thesis on psychological well being pdf

Employee psychological well-being and job performance: exploring mediating and moderating mechanisms

International Journal of Organizational Analysis

ISSN : 1934-8835

Article publication date: 12 August 2020

Issue publication date: 7 May 2021

Given the importance of employee psychological well-being to job performance, this study aims to investigate the mediating role of affective commitment between psychological well-being and job performance while considering the moderating role of job insecurity on psychological well-being and affective commitment relationship.

Design/methodology/approach

The data were gathered from employees working in cellular companies of Pakistan using paper-and-pencil surveys. A total of 280 responses were received. Hypotheses were tested using structural equation modeling technique and Hayes’s Model 1.

Findings suggest that affective commitment mediates the association between psychological well-being (hedonic and eudaimonic) and employee job performance. In addition, perceived job insecurity buffers the association of psychological well-being (hedonic and eudaimonic) and affective commitment.

Practical implications

The study results suggest that fostering employee psychological well-being may be advantageous for the organization. However, if interventions aimed at ensuring job security are not made, it may result in adverse employee work-related attitudes and behaviors.

Originality/value

The study extends the current literature on employee well-being in two ways. First, by examining psychological well-being in terms of hedonic and eudaimonic well-being with employee work-related attitude and behavior. Second, by highlighting the prominent role played by perceived job insecurity in explaining some of these relationships.

• Psychological well-being
• Affective commitment
• Job insecurity
• Job performance
• Eudaimonic wellbeing
• Hedonic wellbeing

Kundi, Y.M. , Aboramadan, M. , Elhamalawi, E.M.I. and Shahid, S. (2021), "Employee psychological well-being and job performance: exploring mediating and moderating mechanisms", International Journal of Organizational Analysis , Vol. 29 No. 3, pp. 736-754. https://doi.org/10.1108/IJOA-05-2020-2204

Emerald Publishing Limited

Copyright © 2020, Yasir Mansoor Kundi, Mohammed Aboramadan, Eissa M.I. Elhamalawi and Subhan Shahid.

Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode

1. Introduction

Does the employee well-being have important implications both at work and for other aspects of an employees’ life? Of course! For years, we have known that they impact life at work and a plethora of research has examined the impact of employee well-being on work outcomes (Karapinar et al. , 2019 ; Turban and Yan, 2016 ). What is less understood is how employee well-being impacts job performance. Evidence suggests that employee health and well-being are among the most critical factors for organizational success and performance (Bakker et al. , 2019 ; Turban and Yan, 2016 ). Several studies have documented that employee well-being leads to various individual and organizational outcomes such as increased organizational performance and productivity (Hewett et al. , 2018 ), customer satisfaction (Sharma et al. , 2016 ), employee engagement (Tisu et al. , 2020 ) and organizational citizenship behavior (OCB; Mousa et al. , 2020 ).

The organizations’ performance and productivity are tied to the performance of its employees (Shin and Konrad, 2017 ). Much evidence has shown the value of employee job performance (i.e. the measurable actions, behaviors and outcomes that employee engages in or bring about which are linked with and contribute to organizational goals; Viswesvaran and Ones, 2017 ) for organizational outcomes and success (Al Hammadi and Hussain, 2019 ; Shin and Konrad, 2017 ), which, in turn, has led scholars to seek to understand what drives employee performance. Personality traits (Tisu et al. , 2020 ), job conditions and organizational characteristics (Diamantidis and Chatzoglou, 2019 ) have all been identified as critical antecedents of employee job performance.

However, one important gap remains in current job performance research – namely, the role of psychological well-being in job performance (Hewett et al. , 2018 ). Although previous research has found happy workers to be more productive than less happy or unhappy workers (DiMaria et al. , 2020 ), a search of the literature revealed few studies on psychological well-being and job performance relationship (Salgado et al. , 2019 ; Turban and Yan, 2016 ). Also, very little is known about the processes that link psychological well-being to job performance. Only a narrow spectrum of well-being related antecedents of employee performance has been considered, especially in terms of psychological well-being. Enriching our understanding of the consequences and processes of psychological well-being in the workplace, the present study examines the relationship between psychological well-being and job performance in the workplace setting. Such knowledge will not only help managers to attain higher organizational performance during the uncertain times but will uncover how to keep employees happy and satisfied (DiMaria et al. , 2020 ).

Crucially, to advance job performance research, more work is needed to examine the relationship between employees’ psychological well-being and their job performance (Ismail et al. , 2019 ). As Salgado et al. (2019) elaborated, we need to consider how an employees’ well-being affects ones’ performance at work. In an attempt to fill this gap in the literature, the present study seeks to advance job performance research by linking ones’ psychological well-being in terms of hedonic and eudaimonic well-being to ones’ job performance. Hedonic well-being refers to the happiness achieved through experiences of pleasure and enjoyment, while eudaimonic well-being refers to the happiness achieved through experiences of meaning and purpose (Huta, 2016 ; Rahmani et al. , 2018 ). We argue that employees with high levels of psychological well-being will perform well as compared to those having lower levels of psychological well-being. We connect this psychological well-being-job performance process through an employee affective commitment (employees’ perceptions of their emotional attachment to or identification with their organization; Allen and Meyer, 1996 ) – by treating it as a mediating variable between well-being-performance relationship.

Additionally, we also examine the moderating role of perceived job insecurity in the well-being-performance relationship. Perceived job insecurity refers to has been defined as the perception of being threatened by job loss or an overall concern about the continued existence of the job in the future (De Witte et al. , 2015 ). There is evidence that perceived job insecurity diminishes employees’ level of satisfaction and happiness and may lead to adverse job-related outcomes such as decreased work engagement (Karatepe et al. , 2020 ), deviant behavior (Soomro et al. , 2020 ) and reduced employee performance (Piccoli et al. , 2017 ). Thus, addressing the gap mentioned above, this study has two-fold objectives; First, to examine how the path between psychological well-being and job performance is mediated through employee affective commitment. The reason to inquire about this path is that well-being is associated with an employees’ happiness, pleasure and personal growth (Ismail et al. , 2019 ). Therefore, higher the well-being, higher will be the employees’ affective commitment, which, in turn, will lead to enhanced job performance. The second objective is to empirically test the moderating effects of perceived job insecurity on employees’ emotional attachment with their organizations. Thus, we propose that higher job insecurity may reduce the well-being of employees and their interaction may result in lowering employees’ emotional attachment with their organization.

The present study brings together employee well-being and performance literature and contributes to these research areas in two ways. First, we contribute to this line of inquiry by investigating the direct and indirect crossover from hedonic well-being and eudaimonic well-being to employees’ job performance. We propose that psychological well-being (hedonic and eudaimonic) influence job performance through employee affective commitment. Second, prior research shows that the effect of well-being varies across individuals indicating the presence of possible moderators influencing the relationship between employee well-being and job outcomes (Lee, 2019 ). We, therefore, extend the previous literature by proposing and demonstrating the general possibility that perceived job insecurity might moderate the relationship of psychological well-being (hedonic and eudaimonic) and affective commitment. While there is evidence that perceived job insecurity influence employees’ affective commitment (Schumacher et al. , 2016 ), what is not yet clear is the impact of perceived job insecurity on psychological well-being − affective commitment relationship. The proposed research model is depicted in Figure 1 .

2. Hypotheses development

2.1 psychological well-being and affective commitment.

Well-being is a broad concept that refers to individuals’ valued experience (Bandura, 1986 ) in which they become more effective in their work and other activities (Huang et al. , 2016 ). According to Diener (2009) , well-being as a subjective term, which describes people’s happiness, the fulfillment of wishes, satisfaction, abilities and task accomplishments. Employee well-being is further categorized into two types, namely, hedonic well-being and eudaimonic well-being (Ballesteros-Leiva et al. , 2017 ). Compton et al. (1996) investigated 18 scales that assess employee well-being and found that all the scales are categorized into two broad categories, namely, subjective well-being and personal growth. The former is referred to as hedonic well-being (Ryan and Deci, 2000 ) whereas, the latter is referred to as eudaimonic well-being (Waterman, 1993 ).

Hedonic well-being is based on people’s cognitive component (i.e. people’s conscious assessment of all aspects of their life; Diener et al. , 1985 ) and affective component (i.e. people’s feelings that resulted because of experiencing positive or negative emotions in reaction to life; Ballesteros-Leiva et al. , 2017 ). In contrast, eudaimonic well-being describes people’s true nature and realization of their actual potential (Waterman, 1993 ). Eudaimonic well-being corresponds to happy life based upon ones’ self-reliance and self-truth (Ballesteros-Leiva et al. , 2017 ). Diener et al. (1985) argued that hedonic well-being focuses on happiness and has a more positive affect and greater life satisfaction, and focuses on pleasure, happiness and positive emotions (Ryan and Deci, 2000 ; Ryff, 2018 ). Contrarily, eudaimonic well-being is different from hedonic well-being as it focuses on true self and personal growth (Waterman, 1993 ), recognition for ones’ optimal ability and mastery ( Ryff, 2018 ). In the past, it has been found that hedonic well-being and eudaimonic well-being are relatively correlated with each other but are distinct concepts (Sheldon et al. , 2018 ).

To date, previous research has measured employee psychological well-being with different indicators such as thriving at work (Bakker et al. , 2019 ), life satisfaction (Clark et al. , 2019 ) and social support (Cai et al. , 2020 ) or general physical or psychological health (Grey et al. , 2018 ). Very limited studies have measured psychological well-being with hedonic and eudaimonic well-being, which warrants further exploration (Ballesteros-Leiva et al. , 2017 ). Therefore, this study assesses employee psychological well-being based upon two validated measures, namely, hedonic well-being (people’s satisfaction with life in general) and eudaimonic well-being (people’s personal accomplishment feelings).

Employee well-being has received some attention in organization studies (Huang et al. , 2016 ). Prior research has argued that happier and healthier employees increase their effort, performance and productivity (Huang et al. , 2016 ). Similarly, research has documented that employee well-being has a positive influence on employee work-related attitudes and behaviors such as, increasing OCB (Mousa et al. , 2020 ), as well as job performance (Magnier-Watanabe et al. , 2017 ) and decreasing employees’ work-family conflict (Karapinar et al. , 2019 ) and absenteeism (Schaumberg and Flynn, 2017 ). Although there is evidence that employee well-being positively influences employee work-related attitudes, less is known about the relationship between psychological well-being (hedonic and eudaimonic) and employee affective commitment (Pan et al. , 2018 ; Semedo et al. , 2019 ). Moreover, the existing literature indicated that employee affective commitment is either used as an antecedent or an outcome variable of employee well-being (Semedo et al. , 2019 ; Ryff, 2018 ). However, affective commitment as an outcome variable of employee well-being has gained less scholarly attention, which warrants further investigation. Therefore, in the present study, we seek to examine employee affective commitment as an outcome variable of employee psychological well-being because employees who are happy and satisfied in their lives are more likely to be attached to their organizations (Semedo et al. , 2019 ).

Hedonic well-being positively predicts employee affective commitment.

Eudaimonic well-being positively predicts employee affective commitment.

2.2 Affective commitment and job performance

The concept of organizational commitment was first initiated by sit-bet theory in the early 1960s (Becker, 1960 ). Organizational commitment is defined as the psychological connection of employees to the organization and involvement in it (Cooper-Hakim and Viswesvaran, 2005 ). It is also defined as the belief of an individual in his or her organizational norms (Hackett et al. , 2001 ); the loyalty of an employee toward the organization (Cooper-Hakim and Viswesvaran, 2005 ) and willingness of an employee to participate in organizational duties (Williams and Anderson, 1991 ).

Organizational commitment is further categorized into three correlated but distinct categories (Meyer et al. , 1993 ), known as affective, normative and continuance. In affective commitment, employees are emotionally attached to their organization. In normative commitment, employees remain committed to their organizations due to the sense of obligation to serve. While in continuance commitment, employees remain committed to their organization because of the costs associated with leaving the organization (Allen and Meyer, 1990 , p. 2). Among the dimensions of organizational commitment, affective commitment has been found to have the most substantial influence on organizational outcomes (Meyer and Herscovitch, 2001 ). It is a better predictor of OCB (Paul et al. , 2019 ), low turnover intention (Kundi et al. , 2018 ) and job performance (Jain and Sullivan, 2019 ).

Affective commitment positively predict employee job performance.

2.3 Affective commitment as a mediator

Many studies had used the construct of affective commitment as an independent variable, mediator and moderating variable because of its importance as an effective determinant of work outcomes such as low turnover intention, job satisfaction and job performance (Jain and Sullivan, 2019 ; Kundi et al. , 2018 ). There is very little published research on employee well-being and affective commitment relationship. Surprisingly, the effects of employee psychological well-being in terms of hedonic well-being and eudaimonic well-being have not been closely examined.

Affective commitment mediates the association between hedonic well-being and job performance.

Affective commitment mediates the association between eudaimonic well-being and job performance.

