The relationship between career adaptability, decent work, job satisfaction and burnout among psychiatrists: a cross-sectional study | BMC Psychiatry

Design

This study employed a cross-sectional survey design, and the research process was meticulously described following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.

Participants

Convenience sampling was conducted in February 2024, focusing on psychiatrists working in three public psychiatric hospitals—two located in Zhejiang Province, with approximately 1,600 employees each, and one in the Xinjiang Uygur Autonomous Region, which has around 400 employees.

This study used G-Power 3.196 for sample size analysis, employing a multivariate regression approach. According to Cohen’s convention, an effect size of 0.02 is considered small, 0.15 medium, and 0.35 large in the context of multiple regression analyses. In the absence of prior empirical data to determine the effect size, a medium effect size of 0.15 was adopted as a reasonable and widely accepted default [28]. The effect size was set at 0.15, with a significance level (α) of 0.05 and a desired power (1 – β error probability) of 0.95. The study included 19 variables: 6 sociodemographic characteristics and 13 dimensions related to the scales. The calculations indicated a minimum of 217 psychiatrists, accounting for a 20% invalid questionnaire rate; therefore, the study aimed to include at least 260 psychiatrists.

Inclusion criteria were: (1) registered psychiatrists; (2) at least one year of clinical psychiatric experience; and (3) willingness to provide informed consent for participation.

Exclusion criteria were: (1) medical interns; (2) a history of psychiatric disorders; and (3) physicians on leave (sick, maternity, or vacation leave) during the survey period.

The electronic questionnaire was distributed to 644 psychiatrists via institutional communication channels. A total of 556 psychiatrists accessed the survey Link and completed the questionnaire. After excluding 40 invalid responses, 516 questionnaires were collected, resulting in an effective response rate of 92.8%.

Instruments

Demographic information

The study used a general demographic questionnaire based on previous similar research, including key demographic factors such as gender, age, education level, years of work experience, professional title, and marital status.

Career adapt-abilities

This study used the Career Adapt-Abilities Scale (CAAS) to measure the career adaptability of psychiatrists. Developed by Savickas [8], the scale was translated and cross-culturally adapted by Chinese scholars [29]. It was tested and cross-culturally calibrated among 296 university students from three universities in Shanghai, China, demonstrating good reliability and validity. The Chinese version retained the original four-dimensional structure ensuring strong cross-cultural equivalence with the international form. Confirmatory factor analyses further supported the structural consistency between the Chinese and international models. The scale includes four dimensions—concern (items 1–6), control (items 7–12), curiosity (items 13–18), and confidence (items 19–24)—for a total of 24 items. Each item is rated on a 5-point Likert scale from 1 (“not strong”) to 5 (“very strong”), with examples such as “Thinking about what my future will be like” and “Realizing that today’s choices shape my future.” The total score ranges from 24 to 120, with higher scores indicating greater career adaptability. The fit indices from the confirmatory factor analysis were χ²/df = 4.863, GFI = 0.830, NFI = 0.916, IFI = 0.932, TLI = 0.923, and RMSEA = 0.087. In this study, the Cronbach’s α coefficient for the scale was 0.976. The Cronbach’s α coefficients for the subscales were: concern = 0.936, control = 0.939, curiosity = 0.945, and confidence = 0.950.

Decent work perception

This study used the Decent Work Perception Scale (DWPS) to assess the perception of decent work among psychiatrists. The reliability and validity of the DWPS, developed by Chinese scholars, have been validated and it has been previously applied among nurses [16, 30]. The scale includes five dimensions—Work Rewards, Work Position, Work Atmosphere, Work Development, and Work Recognition—with a total of 16 items. Responses were rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). For example, “The organization provides me with generous benefits” and “I often need to work overtime”. Scores on the scale range from 16 to 80, with higher scores indicating a greater perception of work decency. The fit indices of the confirmatory factor analysis were χ²/df = 3.364, GFI = 0.928, NFI = 0.946, IFI = 0.962, TLI = 0.950, and RMSEA = 0.068. In this study, the Cronbach’s α coefficient for the DWPS was 0.941. The Cronbach’s α coefficients for the subscales were: Work Rewards = 0.864, work position = 0.705, work atmosphere = 0.842, work development = 0.915, and work recognition = 0.857.

