The Mediating Role of Perceived Social Support and Psychological Resilience in the Relationship between Gratitude and Depression Symptoms among Nurses

Document Type : Research Paper


Psychology Department , Faculty of Literature and Humanities, University of Lorestan, Khorramabad, Iran


The aim of the present study was to examine the mediating role of perceived social support and psychological resilience in the relationship between gratitude and depression symptoms. The research method was basic in objective and correlational and structural equation analysis in data collection. A total of 219 individuals (82 males and 137 females) were selected from the statistical population of nurses working in Tehran in the second half of 2020 using the convenience sampling method. Data were collected using the Connor-Davidson Resiliency Scale (CDRS), Gratitude Questionnaire (GQ-6), Beck Depression Inventory-Second Edition (BDI-II), and Multidimensional Scale of Perceives Social Support (MSPSS). Pearson correlation and structural equation modeling were performed to analyze the data using SPSS-23 and AMOS-21. The results showed that the direct effect of gratitude (β = -0.19, P<0.001), the direct effect of perceived social support (β= -0.32, P<0.001), and the direct effect of psychological resilience (β = -0.41, p < 0.001) on depression symptoms were significantly negative. In addition, the results showed that perceived social support (β = -0.11, P < 0.01) and psychological resilience (β = -0.16, P < 0.01) had a significant mediating role in the relationship between gratitude and depression symptoms. The results of the current study suggest that gratitude may increase perceived social support and resilience and protect nurses from depression, which has applications for clinical interventions for nurses during the coronavirus pandemic.


پورداد، ص.، مؤمنی، خ.، و کرمی، ج. (1398). نقش واسطه‌ای حمایت اجتماعی و شادکامی در رابطۀ قدردانی و اضطراب مرگ در سالمندان. مطالعات روان‌شناختی. 15(1)، 80-57.
زارع، م.، تقی‌لو، ص.، و کاکاوند، ع. ر. (1395). رابطۀ بین اضطراب و افسردگی با میانجی‌گری تفکر ارتجاعی و کمال‌گرایی به روش معادلات ساختاری. مجلۀ بهداشت روانی (ویژه‌نامه). 18(4)، 464-455.
سرتیپ‌زاده، ا.، علی‌اکبری، م.، و طبائیان، م. (1395). اثربخشی معنویت درمانی بر تاب‌آوری سالمندان شهر اصفهان. مجلۀ تحقیقات علوم رفتاری. 14(1)، 63-56.
فتی، ل.، بیرشک، ب.، عاطف‌وحید، م. ک.، و دابسون، ک. (1384). ساختارهای معناگذار طرحواره‌ها، حالت‌های هیجانی و پردازش شناختی اطلاعات هیجانی: مقایسۀ دو چارچوب مفهومی. مجلۀ روان‌پزشکی و روان‌شناسی بالینی ایران. 11(3)، 326-312.
لشنی، ز.، شعیری، م.، و اصغری‌مقدم، م. (1389). رابطۀ شکرگزاری با عاطفۀ مثبت و منفی، شادکامی و خوش‌بینی دانشجویان. بهداشت روانی، 2(5)، 139-135.
مرادی، م.، دهقانی‌زاده، م. ح.، و سلیمانی‌خشاب، ع. (1394). حمایت اجتماعی ادراک‌شده و سرزندگی تحصیلی: نقش واسطه‌ای باورهای خودکارآمدی تحصیلی. مجلۀ مطالعات آموزش و یادگیری. 68(1)، 24-1.
Agnieszkal, L., Katarzynal, T., & Sandra, B. (2020). Empathy, resilience, and gratitude – Does gender make a difference? Annals of Psychology. 36(3), 521-532.
Algoe, S. B., & Zhaoyang, R. (2016). Positive psychology in context: Effects of expressing gratitude in ongoing relationships depend on perceptions of enactor responsiveness. The Journal of Positive Psychology, 11(4), 399-415.
Armenta, C. N., Fritz, M. M., & Lyubomirsky, S. (2017). Functions of positive emotions: Gratitude as a motivator of self-improvement and positive change. Emotion Review, 9(3), 183–190.
Barello, S., Palamenghi, L., & Graffigna, G. (2020). Burnout and somatic symptoms among frontline healthcare professionals at the peak of the Italian COVID-19 pandemic. Psychiatry Research, 290(8), 113-129.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4(12), 561- 571.
Beck, A. T., Steer, R. A., & Brown, G. K. (2000). Manual for the beck depression inventory II. San Antonio: TX: The Psychological Corporation.