2.4 The moderating role of job insecurity

Job insecurity is gaining importance because of the change in organizational structure as it is becoming flattered, change in the nature of the job as it requires a diverse skill set and change in human resource (HR) practices as more temporary workers are hired nowadays (Piccoli et al. , 2017 ; Kundi et al. , 2018 ). Such changes have caused several adverse outcomes such as job dissatisfaction (Bouzari and Karatepe, 2018 ), unethical pro-organizational behavior (Ghosh, 2017 ), poor performance (Piccoli et al. , 2017 ), anxiety and lack of commitment (Wang et al. , 2018 ).

Lack of harmony on the definition of job insecurity can be found among the researchers. However, a majority of them acknowledge that job insecurity is subjective and can be referred to as a subjective perception (Wang et al. , 2018 ). Furthermore, job insecurity is described as the perception of an employee regarding the menace of losing a job in the near future (De Witte et al. , 2015 ). When there is job insecurity, employees experience a sense of threat to the continuance and stability of their jobs (Shoss, 2017 ).

Although job insecurity has been found to influence employee work-related attitudes, less is known about its effects on behavioral outcomes (Piccoli et al. , 2017 ). As maintained by the social exchange theory, behaviors are the result of an exchange process (Blau, 1964 ). Furthermore, these exchanges can be either tangible or socio-emotional aspects of the exchange process (Kundi et al. , 2018 ). Employees who perceive and feel that their organization is providing them job security and taking care of their well-being will turn to be more committed to their organization (Kundi et al. , 2018 ; Wang et al. , 2018 ). Much research has found that employees who feel job security are happier and satisfied with their lives (Shoss, 2017 ; De Witte et al. , 2015 ) and are more committed to their work and organization (Bouzari and Karatepe, 2018 ; Wang et al. , 2018 ). Shoss (2017) conducted a thorough study on job insecurity and found that job insecurity can cause severe adverse consequences for both the employees and organizations.

Employees who are uncertain about their jobs (i.e. high level of perceived job insecurity) are less committed with their organizations.

Employees with temporary job contracts were found to have low organizational committed as compared to the employees with permanent job contracts.

Such a difference between temporary and permanent job contract holders was mainly due to the perceived job insecurity by the temporary job contract holders.

Job insecurity will moderate the relationship between hedonic well-being, eudaimonic well-being and affective organizational commitment.

3.1 Sample and procedure

The data for this study came from a survey of Pakistani employees, who worked in five private telecommunication organizations (Mobilink, Telenor, Ufone, Zong and Warid). These five companies were targeted because they are the largest and highly competitive companies in Pakistan. Moreover, the telecom sector is a private sector where jobs are temporary or contractual (Kundi et al. , 2018 ). Hence, the investigation of how employees’ perceptions of job insecurity influence their psychological well-being and its outcomes is highly relevant in this context. Studies exploring such a phenomenon are needed, particularly in the Pakistani context, to have a better insight and thereby strengthen the employee well-being and job performance literature.

Two of the authors had personal and professional contacts to gain access to these organizations. The paper-and-pencil method was used to gather the data. Questionnaires were distributed among 570 participants with a cover letter explaining the purpose of the study, noted that participation was voluntary, and provided assurances that their responses would be kept confidential and anonymous. After completion of the questionnaires, the surveys were collected the surveys on-site by one of the authors. As self-reported data often render itself to common method bias (CMB; Podsakoff et al. , 2012 ), we applied several procedural remedies such as reducing the ambiguity in the questions, ensuring respondent anonymity and confidentiality, separating of the predictor and criterion variable and randomizing the item order to limit this bias.

Of the 570 surveys distributed initially, 280 employees completed the survey form (response rate = 49%). According to Baruch and Holtom (2008) , the average response rate for studies at the individual level is 52.6% (SD = 19.7). Hence, our response rate meets the standard for a minimum acceptable response rate, which is 49%. Of the 280 respondents, 39% were female, their mean age was 35.6 years (SD = 5.22) and the average organizational tenure was 8.61 years (SD  =  4.21). The majority of the respondents had at least a bachelors’ degree (83 %). Respondents represented a variety of departments, including marketing (29%), customer services (26%), finance (20%), IT (13%) and HR (12%).

3.2 Measures

The survey was administered to the participants in English. English is the official language of correspondence for professional organizations in Pakistan (De Clercq et al. , 2019 ). All the constructs came from previous research and anchored on a five-point Likert scale ranging from 1 = Strongly disagree to 5 = Strongly agree.

Psychological well-being. We measured employee psychological well-being with two sub-dimensions, namely, hedonic well-being and eudaimonic well-being. Hedonic well-being was measured using five items (Diener et al. , 1985 ). A sample item is “my life conditions are excellent” ( α = 0.86). Eudaimonic well-being was measured using 21 items (Waterman et al. , 2010 ), of which seven items were reverse-scored due to its negative nature. Sample items are “I feel that I understand what I was meant to do in my life” and “my life is centered around a set of core beliefs that give meaning to my life” ( α = 0.81).

Affective commitment. The affective commitment was measured using a six-item inventory developed by Allen and Meyer (1990) . The sample items are “my organization inspires me to put forth my best effort” and “I think that I will be able to continue working here” ( α = 0.91).

Job insecurity. Job insecurity was measured using a five-item inventory developed by Chirumbolo et al. (2015) . The sample item is “I fear I will lose my job” ( α = 0.87).

Job performance . We measured employee job performance with the seven-item inventory developed by Williams and Anderson (1991) . The sample items are “I do fulfill my responsibilities, which are mentioned in the job description” and “I try to work as hard as possible” ( α = 0.87).

Controls. We controlled for respondents’ age (assessed in years), gender (1 = male, 2 = female) and organizational tenure (assessed in years) because prior research (Alessandri et al. , 2019 ; Edgar et al. , 2020 ) has found significant effects of these variables on employees’ job performance.

4.1 Descriptive statistics

Table 1 presents the means, standard deviations and correlations among study variables.

4.2 Construct validity

Before testing hypotheses, we conducted a series of confirmatory factor analyzes (CFAs) using AMOS 22.0 to examine the distinctiveness of our study variables. Following the guidelines of Hu and Bentler (1999) , model fitness was assessed with following fit indices; comparative fit index (CFI), root mean square error of approximation (RMSEA) and standardized root mean square residual (SRMR). We used a parceling technique (Little et al. , 2002 ) to ensure item to sample size ratio. According to Williams and O’Boyle (2008) , the item-parceling approach is widely used in HRM research, which allows estimation of fewer model parameters and subsequently leads to the optimal variable to sample size ratio and stable parameter estimates (Wang and Wang, 2019 ). Based on preliminary CFAs, we combined the highest item loading with the lowest item loading to create parcels that were equally balanced in terms of their difficulty and discrimination. Item-parceling was done only for the construct of eudaimonic well-being as it entailed a large number of items (i.e. 21 items). Accordingly, we made five parcels for the eudaimonic well-being construct (Waterman et al. , 2010 ).

As shown in Table 2 , the CFA results revealed that the baseline five‐factor model (hedonic well-being, eudaimonic well-being, job insecurity, affective commitment and job performance) was significant ( χ 2 = 377.11, df = 199, CFI = 0.971, RMSEA = 0.034 and SRMR = 0.044) and better than the alternate models, including a four‐factor model in which hedonic well-being and eudaimonic well-being were considered as one construct (Δ χ 2 = 203.056, Δdf = 6), a three-factor model in which hedonic well-being, eudaimonic well-being and affective commitment were loaded on one construct (Δ χ 2 = 308.99, Δdf = 8) and a one‐factor model in which all items loaded on one construct (Δ χ 2 = 560.77, Δdf = 11). The results, therefore, provided support for the distinctive nature of our study variables.

To ensure the validity of our measures, we first examined the convergent validity through the average variance extracted (AVE). We found AVE scores higher than the threshold value of 0.5 ( Table 1 ; Fornell and Larcker, 1981 ), supporting the convergent validity of our constructs. We also estimated discriminant validity by comparing the AVE of each construct with the average shared variance (ASV), i.e. mean of the squared correlations among constructs ( Hair et al. , 2010 ). As expected, all the values of AVE were higher than the ASV constructs, thereby supporting discriminant validity ( Table 1 ).

4.3 Common method variance

Harman’s one-factor test.

CFA ( Podsakoff et al. , 2012 ).

Harman’s one-factor test showed five factors with eigenvalues of greater than 1.0 accounted for 69.12% of the variance in the exogenous and endogenous variables. The results of CFA showed that the single-factor model did not fit the data well ( χ 2 = 937.88, df = 210, CFI = 0.642, RMSEA = 0.136, SRMR = 0.122). These tests showed that CMV was not a major issue in this study.

4.4 Hypotheses testing

The hypotheses pertaining to mediation were tested using a structural model in AMOS 22.0 ( Figure 2 ), which had an acceptable goodness of fit ( χ 2 = 298.01, df = 175, CFI = 0.97, RMSEA = 0.04 and SRMR = 0.04). Hypotheses about moderation were tested in SPSS (25 th edition) using PROCESS Model I ( Hayes, 2017 ; Table 3 ).

H1a and H1b suggested that hedonic well-being and eudaimonic well-being positively relate to employee affective commitment. According to Figure 2 , the results indicate that hedonic well-being ( β = 0.26, p < 0.01) and eudaimonic well-being ( β = 0.32, p < 0.01) are positively related to employee affective commitment. Taken together, these two findings provide support for H1a and H1b . In H2 , we predicted that employee affective commitment would positively associate with employee job performance. As seen in Figure 2 , employee affective commitment positively predicted employee job performance ( β = 0.41, p < 0.01), supporting H2 .

H3a and H3b suggested that employee affective commitment mediates the relationship between hedonic and eudaimonic well-being and employee job performance. According to Figure 2 , the results indicate that hedonic well-being is positively related to employee job performance via employee affective commitment ( β = 0.11, 95% CI = 0.09; 0.23). Similarly, eudaimonic well-being is positively related to employee job performance via employee affective commitment ( β = 0.15, 95% CI = 0.12; 0.35), supporting H3a and H3b .

Hedonic well-being.

Eudaimonic well-being and employee affective commitment.

In support of H4a , our results ( Table 3 ) revealed a negative and significant interaction effect between hedonic well-being and job insecurity on employee affective commitment ( β = −0.12, p < 0.05). The pattern of this interaction was consistent with our hypothesized direction; the positive relationship between hedonic well-being and employee affective commitment was weaker in the presence of high versus low job insecurity ( Figure 3 ). Likewise, the interaction effect between eudaimonic well-being and job insecurity on employee affective commitment was negatively significant ( β = −0.28, p < 0.01). The pattern of this interaction was consistent with our hypothesized direction; the positive relationship between eudaimonic well-being and employee affective commitment was weaker in the presence of high versus low job insecuritay ( Figure 4 ). Thus, H4a and H4b were supported. The pattern of these interactions was consistent with our hypothesized direction; the positive relationship of hedonic well-being and eudaimonic well-being with an employee affective commitment were weaker in the presence of high versus low perceived job insecurity.

5. Discussion

The present research examined the direct and indirect crossover from psychological well-being (hedonic and eudaimonic) to job performance through employee affective commitment and the moderating role of job insecurity between psychological well-being and affective commitment relationship. The results revealed that both hedonic well-being and eudaimonic well-being has a direct and indirect effect on employee job performance. Employee affective commitment was found to be a potential mediating mechanism (explaining partial variance) in the relationship between psychological well-being and job performance. Findings regarding the buffering role of job insecurity revealed that job insecurity buffers the positive relationship between psychological well-being and employee affective commitment such that higher the job insecurity, lower will be employee affective commitment. The findings generally highlight and reinforce that perceived job insecurity can be detrimental for both employees’ well-being and job-related behaviors (Soomro et al. , 2020 ).

5.1 Theoretical implications

The present study offers several contributions to employee well-being and job performance literature. First, the present research extends the employee well-being literature by investigating employee affective commitment as a key mechanism through which psychological well-being (hedonic and eudaimonic) influences employees’ job performance. In line with SDT, we found that both hedonic well-being and eudaimonic well-being enhanced employees’ affective commitment, which, in turn, led them to perform better in their jobs. Our study addresses recent calls for research to understand better how psychological well-being influence employees’ performance at work (Huang et al. , 2016 ), and adds to a growing body of work, which confirms the importance of psychological well-being in promoting work-related attitudes and behaviors (Devonish, 2016 ; Hewett et al. , 2018 ; Ismail et al. , 2019 ). Further, we have extended the literature on employee affective commitment, highlighting that psychological well-being is an important antecedent of employee’ affective commitment and thereby confirming previous research by Aboramadan et al. (2020) on the links between affective commitment and job performance.

Second, our results provide empirical support for the efficacy of examining the different dimensions of employee well-being, i.e. hedonic well-being and eudaimonic well-being as opposed to an overall index of well-being at work. Specifically, our results revealed that both hedonic well-being and eudaimonic well-being boost both employees’ attachment with his or her organization and job performance (Hewett et al. , 2018 ; Luu, 2019 ). Among the indicators of psychological well-being, eudaimonic well-being (i.e. realization and fulfillment of ones’ true nature) was found to have more influence on employee affective commitment and job performance as compared to hedonic well-being (i.e. state of happiness and sense of flourishing in life). Therefore, employees who experience high levels of psychological well-being are likely to be more attached to their employer, which, in turn, boosts their job performance.

