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Cited by 33COVID-19 and Mental HealthMindfulness and Compassion InterventionsOccupational Health and Burnout

Mental fatigue and negative emotion among nurses during the COVID-19 pandemic

Open access
Wang, Difan, Xie, Xinjie, Tian, Huiyi, Wu, Tong, Liu, Chenjie, Huang, Ke, Gong, Rufang, Yu, Yaqun +3 more·2022·Current Psychology
DOI 10.1007/s12144-022-03468-2PMC PMC9285871
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Abstract

COVID-19 is a major public health event affecting the people worldwide. Nurses are still under immense psychological pressure. This study aimed to explore the relationship between mental fatigue and negative emotions among frontline medical staff during the COVID-19 pandemic. The study was conducted in August 2020, which included 419 medical staff between 17 to 28 years. The Fatigue Scale, Multidimensional Mental Flexibility Questionnaire, Cognitive Fusion Scale, and Depression-Anxiety-Stress Brief Version Scale were used. During the data collection period, the pandemic was under control in China and continued worldwide. The results indicated that 27.7% of the medical staff experienced depression, and 32.3% of them feel stressed. Specifically, first, correlation analyses showed significant positive pairwise correlations between mental fatigue, psychological inflexibility, cognitive fusion, and negative emotions among nurses. Second, mediation model tests showed statistically significant mediating effects of psychological inflexibility and cognitive fusion between mental fatigue on nurses' negative emotions, and statistically, significant chain mediating effects of psychological inflexibility and cognitive fusion. Mental fatigue indirectly affects nurses' negative effects through the mediating effects of psychological inflexibility, cognitive fusion, and the chain mediating effects of psychological inflexibility and cognitive fusion, respectively. the negative effects of mental fatigue come from impairment of cognitive functioning, and interventions using acceptance and commitment therapy for mental fatigue and negative emotions are more effective since both psychological inflexibility and cognitive fusion are important components of the therapy. © 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Integrity signals

Registry

Crossref · 10.1007/s12144-022-03468-2

Cites

39 of 40 references verified0 citation errors · 1 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

6 of 14 cited sources checked · 3 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    High cognitive fusion is linked to worse emotion regulation, including mood disorders.

    “excessive cognitive fusion implies poorer emotion regulation, such as mood disorders (Wersebe et al., 2018).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Wersebe et al., 2018 source

      The Measures section lists defusion as one component of psychological flexibility, and the Results link increased psychological flexibility to improved emotional well-being during the intervention. Neither passage establishes that high cognitive fusion is linked to poorer emotion regulation or mood disorders. Searches for cognitive fusion and emotion regulation found no passage addressing that specific link. (LLM, conf=0.72)

      Experimental — accuracy not yet measured
  • Premisecitation

    In a Spanish COVID-19 study, psychological inflexibility forecast changes in mental health.

    “A Spanish study during the COVID-19 pandemic showed that psychological inflexibility predicted changes in mental health (Hernández-López et al., 2021).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Hernández-López et al., 2021 source
  • Premisecitation

    Cognitive fusion predicts stress, depression, and anxiety indicators.

    “The predictive role of cognitive fusion on psychopathological indicators of stress, depression, and anxiety has been demonstrated in previous studies (Bramwell & Richardson, 2018)”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Bramwell & Richardson, 2018 source

      The Results (Bivariate Correlations; page unavailable) report that changes in cognitive fusion correlated with changes in depression and overall distress. The Methods (Statistical Analysis; page unavailable) say the sample was too small for regression, and the Discussion proposes examining individual distress subscales in future work. The paper therefore does not demonstrate that fusion predicts separate stress and anxiety indicators. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Findingown data

    Mental fatigue positively predicted cognitive fusion (β = 0.319, p < 0.001).

    “mental fatigue significantly and positively predicted psychological inflexibility (β = 0.244, p < 0.001), cognitive fusion (β = 0.319, p < 0.001) and negative emotions (β = 0.157, p < 0.01).”
    Quote in the paperSubstantial claim
  • Findingown data

    Psychological inflexibility acted as a mediator linking mental fatigue to negative emotions.

