Archives of Psychiatric Nursing xxx (2014) xxx–xxx

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Work Satisfaction and Posttraumatic Growth 1 Year After the 2008 Wenchuan Earthquake: The Perceived Stress as a Moderating Factor Jiuping Xu ⁎, Wei Wu 1 Uncertainty Decision-Making Laboratory, Sichuan University, Chengdu 610064, PR China

a b s t r a c t This study investigated the role of perceived stress as a possible moderating factor between posttraumatic growth (PTG) and work satisfaction. A stratified random sampling strategy was used to survey 2080 adult survivors of the 2008 Sichuan earthquake. The Posttraumatic Growth Inventory, the Job Satisfaction Index Scale and the Perceived Stress Scale were used in the assessment of the posttraumatic growth, work satisfaction and perceived stress respectively, and hierarchical multiple regression analyses were used for the analysis. The findings highlight work satisfaction as an important factor in both the prediction of posttraumatic growth and for its moderating effect on perceived stress. Some demographic characteristics, such as gender, education level, and housing condition were found to also affect the survivors' posttraumatic growth. This conclusion indicates that managers should pay closer attention to their employees' psychological state after a disaster and medical practitioners should consider survivors' work status and perceived stress when dispensing mental health care. © 2014 Elsevier Inc. All rights reserved.

Natural disasters such as floods, hurricanes, and earthquakes occur frequently in the world. Although a surprisingly large percentage of individuals are relatively unaffected by traumatic events (Bonnano, 2004, 2005), some individuals experience significant negative or positive trauma consequences. Traumatic events can negatively affect survivors and cause psychological problems such as posttraumatic stress disorder (PTSD), but positive changes have also been reported as a consequence of trauma (Frazier, Conlon, & Glaser, 2001; Frazier, Tashiro, Berman, et al., 2004; Tedeschi & Calhoun, 2004), which has been formally recognized as posttraumatic growth (PTG). A growing body of research has indicated that there can be personal growth after life-threatening events. Generally speaking, posttraumatic growth (PTG) refers to the development of a positive outlook towards change following a trauma, and focuses on five major aspects: an improved relationship with others, an increased personal strength, the identification of new possibilities, positive spiritual changes, and an increased appreciation of life (Tedeschi & Calhoun, 1996; Tedeschi & Calhoun, 2004). Some of the best predictors for posttraumatic growth have been recognized as being female, being of a younger age, having a higher level of education, having a higher degree of earthquake-related exposure, and showing PTSD symptoms such as intrusion and hyper arousal (Xu & Liao, 2011). Strong positive

⁎ Corresponding Author: Jiuping Xu, PhD, Uncertainty Decision-making Laboratory, Sichuan University, No. 24, South Section 1, Yihuan Road, Chengdu, Sichuan, 610064 P. R. China. E-mail address: [email protected] (J. Xu). 1 Uncertainty Decision-Making Laboratory, Sichuan University, No. 24, South Section 1, Yihuan Road, Chengdu, Sichuan, 610064 P. R. China.

associations have also been found between PTG and concurrent stress (Holgersen, Boe, & Holen, 2010), and PTG has been found to be best predicted by event centrality, problem-focused coping, and a positive perspective of the event (Schuettler & Boals, 2011). Although many of these articles have studied PTG and its relationship with other factors, few papers have examined the effect of working status on survivors. After a traumatic event, life really does go on and people continue to work, but their emotions and feelings can influence both their lives and their work. An individual's response to perceived stress is considered to be influenced by the personal and environmental resources available to that person to deal with the stressor (Dirkzwager, Bramsen, & Ploeg, 2003).When traumatic experiences significantly affect a survivors ability to cope, they often label themselves as being stressed and experiencing negative emotional and attitudinal responses. A general population survey of New Yorkers 3 to 6 months after the September 11 attacks found almost one third of people who experienced this trauma had had their employment negatively affected in some way, primarily by losing their job, losing time from work, or experiencing reduced hours or responsibilities at work (Nandi, Galea, Tracy, et al., 2004). Since the 2008 Wenchuan earthquake, significant time has been spent researching PTG and stress, and from the findings the focus of this article was determined. In our previous study, significant correlations were found between work satisfaction and satisfaction with life, satisfaction with life and health self-perception, satisfaction with life and psychological recovery, and psychological pressure and psychosocial recovery (Xu & Wu, 2011). For adults, the status of their work has been found to play an important role after trauma, and research