Third, job insecurity is considered as an important work-related stressor (Schumacher et al. , 2016 ). However, the moderating role of job insecurity on the relationship between psychological well-being and affective commitment has not been considered by the previous research. Based on social exchange theory (Blau, 1964 ), we expected job insecurity to buffer the positive relationship between the psychological well-being and affective commitment. The results showed that employees with high levels of perceived job insecurity reduce the positive relationship of psychological well-being (hedonic and eudaimonic) and affective commitment. This finding is consistent with previous empirical evidence supporting the adverse role of perceived job insecurity in reducing employees’ belongingness with their organization (Jiang and Lavaysse, 2018 ). There is strong empirical evidence (Qian et al. , 2019 ; Schumacher et al. , 2016 ) that employee attitudes and health are negatively affected by increasing levels of job insecurity. Schumacher et al. (2016) suggested in an elaborate explanation of the social exchange theory that the constant worrying about the possibility of losing ones’ job promotes psychological stress and feelings of unfairness, which, in turn, affects employees’ affective commitment. Hence, employees’ psychological well-being and affective commitment are heavily influenced by the experience of high job insecurity.

5.2 Practical implications

Our study has several implications. First and foremost, this study will help managers in understanding the importance of employees’ psychological well-being for work-related attitudes and behavior. Based on our findings, managers need to understand how important psychological well-being is for employees’ organizational commitment and job performance. According to Hosie and Sevastos (2009) , several human resource-based interventions could foster employees’ psychological well-being, such as selecting and placing employees into appropriate positions, ensuring a friendly work environment and providing training that improves employees’ mental health and help them to manage their perceptions positively.

Besides, managers should provide their employees with opportunities to use their full potential, which will increase employees’ sense of autonomy and overall well-being (Sharma et al. , 2017 ). By promoting employee well-being in the workplace, managers can contribute to developing a workforce, which will be committed to their organizations and will have better job performance. However, based on our findings, in the presence of job insecurity, organizations spending on interventions to improve employees’ psychological well-being, organizational commitment and job performance might go in vain. In other words, organizations should ensure that employees feel a sense of job security or else the returns on such interventions could be nullified.

Finally, as organizations operate in a volatile and highly competitive environment, it is and will be difficult for them to provide high levels of job security to their employees, especially in developing countries such as Pakistan (Soomro et al. , 2020 ). Given the fact that job insecurity leads to cause adverse employee psychological well-being and affective commitment, managers must be attentive to subordinates’ perceptions of job insecurity and adverse psychological well-being and take action to prevent harmful consequences (Ma et al. , 2019 ). Organizations should try to avoid downsizings, layoffs and other types of structural changes, respectively, and find ways to boost employees’ perceptions of job security despite those changes. If this is not possible, i.e. the organization not able to provide job security, this should be communicated to employees honestly and early.

5.3 Limitations and future studies

There are several limitations to this study. First, we measured our research variables by using a self-report survey at a single point of time, which may result in CMB. We used various procedural remedies to mitigate the potential for CMB and conducted CFA as per the guidelines of Podsakoff et al. (2012) to ensure that CMV was unlikely to be an issue in our study. However, future research may rely on supervisors rated employees’ job performance or collect data at different time points to avoid the threat of such bias.

Second, the sample of this study consisted of employees working in cellular companies of Pakistan with different demographic characteristics and occupational backgrounds; thus, the generalizability of our findings to other industries or sectors is yet to be established. Future research should test our research model in various industries and cultures.

A final limitation pertains to the selection of a moderating variable. As this study was conducted in Pakistan, contextual factors such as the perceived threat to terrorism, law and order situation or perceived organizational injustice might also influence the psychological well-being of employees working in Pakistan (Jahanzeb et al. , 2020 ; Sarwar et al. , 2020 ). Future studies could consider the moderating role of such external factors in the relationship between employee psychological well-being, affective commitment and job performance.

6. Conclusion

This study proposed a framework to understand the relationship between employee psychological well-being, affective commitment and job performance. It also described how psychological well-being influences job performance. Additionally, this study examined the moderating role of perceived job insecurity on psychological well-being and affective commitment relationship. The results revealed that employee psychological well-being (hedonic and eudaimonic) has beneficial effects on employee affective commitment, which, in turn, enhance their job performance. Moreover, the results indicated that perceived job insecurity has ill effects on employee affective commitment, especially when the employee has high levels of perceived job insecurity.

Research model

Structural model with standardized coefficients; N = 280

Interactive effect of hedonic well-being and job insecurity on employee affective commitment

Interactive effect of eudaimonic well-being and job insecurity on employee affective commitment

Descriptive statistics and correlations among of variables

* p < 0.05,

** p < 0.01; Unstandardized coefficients and average bootstrap estimates are stated; demographic variables are controlled; bootstrapping procedure [5,000 iterations, bias-corrected, 95% CI]

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• Open access
• Published: 27 May 2024

Associations between medical students’ stress, academic burnout and moral courage efficacy

• Galit Neufeld-Kroszynski   ORCID: orcid.org/0000-0001-9093-1308 1   na1 ,
• Keren Michael   ORCID: orcid.org/0000-0003-2662-6362 2   na1 &
• Orit Karnieli-Miller   ORCID: orcid.org/0000-0002-5790-0697 1  

BMC Psychology volume  12 , Article number:  296 ( 2024 ) Cite this article

142 Accesses

Metrics details

Medical students, especially during the clinical years, are often exposed to breaches of safety and professionalism. These contradict personal and professional values exposing them to moral distress and to the dilemma of whether and how to act. Acting requires moral courage, i.e., overcoming fear to maintain one’s core values and professional obligations. It includes speaking up and “doing the right thing” despite stressors and risks (e.g., humiliation). Acting morally courageously is difficult, and ways to enhance it are needed. Though moral courage efficacy, i.e., individuals’ belief in their capability to act morally, might play a significant role, there is little empirical research on the factors contributing to students’ moral courage efficacy. Therefore, this study examined the associations between perceived stress, academic burnout, and moral courage efficacy.

A cross-sectional study among 239 medical students who completed self-reported questionnaires measuring perceived stress, academic burnout (‘exhaustion,’ ‘cynicism,’ ‘reduced professional efficacy’), and moral courage efficacy (toward others’ actions and toward self-actions). Data analysis via Pearson’s correlations, regression-based PROCESS macro, and independent t -tests for group differences.

The burnout dimension of ‘reduced professional efficacy’ mediated the association between perceived stress and moral courage efficacy toward others’ actions. The burnout dimensions ‘exhaustion’ and ‘reduced professional efficacy’ mediated the association between perceived stress and moral courage efficacy toward self-actions.

Conclusions

The results emphasize the importance of promoting medical students’ well-being—in terms of stress and burnout—to enhance their moral courage efficacy. Medical education interventions should focus on improving medical students’ professional efficacy since it affects both their moral courage efficacy toward others and their self-actions. This can help create a safer and more appropriate medical culture.

Peer Review reports

Introduction

In medical school, and especially during clinical years, medical students (MS) are often exposed to physicians’ inappropriate behaviors and various breaches of professionalism or safety [ 1 , 2 , 3 ]. These can include lack of respect or sensitivity toward patients and other healthcare staff, deliberate lies and deceptions, breaching confidentiality, inadequate hand hygiene, or breach of a sterile field [ 4 , 5 ]. Furthermore, MS find themselves performing and/or participating in these inappropriate behaviors. For example, a study found that 80% of 3 rd– 4th year MS reported having done something they believed was unethical or having misled a patient [ 6 ]. Another study showed that 47.1–61.3% of females and 48.8–56.6% of male MS reported violating a patient’s dignity, participating in safety breaches, or examining/performing a procedure on a patient without valid consent, following a clinical teacher’s request, as a learning exercise [ 5 ]. These behaviors contradict professional values and MS’ own personal and moral values, exposing them to a dilemma in which they must choose if and how to act.

Taking action requires moral courage, i.e., taking an active stand or acting in the face of wrongdoing or moral injustice jeopardizing mental well-being [ 7 , 8 , 9 , 10 ]. Moral courage includes speaking up and “doing the right thing” despite risks, such as shame, retaliation, threat to reputation, or even loss of employment [ 8 ]. Moral courage is expressed in two main situations: when addressing others’ wrongdoing (e.g., identifying and disclosing a past/present medical error by colleagues/physicians); or when admitting one’s own wrongdoing (e.g., disclosing an error or lack of knowledge) [ 11 ].

Due to its “calling out” nature, acting on moral courage is difficult. A hierarchy and unsafe learning environment inhibits the ability for assertive expression of concern [ 12 , 13 , 14 ]. This leads to concerning findings indicating that only 38% of MS reported that they would approach someone performing an unsafe behavior [ 12 ], and about half claimed that they would report an error they had observed [ 15 ].

Various reasons were suggested to explain why MS, interns, residents, or nurses, hesitate to act in a morally courageous way, including difficulty questioning the decisions or actions of those with more authority [ 12 ], and fear of negative social consequences, such as being disgraced, excluded, attacked, punished, or poorly evaluated [ 13 ]. Other reasons were the wish to fit into the team [ 6 ] and being a young professional experiencing “lack of knowledge” or “unfamiliarity” with clinical subtleties [ 16 ].

Nevertheless, failing to act on moral courage might lead to negative consequences, including moral distress [ 17 ]. Moral distress is a psychological disequilibrium that occurs when knowing the ethically right course of action but not acting upon it [ 18 ]. Moral distress is a known phenomenon among MS [ 19 ], e.g., 90% of MS at a New York City medical school reported moral distress when carrying for older patients [ 20 ]. MS’ moral distress was associated with thoughts of dropping out of medical school, choosing a nonclinical specialty, and increased burnout [ 20 ].

These consequences of moral distress and challenges to acting in a morally courageous way require further exploration of MS’ moral courage in general and their moral courage efficacy specifically. Bandura coined the term self-efficacy, focused on one’s perception of how well s/he can execute the action required to deal successfully with future situations and to achieve desired outcomes [ 21 ]. Self-efficacy plays a significant role in human behavior since individuals are more likely to engage in activities they believe they can handle [ 21 ]. Therefore, self-efficacy regarding a particular skill is a major motivating factor in the acquisition, development, and application of that skill [ 22 ]. For example, individuals’ perception regarding their ability to deal positively with ethical issues [ 23 ], their beliefs that they can handle effectively what is required to achieve moral performance [ 24 ], and to practically act as moral agents [ 25 ], can become a key psychological determinant of moral motivation and action [ 26 ]. Due to self-efficacy’s importance there is a need to learn about moral courage efficacy, i.e., individuals’ belief in their ability to exhibit moral courage through sharing their concerns regarding others and their own wrongdoing. Moral courage efficacy was suggested as important to moral courage in the field of business [ 27 ], but not empirically explored in medicine. Thus, there is no known prevalence of moral courage efficacy toward others and toward one’s own wrongdoing in medicine in general and for MS in particular. Furthermore, the potential contributing factors to moral courage efficacy, such as stress and burnout, require further exploration.

The associations between stress, burnout, and moral courage efficacy

Stress occurs when people view environmental demands as exceeding their ability to cope with them [ 28 ]. MS experience high levels of stress during their studies [ 29 ], due to excessive workload, time management difficulties, work–life balance conflicts, health concerns, and financial worries [ 30 ]. Studies show that high levels of stress were associated with decreased empathy [ 31 ], increased academic burnout, academic dishonesty, poor academic performance [ 32 ], and thoughts about dropping out of medical school [ 33 ]. As stress may impact one’s perceived efficacy [ 34 ], this study examined whether stress can inhibit individuals’ moral courage efficacy to address others’ and their own wrongdoing.

An aspect related to a poor mental state that may mediate the association between stress and MS’ moral courage efficacy is burnout. Burnout includes emotional exhaustion, cynicism toward one’s occupation value, and doubting performance ability [ 35 ]. Burnout is usually work-related and is common in the helping professions [ 60 ]. For students, this concept relates to academic burnout [ 36 ], which includes exhaustion due to study demands, a cynical and detached attitude to studying, and low/reduced professional efficacy, i.e. feeling incompetent as learners [ 37 ].

Burnout has various negative implications for MS’ well-being and professional development. Burnout is associated with psychiatric disorders and thoughts of dropping out of medical school [ 33 ]. Furthermore, MS’ burnout is associated with increased involvement in unprofessional behavior, eroding professional development, diminishing qualities such as honesty, integrity, altruism, and self-regulation [ 38 ], reducing empathy [ 31 , 39 ] and unwillingness to provide care for the medically underserved [ 40 ]. Thus, burnout may also impact MS’ views on their responsibility and perceived ability to promote high-quality care and advocate for patients [ 41 ], possibly leading them to feel reluctant and incapable to act with moral courage [ 42 ]. Earlier studies exploring stress and its various outcomes, found that burnout, and specifically exhaustion, can become a crucial mediator for various harmful outcomes [ 43 ]. Although stress is impactful to creating discomfort, the decision and ability to intervene requires one’s own drive and power. When one is feeling stress, leading to burnout their depleted energy reserves and diminished sense of professional worth likely undermine their perceived power (due to exhaustion) or will (due to cynicism) to uphold professional ethical standards and intervene to advocate for patient care in challenging circumstances, such as the need to speak up in front of authority members. Furthermore, burnout may facilitate a cognitive distancing from professional values and responsibilities, allowing for moral disengagement and reducing the likelihood of morally courageous actions. This mediation role requires further exploration.