    “statistically significant mediating effects of psychological inflexibility and cognitive fusion between mental fatigue on nurses' negative emotions”
    • Also stated in: § Chain mediation effect test · plain
      “psychological inflexibility and cognitive fusion can be seen to play a significant mediating role between nurses' mental fatigue and negative emotions, respectively”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The variables in the mediation model are causally ordered as mental fatigue → psychological inflexibility → cognitive fusion → negative emotions.
  • Classified as probably not a substantial claim. 5
  • May combine two claims. 12
  • The quote only partly states this claim. 1

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Psychological inflexibility and cognitive fusion are core components of acceptance and commitment therapy.

    “psychological inflexibility (PI) is one of the core concepts of ACT”
    • Also stated in: § The chain mediating role of psychological inflexibility and cognitive fusion · plain
      “ACT considers cognitive fusion as a key feature of psychological inflexibility”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Hayes et al., 2006 source

  • May combine two claims.

    Premisecitation

    Mental fatigue lowers cognitive control and makes cognitive fusion more likely.

    “mental fatigue leads to reduced cognitive control and is more likely to trigger cognitive fusion (Bramwell & Richardson, 2018).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Bramwell & Richardson, 2018 source

      The Discussion reports that reductions in cognitive fusion were associated with improvements in distress and depression, but it does not address mental fatigue or cognitive control. Searches for mental fatigue, reduced cognitive control, and related terms found no passage supporting the claimed sequence. (LLM, conf=0.72)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Mental fatigue harms emotion regulation but leaves emotion reactivity unchanged.

    “mental fatigue impairs emotion regulation without affecting emotion reactivity, (Grillon et al., 2015).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Grillon et al., 2015 source

  • May combine two claims.

    Findingown data

    Negative emotions, cognitive fusion, psychological inflexibility, and mental fatigue were all positively correlated with one another.

    “correlation analyses showed significant positive pairwise correlations between mental fatigue, psychological inflexibility, cognitive fusion, and negative emotions among nurses.”
    • Also stated in: § Correlations between all variables · plain
      “psychological inflexibility, mental fatigue, and cognitive fusion were all significantly and positively correlated with negative emotions, and all three variables were significantly and positively correlated with each other in two ways.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The indirect effect through cognitive fusion was 0.178, accounting for 66.41% of the total effect.

    “(2) indirect effect 2 (0.178, 66.41% of the total effect): Mental Fatigue → cognitive fusion → negative emotions”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The variables in the mediation model are causally ordered as mental fatigue → psychological inflexibility → cognitive fusion → negative emotions.

  • May combine two claims.

    Findingown data

    The indirect effect through psychological inflexibility was 0.037, accounting for 13.85% of the total effect.

    “(1) indirect effect 1 (0.037, 13.85% of the total effect): mental fatigue → psychological inflexibility → negative emotions”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The variables in the mediation model are causally ordered as mental fatigue → psychological inflexibility → cognitive fusion → negative emotions.

  • May combine two claims.

    Findingown data

    The indirect effect through psychological inflexibility and cognitive fusion in sequence was 0.05, accounting for 19.74% of the total effect.

    “(3) indirect effect 3 ( 0.05, accounting for 19.74% of the total effect): mental fatigue → psychological inflexibility → cognitive fusion → negative emotions”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The variables in the mediation model are causally ordered as mental fatigue → psychological inflexibility → cognitive fusion → negative emotions.

  • May combine two claims.

    Study design and conductown data

    Harman's single-factor test showed no common method bias; the first factor accounted for 27.78%, under the 40% cutoff.

    “the variance explained by the first common factor was 27.78%, which was less than the critical criterion of 40%, indicating that there was no common method bias in this study.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Psychological inflexibility and cognitive fusion forecast negative emotions.

    “Psychological inflexibility and cognitive fusion, as important diagnostic criteria for mental health, predict negative emotions (Xing et al., 2020).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Xing et al., 2020 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The pre-study sample size calculation called for a minimum of 384 valid questionnaires.

    “at least 384 valid questionnaires need to be obtained.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Mental fatigue, psychological inflexibility, and cognitive fusion each affect negative emotions and are intercorrelated.

    “mental fatigue, psychological inflexibility, and cognitive fusion all have an impact on negative emotions, and these three factors are correlated with each other.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Mental fatigue damages executive functions, which lowers psychological flexibility.

    “mental fatigue makes individuals' executive functions impaired, leading to an inability to continuously focus on situational needs and thus to match and adopt optimal strategies, resulting in significantly reduced psychological flexibility (Jacquet et al., 2021).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Jacquet et al., 2021 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Responses from self-report questionnaires could have been influenced by social desirability bias.