Bohlken, J., Schomig, F., Lemke, M. R., Pumberger, M., & Riedel-Heller, S. G. (2020). COVID-19 pandemic: Stress experience of healthcare workers – a short current review. Psychiatrische Praxis, 47(4), 190-197.
Chen, S., & Bonanno, G. A. (2020). Psychological adjustment during the global outbreak of COVID-19: A resilience perspective. Psychological Trauma, 12(1), 51–54.
Cheng, S. T., Tsui, P. K., & Lam, J. H. (2015). Improving mental health in health care practitioners: Randomized controlled trial of a gratitude intervention. Journal of Consulting and Clinical Psychology, 83(1), 177-186.
Connor, K. M., & Davidson, J. R. (2003). Development of new resilience scale: The Connor-Davidson resilience scale. Depression and Anxiety, 18(2), 76- 82.
Conti, C., Fontanesi, L., Lanzara, R., Rosa, I., & Porcelli, P. (2020). Fragile heroes: The psychological impact of the COVID-19 pandemic on health-care workers in Italy. PLoS One, 15(11), e0242538.
Cregg, D., & Cheavens, J. S. (2021). Gratitude interventions: Effective self-help? A meta-analysis of the impact on symptoms of depression and anxiety. Journal of Happiness Studies, 22(4), 1-33.
Cutuli, J. J., & Herbers, J. E (2018). Resilience in the context of development: Introduction to the special issue. The Journal of Early Adolescence, 38(9), 1205-1214.
Deichert, N. T., Fekete, E. M., & Craven, M. (2019). Gratitude enhances the beneficial effects of social support on psychological well-being. Journal of Positive Psychology, 14(2), 168-177.:e1689425.
Dickens, L. R. (2017). Using gratitude to promote positive change: A series of meta- analyses investigating the effectiveness of gratitude interventions. Basic and Applied Social Psychology, 39(4), 193-208.
Eagle, D. E., Hybels, G. F., & Proeschold-Bell, R. J. (2019). Perceived social support, received social support, and depression among clergy. Journal of Social and Personality Relationship, 36(7), 2055–2073.
Feng, L., & Yin, R. (2021). Social support and hope mediate the relationship between gratitude and depression among front-line medical staff during the pandemic of COVID-19. Frontiers in Psychology, 12(6), 623873.
Franceschini, C., Musetti, A., Zenesini, C., Palagini, L., Scarpelli, S., Quattropani, M. C.,... D., & Castelnuovo, G. (2020). Poor sleep quality and its consequences on mental health during the COVID-19 lockdown in Italy. Frontiers in Psycholog, 11(9), 574475.
Fredrickson, B. L. (2001). The role of positive emotions in positive psychology: The broaden–and–build theory of positive emotions. American Psychologist Journal, 56(3), 218-226.
George, A., & Moolman, R. (2017). Resilience and suicide ideation: Coping mediator-moderator effects among adolescent learners. Journal of Psychology in Africa, 27(6), 494-502.
Ghebreyesus, T. A. (2020). Addressing mental health needs: An integral part of COVID-19 response. World Psychiatry, 19(2), 129–130.
Grey, I., Arora, T., Thomas, J., Saneh A., Tomhe, P., & Abi-Habib, R. (2020). The role of perceived social support on depression and sleep during the COVID-19 pandemic. Psychiatry Research, 293(4), e113452.
Huang, Y., & Zhao, N. (2020). Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: A web-based cross-sectional survey. Psychiatry Research, 288, 112954.
Hudecek, M. F. C., Blabst, N., Morgan, B., & Lermer, E. (2020) Measuring gratitude in germany: Validation study of the german version of the gratitude guestionnaire-six item form (GQ-6-G) and the multi-component gratitude measure (MCGM-G). Frontiers in Psychology, 11(4), 1-11.
Kaleta, K., & Justyna, M. (2020). The relationship between basic hope and depression: Forgiveness as a mediator. Psychiatric Quarterly, 91(3), 877–886.
Kang, L., Li, Y., Hu, S., Chen, M., Yang, C., & Yang, B. X. (2020). The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry, 7(3), e14.
 Klein, R. (2011). Principles and practices of structural equation modeling (4nd Eds). New York: Guilford Press.
Lan, X., & Wang, W. (2019). Direct and interactive effects of peer support and resilience on psychosocial adjustment in emerging adults with early left– behind experiences. Psychological Research and Behavior Management, 12(6), 277–288.
Llenares, I. I., Deocarisb, C. C., Espanolac, M., & Sario, J. A. (2020). Gratitude moderates the relationship between happiness and resilience. International Journal of Emotional Education, 12(2), 103-108.
Marshall, B. (2020). Impact of COVID-19 on nurses' mental health. Issues in Mental Health Nursing, 41(10), 853–854.