This study examined associations between perceived stress, academic burnout, and moral courage efficacy. In addition to the mere associations among the variables, it will be examined whether there is a mediation effect (perceived stress → academic burnout → moral courage efficacy) to gain more insight into possible mechanisms of the development of moral courage efficacy and of protective factors. Understanding these mechanisms has educational benefit for guiding interventions to enhance MS’ moral courage efficacy.

H1: Perceived stress and academic burnout dimensions will be negatively associated with moral courage efficacy dimensions.

H2: Perceived stress will be positively associated with academic burnout dimensions.

H3: Academic burnout dimensions will mediate the association between perceived stress and moral courage efficacy dimensions.

Materials and methods

Sample and procedure.

A quantitative cross-sectional study among 239 MS. Most participants were female (60%), aged 29 or less (90%), and unmarried (75%). About two thirds (64.3%) were at the pre-clinical stage of medical school and about a third (35.7%) at the clinical stage. In December 2019, the research team approached MS through email and social media to participate in the study and complete an online questionnaire. This was a part of a national study focused on MS’ burnout [ 44 ]. The 239 participants were recruited by a convenience sampling. Data were collected online through Qualtrics platform, via anonymous self-reported questionnaires. The University Ethics Committee approved the study, and all participants signed an informed consent form.

Moral courage efficacy —This 8-item instrument, developed for this study, is based on the literature on moral courage, professionalism, and speaking-up, including qualitative and quantitative studies [ 7 , 13 , 45 , 46 , 47 ], and discussions with MS and medical educators. The main developing team included a Ph.D. medical educator expert in communication in healthcare and professionalism; an M.D. psychiatrist expert in decision making, professionalism, and philosophy; a Ph.D. graduate who analyzed MS’ narratives focused on moral dilemmas and moral courage during professionalism breaches; and a Ph.D. candidate focused on assertiveness in medicine [ 14 ]. This allowed the identification of different types of situations MS face that may require moral courage.

As guided by instructions for measuring self-efficacy, which encourage using specific statements that relate to the specific situation and skill required [ 48 ], the instrument measures MS’ perception of their own ability, i.e., self-efficacy, to act based on their moral beliefs when exposed to safety and professionalism breaches or challenges. Due to our qualitative findings indicating that students change their interpretation of the problematic event based on their decision to act in a morally courageous way and that some are exposed to specific professionalism violations while others are not when designing the questionnaire, we decided to make the cases not explicit to specific types of professionalism breaches – e.g., not focused on talking above a patient’s head [ 1 ], but rather general the type of behavior e.g., “behaves immorally”. This decreases the personal interpretation if one behavior is acceptable by this individual; and also decreases the possibility of not answering the question if the individual student has never seen that specific behavior. Furthermore, to avoid “gray areas” in moral issues, we wrote the statements in a manner where there is no doubt whether there is a moral problem (“problematic situation”) [ 47 ], and thus the focus was only on one’s feeling of being capable of speaking up about their concern, i.e., act in a moral courage efficacy (see Table  1 ).

The instrument’s initial development consisted of 14 items addressing various populations, including senior MDs. The 14-item tool included questions regarding the willingness to recommend a second opinion or to convey one’s medical mistake to patients and their families. These actions are less relevant to MS. Thus, we extracted the questionnaire to a parsimonious instrument of 8 items.

The 8 items were divided into two dimensions: others and the self. This division is supported by the literature on moral courage that distinguishes between courage regarding others- vs. self-behavior. Hence, the questionnaire was designed to assess one’s perceived ability to act/speak up in these two dimensions: (a) situations of moral courage efficacy relating to others’ behavior (e.g., “ capable of telling a senior physician if I have detected a mistake s/he might have made ”); (b) situations of moral courage efficacy relating to self (e.g., “ capable of disclosing my mistakes to a senior physician ”). This two-dimension division is important and was absent in former measurements of moral courage. It was also replicated in another study we conducted among MS [ 49 ]. Furthermore, factor analysis with Oblimin rotation supported this two-factor structure (Table  1 ). All items had a high factor loading on the relevant factor (it should be mentioned that item 4 was loaded 0.59 on the relevant factor and 0.32 on the non-relevant factor).

All items are rated on a 5-point Likert scale (0 = to a small extent; 4 = to a very great extent) and are calculated by averaging the answers on the dimension, with higher scores representing higher moral courage efficacy. Internal reliability was α = 0.80 for the “others” dimension and α = 0.84 for the “self” dimension.

Perceived stress —This single-item questionnaire (“How would you rate the level of stress you’ve been experiencing in the last few days?” ) evaluates MS’ perceived stress currently in their life on an 11-point Likert scale (0 = no stress; 10 = extreme stress), with higher scores representing higher perceived stress. It is based on a similar question evaluating MS’ perceived emotional stress [ 29 ]. Even though a multi-item measure might be more stable, previous studies indicated that using a single item is a practical, reliable alternative, with high construct validity in the context of felt/perceived stress, self-esteem, health status, etc [ 43 , 50 , 51 ].

Academic burnout —This 15-item instrument is a translated version [ 44 ] of the MBI-SS (MBI–Student Survey) [ 37 ], a common instrument used to measure burnout in the academic context, e.g. MS [ 52 , 53 ]. It measures students’ feelings of burnout regarding their studies on three dimensions: (a) ‘exhaustion’ (5 items; e.g., “ Studying or attending a class is a real strain for me ”), (b) ‘cynicism’ (4 items; e.g., “ I doubt the significance of my studies ”), (c) lack of personal academic efficacy (‘reduced professional efficacy’) (6 items; “ I feel [un]stimulated when I achieve my study goals ”). Each item is rated on a 7-point Likert scale (0 = never; 6 = always) and is calculated by summing the answers on the dimension (after re-coding all professional efficacy items), with higher scores representing more frequent feelings of burnout. Internal reliability was α = 0.80 for ‘exhaustion’, α = 0.80 for ‘cynicism’, and α = 0.84 for ‘reduced professional efficacy’.

Statistical analyses

IBM-SPSS (version 25) was used to analyze the data. Pearson’s correlations examined all possible bivariate associations between the study variables. PROCESS macro examined the mediation effects (via model#4). The significance of the mediation effects was examined by calculating 5,000 samples to estimate the 95% percentile bootstrap confidence intervals (CIs) of indirect effects of the predictor on the outcome through the mediator [ 54 ]. T -tests for independent samples examined differences between the study variables in the pre-clinic and clinic stages. The defined significance level was set generally to 5% ( p  < 0.05).

This study focused on understanding moral courage efficacy, i.e., MS’ perceived ability to speak up and act while exposed to others’ and their own wrongdoing. The sample’s frequencies demonstrate that only 10% of the MS reported that their moral courage efficacy toward the others was “very high to high,” and 54% reported this toward the self. Mean scores demonstrate that regarding the others, MS showed relatively low/moderate levels of moral courage and higher levels regarding the self. As for the variables tested to be associated with moral courage efficacy, MS showed relatively high perceived stress and low-to-moderate academic burnout (see Table  2 for the variables’ psychometric characteristics).

Table  2 also shows the correlations among the study variables. According to Cohen’s (1988) [ 55 ] interpretation of the strength in bivariate associations (Pearson correlation), the effect size is low when r value varies around 0.1, medium when it is around 0.3, and large when it is more than 0.5. Hence, regarding the associations between the two dimensions of moral courage efficacy: we found a moderate positive correlation between the efficacy toward others and the efficacy toward the self. Regarding the associations among the three academic burnout dimensions: we found a strong positive correlation between ‘exhaustion’ and ‘cynicism,’ a weak positive correlation between ‘exhaustion’ and ‘reduced professional efficacy,’ and a moderate positive correlation between ‘cynicism,’ and ‘reduced professional efficacy.’

As for the associations concerning H1, Table  2 indicates that one academic burnout dimension, i.e., ‘reduced professional efficacy,’ had a weak negative correlation with moral courage efficacy toward the others, thus high burnout was associated with lower perceived moral courage efficacy toward others. Additionally, perceived stress and all three burnout dimensions had weak negative correlations with moral courage efficacy toward the self—partially supporting H1.

As for the associations concerning H2, Table  2 indicates that perceived stress had a strong positive correlation with ‘exhaustion,’ a moderate positive correlation with ‘cynicism,’ and a weak positive correlation with ‘reduced professional efficacy’—supporting H2.

Based on these correlations, we conducted regression-based models to examine the unique and complex relationships among the study variable, including their various dimensions, while focusing on the examination of whether academic burnout mediates the association between perceived stress and moral courage efficacy (see Tables  3 and 4 ; and Figs.  1 and 2 ).

A model presenting the association between perceived stress and moral courage efficacy toward others, mediated by academic burnout. Note full arrows contain significant β coefficient values (fractured arrows mean nonsignificance

Focusing on moral courage efficacy toward others

Table  3  and Fig.  1 indicate that perceived stress was positively associated with all three academic burnout dimensions: ‘exhaustion’ (path a 1 ), ‘cynicism’ (path a 2 ), and ‘reduced professional efficacy’ (path a 3 ). These paths support H2. In turn, ‘reduced professional efficacy’ was negatively associated with moral courage efficacy toward the others (path b 3 ), supporting H1. The CIs of the indirect effect (paths a 3 b 3 ) did not contain zero; therefore, perceived stress had a significant indirect effect on moral courage efficacy toward the others, through the burnout dimension ‘reduced professional efficacy.’ This path supports H3.

A model presenting the association between perceived stress and moral courage efficacy towards self, mediated by academic burnout. Note full arrows contain significant β coefficient values (fractured arrows mean non-significance

Focusing on moral courage efficacy toward the self

Table  4  and Fig.  2 also indicate that perceived stress was positively associated with all three academic burnout dimensions: ‘exhaustion’ (path a 4 ), ‘cynicism’ (path a 5 ), and ‘reduced professional efficacy’ (path a 6 ). These paths support H2. In turn, ‘exhaustion’ and ‘reduced professional efficacy’ were negatively associated with moral courage efficacy toward the self (paths b 4 , b 6 respectively). These paths support H1 The CIs of the indirect effects (paths a 4 b 4 , a 6 b 6 ) did not contain zero; therefore, perceived stress had a significant indirect effect on moral courage efficacy toward the self, through the burnout dimensions ‘exhaustion’ and ‘reduced professional efficacy.’ These paths support H3. It should be noted that in this analysis, the initially significant association between perceived stress and moral courage efficacy toward the self (path c 2, representing H1) became insignificant in the existence of academic burnout dimensions (path c’ 2 ). These results demonstrate complete mediation and also support H3.

In addition to examining the complex relationships between stress, academic burnout, and moral courage efficacy among MS, we tested the differences between MS in the pre-clinical and clinical school stages in all study variables. The results indicate non-significant differences in moral courage efficacy. However, medical-school-stage differences were found in stress [t(197.4)=-4.36, p  < 0.001] and in one academic burnout dimension [t(233)=-2.40, p  < 0.01]. In that way, MS at the clinical stage reported higher levels of perceived stress ( M  = 7.32; SD  = 2.17) and exhaustion ( M  = 19.67; SD  = 6.58) than MS in the pre-clinical stage ( M  = 5.94; SD  = 2.59 and M  = 17.48; SD  = 6.78, respectively).

This study examined the associations between perceived stress, academic burnout, and moral courage efficacy to understand MS’ perceived ability to speak up and act while exposed to others’ and their own wrongdoing. The findings show that one dimension of burnout, that of ‘reduced professional efficacy,’ mediated the associations between perceived stress and moral courage efficacy toward both others and self. ‘Exhaustion’ mediated the association between perceived stress and moral courage efficacy only toward the self.

Before discussing the meanings of the associations, this study was an opportunity to explore moral courage efficacy occurrence. The findings indicated fairly low/moderate mean scores of perceived ability to speak up and act while confronted with others’ wrongdoing and moderate/high scores of perceived ability while confronted with one’s own wrongdoing. This implies that students do not feel capable enough to share their concerns regarding others’ possible errors and feel more able, but still not enough, to share their own flaws and needs for guidance. These findings require attention, from both patient safety and learning perspectives.

Regarding patient safety, feeling unable to act while confronted with others or self- wrongdoing means that some errors may occur and not be addressed. This is in line with former findings that showed that less than 50% of MS would actually approach someone performing an unsafe behavior [ 12 ], or report an error they had observed [ 15 ]. These numbers are likely to improve in postgraduates as studies showed that between 64 and 79% of interns and residents reported they would likely speak up to an attending when exposed to a safety threat [ 56 , 57 ].