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Please cite this article as: Xu, J., & Wu, W., Work Satisfaction and Posttraumatic Growth 1 Year After the 2008 Wenchuan Earthquake: The Perceived Stress as a Moderating Factor, Archives of Psychiatric Nursing (2014), http://dx.doi.org/10.1016/j.apnu.2013.12.006

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J. Xu, W. Wu / Archives of Psychiatric Nursing xxx (2014) xxx–xxx

has demonstrated that having paid work is significantly associated with PTG after a severe trauma (Powell, Gilson, & Collin, 2012). These studies highlight that work status is significantly related to PTG, yet few studies so far have fully examined how work satisfaction influences PTG and vice versa. From an increasing body of research, there is more evidence that growth and adaptability are related to mental health levels (Mccausland & Pakenham, 2003). The growth associated with perceived stress can predict a positive psychological outlook after 6 months (Park & Fenster, 2004). Hobfoll (Hobfoll, Hall, Nisim, et al., 2007) found that after witnessing terror or violence, individual posttraumatic growth levels were related to increased psychological pain. Some research has suggested that multiple traumatic events may increase the level of traumatic stress among individuals (Brewin, Andrews, & Valentine, 2000; Resick, Yehuda, Pitman, et al., 1995). Other studies indicate that stress may be interpreted as a neutral, negative, or positive experience; however, if the stress becomes excessive, resolution is inevitably needed because left untreated this stress may cause anxiety (escape) or depression (withdrawal) (Schafer, 1987; Segerstrom & Miller, 2004). These concepts are particularly relevant to employees working in poor working conditions in disaster regions following a traumatic event who suffer from prolonged stress and who usually do not have many social resources to combat this stress. Studies on nurses working in a healthcare telephone-advice service indicated that the perceived stress from doing shift work was a significant, independent predictor of job satisfaction and showed a negative effect (Farquharson, Allan, Johnston, et al., 2012).This finding is consistent with the findings in the pilot test of our investigation after the Wenchuan earthquake. Though previous research has separately investigated the relationship between work satisfaction and PTG, the relationship between stress and work satisfaction, and the influence stress has on PTG, few studies have addressed the possibility that perceived stress may be associated with work satisfaction and PTG. This study has sought to identify the link between the stressor—work satisfaction, the moderator—perceived stress, and the outcome—PTG. Specifically, this study hypothesized that H1: Work satisfaction has a positive effect on the PTG among survivors post-earthquake. H2: Perceived stress has negative effort on PTG as well as work satisfaction. H3: Perceived stress weakens the positive effect of job satisfaction on the PTG among survivors post-earthquake depending on severity. A year after the Wenchuan earthquake, we investigated the psychological state of 2080 individuals in regions affected by the disaster. Our project was partly sponsored by the China Association for Science and Technology, which aims to provide profiles of the current status of workers in local areas, and especially those whose work is related to science and technology. In this paper we focus on the factors related to work satisfaction, and examine the moderating role that perceived stress may have. We further evaluate the effect of the earthquake and the new working and living conditions 1 year after the earthquake. Such research is important for policy makers and society to assist in understanding the consequences of PTG on an earthquake victims' job satisfaction, and clear the mechanism of stress between them to help them develop strategies to aid the disaster survivors. METHODS Data Collection Earthquakes are life threatening, unpredictable and uncontrollable phenomena which cause widespread devastation and loss of life and

