mediating effect of emotional labor and burnout in the association between personal-job fit and physical and mental health among medical staff during the two years after COVID-19 pandemic.

1.1. Personal-job fit and physical and mental health

Personal-job fit is defined as the abilities of organizations to provide employees with resources and rewards that meet their needs, and the abilities of individuals that match the requirements of the job, which consists of two dimensions: demand-supply fit and requirement-capability fit (Edwards, 2008; Edwards and Harrison, 1993). According to the JD-R model, firstly, job resources can provide medical staff with job feedback, learning and training opportunities, and career advancement and development, which could enhance positive work outcomes and alleviate the health depletion caused by job requirements. Secondly, when the demands of the job are high, medical staff must exert additional skill, cognitive and emotional effort to achieve their work goals, which obviously takes a physical and mental impairment (Bakker and Demerouti, 2017; Demerouti et al., 2001; Tummers and Bakker, 2021). The COVID-19 pandemic has had a negative impact on the well-being among medical staff. Since the beginning of the pandemic, medical staff have been highly exposed to shift work and their work schedules have become increasingly unpredictable. This could lead to symptoms of insomnia, anxiety, and depressive states, which could all be seen as a result of the high work demands associated with pandemic COVID-19 (Power et al., 2022; Zou et al., 2022). In addition, during the COVID-19 pandemic, medical staff have faced inadequate job resources such as insufficient protective resources, and salary reduction, which would also have a negative impact on their personal-job fit (Liu et al., 2021). Therefore, it is important to focus on improving the personal-job fit among medical staff to improve their physical and mental health and provide higher quality health care during major public health emergencies. In summary, the following hypothesis was proposed.

Hypothesis 1 (H1)

Personal-job fit would predict physical and mental health among medical staff.

1.2. Emotional labor as a mediator

Emotional labor is defined as the process by which employees adjust their emotional perceptions, feelings, and expressions of appropriate emotions to accomplish organizational goals (Grandey, 2000). Emotional labor is divided into two emotion regulation strategies: surface acting and deep acting. Surface acting involves the suppression of real emotions, or the simulation of spurious emotions to show a professional and reasonable response, such as the need for medical staff to smile and provide services despite excessive overtime during the COVID-19 pandemic. Deep acting involves self-induced “real” emotions, changing perceptions to access and express a truly felt emotion (Riley and Weiss, 2016). It was worth emphasizing that in the context of the COVID-19 pandemic, medical staff often engaged in more severe emotional labor behaviors (Choi and Hyun-Young, 2022). The reason for this was that it required a high level of effort on the part of the medical staff to not only role-play in their clinical work, but also to manage negative emotions and not reflect them on patients and others in the uncertain and problematic environment brought about by the COVID-19 pandemic (Buyukbayram and Gul, 2022). However, research on personal-job fit and emotional labor has been conducted mostly in the sales and service industry, and fewer studies have been conducted among medical staff. Therefore, it is important to pay attention to the emotional labor problems of medical staff in the context of the COVID-19 pandemic and to explore the impact pathway, which will help to improve the physical and mental health among medical staff. From the perspective of the JD-R model, personal-job fit is a resource generated by person-job related cognitive processes, and emotional labor is the process of emotional regulation and emotional expression that occurs during the interaction between medical staff and patients in the work environment. Hence, the mediated pathways proposed in this study was logically justified. Therefore, the following hypotheses were proposed.

Hypothesis 2 (H2)

The relationship between personal-job fit and physical and mental health would be mediated by surface acting.

Hypothesis 3 (H3)

The relationship between personal-job fit and physical and mental health would be mediated by deep acting.

1.3. Burnout as a mediator

Burnout is a psychological syndrome caused by prolonged reactions to job stressors and includes the following three dimensions: emotional exhaustion, cynicism, and reduced professional accomplishment (Maslach and Leiter, 2016; Maslach et al., 2001). According to the JD-R model, burnout occurs when demands outweigh resources, such as work overload or role conflict, or when there is a lack of autonomy and insufficient social support from leaders and colleagues (Edú-Valsania et al., 2022). Previous studies have shown that personal-job fit had a significant negative effect on job burnout, the lower the personal-job fit, the higher the level of burnout (Heo and Shin, 2012; Xu et al., 2015). Notably, studies investigating burnout during the COVID-19 pandemic have shown that medical staff experience high levels of mental health problems, including burnout (Fu et al., 2022; Sung, 2020; Ziabari et al., 2023). In addition, burnout can lead to a wide range of physical and mental health impairments, such as higher levels of burnout associated with sleep disturbances, back and neck pain, which may increase turnover intentions and reduce the quality of care delivery (Mat Rifin and Danaee, 2022; Tang et al., 2022). Despite this evidence, research on the relationship between personal-job fit and burnout among medical staff in the specific context of the COVID-19 pandemic remains limited. For medical staff, it is important to focus on the mediating effect of burnout between personal-job fit and physical and mental health during the COVID-19 pandemic, and timely interventions for medical staff can help reduce burnout and physical and mental health impairment due to pandemic-related stress and uncertainty. Accordingly, the following hypothesis was proposed.