Regarding learning, our MS’ scores must improve for various reasons. First, moderate scores may indicate a psychologically unsafe learning environment, which prevents or discourages sharing uncertainties, especially about others’ behavior, and creates difficulty for students to share their own concerns, limitations, mistakes, and hesitations when feeling incapable or unqualified for a task [ 58 ]. Second, limited sharing of errors may be problematic because by not disclosing their error, students miss the chance to learn from it; [ 59 ] they lose the opportunity for reflective guidance to explore what worked well, what did not, and how to improve [ 59 , 60 ]. Third, if they do not discuss others’ errors or their own, they may deny themselves the necessary support to learn the all-important skills of how to deal with the emotional turmoil and challenges of errors, and how to share the error with a patient or family member [ 61 ]. Furthermore, if MS feel incapable of sharing their concern about a senior’s possible mistake, they miss other learning opportunities—e.g., the senior’s reasoning and clinical judgment may show that a mistake was not made. In this case, the student would miss being shown why they were wrong and what they did do well. Thus, identifying what can enhance moral courage efficacy and practice is needed. The fact that there are no significant differences between pre-clinical and clinical years students in their perceived ability to apply moral courage, may indicate that there is a cultural barrier in perceiving the idea of sharing weakness or of revealing others’ mistakes as unacceptable. Thus, the socialization, in the medical school environment, both in pre-clinical and clinical years, perhaps lacks the encouragement to speak up and provision of safe space.

This study examined the associations between perceived stress, academic burnout, and moral courage efficacy among MS. The findings indicate that, like earlier studies, stress is not directly connected to speaking up [ 62 ] or moral courage. It rather contributes to it indirectly, through the impact of burnout. Beyond the well-established role of stress in explaining burnout [ 63 , 64 ], we identified a negative consequence of burnout—hindering moral courage efficacy. This may help explain the path in which previous studies found burnout to impair MS’ quality of life, how it leads to dropout, and to more medical errors [ 65 ]. When individuals experience the burnout dimension of ‘reduced professional efficacy,’ they may feel less confident and fit, leading them to feel more disempowered to take the risk (required in courage) and share their concerns and hesitations about others’ mistakes and their own challenges. This fits earlier studies indicating that being a young professional experiencing “lack of knowledge” or “unfamiliarity” with clinical subtleties is a barrier to moral courage [ 11 ]. This may have various negative implications, of limited moral courage efficacy, as seen here, as well as paying less attention and not fully addressing their learning needs, leading to a vicious cycle of “feeding” the misfit feeling, potentially increasing their moral distress. Furthermore, those who feel they know less and, therefore, need more support to fill the gap in knowledge and skills, are less inclined to ask for help.

Beside the negative associations between ‘reduced professional efficacy’ and both dimensions of moral courage efficacy (toward others and the self), another dimension of academic burnout—‘exhaustion’—was negatively associated with moral courage efficacy toward the self. This is worrying because when learners are exhausted, their attention is reduced and they are at greater risk of error, as proven in an earlier study [ 65 ]. The current study adds to this information another worry, showing that MS are less willing to share their hesitations about themselves or the mistakes they already made, thus perhaps not preventing the error or fixing it. MS might create an unspoken contract with senior physicians about not exposing each other’s mistakes, with various possible negative implications. Some MS’ tendency to defend physicians’ mistakes was identified elsewhere [ 66 ].

The findings concerning medical-school-stage differences demonstrated that MS in the clinical stage had higher perceived stress and exhaustion levels than MS in the pre-clinical stage. These results support previous studies indicating stress, academic burnout, and more challenging characteristics among more senior students, including a decline in ideals, altruistic attitudes, and empathy during medical school studies; or more exhaustion, cynicism, and higher levels of detached emotions and depression through the years of medical school [ 67 , 68 , 69 ]. These higher levels of stress and exhaustion, can be explained by the senior students’ exposure to the rounds in the hospitals, which requires ongoing learning, more pressure, and a sense of overload in their academic life.

Limitations and future studies

Despite the importance of the findings, the study has several limitations. First, the participants were from one university, and recruited via convenience sampling, including only MS who voluntarily completed the questionnaires, undermining generalizability. To address this limitation, future research should aim to include a more diverse and representative sample of medical students from multiple universities and geographical regions. This would enhance the external validity and applicability of the findings across different educational and cultural contexts. Second, future studies are recommended to follow up on medical students’ stress, academic burnout, and moral courage efficacy over time. Exploring the development of professional efficacy and the barriers to exposing one’s and others’ weaknesses and flaws within the medical environment can help improve the medical culture into a safer space. Third, an intriguing avenue for future research is the exploration of the construct of ‘moral courage efficacy’ within different cohorts of healthcare students throughout their undergraduate and postgraduate years to learn about their moral courage efficacy development as well as and to verify the association between the findings from this newly developed scale and actual moral courage behavior. Additionally, experimental designs, such as interventions to reduce stress and burnout among medical students, could be employed to observe the impact on moral courage efficacy.

Conclusions and implications

This study is a first step in understanding moral courage efficacy and what contributes to it. The study emphasizes the importance of promoting MS’ well-being—in terms of stress and burnout—to enhance their moral courage efficacy. The findings show that the ‘reduced professional efficacy’ mediated the association between perceived stress and moral courage efficacy, toward both the others and self. This has potential implications for safety, learning, and well-being. To encourage MS to develop moral courage efficacy that will potentially increase their morally courageous behavior, we must find ways to reduce their stress and burnout levels. As the learning and work environments are a major cause of burnout [ 38 ], it would be helpful to focus on creating safe spaces where they can share others- and self-related concerns [ 70 ]. The first step is a learning environment promoting students’ overall health and well-being [ 71 ]. Useful additions are processes that support MS while dealing with education- and training-related stresses, improving their academic-professional efficacy, and constructively helping them handle challenging situations through empathic feedback [ 70 ]. This can lead them to a stronger belief in their ability to share safety and professionalism issues, thus enhancing their learning and patient care.

Data availability

No datasets were generated or analysed during the current study.

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Acknowledgements

The authors wish to thank Dr. Lior Rozental in helping in recruiting students to the study. This study was done as part of Orit Karnieli-Miller’s Endowed chair of the Dr. Sol Amsterdam, Dr. David P. Schumann in Medical Education, Tel Aviv University. This study is written in the blessed memory of Oshrit Bar-El, devoted to enhancing Moral Courage.

The manuscript was partially supported by a grant by the by the Israel Science Foundation (grant no. 1599/21).

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Galit Neufeld-Kroszynski and Keren Michael contributed equally to this work.

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Department of Medical Education, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, 69778, Israel

Galit Neufeld-Kroszynski & Orit Karnieli-Miller

Department of Human Services, Max Stern Yezreel Valley College, Yezreel Valley, Israel

Keren Michael

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GNK: conception and design, interpretation of data, drafting and revision of the manuscript, and final approval of the version to be published; KM: analysis and interpretation of data, drafting and revision of the manuscript, and final approval of the version to be published; OKM: conception and design, interpretation of data, drafting and revision of the manuscript, and final approval of the version to be published.

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Correspondence to Orit Karnieli-Miller .

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Study findings were presented at the Academy for Professionalism in Healthcare Conference, June 2nd, 2022, virtual; and the 7th International Conference on Public Health, August 8th, 2021, virtual.

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Neufeld-Kroszynski, G., Michael, K. & Karnieli-Miller, O. Associations between medical students’ stress, academic burnout and moral courage efficacy. BMC Psychol 12 , 296 (2024). https://doi.org/10.1186/s40359-024-01787-6

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The Relationship between Psychological Well-Being and Psychosocial Factors in University Students

Francisco manuel morales-rodríguez.

1 Department of Educational and Developmental Psychology, Faculty of Psychology, Campus Universitario de Cartuja, University of Granada, 18071 Granada, Spain; se.rgu@selarommf

Isabel Espigares-López

2 Department of Legal Medicine, Toxicology and Psychiatry, Faculty of Medicine, Avda. de la Investigación, 11, 18016 Granada, Spain; se.rgu.oerroc@seragipseasi

3 Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University—Peninsula Campus, Frankston, VIC 3199, Australia; [email protected]

José Manuel Pérez-Mármol

4 Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Avda. de la Ilustración, 60, 18016 Granada, Spain

5 Instituto de Investigación Biosanitaria de Granada (ibs.Granada), 18016 Granada, Spain

Determining what factors influence the psychological well-being of undergraduate university students may provide valuable information to inform the development of intervention programs and targeted learning activities. The objective of this study was to investigate the correlation between psychological well-being in university students and their self-reported learning styles and methodologies, social skills, emotional intelligence, anxiety, empathy and self-concept. The final sample consisted of 149 Spanish university students, with an average age of 21.59 years ( SD = 4.64). Psychological well-being dimensions, along with learning style and methodology preferences, social skills, level of social responsibility, emotional intelligence, state and trait anxiety, empathy and levels of self-concept were measured using a series of validated self-report scales. The results indicate that the total variance explained by the university students’ psychological well-being factors were as follows: i) self-acceptance dimension (R 2 = 0.586, F (6,99) = 23.335, p < 0.001); ii) positive relationships dimension (R 2 = 0.520, F (6,99) = 17.874, p < 0.001); iii) autonomy dimension (R 2 = 0.313, F (4,101) = 11.525, p < 0.001); iv) environmental mastery dimension (R 2 = 0.489, F (4,101) = 24.139, p < 0.001); v) personal growth dimension (R 2 = 0.354, F (4,101) = 13.838, p < 0.001); and vi) purpose-in-life dimension (R 2 = 0.439, F (4,101) = 19.786, p < 0.001). The study findings may be used to inform new educational policies and interventions aimed at improving the psychological well-being of university students in the international context.

1. Introduction

1.1. psychological well-being.

Psychological well-being has been defined within the eudaimonic perspective as the development of one’s true potential. This is in contrast to the subjective well-being view [ 1 , 2 ]. Psychological well-being is viewed as the result of a life well-lived and is an important factor in students successfully adapting to college/university life. For this reason, this construct usually includes dimensions such as self-acceptance, positive relationships, autonomy, environmental mastery, personal growth and purpose-in-life [ 3 ]. Students attending university have to adjust to a new learning context and are under increased academic pressure [ 4 , 5 ]. This stage is considered to be one of the highest anxiety and lowest psychological well-being phases in the life cycle, with high levels of psychological distress compared with the general population [ 4 , 6 ]. Several studies have reported lower levels of psychological well-being in students attending university [ 3 , 7 , 8 ]. In a recent study by Sandoval et al. [ 8 ], a high percentage of university students exhibited a medium degree of psychological well-being, indicating that it is an indicator of their degree of adjustment adaptation.

1.2. Psychosocial Factors

Several models support the possible psychosocial factors related to psychological well-being. From a general perspective, the psycho-educational approach is an integral framework for the development and evaluation of psychological and educational constructs such as social skills, empathy, self-concept, anxiety and emotional intelligence, among others [ 9 , 10 , 11 ]. More specific frameworks, such as EuroPsy for the development of standards for high-quality professional education in psychology, include the following higher education competencies: adequate levels of empathy or anxiety, socially responsible attitudes, emotional management, problem solving and learning style preferences [ 11 ]. Other frameworks, such as the European Higher Education Area [ 10 ] and the Organization for Economic Cooperation and Development [ 9 ], highlight the importance of developing systemic competencies that include inter- and intra-personal psychological resources such as emotional intelligence, self-esteem, social skills, social responsibility and empathy [ 9 , 10 ]. From a psychological perspective, emotions are key constructs related to psychological well-being and satisfaction with life, according to classical theoretical models such as that of Goleman [ 12 ], Mayer et al. [ 13 ] and Bar-On [ 14 ]. Other more contemporary models include those by Bisquerra and Pérez-Escoda [ 12 , 15 , 16 , 17 , 18 ]. These models propose that emotional/psychological skills may be divided into two poles inside a continuum. The positive side includes elements such as self-esteem, social skills and empathic attitudes, and the negative side includes symptoms such as anxiety [ 5 , 19 , 20 , 21 , 22 ]. Both sides seem to have a relationship with psychological well-being, according to the existing empirical literature [ 5 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ].

From an educational perspective, learning style preferences are understood as the various ways of overcoming, planning and resolving the demands of learning. There are four learning styles based on the preferences of the individual: the activist style based on direct experience, the reflector style based on observation and data collection, the theorist style based on abstract conceptualization and conclusion formation and the pragmatist style based on active experimentation and a search for practical applications [ 26 ]. In relation to learning methodologies, two types are usually differentiated, traditional learning, usually more common in education, whose methodology is expository, individualistic and competitive, and cooperative learning, which is characteristically more autonomous, social and dialectical. García-Ruiz and González Fernández [ 27 ] noted that the cooperative learning methodology was more positive for students than the traditional approach, since their learning was greater and of better quality. Cooperative learning methodologies usually influence the degree of academic satisfaction [ 5 , 28 ]. In turn, the greater the satisfaction with the academic environment in general (contents of university subjects, types of assessments used, methodologies applied to learning, teaching / learning styles, etc.), the larger the psychological well-being perceived by university students [ 22 ].