livelihood. On May 12, 2008, an earthquake measuring 8.0 on the Richter scale struck Wenchuan in Sichuan Province, China. According to the Ministry of Civil Affairs, more than 70,000 were confirmed dead and more than 400,000 were injured, with 18,467 listed as missing and 6.5 million people made homeless. Earthquakes can affect many people and cause great destruction; however, the experience of this trauma at an individual level is a struggle which can result in a positive experience, and produce a positive change. We conducted a large-scale survey (N = 2080) in severely affected counties in Sichuan and Shanxi 1 year after the Wenchuan earthquake. A total of 2300 individuals were involved in this survey with 2080 completing the questionnaire in May and June 2009, a response rate of 90.4%. All participants were randomly selected from the worst-hit areas in two provinces: Sichuan and Shanxi. In Sichuan Province, eighteen worst-hit counties were chosen: Dujiangyan, Pengzhou, Chongzhou, Shifang, Mianzhu, Jiangyou, Anxian, Pingwu, Beichuan, Jiange, Qingchuan, Hanyuan, Wenchuan, Lixian, Maoxian, Songpan, Heishui, and Xiaojin. For Shanxi province, Lueyang was selected. Our survey teams were temporarily established and divided into 19 small groups, with each team, including two graduate students from Sichuan University and one staff from the local government, presiding over one county. It was guaranteed that the subjects' information would remain confidential. Before conducting the formal investigation, a pilot test was carried out in May and June 2009 with a group of randomly selected survivors participating, the feedback from which led to some minor modifications and adjustments to the final version. All assessment forms were translated from English to Chinese and back-translated by a bilingual team of professionals. From July to September 2009, the trained groups were assigned to the counties based on a previously arranged schedule. They visited households who lived in both their original houses and in temporary shelter. Houses and temporary accommodations were randomly selected on the basis of the total number, and one respondent within each selected house or temporary shelter was randomly selected. Group members explained the goals of the study to the inhabitants and made clear that anonymity would be ensured. Some of the inhabitants declined to be interviewed because they were wary of such earthquake surveys and wished to avoid talking about the event. If this was the case, the next closest family member was invited. Very few respondents had a low education level or had literacy problems. The group members helped those who had problems to note down answers and assisted them in completing

Table 1 Demographic Characteristics.

Age 18–30 31–40 41–50 ≥51 Gender Male Female Income (unit: yuan) b1000 1000–2000 2000–3000 3000+ Education level High school or below University or college Above university Housing status Original house Temporary settlement Rented house Public dormitory

n

%

441 849 609 181

21.20 40.80 29.30 8.70

1227 853

59.00 41.00

484 1352 214 29

23.30 65.00 10.30 1.40

325 1708 47

15.63 82.12 2.25

1057 328 199 388

53.6 16.6 10.1 19.7

Please cite this article as: Xu, J., & Wu, W., Work Satisfaction and Posttraumatic Growth 1 Year After the 2008 Wenchuan Earthquake: The Perceived Stress as a Moderating Factor, Archives of Psychiatric Nursing (2014), http://dx.doi.org/10.1016/j.apnu.2013.12.006