    “results obtained from the self-report questionnaire may have been subject to social desirability bias.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Cognitive resources are finite, and regulating emotions demands effortful cognitive control.

    “Cognitive Load Theory suggests that individual cognitive resources are limited, and emotion regulation requires effortful cognitive control (Sweller et al., 1994).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Sweller et al., 1994

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • The quote only partly states this claim.

    Study design and conductown data

    In this sample, the instruments showed acceptable internal consistency, with Cronbach's alphas between 0.791 and 0.970.

    “The Cronbach alpha coefficient in this study was 0.791.”
    • Also stated in: § Data gathering instrument · plain
      “The Cronbach alpha coefficient in this study was 0.970.”
    • Also stated in: § Data gathering instrument · plain
      “The Cronbach alpha coefficient in this study was 0.965.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    After exclusions, 419 valid questionnaires remained, yielding an effective response rate of 81.4%.

    “419 valid questionnaires were left after deleting the questionnaires with too many missing items (i.e., more than 20% of items were not answered) or too short answer time (i.e., the questionnaire completion time was less than 1 min), with an effective response rate of 81.4% eventually.”
    Quote in the paperNot a substantial claim
16 of 16

  • The paper relies on this without support.

    The variables in the mediation model are causally ordered as mental fatigue → psychological inflexibility → cognitive fusion → negative emotions.

    “We proposed a conceptual model (Fig. 1)”
    “mental fatigue → psychological inflexibility → cognitive fusion → negative emotions”

  • The paper relies on this without support.

    The sample of nurses in Beijing is representative of nurses during the COVID-19 pandemic.

    “An online survey was conducted in Beijing, China, in August 2020.”
    “survey 419 nurses in Beijing”
2 of 2

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Reported age spread is incompatible with the stated age range

    Major

    If all 419 participants were aged 17-28 and their mean age was 27.99, their standard deviation could not exceed about 0.33 years. The reported standard deviation is 6.1 years.

  • Indirect-effect shares leave no room for the reported direct effect

    Minor

    The three indirect pathways are assigned shares of 13.85%, 66.41%, and 19.74% of the total effect, which add to 100%. That contradicts the separately reported nonzero direct effect of mental fatigue on negative emotions.

  • One mediation statement reverses the modeled pathway

    Minor

    One results statement describes mental fatigue as a mediator of psychological inflexibility's effect. The listed pathway instead places psychological inflexibility between mental fatigue and negative emotions.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Xue, G., Xiyao, X., Rui, X., et al. (2010). Report on the depression-anxiety-stress scale simplified Chinese version (dass-21) among Chinese university students. Chinese Journal of Clinical Psychology, 18(04), 443–446. https://doi.org/10.16128/j.cnki.1005-3611.2020.05.019 · DOI
  2. Zuoji, Z. (2015). The Handbook of Behavioral Medicine. https://onlinelibrary.wiley.com/doi/book/10.1002/9781118453940 [2022-07-13] · DOI

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Related

Authors
Wang, D., Xie, X., Tian, H., Wu, T., Liu, C., Huang, K., Gong, R., Yu, Y., Luo, T., Jiao, R., & Zhang, L.
Affiliations
  • Chinese PLA General Hospital (CN)
  • Central China Normal University (CN)
  • Wuhan Children's Hospital (CN)
  • First Affiliated Hospital of Chinese PLA General Hospital (CN)
  • Chinese People's Armed Police Force (CN)
Corresponding author
Zhang, Lin
ORCID
Venue
Current Psychology
Publisher
Springer Science and Business Media LLC
Published
2022-07-15
Volume
41
Issue
11
Pages
8123-8131
ISSN
  • 1046-1310 (ISSN-L)
  • 1936-4733
DOI
10.1007/s12144-022-03468-2
PMC
PMC9285871
OpenAlex
W4285492634
Cited by
33
References
39
Citations by year
2026: 6 · 2025: 11 · 2024: 9 · 2023: 7
FWCI
6.16
Type
journal article
Language
en
Open access
Licence
Locations
  • Current Psychology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
self-determined research funds of CCNU from the colleges’ basic research and operation of MOE (CCNU20TD001)
Topics
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Burnout
Keywords
mental fatigue, negative emotions, nurses, COVID-19 pandemic, psychological inflexibility, cognitive fusion, depression, anxiety, stress, acceptance and commitment therapy, frontline health workers, mediating effect

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