Under the umbrella of educational resources, social skills are the ability to adequately manage interpersonal relationships with the environment and to correctly understand, control and adjust interpersonal strategies. Social skills are measured by the overall social competence of the individual and by the inter- and intra-personal strategies used [ 29 ]. These skills appear to be related to academic performance in the university environment [ 30 ]. Positive social relationships have been shown to be associated with psychological well-being [ 31 ]. In addition, university social responsibility has been studied from the perspective of the organization, understanding that it should meet the expectations of stakeholders such as current and/or future students [ 32 ]. However, the importance of the individual perspective of the students’ values should be emphasized [ 33 ].

On the positive side of the psychological continuum, emotional intelligence interconnects emotions with reason, or in other words, emotions influence our thoughts, just as our cognitive processes influence our emotional states [ 34 ]. The concept of emotional intelligence is defined as the cognitive abilities that can be measured through tasks involving the processing of emotional information. This has been developed at a theoretical and empirical level, to demonstrate its predictive ability in different areas of daily life [ 35 , 36 ]. The latest research on emotional intelligence highlights its role in the ability of individuals to adapt to daily life environments and is linked to well-being [ 36 , 37 , 38 , 39 ]. In the tertiary context, the implication of high emotional intelligence in relation to academic performance in university students has been studied, emphasizing the role of emotional skills [ 24 ]. Some authors have highlighted the importance of emotional intelligence as a type of psychosocial adaptation in the university educational environment [ 38 ], it being a possible predictor of psychological well-being [ 23 ]. Several studies involving university students have examined the impact of proficient emotional intelligence skills in relation to academic performance, highlighting the key role of emotional skills [ 24 ]. This indicates the key role of emotional intelligence and its related dimensions (such as empathy) in university teaching and learning environments with students.

Empathy is the skill that allows us to know how other people are feeling, what they are thinking, understand their intentions, predict their behavior and understand their emotions [ 39 ]. Some studies on empathy have focused on analyzing it in young people, as it contributes to the enhancement of social skills and prosocial behavior [ 40 , 41 ]. The psychological well-being perceived by students appears to be strongly associated with empathy. Gustems Carnicer and Calderón [ 42 ] conducted a study with a group of university students where they found that students at high risk of psychological distress had higher scores for empathic stress and avoidance coping strategies. On the one hand, they obtained a direct correlation between psychological distress and emotional discharge, cognitive avoidance, the search for alternative rewards and resignation [ 42 ]. Recent studies have reported relationships between the emotional ability known as empathy and subjective well-being in university students [ 5 , 43 , 44 ]. Self-concept is considered a complex term because of the difficulty of differentiating it from similar terms that have even been used as synonyms, such as self-esteem [ 45 ]. Several authors refer to this as the labels that people give themselves, generally related to their physique, behavior and emotions [ 46 ]. Behavioral, affective and social functioning are explained by the perception of an individual’s experiences; therefore, one’s self-concept could be a predictor of one’s psychological well-being [ 45 , 47 ]. In a study conducted with university students in the area of self-concept within a cooperative learning structure, there was an improvement in self-concept [ 48 ]. Other studies [ 49 ] have reported positive relationships between psychological well-being and physical self-concept and self-esteem [ 22 , 49 , 50 , 51 ]. Therefore, self-concept could be included in studies as a probable factor related to university students’ psychological profiles.

On the negative side of the psychological continuum, anxiety has been erroneously considered synonymous with other concepts such as stress, fear or distress. Spielberger et al. [ 52 ] defined anxiety as an emotional reaction that is externalized through tension, apprehension, nervousness and worry, in addition to activation of the autonomous nervous system. Spielberger, Gorsuch and Lushene [ 53 ] establish two types of anxiety based on lengths of time: state and trait anxiety. For Spielberger [ 54 ], state anxiety refers to an immediate emotional state, modifiable over time, while trait anxiety is a relatively stable disposition, tendency or personality trait. Different concepts of anxiety (state and trait) need to be studied. According to Sandín and Chorot [ 55 ], anxiety implies at least three response systems (cognitive, physiological and behavioral), with their activation creating a fight or flight response, which in turn can have an effect at the psychological level [ 55 ]. The vast majority of the scientific literature suggests that approximately 50% of university students have experienced significant levels of anxiety [ 56 , 57 ]. Research focused on the university population concludes that the effects of anxiety are closely related to certain variables such as academic performance, abandoning the course and psychological and emotional well-being [ 58 , 59 ]. However, it has not been studied in conjunction with other explanatory variables of psychological well-being.

The study of the potential predictive relationship between the psychosocial factors previously described and psychological well-being in a university student sample provides a more holistic view for prospective educators, researchers and health care practitioners. Findings from this study may inform the development of new educational policies and intervention programs aimed at directly improving the psychological well-being of university students in the international context. Likewise, studies of this type could strengthen lines of research oriented towards the application of intervention programs aimed at the well-being of students and their academic performance. Conducting studies with sample groups of first-year undergraduate students from social and health areas allows a suite of baseline educational and psychosocial data measures to be collected on which intervention programs can be founded. This is beneficial in two key ways. Firstly, the objective data can be used to determine what psychosocial and educational factors need urgent attention and remediation activities put in place in courses such as social education, pedagogy or speech therapy. Secondly, follow-up data can be then collected after program planning, implementation and completion to determine its efficacy in those disciplines. The information about the possible potential relationship between psychological well-being and psychosocial factors provides a landscape overview about potential strategic changes that are needed in this higher education context over the duration of enrolment of first-year students up until they finish their degree. This evaluation is useful to improve the process of adjustment, socio-emotional adaptation to the university context and the quality of life of first-year students to better equip them with the foundation skills needed to be successful upon graduation and during the first few years of their work life. In sum, collecting baseline data from first-year students can have both short- and long-term benefits for the designer of intervention programs and for the students themselves.

1.3. Research Hypothesis

The research hypothesis of this study is as follows: psychological well-being dimensions are significantly related to a multifactorial construct composed of psycho-educational dimensions, such as educational aspects (learning style and methodology, social skills and level of social responsibility) and psychological or cognitive-affective skills (emotional intelligence, anxiety, empathy and levels of self-concept).

To investigate the possible association between psychological well-being and psychological factors among undergraduate university students.

2. Materials and Methods

2.1. design.

A cross-sectional approach using standardized self-report scales.

2.2. Participants

The initial sample consisted of 164 participants, of whom 32.3% were men and 67.7% women. The sample was taken from the first year of the undergraduate degree courses in Social Education, Pedagogy and Speech Therapy at the University of Granada, Spain. After applying the selection criteria for the present study, the final sample was 149 university students (15 students were excluded). The inclusion criteria were: a) being a full-time university student enrolled in the first year of his/her course; and b) providing informed consent to take part in the study. The exclusion criteria included: a) not completing each and every one of the questionnaires provided; b) not being a full-time student, having a recognized part-time student status and/or having requested a single assessment; and c) being a student with special educational needs. The present study protocol was approved by the Ethics Committee of the University of Granada (Granada, Spain), with the registration number: 328/CEIH/2017. The participants completed an individual informed consent form to participate in the study.

2.3. Instruments

Demographic data were collected through a self-report questionnaire. It included items asking questions about the following information: age, sex, academic program, year and semester of course. There was an evaluation of psychological well-being, learning styles, learning methodologies, social skills, social responsibility, emotional intelligence, anxiety, empathy and levels of self-concept. All the instruments used in the study were validated in Spanish language versions: they were available and were completed in Spanish.

2.3.1. Psychological Well-Being

The starting point was Ryff’s Psychological Well-Being Scale [ 1 , 22 ]. The Spanish adaptation was provided by Díaz et al. [ 3 ], who assessed six dimensions of psychological well-being: self-acceptance: as the individual’s attempt to feel good about themselves; positive relationships: understood as the capacity to love, where social relationships are stable and trustworthy; autonomy: described as self-determination, independence and personal authority; environmental mastery: involving managing the demands and opportunities of the environment to satisfy one’s own needs and capacities; personal growth: where there is an effort to develop one’s capabilities and maximize them; and purpose in life: it consists of the need to set goals and define objectives to give life meaning. The scale consists of 39 items that use a Likert-type response format, ranging from one (total disagreement) to six (total agreement). A higher score means that the person shows higher levels of well-being. The Spanish version of the instrument has adequate reliability and validity properties for the six dimensions (RMSEA = 0.07). Internal consistency coefficients for the subscales of the Spanish version for the sample of this study were as follows: self-acceptance, 0.88; positive relationships with others, 0.72; autonomy, 0.90; environmental mastery, 0.89; purpose-in-life, 0.88; and personal growth, 0.94.

2.3.2. Learning Styles and Methodologies

The Honey-Alonso Learning Styles Questionnaire [ 26 ] evaluates the psychological, affective and physiological characteristics expressed by a person when faced with a learning situation. Learning styles are divided into four dimensions: 1) active style, based on direct experience, 2) reflexive style, based on observation and data collection, 3) theoretic style, based on abstract conceptualization and conclusion formation and 4) pragmatic style, based on active experimentation and the search for practical applications. The questionnaire is composed of 80 items that use a dichotomous response format. The maximum score is 20 points for each style. The Spanish version of the instrument exhibited adequate validity properties for the 4 dimensions after factorial analysis. The active style explained 41% of total variance, the theoretic style 39.5%, the pragmatic style 40.2% and reflexive style 42.7% [ 26 ]. The reliability results obtained for the sample of this study for the styles were a Cronbach alpha of: 0.88 (active), 0.90 (reflexive), 0.88 (theoretic) and 0.76 (pragmatic). Further, also used was the questionnaire on cooperative learning and traditional learning methods [ 41 ]. This questionnaire assesses the respondent’s skill acquisition level, based on the respondents’ preference for the two learning approaches. This instrument has adequate psychometric properties of reliability and validity. The questionnaire consists of 34 items. Internal consistency coefficients of Cronbach’s alpha of 0.92 for traditional learning, and 0.89 for cooperative learning have been reported.

2.3.3. Social Skills

The social skills scale consists of 20 items, each item representing one inter- or intra-personal social skill, using a Likert scale of five response options, ranging from one (never) to five (always) [ 29 ]. This instrument has adequate psychometric properties of reliability and validity. The study of the validity of this instrument yields satisfactory results. The reliability analysis for the present study showed a Cronbach alpha coefficient of 0.93. The social responsibility questionnaire [ 60 ] evaluates the self-attribution of socially responsible behavior. The questionnaire is divided into 40 items that use a Likert scale scoring format from one (never) to five (always). The higher the score, the more frequently an individual engages in socially responsible behavior. This instrument has adequate psychometric properties of reliability and validity. The validity was verified by the inter-judge agreement method and was satisfactory [ 60 ]. A Cronbach alpha of 0.96 was obtained for this questionnaire.

2.3.4. Emotional Intelligence

The Trait Meta-Mood Scale-24 (TMMS-24) [ 61 , 62 ] emotional intelligence questionnaire was used. This questionnaire evaluates perceived emotional intelligence, understood as the ability to control feelings and emotions, to discriminate between them, and to use that ability to direct one’s own thoughts and actions. The instrument has three dimensions: emotional attention, understood as the capacity to feel and adequately express feelings; clarity, interpreted as an optimal understanding of one’s own emotional states; and repair, which alludes to the capacity for optimal control of emotional states. The questionnaire consists of 24 items rated on a Likert scale from one to five points. In terms of validity, all three factors were correlated appropriately and in the expected direction with classical criteria variables such as depression, anxiety, rumination and life satisfaction [ 61 ]. The instrument has shown a high reliability in its three dimensions: Cronbach alpha of 0.87 for emotional attention, 0.78 for clarity and 0.57 for repair.

2.3.5. Anxiety

The State-Trait Anxiety Inventory [ 63 ] was used. This inventory has been designed to evaluate two aspects of anxiety: anxiety as a state, understood as a transient emotional condition; and anxiety as a trait, attributed to a relatively stable propensity for anxiety. The questionnaire consists of 40 items that are rated using a four-point Likert response scale which depends on intensity, ranging from zero (almost never/nothing) to three (almost always/much) [ 63 ]. The Spanish version of the instrument has adequate psychometric properties of reliability and validity. The Cronbach’s alpha coefficient for the state anxiety subscale was 0.93, while for the trait anxiety subscale it was 0.88.

2.3.6. Empathy

The Test of Cognitive and Affective Empathy—TECA [ 39 ] was used. This test evaluates cognitive-affective skills related to the level of empathy. The test consists of four dimensions. Within the cognitive area are the dimensions of perspective taking (capacity for tolerance, communication and personal relationships) and emotional understanding (ability to recognize and understand emotional states, intentions and impressions of others). The affective area includes empathic stress (connection with other people’s negative emotional states) and empathic happiness (ability to share other people’s positive emotions) [ 39 ]. The test consists of 33 items that are rated on a Likert scale from one (totally disagree) to five (totally agree). High scores in each dimension indicate a higher level of empathy. The Spanish version of the instrument has adequate psychometric properties of reliability and validity [ 39 ]. Cronbach’s alpha resulted in 0.87 for the global TECA and the higher value for the four dimensions was a Cronbach alpha of 0.63.