J. Xu, W. Wu / Archives of Psychiatric Nursing xxx (2014) xxx–xxx

the survey. To ensure privacy, interviewers and participants were encouraged to complete the questionnaire in private. There was daily supervision throughout the survey. The study and procedures described were approved by the ethics committee of Sichuan University, and written informed consent was obtained from each subject after a full explanation of the study procedures. The investigation was conducted in accordance with the latest version of the Declaration of Helsinki. Measures The Job Satisfaction Index Scale (JSS) developed by Brayfield and Rothe measures workers' general work satisfaction, i.e. their comprehensive satisfaction. This scale quotes Hackman and Lawler (1971) for a definition for job satisfaction from a discrepancy point of view to assess the sum of the gap between the employee's view of the whole work environment for "expected satisfaction" and "practical satisfaction". Factors related to work were assessed on 6 items over three dimensions: inner job satisfaction (wages and benefits, promotional prospects), external satisfaction (work environment, management and colleagues interpersonal relationships) and job and overall satisfaction (personal expertise and interest in job, learning opportunities and job security). Participants were questioned about their opinions and personal experiences on job specification satisfaction, management relationship satisfaction, colleague interpersonal relationships satisfaction, income satisfaction, promotional prospects satisfaction and overall work situation satisfaction. A five-point Likert scale was used to quantify each of these options. For instance, the intensity scale for promotion prospects was scaled as follows: 1 = very satisfied, 2 = relatively satisfied, 3 = fair, 4 = relatively dissatisfied and 5 = very dissatisfied. The assessment of positive post-disaster outcomes was evaluated using the Posttraumatic Growth Inventory (PTGI, Tedeschi & Calhoun, 1996). This inventory has 21 items across five major domains: relating to others (7 items), new possibilities (5 items), personal strength (4 items), spiritual changes (2 items), and appreciation of life (3 items). Before the investigation a pilot test was carried out with a pool of 118 workers and some minor modifications and adjustments made according to the feedback to form the final version of the questionnaire. Two items were excluded (“A better understanding of spiritual matters” and “I have a stronger religious faith”), as no participant were found to have any religious beliefs in the pilot test. Participants responded on a 6-point scale (0 as no change and 5 as complete change), with higher scores representing higher levels of posttraumatic growth. The total PTGI score was the sum of the remaining 19 items, with a total possible score of 95. In Tang's (2006) study, average mean scores above 3 for the PTGI were indicative of moderate levels of PTG, and according to Yu, Lau, Zhang, Mak, et al. (2010), total scores above the 75th percentile were considered to have probable PTG. In the present study, scores above 57 (including 57) were considered to indicate a moderate level of posttraumatic growth 1 year following the Wenchuan earthquake. In other words, 57 was the cutoff point for the assessment of posttraumatic growth. This inventory has previously demonstrated good internal and test–retest reliability for western (Tedeschi & Calhoun, 1996) and Asian samples (Ho, Chan, & Ho, 2004). The total PTGI internal consistency was 0.90 (Tedeschi & Calhoun, 1996). In the present study, the Cronbach's alphas coefficient for this instrument was 0.88, and the internal reliabilities of the four subscales were 83, 79, 81, and 80, respectively. Perceived stress was measured using the fourteen-item perceived stress scale, PSS (Cohen, Kamarck, & Mermelstein, 1983). This scale assesses the degree to which situations in an individual's life are regarded as stressful. The study used a five-point Likert scale with responses ranging from 0 = never, 1 = occasionally, 2 = frequently, 3 = very often, 4 = invariably. A sample item is “Have you been upset because of something that happened unexpectedly?” Reliability

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Table 2 Scores of Subgroups in Three Aspects (N = 2080). Work satisfaction

Perceived stress

PTG

Category

M

SD

M

SD

M

SD

All participants Gender Male Female Education level Doctor Master Bachelor No degree Age 18–30 31–40 41–50 51–68 Income (yuan) b1000 1000–2000 2000–3000 3000+ Housing status Original house Temporary settlement Rented house Public dormitory

2.58

0.64

2.77

0.88

55.68

11.50

2.52 2.66

0.65 0.61

2.74 2.80

0.53 0.53

55.82 56.81

10.36 10.26

1.58 2.24 2.61 2.58

0.64 0.52 0.68 0.60

1.70 2.63 2.74 2.80

0.90 0.57 0.57 0.50

50.25 56.65 56.95 55.61

5.53 6.35 9.52 11.06

2.53 2.65 2.53 2.48

0.66 0.65 0.60 0.66

2.76 2.78 2.75 2.71

0.57 0.55 0.49 0.54

56.20 57.14 55.70 53.40

9.95 10.27 10.16 11.02

2.63 2.61 2.45 2.24

0.67 0.64 0.58 0.65

2.79 2.79 2.63 2.58

0.62 0.53 0.49 0.43

55.15 56.05 54.93 54.46

12.04 11.45 10.94 11.47

2.53 2.76 2.64 2.54

0.65 0.61 0.59 0.64

2.70 2.89 2.82 2.76

0.54 0.52 0.47 0.58

56.05 58.10 56.91 57.70

9.18 9.24 9.30 9.04

NOTE. M: mean, SD: standard deviation, PTGI: Posttraumatic Growth Inventory.