Hypothesis 4 (H4)

The relationship between personal-job fit and physical and mental health would be mediated by burnout.

1.4. Chain mediator of emotional labor and burnout

In terms of the perspective of JD-R model, there are a series of potential factors in the organizational environment that bring stress to employees, which in turn have different psychological effects on employees (Bakker et al., 2003). In addition, personal-job fit included both job requirements and job resources, which was confirmed relate to emotional labor (Lam et al., 2018). Furthermore, some empirical studies have also shown that personal-job fit and emotional labor was associated with burnout and ultimately affect physical and mental health (Kwon et al., 2021; Lee et al., 2021; Tanner et al., 2022). Notably, previous studies failed to further measure the chain mediating effect of emotional labor and burnout in the relationship between personal-job fit and physical and mental health especially during the COVID-19 pandemic. Therefore, the purpose of present study was to investigate the mechanisms and pathways by which personal-job fit affects physical and mental health among medical staff. In conclusion, the following hypotheses were proposed.

Hypothesis 5 (H5)

The relationship between personal-job fit and physical and mental health would be serially mediated by surface acting and burnout.

Hypothesis 6 (H6)

The relationship between personal-job fit and physical and mental health would be serially mediated by deep acting and burnout.

Based on above hypotheses, the present study formulated the research theoretical model shown in Fig. 1 .

Fig. 1.

Fig. 1

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Research theoretical model.

2. Materials and methods

2.1. Design and participants

This was a cross-sectional design study conducted in Wuhan, China. The participants were medical staff working in two general hospitals in Wuhan, China. The inclusion criteria were the medical staff working as registered medical staff for 6 months or more and who volunteered to participate in present study. The medical staff not directly involved in patient treatment and care, such as hospital logistics staff, and non-hospital long-term stable medical staff, such as standardized training physicians and nurses, were excluded.

2.2. Measures

2.2.1. General information

A general demographic characteristics questionnaire was developed through a literature review, including gender, type of occupation, work department, and whether occupational exposure had occurred in the last year.

2.2.2. Personal-job fit

Personal-job fit was measured using the Personal-job Fit Scale developed by Cable and DeRue based on Edwards' definition of personal-job fit, with a Cronbach's alphas of 0.93 for demand-supply fit and 0.84 for requirement-capability in the original scale (Cable and DeRue, 2002; Edwards, 1996). The scale has 6 items with two dimensions, demand-supply fit (three items), requirement-capability fit (three items). Participants rated each item on a five-point Likert scale (1 = strongly disagree; 5 = strongly disagree). The total scores of personal-job fit were the sum of the scores for each item, with a high total score meaning a high level of personal-job fit. In addition, the Cronbach's alpha (reliability coefficient) in present study was 0.942.

2.2.3. Emotional labor

Emotional labor was evaluated using the Emotional Labor Scale compiled by Groth et al., with the satisfactory reliability (Groth et al., 2009). The scale includes two dimensions, surface acting and deep acting, with a total of 6 items, 3 items each for surface acting and deep acting. All participants were asked to rate on a five-point Likert scale (1 = strongly disagree; 5 = strongly disagree). The sum of the scores of each entry were the total scores of the scale, and higher final total scores indicated higher levels of emotional labor. In Chinese medical staff, the reliability of the Emotional Labor Scale have been validated with a Cronbach's alpha of 0.82 for surface acting and 0.90 for deep acting (Du, 2020). In present survey, the Cronbach's alpha (reliability coefficient) in current study was 0.851.