2.3.7. Self-Concept

The AF5 Multidimensional Self-Concept Scale [ 64 ] was used. This scale is based on a model that views self-concept as a multidimensional construct organized hierarchically from a general dimension. This questionnaire evaluates five dimensions: academic/professional, social, emotional, family and physical. This instrument consists of 30 items, scored on a scale from 1 to 99 points, where 1 corresponds to total disagreement and 99 to total agreement. The higher the score, the better the self-concept. The Spanish version of the instrument has adequate psychometric properties of reliability and validity. The factor analysis satisfactorily confirmed the five theoretical dimensions, explaining 51% of the total variance [ 64 ]. The reliability of the total scale in this study using Cronbach’s alpha test was 0.86 and this was 0.90 for academic/professional, 0.50 for social, 0.82 for emotional, 0.53 for family and 0.83 for physical.

2.4. Procedure

Regarding recruitment of the sample, participation was voluntary, i.e., the consecutive recruitment of participants was performed. The questionnaires were completed by the student participants at the end of a scheduled morning class during the second semester, under the supervision of a research assistant. Once the general procedures and objectives of the study had been explained, instructions were given to complete the questionnaires in hard copy version. The students provided written consent and the confidentiality of the data obtained was assured. The questionnaires were field-tested beforehand. The average time it took participants to complete the questionnaire was two hours, split between two sessions. In each session, the participants took at least one voluntary five-minute break. The anonymity of the participants was guaranteed since the hard copy included only a number, and their personal data were preserved in a different document linking this number and their personal data. Power relationships from an ethical perspective were not present. The data were manually entered into a database.

2.5. Data Analysis

The SPSS software (version 22.0, IBM Corp, Armonk, NY, USA) was used for the statistical analysis. A descriptive analysis was performed and the normal distribution of the variables was confirmed. Student t-test and univariate analysis of variance (ANOVA) were completed to investigate the relationship between psychological well-being and sex and level of course, respectively. Pearson’s correlation coefficient was used to determine the association between psychosocial variables and each of the psychological well-being dimensions. We used multiple linear regression analysis to investigate the predictive relationship between emotional well-being as the dependent variable, and age and the psychosocial variables (learning style and methodology preferences, social skills, level of social responsibility, emotional intelligence, anxiety, empathy and levels of self-concept) as the independent variables. The regression analysis was also executed in an independent manner when differences between academic disciplines were found for any of the psychological well-being dimensions. Normality of residuals, homogeneity of variance for residuals and linearity of data were examined before completing the regression model. The data met all the assumptions required to carry out the multiple linear regression analyses. Multi-collinearity was avoided by selecting a stepwise method in the regression model. A p < 0.05 was used as the significance level in the study.

2.6. Sample Size

In a previous study completed by Atienza [ 22 ], a significant bivariate correlation of 0.298 between psychological well-being (self-acceptance dimension) and emotional intelligence (repair dimension), measured with the Ryff scale (assessing well-being) and the TMMS-24 scale (evaluating repair), was used to calculate the sample size required to detect this size effect in the sample. This was carried out using the G*power software (version 3.1, Institut für Experimentelle Psychologie, Düsseldorf, Germany). This calculation demonstrated that a sample size of 140 university students was needed to provide a confidence interval of 95%, with a power of 95%, assuming a bilateral significance level (α) of 0.05. To be able to handle possible missing data, any participants dropping out or badly completed instruments, the recruited sample should be increased by around 5%. As a result, the final sample should include at least 147 participants.

3.1. Description of the Sample

The total sample consisted of 149 students enrolled on the Social Education ( n = 52), Pedagogy ( n = 56) and Speech Therapy ( n = 41) courses at the University of Granada, of whom 67.7% were women and 32.3% men, with an average age of 21.59 ( SD = 4.64) years. One hundred percent of the sample was recruited from the first year of the three courses. The descriptive statistics of the independent and independent variables of the sample are reported in Table 1 .

Descriptive results (range, mean, SD and quartile scores) of psychological well-being, learning style and methodology, social skills, social responsibility, emotional intelligence, anxiety, empathy and levels of self-concept in university students.

SD = standard deviation; Q = quartile scores.

3.2. Confounding Variables for Psychological Well-Being

No statistically significant differences between sexes in relation to psychological well-being were found since there were no differences between male and female participants in terms of self-acceptance ( t = 0.285, p = 0.776), positive relations with others ( t = -0.971, p = 0.333), autonomy ( t = 0.929, p = 0.354), environmental mastery ( t = 0.067, p = 0.947), purpose-in-life ( t = −1.344, p = 0.181) and personal growth ( t = −0.955, p = 0.343). Among the three student course groups, statistically significant differences in the scores for the psychological well-being dimensions of environmental mastery (F(2,101) = 3.682, p = 0.028) and purpose-in-life (F(2,101) = 4.631, p = 0.011) (ANOVA) were found.

Specifically, the post-hoc analysis showed differences between the student participants enrolled on the Pedagogy and Speech Therapy academic courses for environmental mastery ( p = 0.037; Pedagogy M ± SD = 12.90 ± 0.62; Speech Therapy M ± SD = 10.56 ± 0.68) and purpose-in-life ( p = 0.011; Pedagogy M ± SD = 21.19 ± 4.33; Speech Therapy M ± SD = 18.17 ± 5.69).

3.3. The Correlation between the Psychological Well-Being Dimensions and Psychosocial Factors

Bivariate correlation analyses have shown direct and inverse relationships between the psychological well-being dimensions and the cooperative learning methodology, the empathy dimension of emotional understanding, social skills and all dimensions of the levels of self-concept, emotional intelligence and levels of anxiety in university students. These results are shown in Table 2 .

Correlations between psychological well-being and age, sex, learning style and methodology, level of social responsibility, empathy, anxiety, social skills, level of self-concept and emotional intelligence in university students.

* p < 0.05; ** p < 0.001.

The dependent variables (each dimension on the Ryff’s Psychological Well-Being Scale) exhibited a normal distribution. After testing the normality of the residuals in the regressions, it was confirmed that the observed residuals were normally distributed. The independence of data for all regressions performed for each dimension of well-being was confirmed. There was a linear relationship between the independent variables and the dependent variables. Homogeneity of the residuals’ variance was not violated and the data met the assumption of homoscedasticity.

3.4. Influence of Psychosocial Factors on Psychological Well-Being in University Students

Multivariate regression analysis showed that the cooperative learning methodology, the clarity dimension of emotional intelligence, state anxiety, the emotional understanding dimension of empathy and physical and family self-concept were significantly related to the dependent variable, predicting 58.6% of the total variance (R 2 = 0.586, F(6,99) = 23.335, p < 0.001) of levels of self-acceptance in university students. The active learning style, emotional understanding and empathic stress, academic/professional self-concept, social self-concept and family self-concept were significantly related to the dependent variable, predicting 52% of the total variance (R 2 = 0.520, F(6,99) = 17.874, p < 0.001) of levels of positive relationships in this sample. Social skills, the emotional attention and clarity dimensions of emotional intelligence and emotional self-concept were significantly related to the dependent variable, predicting 31% of the total variance (R 2 = 0.313, F(4,101) = 11.525, p < 0.001) of levels of autonomy. Global emotional intelligence, state anxiety, emotional understanding and family self-concept were significantly related to the dependent variable, predicting 48.9% of the total variance (R 2 = 0.489, F(4,101) = 24.139, p < 0.001) of levels of environmental mastery. The emotional attention dimension of emotional intelligence, state anxiety, the emotional understanding dimension of empathy and academic/professional self-concept were significantly related to the dependent variable, predicting 35.4% of the total variance (R 2 = 0.354, F(4,101) = 13.838, p < 0.001) of levels of personal growth. Global emotional intelligence, state anxiety, empathic happiness and family self-concept were significantly related to the dependent variable, predicting 43.9% of the total variance (R 2 = 0.439, F(4,101) = 19.786, p < 0.001) of levels of purpose-in-life. There was no collinearity between the variables included in the regression model.

Figure 1 depicts the relationship between the psychological well-being dimensions and psychosocial factors. Table 3 shows the final multiple regression models of the psychological well-being dimensions after the selection of independent variables.

Directed acyclic graph of the relationship between the psychological well-being dimensions and psychosocial factors. Source: created with DAGitty.

Influence of psychosocial factors on psychological well-being in university students.

R 2 , regression coefficient of determination; B, regression coefficient; CI , confidence interval; β , adjusted coefficient from multiple linear regression analysis; SE coefficient standard error.

The multivariate linear regression analysis involving the students on the Pedagogy program indicated that state anxiety, family self-concept, traditional learning methodologies and empathy (emotional understanding) were significantly related to environmental mastery, predicting 54% of its total variance (R 2 = 0.540, F = 9.990, p < 0.001). For students on the Speech Therapy program, state anxiety and emotional intelligence (emotional attention) were significant predictors of the psychological well-being dimension (R 2 = 0.593, F = 21.110, p < 0.001), accounting for 59.3% of its total variance. For student participants enrolled on the Pedagogy course, the results demonstrated that state anxiety, social responsibility and theoretic learning style were significantly related to purpose-in-life, predicting 49% of its total variance (R 2 = 0.492, F = 11.306, p < 0.001). In the Speech Therapy program, the perspective taking, empathic stress and empathic happiness empathy dimensions predicted 57.3% of the total variance of this dimension (R 2 = 0.573, F = 12.528, p < 0.001). In Table 4 , the independent multiple regression models for the psychological well-being dimensions of environmental mastery and purpose-in-life among the students of the Pedagogy and Speech Therapy courses are shown.

Influence of psychosocial factors on psychological well-being in university students according to the academic program—Pedagogy or Speech Therapy.

4. Discussion

This study investigated the possible association between self-reported levels of psychological well-being and educational aspects (learning style and methodology, social skills and level of social responsibility) and psychological or cognitive-affective skills (emotional intelligence, anxiety, empathy and levels of self-concept). The final regression models indicated that the psychological well-being dimension of self-acceptance appears to be related to the cooperative learning methodology, the clarity dimension of emotional intelligence, state anxiety, the emotional understanding dimension of empathy and physical and family self-concept. The positive relationships dimension appeared to be related to the active learning style, the emotional understanding and empathic stress dimensions of empathy, academic/professional self-concept, social self-concept and family self-concept. Autonomy was associated with the emotional attention and clarity dimensions of emotional intelligence, emotional self-concept and social skills. Environmental mastery was related to global emotional intelligence, state anxiety, the emotional understanding dimension of empathy and family self-concept. Personal growth was associated with the emotional attention dimension of emotional intelligence, state anxiety, the emotional understanding dimension of empathy and academic/professional self-concept. Finally, purpose-in-life was related to global emotional intelligence, state anxiety, the empathic happiness dimension of empathy and family self-concept.

4.1. Learning Styles

Consistent with the emotional skills model [ 5 , 23 , 34 ], the results of this study demonstrate the importance of educational and socio-emotional constructs on psychological well-being. Nevertheless, the current study focuses on a particular group of university students (Social Education, Pedagogy and Speech Therapy) that could be more sensitized than others to the study variables due to the nature of these disciplines in themselves. These disciplines usually give help and service to people with disabilities. Specifically, the present study demonstrates that Pedagogy and Speech Therapy students exhibited differences for the two psychological well-being dimensions of environmental mastery and purpose-in-life. Pedagogy students demonstrated that state anxiety, family self-concept, traditional learning methodologies and empathy (emotional understanding) were significantly related to environmental mastery, and that state anxiety, social responsibility and theoretic learning style predicted purpose-in-life. For students enrolled in the Speech Therapy program, state anxiety and emotional intelligence (emotional attention) predicted the environmental mastery dimension, and the empathy dimensions of perspective taking, empathic stress and empathic happiness predicted purpose-in-life.

Within the two learning methodology options evaluated, a direct and significant relationship has been found between the cooperative learning methodology and the psychological well-being dimensions of self-acceptance, environmental mastery, personal growth and purpose-in-life. This indicates that a more cooperative learning methodology is more positive for students than the traditional one, since their learning could be greater and improved in quality [ 65 , 66 ]. Therefore, students who prefer this methodology will have a higher probability of showing higher psychological well-being. However, the results have shown that there is no significant relationship between learning style and psychological well-being in the population studied. Generally, while there is previous scientific literature including this educational variable, as far as we know, no conclusive results have been obtained about student preferences for one style or another, since this preference seems to vary with time and experience [ 67 , 68 ]. Another study found that the most effective active methodologies according to students were work and group dynamics [ 69 ]. Online, the higher the level of satisfaction and emotional well-being, the better the academic performance of students seems to be [ 70 ].

4.2. Social Skills

Regarding social skills, a significant direct relationship with all psychological well-being dimensions has also been observed. Therefore, the higher the level of social skills in these students, the higher the level of general psychological well-being. These results are consistent with those reported by Recabarren [ 71 ], Vasilenko et al. [ 31 ], Souri and Hasanirad [ 72 ] and Freire et al. [ 73 ]. These authors concluded that a larger number of positive relationships in one’s own environment or context led to better coping strategies and more resilience or capacity to adapt. This strengthening of strategies is likely to produce higher levels of psychological well-being for students because they achieve a higher level of support and optimism. In relation to social responsibility, no significant association with psychological well-being has been found [ 72 , 73 ]. The reason for this could be that while social responsibility is based on positive values such as altruism, more individualistic and selfish behaviors may prevail in the current world. This construct could be affecting the psychological well-being of university students in Spain [ 33 ]. In some recent studies [ 74 ], social responsibility has been shown to be correlated directly with life satisfaction for students during university years. The higher the social skills, the higher the level of emotional intelligence [ 13 , 15 ], which is associated with better psychological well-being [ 23 ].

