title: The mediating effects of burnout on the relationship between anxiety symptoms and occupational stress among community healthcare workers in China: a cross-sectional study.
abstract: BACKGROUND
  Several occupational stress studies of healthcare workers have predicted a high prevalence of anxiety symptoms, which can affect their quality of life and the care that they provide. However, few studies have been conducted among community healthcare workers in China. We attempted to explore whether burnout mediates the association between occupational stress and anxiety symptoms.
  
  
  METHODS
  A cross-sectional survey was completed in Liaoning Province, China from November to December 2012. A total of 1,752 healthcare workers from 52 Community Health Centers participated in this study, and all participants were given self-administered questionnaires. These questionnaires addressed the following aspects: the Zung Self-Rating Anxiety Scale, the Chinese version of the effort-reward imbalance scale and the Maslach Burnout Inventory-General Survey. Finally, the study included 1,243 effective respondents (effective response rate, 70.95%). Hierarchical linear regression analysis, performed with SPSS 17.0, was used to estimate the effect of burnout.
  
  
  RESULTS
  The prevalence of anxiety symptoms among the community healthcare workers was 38.0%. After adjusting for demographic characteristics, the effort-reward ratio and overcommitment positively predicted anxiety symptoms. Meanwhile, the effort-reward ratio and overcommitment were positively related to the emotional exhaustion and cynicism subscales of burnout. In addition, the emotional exhaustion and cynicism subscales were positively related to anxiety symptoms. Thus, there is a link between burnout, occupational stress and anxiety symptoms.
  
  
  CONCLUSIONS
  Burnout mediates the effect of occupational stress on anxiety symptoms. To effectively reduce the impact of occupational stress on anxiety symptoms, burnout management should be considered.
authors.affiliation: Department of General Practice, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China.
authors.forename: Yanwei
authors.initials: Y
authors.lastname: Ding
authors.affiliation: Department of General Practice, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China.
authors.forename: Jianwei
authors.initials: J
authors.lastname: Qu
authors.affiliation: Department of General Practice, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China.
authors.forename: Xiaosong
authors.initials: X
authors.lastname: Yu
authors.affiliation: Department of General Practice, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China.
authors.forename: Shuang
authors.initials: S
authors.lastname: Wang
mesh_terms: D001008:Anxiety Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology* / Q000523:psychology; D002681:China; D003150:Community Health Workers / Q000523:psychology*; D003430:Cross-Sectional Studies; D006801:Humans; D008603:Mental Health / Q000592:standards; D010820:Physicians / Q000523:psychology; D011788:Quality of Life; D013315:Stress, Psychological / Q000453:epidemiology* / Q000473:pathology; D011795:Surveys and Questionnaires