2.2.4. Burnout

Burnout was accessed using the Chinese version of the Maslach Burnout Inventory-General Survey (MBI-GS), with a Cronbach's alphas of 0.85 (Chirico and Leiter, 2022; Li and Shi, 2003). This scale is the only scale that contains three dimensions and is widely used to assess burnout among medical staff consisted of 15 items: emotional exhaustion (5 items), cynicism (4 items), and reduced personal accomplishment (6 items). Each item was rated on a seven-point Likert scale (0 = never; 6 = everyday). Items with reduced personal accomplishment were reverse scored. The total scores of burnout were the sum of the scores for each item, with higher total scores indicating the presence of more burnout. In current survey, the Cronbach's alpha (reliability coefficient) was 0.879.

2.2.5. Physical and mental health

Physical and mental health was surveyed using the 12-Item Short Form Health Survey (SF-12) developed by Ware et al., which based on the MOS 36-item Short-Form Health Survey (SF-36) reduced to 12 items (Ware et al., 1996). The scale consists of 12 items and contains two dimensions: physical health and mental health. All responses were rated on five-point Likert scale reverse scoring method, with higher total scores meaning a higher level of physical and mental health. The reliability and validity of the SF-12 have been validated with the Cronbach's alpha of 0.914 in the Chinese population (Huang et al., 2013). Moreover, the Cronbach's alpha (reliability coefficient) in present study was 0.970.

2.3. Data collection

This study was conducted from July 3 to July 27, 2022, in Wuhan, China. A total of 2868 medical staff were included in this survey. The data collection process in study consisted of two stages. In the first stage, two general hospitals in Wuhan, China, were randomly selected through a simple random sampling principle. In the second stage, researchers sent online questionnaires through the medical office and nursing department to medical staff at the two selected hospitals and explained the purpose of this study. All questionnaires were accomplished via an online survey platform (“SurveyStar”, Changsha Ranxing Science and Technology, Shanghai, China). To prevent receiving duplicate questionnaires, each Internet Protocol Address was eligible to fill out the questionnaire only once. At the same instant, we identified invalidly filled questionnaires by setting up intelligent logic checks in the questionnaire software. Two researchers independently checked the answers of all valid questionnaires and then the entry of these answers into the data file was performed automatically by the software.

2.4. Data analysis

The descriptive statistics, correlations, and the Cronbach's α coefficient of each variable in present study were analyzed using SPSS 26.0 (IBM, New York, NY, USA). Additionally, structural equation modeling (SEM) was executed to analysis the relationship between personal-job fit, emotional labor, burnout and physical and mental health using AMOS 26.0 (IBM, New York, NY, USA). We used means ± standard deviations (SD) to describe the scores of each scale, respectively and independent samples t-tests and one-way ANOVA to compare the differences of the scores of each scale between categorical variables. Moreover, Pearson correlation analysis was utilized for the correlation analysis among continuous variables, such as personal-job fit, emotional labor, burnout, and physical and mental health. To evaluate the significance of the mediating effects model, we used the bootstrapping procedure 5000 resamples and that we consider the effect to be significant when the 95 % confidence interval does not include zero. P values were calculated using two-tailed tests. To verify the model fit, we used multiple fit indices as follows: χ2 test (P < 0.05), χ2/df < 3, comparative fit index (CFI > 0.90), incremental fit index (IFI > 0.90), goodness of fit index (GFI > 0.90), Tucker-Lewis index (TLI > 0.90), and root mean square error of approximation (RMSEA <0.05) (Hu and Bentler, 1999).

2.5. Ethical statement

The study was conducted in accordance with the principles stated in the Declaration of Helsinki and was approved by the Research Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. The participation of the participants in this questionnaire was voluntary. Prior to completing the questionnaire, ensured that the electronic informed consent forms were available to all participants. Additionally, participant IDs were randomly assigned in this study survey to ensure anonymity.

3. Results

3.1. Characteristics of participants

Table 1 showed the characteristics of the participants as well as the mean, SD and univariate analysis of personal-job fit, emotional labor, burnout and physical and mental health. A total of 2868 medical staff members participated in present survey. 82.8 % of participants were female, 78 % of participants were nurses, and 15.7 % of participants had experienced occupational exposure in the past nearly one year. Notably, differences in personal-job fit, emotional labor, burnout, and physical and mental health scores were significant among medical staff by gender and whether occupational exposure occurred. In addition, differences in emotional labor, burnout, and physical and mental health scores were significant between type of occupation, with scores among nurses significantly higher in emotional labor and burnout and significantly lower in physical and mental health than doctors and others.