has been reported in the range 0.84 to 0.86 (Cohen et al., 1983). The Cronbach's alpha among the present sample was 0.81. In this study, we assumed that work satisfaction has a primary effect on PTG, and the survivor's perceived stress played a moderating role. With this in mind we developed the following hypotheses: Data Analysis In our study, descriptive statistics, variance analysis, and correlation analysis were calculated and presented. Data were expressed as a frequency for the nominal variables and as a mean ± standard deviation (SD) for continuous variables. In multiple linear regression analysis, demographic characteristics such as gender, age, education level, income and housing conditions were control variables in the analysis, and work satisfaction and perceived stress were independent variables, whereas PTG was a dependent variable. For missing data, list wise deletion was used. SPSS 16.0 for Windows was used for data analysis and p b 0.05 was considered statistically significant. RESULTS Demographic Characteristics The first part shows the basic demography and socioeconomic status, including age, gender, level of education, monthly income, ethnicity and housing status, which were considered the control variables (Table 1). Age was divided into four groups: 18 to 30 (coded as 1), 31 to 40 (coded as 2), 41 to 50 (coded as 3), older than 51 (coded as 4). Gender was coded 1 (male) and 2 (female). Level of education was coded 1–3 and referred to the different education levels. Income was divided into four income levels, namely, 1 = less than 1000 Yuan, 2 = from 1000 to 2000 Yuan, 3 = from 2000 to 3000 Yuan, 4 = more than 3000 Yuan. Ethnic groups are also listed, coded 1–5 referring to the Han, Tibetan, Qiang, Hui and others respectively. In terms of housing, 1 = original house, 2 = public dormitory, 3 = rented house, 4 = temporary settlement.

Please cite this article as: Xu, J., & Wu, W., Work Satisfaction and Posttraumatic Growth 1 Year After the 2008 Wenchuan Earthquake: The Perceived Stress as a Moderating Factor, Archives of Psychiatric Nursing (2014), http://dx.doi.org/10.1016/j.apnu.2013.12.006

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J. Xu, W. Wu / Archives of Psychiatric Nursing xxx (2014) xxx–xxx

Table 3 Correlation Coefficients Among the Variables. 1 1 Work satisfaction-total 2 Overall satisfactiona 3 Inner satisfactionb 4 External satisfactionc 5 PTG-total 6 Perceived stress-total

2

3

4

5

6

0.015 −0.479⁎⁎

−0.190⁎⁎

-

-

0.846⁎⁎ 0.845⁎⁎ 0.861⁎⁎ 0.324⁎⁎ −0.556⁎⁎

-

0.551⁎⁎ 0.634⁎⁎ 0.289⁎⁎ −0.450⁎⁎

-

0.570⁎⁎ 0.404⁎⁎ −0.502⁎⁎

-

NOTE. PTGI: Posttraumatic Growth Inventory. ⁎⁎ p b 0.01 (two-tailed). a Personal expertise and interest in job, learning opportunities and job security. b Wages and benefits, promotional prospects. c Work environment, management and colleagues' interpersonal relationships.

