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A Multigroup Analysis of the Effect of Cognitive Appraisal on Nurses' Psychological Distress

Simães, Clara; Gomes, António R.; Costa, Patrício

doi: 10.1097/NNR.0000000000000352

Background Cognitive appraisal constitutes an important mechanism in the process of human adaptation to work environment and occupational stress. In this domain, nursing professionals are one of the occupational groups most affected by job stress, suffering high levels of psychological distress.

Objectives The aims of this study were to analyze the moderator effect of shift work and the type of job contract on the relationship between work cognitive appraisal and nurses' psychological distress and to explore the interaction effect of the two moderator variables on that relationship.

Methods A sample comprised of 2,310 Portuguese registered nurses completed a sociodemographic and professional questionnaire: the Primary and Secondary Cognitive Appraisal Scale and the General Health Questionnaire-12. Data were analyzed through structural equation modeling and multigroup analyses considering the following groups: (a) “shift” versus “nonshift work”; (b) “precarious job contract” versus “nonprecarious job contract”; and (c) “shift and precarious” versus “shift and nonprecarious” versus “nonshift and precarious” versus “nonshift and nonprecarious.”

Results Data confirmed the invariance for the measurement model, but the structural model presented a significantly worse adjustment for all grouping variables, showing the moderator effect of shift work and job contract and of their interaction. Difference tests in structural path coefficients revealed that shift work moderated the relationship between challenge perception and psychological distress—which was stronger for shift work nurses—and that a higher threat perception was related to greater psychological distress, especially in nurses with a precarious job contract. Among the four categories of interaction between job contract and shift work, cognitive appraisal became central in predicting nurses' mental health, explaining more variance in the group that did shift work and had a nonprecarious job contract.

Discussion The study results highlight the need to develop occupational health intervention programs to promote nurses' mental health, focusing on reducing work perception as a threat and on making nurses' jobs more challenging and controllable.

Clara Simães, PhD, is Adjunct Professor, University of Minho, School of Nursing, Braga, and Postdoctoral Researcher, Portuguese Catholic University, Institute of Health Sciences, School of Nursing, Porto, Portugal.

António R. Gomes, PhD, is Assistant Professor, University of Minho School of Psychology, Braga, Portugal.

Patrício Costa, PhD, is Assistant Professor, University of Minho, School of Medicine and Researcher, Life and Health Sciences Research Institute, ICVS/3B's-PT Government Associate Laboratory, Braga, and Assistant Professor, University of Porto, Faculty of Psychology and Educational Sciences, Porto, Portugal.

Accepted for publication September 11, 2018.

The study was conducted in accordance with the internal guidelines of the Research Centre of Psychology, from the University of Minho, being in conformity with both the national and European regulations, regarding research with human participants and the management of personal data. The study was exempt from institutional review board approval.

The authors have no funding or conflicts of interest to report.

Corresponding author: Clara Simães, PhD, Universidade do Minho, Escola Superior de Enfermagem, Campus de Gualtar, 4710-057 Braga, Portugal (e-mail:

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