Table 1.

Demographic characteristics of the participants and univariate analysis for the research variables.

Variables Total (N = 2868)
 Personal-job fit
 Emotional labor
 Burnout
 Physical and mental health
n % M ± SD P M ± SD P M ± SD P M ± SD P
Sex
Male 492 17.2 20.26 ± 4.68 0.028⁎ 14.76 ± 3.90 0.001⁎⁎ 36.94 ± 11.83 0.141 47.89 ± 7.61 0.000⁎⁎⁎
Female 2736 82.8 19.72 ± 5.02 16.58 ± 4.47 37.92 ± 13.87 42.63 ± 9.31



Type of occupation
Physician 569 19.8 20.03 ± 4.78 0.062 15.07 ± 4.30 0.000⁎⁎⁎ 36.80 ± 12.67 0.024⁎ 46.35 ± 8.12 0.000⁎⁎⁎
Nurse 2238 78 19.72 ± 5.02 16.58 ± 4.41 38.08 ± 13.71 42.77 ± 9.37
Others 61 2.1 21.05 ± 4.73 15.87 ± 4.54 34.61 ± 14.74 45.20 ± 9.95



Department
Department of internal Medicine 718 25 19.94 ± 4.80 0.245 16.27 ± 4.48 0.156 38.00 ± 13.70 0.319 43.22 ± 9.12 0.317
Surgical department 668 23.3 19.96 ± 5.11 15.98 ± 4.50 37.43 ± 13.10 44.20 ± 9.28
Emergency Department 70 2.4 18.64 ± 4.46 15.91 ± 4.36 39.77 ± 12.05 43.33 ± 9.07
Department of Intensive Care Medicine 197 6.9 19.62 ± 4.70 16.02 ± 4.33 39.10 ± 12.23 43.43 ± 9.12
Others 1215 42.4 19.75 ± 5.06 16.48 ± 4.37 37.46 ± 13.97 43.37 ± 9.36



Occupational exposure
Yes 449 15.7 15.57 ± 3.71 0.000⁎⁎⁎ 19.86 ± 3.98 0.000⁎⁎⁎ 51.12 ± 9.55 0.000⁎⁎⁎ 38.35 ± 10.06 0.000⁎⁎⁎
No 2419 84.3 20.60 ± 4.77 15.60 ± 4.18 35.27 ± 12.70 44.49 ± 8.77
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Notes: M: mean; SD: standard deviation.

⁎

P < 0.05.

⁎⁎

P < 0.01.

⁎⁎⁎

P < 0.001.

3.2. Bivariate associations among research variables

Table 2 showed the results of the Pearson correlation analysis between personal-job fit, emotional labor, burnout and physical and mental health. In the research variables, personal-job fit was significantly positively correlated to deep acting (r = 0.244, p < 0.001) and physical and mental health (r = 0.230, p < 0.001), and negatively correlated to surface acting (r = −0.158, p < 0.001) and burnout (r = −0.421, p < 0.001). Surface acting was significantly positively correlated to deep acting (r = 0.175, p < 0.001) and burnout (r = 0.415, p < 0.001), and negatively correlated to physical and mental health (r = −0.428, p < 0.001). Deep acting was significantly positively correlated to physical and mental health (r = 0.067, p < 0.001), and negatively correlated to burnout (r = −0.291, p < 0.001). Burnout was significantly negatively correlated to physical and mental health (r = −0.532, p < 0.001).

Table 2.

The Pearson correlations between personal-job fit, emotional labor, burnout and physical and mental health.