McCullough, M. E., Emmons, R., & Tsang, J. A. (2002). The grateful disposition: A conceptual and empirical topography. Journal of Personality and Social Psychology, 82(1), 112–127.
Merçon-Vargas, E. A., Poelker, K. E, & Tudge, J. R. H. (2018). The development of the virtue of gratitude: Theoretical foundations and cross-cultural issues. Cross-Cultural Research, 52(1), 3–18.
O’Connell, B.H., O’Shea, D., & Gallagher, S. (2016). Mediating effects of loneliness on the gratitude-health link. Personality and Individual Differences, 98(12), 179-183.
Pappa, S., Ntella, V., Giannakas, T., Giannakoulis, V. G., Papoutsi, E., & Katsaounou, P. (2020). Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain, Behavior and Immunity, 88(5), 901–907.
Paules, C. I., Marston, H. D, & Fauci, A. S. (2020). Coronavirus infections- more than just the common cold. JAMA, 323(8), 707-708.
Petrocchi, N., & Couyoumdjian, A. (2016). The impact of gratitude on depression and anxiety: The mediating role of criticizing, attacking, and reassuring the self. Self and Identity, 15)2), 191-205.
Samson, P. (2020). Effect of perceived social support on stress, anxiety and depression among Nepalese nursing students. Indian Journal of Continuing Nursing Education, 21(1), 59-63.
Sasaki, E., Jia, L., Lwa, H. Y., & Goh, M. T. (2020). Gratitude inhibits competitive behavior in threatening interactions. Cognition and Emotion, 22(4), 1–15.
Seçer, ˙I., Ula¸s, S., & Karaman-Ozlu, Z. (2020). The effect of the fear of COVID-19 on healthcare professionals’ psychological adjustment skills: Mediating role of experiential avoidance and psychological resilience. Frontiers in Psychology, 11(7), e561536.
Seligman, M., Ernst, R. M., Gillham, J., Reivich, K., & Linkins, M. (2009). Positive education psychology and classroom intervention. Oxford Review of Education, 35(3), 293-311.
Shin, T. Y., Cheng, Sh, L., Cheng, Sh, H., & Sun, H. F. (2020). Perceived social support and depression symptoms in patients with major depressive disorder in Taiwan: An association study. Archives of Psychiatric Nursing, 34(5), 384-390.
Spoorthy, M. S. (2020). Mental health problems faced by healthcare workers due to the COVID-19 pandemic: A review. Asian Journal of Psychiatry, 51(3), 102–119.
Sztachanska, J., Krejtz, I., & Nezlek, J. B. (2019). Using a gratitude intervention to improve the lives of women with breast cancer: A daily diary study. Frontiers in Psychology, 10(1), 13-25.
Taylor, C., Lyubomirsky, S., & Stein, M. (2017). Up regulating the positive affect system in anxiety and depression: Outcomes of a positive activity intervention. Depression and Anxiety, 34(3), 267–280.
Thomas, S.P. (2020). Focus on depression and suicide in the era of COVID-19. Issues in Mental Health Nursing, 41(7), 559-572.
Toscano, F., & Zappala, S. (2020). Social isolation and stress as predictors of productivity perception and remote work satisfaction during the COVID-19 pandemic: The role of concern about the virus in a moderated double mediation. Sustainability, 12(23), 9804-9818.
Tudge, J. R. H., & Freitas, L. B. L. (2018). Developing gratitude: An introduction In J. R. H. Tudge & L. B. L. Freitas (Eds.), developing gratitude in children and adolescents (pp. 1–22). New York: Cambridge University Press.
Wang, W., & Wu, X. (2020). Mediating roles of gratitude, social support and posttraumatic growth in the relation between empathy and prosaically behavior among adolescents after the Ya’an earthquake. Acta Psychologica Sinica, 52(3), 307–316.
Wang, W., Liu, A., Wu, X., & Lan, X. (2020). Moderating role of social support in the relationship between posttraumatic stress disorder and antisocial behavior in adolescents after the Ya’an earthquake. Psych Journal, 9(3), 350–358.
Witvliet, C., Richie, F., Luna, L., & Tongeren, D. (2019). Gratitude predicts hope and happiness: A two–study assessment of traits and states. Journal of Positive Psychology, 14(3), 271–282.
Xiao, H., Zhang, Y., Kong, D., Li, S., & Yang, N. (2020). The effects of social support on sleep quality of medical staff treating patients with coronavirus disease 2019 (COVID-19) in January and February 2020 in China. Medical Science Monitor, 26(5), e923549–1.
Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52(1), 30–41.