4.3. Emotional Intelligence

The emotional attention dimension was directly correlated with all psychological well-being dimensions and inversely correlated with the autonomy dimension. This finding may be interpreted as suggesting that the greater the emotional attention, the higher the level of psychological well-being. However, a high level of emotional attention seems to imply a regression in the student’s level of autonomy. In the case of the clarity dimension, a direct association with all psychological well-being dimensions was observed. The reparation dimension had a direct relationship with the psychological well-being dimensions of self-acceptance, positive relationships, autonomy and mastery of the environment. This may mean that students who have greater repair emotional intelligence achieve better self-acceptance and autonomy, along with better mastery of the environment, which in turn fosters more positive relationships. Overall, high emotional intelligence in the student sample group appeared to contribute to high psychological well-being. The results in the current study highlight the importance of emotional skills in relation to psychological well-being, being a type of psychosocial adaptation to the educational environment [ 75 , 76 ]. For example, authors such as Burris et al. [ 77 ] point out how good management of emotional intelligence influences psychological well-being. These authors found a relationship between optimism and high psychological well-being in the university stage and pointed out that, in order to achieve this, one must have a defined awareness of one’s own emotional intelligence in order to actively train optimism in this group [ 77 ].

4.4. Anxiety

If anxiety levels are considered, both of these (state and trait) showed a significant but inverse relationship with the psychological well-being dimensions. State anxiety shows a relationship with all the well-being dimensions, although the highest significant association was observed with the environmental mastery dimension. This can be interpreted as meaning that the greater the state of anxiety that students feel at the present moment, the lower their levels of general psychological well-being in all its dimensions. In contrast, trait anxiety, characterized by a more stable construct over time, was only inversely related to the positive relationships dimension. It follows that students who have the personality trait of anxiety will have greater difficulties in establishing positive relationships with their environment. It can be concluded that, in keeping with the studies of Cooke et al. [ 4 ], Recabarren [ 71 ] and Stallman [ 6 ], higher levels of anxiety occur in the university stage and psychological well-being declines worryingly. Zuñiga [ 51 ] pointed out that state anxiety and trait anxiety seem to be correlated with all psychological well-being dimensions, except the personal growth dimension, applying the same instruments to assess anxiety and well-being in university students.

4.5. Empathy

Within the empathy dimensions, the emotional understanding dimension has been shown to be directly related to all psychological well-being dimensions, although the highest significant correlation has been obtained with the personal growth dimension. Therefore, students who are most able to understand their emotions and the emotions of others seem to show higher levels of overall psychological well-being. These results are also similar to those found by Cicognani et al. [ 78 ], where they show the importance of a sense of community, participation and social understanding for psychological well-being. In line with this, Gustems Carnicer and Calderón [ 42 ] found that students at high risk of psychological distress were more likely to show empathic stress and avoidance coping strategies. As in our study, other authors such as Serrano and Andreu [ 43 ] and Cañero et al. [ 5 ] showed, in the Spanish university context, that empathy was a predictor of subjective well-being in university students. Likewise, Malhotra and Kaur [ 44 ] also found a relationship between emotional empathy and perceived well-being. Sánchez-López et al. [ 79 ] found no significant correlation between psychological well-being and empathy in a study they reported.

4.6. Self-Concept

The levels of self-concept in the academic/professional, social and physical areas have been found to have a direct relationship with all psychological well-being dimensions. Therefore, students who have a good concept of themselves, both physically and in their studies and social relationships, appear to have a higher level of psychological well-being. The family self-concept dimension has a direct relationship with all psychological well-being dimensions except for the autonomy dimension. This relationship may indicate that, although at a general level a high self-concept in the family environment leads to high psychological well-being, this construct does not generate greater or lesser feelings of autonomy. In this line, Kazarian [ 80 ] has pointed out that having good family relationships influences students’ personalities and entails an improvement in psychological well-being and in one’s concept of oneself. In another study by Sánchez-López et al. [ 79 ], it was reported that self-esteem constitutes one of the elements that determines the so-called emotional intelligence profile and it was determined that positive relationships existed between self-esteem and subjective psychological well-being and material psychological well-being. Likewise, Fernández-Zabala et al. [ 74 ] found direct correlations between some self-concept dimensions and the satisfaction with life variable in university students. Other recent research [ 63 ] has also found that self-concept was one of the predictors of life satisfaction. In turn, emotional self-concept has been found to have an inverse relationship with four of the psychological well-being dimensions: self-acceptance, autonomy, environmental mastery and personal growth. This result may imply that a high emotional self-concept may generate a negative impact on these psychological well-being dimensions. In this way, some studies report that the greater the sense of humor (which is more frequent in people with greater positive self-concept), the greater their level of psychological well-being [ 81 ].

4.7. Limitations

Participants took part in the study on a voluntary basis and were not randomly selected. This research only used self-reported measures (i.e., self-rating scales) to evaluate psychological well-being and the set of constructs from the psycho-educational approach which may have been subject to recall bias. As a result, respondent bias may have been present due to social desirability. Additionally, participants may have answered items on the social responsibility questionnaire and the TECA in a socially desirable manner. Hence, objective evaluations would be more appropriate to evaluate the constructs examined in this study. Students were recruited from a single geographical location, so the generalizability of the results may be limited. The nature of the courses taken by the students in the study sample (Degree in Social Education, Pedagogy and Speech Therapy) may have sensitized them (had an influence) to the study variables response, therefore impacting on the results. Likewise, all of the student participants were recruited from the first year of the three courses which may have impacted their answers on the self-report questionnaire. For this reason, the interpretation of the findings for other similar populations of university students should be approached with caution.

4.8. Future Research

Future studies should evaluate the impact of educational initiatives taking into account the psychological well-being of university students and their learning styles, social skills, emotional intelligence, anxiety, empathy and self-concept and the emotional dimension, whether positive (emotional intelligence) or negative (anxiety), in university students as a group. However, since the study was conducted at one university site, future research in this topic should be made multi-center by including student data from several educational institutions. Additionally, multi-level analysis could be performed by taking into consideration specific needs and demands by geographical location or sociodemographic characteristic. In future research, it is important to test the role of possible moderators other than age, sex or academic discipline. A longitudinal study should be designed to evaluate the change in the variables investigated in this research as participants get older.

4.9. Implications for Education

Some possible educational implications arise from the current findings which may help to improve the learning process and its quality for students. The results can be used to design initiatives that increase the general perception of psychological well-being, prevent stress in the educational setting and lead to better academic performance.

The data could be used to implement academic development and an effective approach to the educational process and provide counselling and support services with strategies that will enhance students’ management of emotions and their ability to cope with certain conflict situations.

5. Conclusions

Among the psychological and cognitive dimensions selected, emotional intelligence, empathy, social skills and self-concept were positively correlated with all psychological well-being dimensions, whereas for learning methodologies, only the cooperative one was positively correlated with most of the psychological well-being dimensions. In contrast, anxiety was inversely correlated with the perception of well-being in university students, negatively influencing it. Therefore, it is necessary to look at this issue in more depth, providing more comments and observations on these results.

This research has shown that psychological well-being is associated with different psychological and educational constructs, both intra- and inter-personal. Firstly, students who prefer a cooperative learning methodology have greater self-acceptance. This implies their recognition of their worth and having better psychological well-being in themselves. Secondly, students who show a high capacity for adaptation and social skills use them to grow personally in situations that require this, obtaining higher levels of psychological well-being. Thirdly, we highlight the importance of students’ emotional skills, since a type of psychosocial adaptation that shows high emotional intelligence leads to high psychological well-being. Fourthly, in the university stage, there seem to be high levels of anxiety, generating psychological discomfort in students. Fifthly, the emotional understanding, both internal and external, of students seems to propitiate a high psychological well-being that could help them to grow personally. Finally, the importance of self-concept in all its dimensions, except the emotional one, has a significant influence on the psychological well-being of students. Having a good self-concept will, on the whole, produce higher levels of psychological well-being. Therefore, the individuals’ psycho-educational resources should be integrated and studied as a whole in relation to psychological well-being.

Acknowledgments

The authors would like to thank the students who participated in this study, as well as the university authorities for their help in recruiting the sample.

Author Contributions

F.M.R. conceived and designed the study, recruited the participants, and contributed to the manuscript writing and data analysis. I.E.L. and T.B. contributed to the bibliographic review and the manuscript writing. J.P.M. conceived and designed the study, contributed to the bibliographic review, manuscript writing and data analysis. All authors revised the manuscript critically and approved the final version of the manuscript.

This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.

Zodiac signs irrelevant to psychological well-being, research confirms

A recent study set out to investigate whether the Western zodiac signs have any impact on various aspects of subjective well-being. Contrary to popular astrological beliefs, the research found no significant evidence linking zodiac signs to happiness, financial satisfaction, marital satisfaction, or overall health. The study has been published in the scientific journal Kyklos .

Astrology has long suggested that the positions of celestial bodies at the time of one’s birth influence personality traits and life outcomes. Despite skepticism from the scientific community, astrology remains widely popular, with about 30% of Americans expressing belief in astrological influences. Previous studies attempting to validate or debunk these claims have often faced criticism for their small sample sizes and methodological weaknesses.

In his new study, Mohsen Joshanloo of Keimyung University and the University of Melbourne’s Centre for Wellbeing Science aimed to address these issues by using a large, nationally representative sample and robust statistical methods to examine whether zodiac signs truly affect subjective well-being. He utilized data from the General Social Survey (GSS), a large, nationally representative survey of American adults.

This survey, conducted periodically since 1972, gathers extensive information on a wide range of topics, including attitudes, behaviors, and opinions of U.S. residents. For his study, Joshanloo focused on data from the four most recent waves of the GSS, specifically from the years 2016, 2018, 2021, and 2022, encompassing responses from 12,791 participants.

The sample was diverse, with an average age of around 50 years and a slight majority of female respondents (55%). Zodiac signs were derived from participants’ self-reported birth dates. Joshanloo analyzed eight key outcome variables related to well-being: general happiness, depressive symptoms, psychological distress, work satisfaction, financial satisfaction, life excitement, general health, and marital happiness.

Joshanloo employed a combination of statistical methods to ensure robust and reliable results. The primary method used was analysis of covariance (ANCOVA), which allows for the comparison of group means while controlling for the effects of other variables such as age, gender, and education. By including these covariates, the study aimed to isolate the unique effect of zodiac signs on the various well-being outcomes. For additional rigor, Joshanloo also conducted analysis of variance (ANOVA) without covariates and nonparametric Kruskal-Wallis tests to account for potential non-normal data distributions.

For seven out of the eight well-being outcomes, there was no statistically significant effect of zodiac signs. These outcomes included general happiness, depressive symptoms, psychological distress, work satisfaction, life excitement, general health, and marital happiness. The only exception was financial dissatisfaction, where a statistically significant effect was found. However, the effect size for this finding was negligible, indicating that the practical significance was minimal.

To further examine the robustness of his findings, Joshanloo conducted a post hoc analysis. He created a random variable and compared its predictive power to that of zodiac signs for the well-being outcomes. The results showed no significant differences between the predictive abilities of the zodiac signs and the random variable. This strongly suggested that zodiac signs do not meaningfully predict well-being, and any observed effects were likely due to chance.

The researcher explained that “the post hoc analysis revealed that the predictive power of zodiac signs is statistically indistinguishable from a randomly generated categorical variable. These results indicate that consulting astrological signs tells us just as little about a person’s level of well-being as simply putting them into a category based on a coin flip or rolling dice.”

Joshanloo’s study provides compelling evidence against the popular belief that zodiac signs influence various aspects of well-being. Despite the widespread cultural and historical significance of astrology, his findings align with previous research that has generally failed to support astrological claims. The negligible effect sizes across all outcomes indicate that knowing someone’s zodiac sign does not offer any meaningful insight into their levels of happiness, health, or satisfaction in different life domains.

“These findings underscore the urgent need to increase public awareness of the lack of scientific evidence supporting astrological beliefs through robust public education initiatives,” Joshanloo concluded. “Such initiatives can play a pivotal role in promoting scientific literacy and critical thinking skills, equipping individuals with the rational tools to make informed decisions and challenge pseudoscientific beliefs that lack empirical support.”

“In addition, the pernicious potential of astrological stereotypes to negatively influence perceptions of self and others should also be considered. Multidisciplinary stakeholders (e.g., psychologists, educators, and policy-makers) must work together to educate the public about the risks associated with astrological stereotypes and to promote a more evidence-based understanding of human personality and well-being.”

The study, “ The sun’s position at birth is unrelated to subjective well-being: Debunking astrological claims ,” was published May 27, 2024.