Correlation 1 2 3 4 5 6 7 8 9 10 11 12 13
1. Total scale of personal-job fit 1
2. Demand-supply fit 0.862⁎⁎⁎ 1
3. Requirement-capability fit 0.844⁎⁎⁎ 0.524⁎⁎⁎ 1
4. Total scale of emotional labor 0.086⁎⁎⁎ 0.100⁎⁎⁎ 0.053⁎⁎⁎ 1
5. Surface acting −0.158⁎⁎⁎ −0.083⁎⁎⁎ −0.188⁎⁎⁎ 0.702⁎⁎⁎ 1
6. Deep acting 0.244⁎⁎⁎ 0.204⁎⁎⁎ 0.222⁎⁎⁎ 0.852⁎⁎⁎ 0.175⁎⁎⁎ 1
7. Total scale of burnout −0.421⁎⁎⁎ −0.328⁎⁎⁎ −0.404⁎⁎⁎ 0.028⁎⁎⁎ 0.415⁎⁎⁎ −0.291⁎⁎⁎ 1
8. Emotional exhaustion −0.240⁎⁎⁎ −0.203⁎⁎⁎ −0.216⁎⁎⁎ 0.119⁎⁎⁎ 0.401⁎⁎⁎ −0.153⁎⁎⁎ 0.828⁎⁎⁎ 1
9. Cynicism −0.325⁎⁎⁎ −0.243⁎⁎⁎ −0.322⁎⁎⁎ 0.130⁎⁎⁎ 0.456⁎⁎⁎ −0.183⁎⁎⁎ 0.856⁎⁎⁎ 0.787⁎⁎⁎ 1
10. Reduced professional accomplishment −0.424⁎⁎⁎ −0.321⁎⁎⁎ −0.415⁎⁎⁎ −0.142⁎⁎⁎ 0.173⁎⁎⁎ −0.334⁎⁎⁎ 0.707⁎⁎⁎ 0.234⁎⁎⁎ 0.355⁎⁎⁎ 1
11. Total scale of physical and mental health 0.230⁎⁎⁎ 0.130⁎⁎⁎ 0.267⁎⁎⁎ −0.198⁎⁎⁎ −0.428⁎⁎⁎ 0.067⁎⁎⁎ −0.532⁎⁎⁎ −0.576⁎⁎⁎ −0.543⁎⁎⁎ −0.189⁎⁎⁎ 1
12. Physical health 0.270⁎⁎⁎ 0.149⁎⁎⁎ 0.315⁎⁎⁎ −0.174⁎⁎⁎ −0.367⁎⁎⁎ 0.051⁎⁎⁎ −0.468⁎⁎⁎ −0.481⁎⁎⁎ −0.473⁎⁎⁎ −0.193⁎⁎⁎ 0.874⁎⁎⁎ 1
13. Mental health 0.176⁎⁎⁎ 0.101⁎⁎⁎ 0.202⁎⁎⁎ −0.187⁎⁎⁎ −0.412⁎⁎⁎ 0.069⁎⁎⁎ −0.504⁎⁎⁎ −0.562⁎⁎⁎ −0.517⁎⁎⁎ −0.162⁎⁎⁎ 0.952⁎⁎⁎ 0.683⁎⁎⁎ 1
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⁎⁎⁎

P < 0.001.

3.3. Direct effects among variables

The SEM analysis results for direct effects between personal-job fit, surface acting, deep acting, burnout, and physical and mental health were shown in Fig. 2 . Personal-job fit had an insignificant positive effect on physical and mental health (β = 0.062, SE = 0.040, p = 0.124), and a significant negative effect on burnout (β = −0.784, SE = 0.070, p < 0.001). Meanwhile, personal-job fit had a significant negative effect on surface acting (β = −0.305, SE = 0.032, p < 0.001) and a significant positive effect on deep acting (β = 0.531, SE = 0.042, p < 0.001). In addition, surface acting had a significant positive effect on burnout (β = 0.955, SE = 0.042, p < 0.001), and deep acting had a significant negative effect on burnout (β = −0.328, SE = 0.031, p < 0.001). Moreover, surface acting had a significant negative effect on physical and mental health (β = −0.255, SE = 0.024, p < 0.001), and deep acting had a significant positive effect on physical and mental health (β = 0.010, SE = 0.018, p < 0.001). Finally, burnout had a significant negative effect on physical and mental health (β = −0.280, SE = 0.014, p < 0.001).

Fig. 2.

Fig. 2

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The mediating effect of emotional labor and burnout in the relationship between personal-job fit and physical and mental health.