Job satisfaction

This study used the Chinese version of the Minnesota Satisfaction Questionnaire (MSQ) to assess the job satisfaction of psychiatrists. The questionnaire, developed by Weiss, underwent translation and validation by Chinese scholars [31, 32]. The Scale and has been widely applied in hospital-based samples, including nurses, physicians, and administrators in China. It comprises three dimensions—intrinsic satisfaction, extrinsic satisfaction, and general satisfaction—with a total of 20 items. Responses were rated on a 5-point Likert scale ranging from “1” (very dissatisfied) to “5” (very satisfied), for example, “The feeling of accomplishment I get from the job.” The total score ranges from 20 to 100, with higher scores indicating greater job satisfaction. In this study, the MSQ had a Cronbach’s α coefficient of 0.972. The Cronbach’s α coefficients for the subscales were: extrinsic satisfaction = 0.928, intrinsic satisfaction = 0.963.

Burnout

This study used the Maslach Burnout Inventory-General Survey (MBI-GS) to investigate burnout among psychiatrists. Developed by Maslach and cross-culturally validated by Li [33, 34], the Chinese version used in this study was adapted through a rigorous process including independent translation, expert discussion, back-translation, and confirmation by one of the original developers, Michael Leiter. The MBI comprises three subscales: emotional exhaustion (items 1–5), depersonalization (items 6–9), and personal accomplishment (items 10–15), totaling 15 items. Each item is rated on a 7-point Likert scale ranging from 0 (never) to 6 (daily), for example, “Work makes me feel physically and mentally exhausted”. Higher scores on the emotional exhaustion and depersonalization subscales indicate greater levels of burnout. The personal accomplishment subscale is reverse-scored. A higher total score reflects higher levels of burnout among psychiatrists. The fit indices of the confirmatory factor analysis were χ²/df = 3.430, GFI = 0.928, NFI = 0.962, IFI = 0.973, TLI = 0.966, and RMESA = 0.069. The Cronbach’s α coefficients for the subscales were: emotional exhaustion = 0.950, depersonalization = 0.930, and personal accomplishment = 0.831.

Data collection

The research team, based on previous studies and a literature review, first identified the key variables and conceptual framework, then developed and revised the questionnaire items based on these variables. The questionnaire mainly consisted of three sections: the introduction, which detailed the research background, objectives, and potential risks and benefits; the informed consent section; and the main body of the questionnaire. After discussions with two organizational psychology experts and one psychiatric manager, minor revisions were made, resulting in the initial version of the questionnaire. We then sent the questionnaire to 10 psychiatrists for testing to ensure its clarity and logical structure. Based on their feedback, the wording of the introductory instructions was revised, while the content of the measurement items remained unchanged. The survey was implemented through an online platform. Before the study began, we conducted a 48-minute online training session, which provided a detailed introduction to the research background, objectives, questionnaire content, and clarified the informed consent and introduction process. The researchers distributed the questionnaire link to the team members responsible for data collection in their respective regions and standardized the introduction. Finally, data collection was conducted using the Wenjuanxing platform. The data were independently reviewed by two research team members to ensure the accuracy of data entry.

Statistical analysis

This study used IBM SPSS Statistics 26.0 and the PROCESS macro for rigorous statistical analysis. Harman’s single-factor test was utilized to assess common method bias. Descriptive statistics were used to present categorical variables as frequencies and percentages, and continuous variables were summarized using means and standard deviations in the demographic data of psychiatrists. This study used IBM SPSS Statistics 26.0 and the PROCESS macro for rigorous statistical analysis. Harman’s single-factor test was utilized to assess common method bias. Descriptive statistics were used to present categorical variables as frequencies and percentages, and continuous variables were summarized using means and standard deviations in the demographic data of psychiatrists. Before conducting the analysis, we confirmed the normality of the variables using Q-Q plots and checked the linearity assumption using scatter plots. Pearson correlation analysis was used to explore the relationships between career adaptability, decent work, job satisfaction, and burnout. Mediation analyses were conducted using PROCESS v4.0. Bootstrap resampling with 5,000 samples was used for mediation analysis, and a 95% confidence interval evaluated the significance of path coefficients, with a significance level set at p < 0.05. Additionally, AMOS 28.0 software was used for confirmatory factor analysis and structural equation modeling (SEM) path analysis in this study.