3.4. Total effect and mediating effects among variables

Table 3 presented bootstrapping effects and 95 % confidence interval for the total effect model and indirect effect model. The results indicated that personal-job fit was positively related to physical and mental health, consistent with Hypothesis 1, with the total effect of 0.855 (95 % CI: 0.748–0.972, p < 0.001). However, emotional labor and burnout played fully mediating roles in the mediation model. In Hypothesis 2, there was a significant mediation effect of personal-job fit on physical and mental health through surface acting with the indirect effect of 0.078 (95 % CI: 0.053–0.110, p < 0.001). In Hypothesis 3, there was an insignificant mediation effect of personal-job fit on physical and mental health through deep acting with the indirect effect of 0.006 (95 % CI: −0.013–0.025, p = 0.541). In Hypothesis 4, there was a significant mediation effect of personal-job fit on physical and mental health through burnout with the indirect effect of 0.220 (95 % CI: 0.175–0.274, p < 0.001). In Hypothesis 5, personal-job fit and physical and mental health had a significant chain mediating effect between surface acting and burnout. The indirect effect was 0.082 (95 % CI: 0.059–0.108, p < 0.001). In Hypothesis 6, personal-job fit and physical and mental health had a significant chain mediating effect between deep acting and burnout. The indirect effect was 0.049 (95 % CI: 0.038–0.063, p < 0.001).

Table 3.

Total and indirect effects of personal-job fit on physical and mental health.

Effects Hypothesis β SE 95 % CI
LL UL
Total H1: personal-job fit → physical and mental health 0.855⁎⁎⁎ 0.057 0.748 0.972
Indirect H2: personal-job fit → surface acting → physical and mental health 0.078⁎⁎⁎ 0.014 0.053 0.110
H3: personal-job fit → deep acting → physical and mental health 0.006 0.010 −0.013 0.025
H4: personal-job fit → burnout → physical and mental health 0.220⁎⁎⁎ 0.025 0.175 0.274
H5: personal-job fit → surface acting → burnout → physical and mental health 0.082⁎⁎⁎ 0.012 0.059 0.108
H6: personal-job fit → deep acting → burnout → physical and mental health 0.049⁎⁎⁎ 0.006 0.038 0.063
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Notes: LL: lower confidence limit; UL: upper confidence limit.

⁎⁎⁎

P < 0.001.

3.5. Structural model analysis

Seven indicators of χ2 test, χ2/df, CFI, IFI, GFI, TLI, and RMSEA were used to appraise the overall goodness for the structural model fit of this study. P value of χ2 test was 0.008, the value of χ2/df was 2.48, the value of CFI was 0.999, the value of IFI was 0.999, the value of GFI was 0.998, the value of TLI was 0.994, and the value of RMSEA was 0.023. These indicators were within the acceptable range; thus, the structural model analysis indicated a good fit.

4. Discussion

Overall, this study is the first to investigate the relationship between personal-job fit and physical and mental health, and the mediating roles of emotional labor and burnout among Chinese medical staff based on JD-R model during the two years after COVID-19 pandemic. The results revealed that personal-job fit among medical staff was positively related to their physical and mental health in the context of major public health emergencies. Additionally, the results of present study indicated that surface acting, deep acting, and burnout played fully mediating roles in the relationship between personal-job fit and physical and mental health. In this study, we sought to promote the physical and mental health among medical staff by identifying the predictive role and impact pathways of personal-job fit, emotional labor, and burnout in the context of the COVID-19 pandemic.

In the present study, a significant positive effect was found by exploring the relationship between personal-job fit and physical and mental health among medical staff during the two years after COVID-19 pandemic, suggesting that medical staff with higher personal-job fit were in better physical and mental health, which support Hypothesis 1 of our study. This could be explained by the health attrition process and the incentive process in the JD-R model, when the requirement-capability fit is low, the job requirements require effort or appropriate skills from the medical staff, and in turn, the medical staff would bear a degree of physical or psychological cost that compromises physical and mental health. In addition, when the demand-supply fit is high, work resources play the role of intrinsic and extrinsic motivation, allowing medical staff to feel the joy of work, promote learning, growth, and development, and give them enough resources to achieve their work goals, thus promoting their physical and mental health (Demerouti and Bakker, 2022; Schaufeli et al., 2009). In the context of the COVID-19 pandemic, medical resources were facing severe supply and demand constraints, and many medical staff were faced with overloaded work demands and work intensity, all of which could lead to a reduction in their personal-job fit (Parvaresh-Masoud et al., 2021). Therefore, any measures to improve personal-job fit during major public health emergencies are beneficial in promoting the physical and mental health of medical staff.

In the SEM, it was worth noting that the parallel and chained mediating effects of surface acting, deep acting and burnout played fully mediating roles between personal-job fit and physical and mental health. On the one hand, the results of the SEM confirmed that emotional labor mediated the relationship between personal-job fit and physical and mental health among medical staff. Specifically, a higher level of personal-job fit was associated with a lower level of surface acting, then serving to improve physical and mental health of medical staff, and that a higher level of personal-job fit was associated with a higher level of deep acting which could serve to promote physical and mental health of medical staff, but this mediating effect path was not significant. According to Gross's model of the emotion regulation process, the surface acting used more masking or suppression of real feelings to express the desired emotion, increasing the gap between inner emotional experience and outer emotional expression (Gross, 1998). In the context of the COVID-19 pandemic, the emotional labor burden of medical staff was high, and medical staff were required to undertake tasks related to pandemic prevention in addition to their normal work. Therefore, medical staff need to play more superficially to suppress their real inner emotions such as fatigue, irritability to show a professional and reasonable response. The process of surface acting by medical staff required mental effort and depletion of resources received from the organization, resulting in a mediating effect pathway of personal-job fit influencing surface acting to further impact physical and mental health. However, the results of this study indicated that the mediating role of deep acting was not significant. This might be due to the fact that deep acting referred to the way in which medical staff both adjusted their internal emotions and changed their external emotional expressions when their feelings did not match the emotions that the organization required them to express. This allowed medical staff to go through the process of moving from emotional ambivalence to emotional congruence, and although their emotional ambivalence would have a passive outcome on their physical and mental health, they were ultimately able to achieve inner peace and comfort by self-adjusting to the emotions required by the organization (Grandey, 2015). It was possible that this complex mechanism contributed the mediating role of deep performances insignificant.

On the other hand, the present study findings provided support for a mediation effect of burnout between personal-job fit and physical and mental health among medical staff. Specifically, a higher level of personal-job fit was associated with a lower level of burnout, then serving to promote physical and mental health among medical staff. According to JD-R model, high job demands and low organization and/or personal resources could lead to burnout, and that this situation may be exacerbated during the COVID-19 pandemic, which was consistent with present study findings (Bakker et al., 2004; Demerouti et al., 2001). Moreover, these findings were compliance with previous studies, which confirmed that the health status among medical staff could be compromised to varying degrees when coping with a high level of burnout (Hall et al., 2016; Ruisoto et al., 2021). In our view, the current situation of pandemic prevention and control in China was still very serious, and medical staff long-term suffered more pressure such as isolation, overtime work, doctor-patient relationship tension, and lower salary, which might reduce their personal-job fit and make them more prone to burnout during the two years after COVID-19 pandemic, thus negatively impacting their physical and mental health.

In the chain mediating effect pathway of surface acting and burnout, consistent with Hypothesis 5. The result of present study confirmed that there was a chain mediating role of surface acting and burnout between personal-job fit and physical and mental health. Some previous studies related to personal-job fit and emotional labor has indicated that individuals alleviated emotional exhaustion by increasing their personal-job fit, and then avoid the surface acting against true thoughts, consuming more resources and thus creating burnout (Grandey, 2000; Seo and Jeong, 2020). Medical staff would face more uncertainty and problems after the COVID-19 pandemic outbreak (Buyukbayram and Gul, 2022). Therefore, it is particularly important to improve personal-job fit and reduce surface acting and burnout in the context of the COVID-19 pandemic. When the needs of medical staff were better matched with organizational supply and personal capabilities could meet job requirements, medical staff would be more inclined to express their true feelings, avoiding surface acting and helping them to adopt effective way to cope with burnout (Bartram et al., 2012). Medical staff with a lower level of surface acting were more likely to focus on adopting a positive approach to their work, reducing their experience of burnout at work, which would be more beneficial to their physical and mental health status and could be become a virtuous circle in the context of a major public health emergency (Akin et al., 2014).

In addition, current study found a chain mediating role of deep acting and burnout between personal-job fit and physical and mental health, which was consistent with Hypothesis 6. Medical staff who were personally aligned with the needs and job requirements of the organization were likely to have a more positive attitude toward their work and made a conscious effort to internalize the emotions required by the organization (Oh et al., 2014). Moreover, research related to emotional labor have proposed that deep acting means that medical staff can adapt to the uncertainties and circumstances during the COVID-19 pandemic by adjusting their true feelings and understanding, such as the possibility of being infected, longer working hours, and lower pay and income (Pace et al., 2022). This behavior of aligning internal feelings with external emotional expressions promotes the ability of medical staff to manage their emotions at work and appropriately consume fewer physical and mental resources, thus alleviating their burnout in the delivery of healthcare services (Hong et al., 2008; Lin et al., 2022). Suffering from lighter burnout among medical staff might lead to higher job satisfaction, a positive coping style to work and life, and the promotion of their physical and mental health.

Based on above discussion, the following recommendations for promoting the health among medical staff during major public health emergencies were presented for reference. For hospital organizations and administrators, they were suggested to pay more attention to personal-job fit among medical staff and provide more organizational support and resources which can improve their personal resources and fit with organization. Furthermore, programs targeted at enhancing emotional management and coping style of burnout among medical staff might be useful to reduce the physical and mental health impairments, especially during the COVID-19 pandemic. For medical staff, they were advised to confront their emotions, whether positive or negative, and to handle and release negative emotions appropriately to avoid burnout and health damage.

We acknowledge that there are several limitations of present study should be considered in interpreting the results. Firstly, the representativeness of the sample has certain limitations because a simple random sampling principle was used to select on two general hospitals and female nurses were most participants. Even though the preponderance of female nurses in the medical staff is a phenomenon across the healthcare industry, future studies could consider proportion of physicians and nurses and proportion of sex to improve the representativeness of the sample. Furthermore, sex could be considered as a moderating variable in the mediation model to better interpret the results in future studies. Secondly, since this is a cross-sectional study, causal relationship, and direction of effects among variables could not be determined. Thus, it is proposed that longitude studies be performed to explore the mediation effects in the future.

Despite these limitations, several highlights of present study are noteworthy. To the best of our current knowledge, this study is the first large sample study to include 2868 medical staff and reveals the mechanisms and pathways by which personal-job fit affects the physical and mental health among medical staff during the two years after COVID-19 pandemic. Secondly, this study verifies the fully mediated role of emotional labor and burnout as well, which might provide stronger and more reliable evidence on the factors and mechanisms that influence physical and mental health among medical staff. Thirdly, this study has theoretical and practical implications, which lays the foundation for future studies and provides a direction for future health interventions for medical staff. More specifically, present study suggests that qualitative studies could be conducted to obtain more inner process about emotional labor and burnout among medical staff especially during the COVID-19 pandemic and that future interventions might be implemented in terms of improving organizational resources and enhancing emotion regulation.

5. Conclusions

The present study confirmed a significant positive association between personal-job fit and physical and mental health among medical staff during the two years after COVID-19 pandemic based on JD-R model, and emotional labor and burnout played a mediating role, which filled the gap in the Chinese cultural context. Specifically, this could contribute an important empirical reference value for promoting measures of physical and mental health among medical staff during major public health emergencies. In particular, improving personal-job fit, enhancing deep acting, and reducing surface acting and burnout might be an entry point for subsequent research and interventions to improve the physical and mental health among medical staff.

Ethics statement

All methods in this study were conducted in accordance with the principles stated in the Declaration of Helsinki. This study was approved by the Research Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Informed consent was obtained from all participants.

Funding

This study was supported by the National Natural Science Foundation of China (Grant. 72104082), and the Program of Excellent Doctoral (Postdoctoral) of Zhongnan Hospital of Wuhan University (Grant. ZNYB2021003), and Innovation and Entrepreneurship Training Program for University Students of Huazhong University of Science and Technology (Grant. 2022A002), and Innovation and Entrepreneurship Training Program for Students of Hubei Province (Grant. S202210487184).

CRediT authorship contribution statement

Jing Wen: Conceptualization, Investigation, Formal analysis, Writing – original draft, Writing – review & editing. Li Zou: Investigation, Data curation, Methodology, Writing – review & editing. Ying Wang: Conceptualization, Methodology, Writing – original draft. Yifang Liu: Investigation, Formal analysis, Writing – review & editing. Wenjing Li: Data curation. Zewei Liu: Data curation. Qian Ma: Data curation. Yang Fei: Formal analysis, Methodology. Jing Mao: Conceptualization, Methodology, Writing – review & editing. Wenning Fu: Methodology, Formal analysis, Data curation, Writing – review & editing.

Conflict of interest

The authors declare that they have no competing interests.

Acknowledgments

Acknowledgement

We thank the participants of the survey and all medical staff involved in this study for their painstaking efforts in conducting the data collection.

Availability of data and materials

Some of the data and materials used in this study can be obtained from the corresponding author (Wenning Fu).

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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

Some of the data and materials used in this study can be obtained from the corresponding author (Wenning Fu).

Articles from Journal of Affective Disorders are provided here courtesy of Elsevier

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