Basic Data Analysis The date was grouped according to the demographic variables and other control variables to assess the effect of these distinct characteristics on work satisfaction, perceived stress and PTG, the scores for which are presented in Table 2. For perceived stress, a lower mean score indicated a better assessment; for work satisfaction and PTG, a higher mean score indicated a better performance. For all participants, the work satisfaction mean of 2.58 was between relatively satisfied (2) and fair (3), the total stress mean of 2.77 was between frequently (2) and very often (3), and the PTG was close to a moderate level (55.68 (SD ± 11.50)). In all three areas, men scored lower than women. When looking at participants with an undergraduate or lower education level, the higher the education level the higher work satisfaction and PTG were found to be. However, for those participants with post graduate education, lower performance was perceived with PhD level participants showing the lowest PTG. Elderly people reported higher assessments in all three areas. The lower income group were found to have a higher stress level, and participants living in their original houses had the lowest perceived stress. Correlation Analysis Table 3 shows the extent that work satisfaction, PTG, and perceived stress relate to each other. Most pairs of the selected five variables were significantly correlated but at different levels. As can be seen from Table 3, the correlations between inner satisfaction and PTG, each aspect of satisfaction and perceived stress-total, and the perceived stress-total and PTG were significant at 0.01 level. The bivariate correlation analyses showed that PTG was related to "overall satisfaction" (r = 0.289) and "inner satisfaction" (r = 0.404), and stress was associated with all three aspects of work satisfaction (r = 0.450, r = 0.502, r = 0.479). There was a moderate correlation between PTG and perceived stress (r = 0.190).

explanation (ΔR 2 = 0.011, p b 0.01). In step 4 a new variable multiplying the dependent variable work satisfaction by the moderator variable perceived stress was created to test if stress was a moderating variable. The interaction was found to make a significant contribution to the explained variance (ΔR 2 = 0.013, p b 0.05). Thus, hypothesis 1(work satisfaction has a positive effect on the PTG among survivors post-earthquake) and hypothesis 2 (perceived stress was a moderator which weakened the effect of work satisfaction on PTG) were supported by the analysis. DISCUSSION The present literature represents the mitigating effort of stress on the positive relationship between PTG and work satisfaction. It indicated that work satisfaction was positively related to PTG, while perceived stress weakened the positive effect of the work satisfaction on PTG among survivors 1 year after the Wenchuan earthquake. Our study first examined the risk factors of survivors' three aspects: PTG, stress and work satisfaction (Table 2). Our survey indicated that females had lower work satisfaction and higher perceived stress consistent with previous findings that being female was a predictor of mental issues such as depression, traumatic stress response and anxiety (Armenian, Morikawa, Melkonian, et al., 2002; Liu, Xiao, Chen, et al., 2009; Varela, Koustouki, Davos, et al., 2008). Older people reported better evaluations for work satisfaction and less for perceived stress. As these subjects were mostly workers from nationally owned enterprises and departments and were usually in higher level positions, they may have been more content with their current lives. In our research, participants with a higher educational level suffered less psychological stress than those with Table 4 Risk Factors and Interaction Effect Analysis for Total PTG Score. PTG

The Regression Analysis With work satisfaction as the independent variable and PTG as the dependent variable, the results for the hierarchical regression analyses are presented in Table 4. In step 1, when all demographic variables were considered, the control variables, gender, education level and housing status were found to be significant. Generally speaking, male survivors and those with a better level of housing showed higher PTG points. However, survivors with a higher education had a lower PTG. The demographic characteristics showed a 14.0% change in the PTG points (ΔR 2 = 0.14, p b 0.01). In step 2 demographic variables were controlled, and a higher PTG score was explained by a higher level of work satisfaction, which accounted for the 12.2 % change in the R 2 of the model (ΔR 2 = 0.122, p b 0.01). In step 3 perceived stress was added to test its moderating effect on PTG and work satisfaction and was found to negatively contribute to the

Variables Step 1 Gender Age Education Income Housing Step 2 WS Step 3 Perceived stress Step 4 WS × perceived stress

B

Std. error

Beta

0.747 −0.259 −0.250 0.377 0.373

0.404 0.242 0.376 0.299 0.159

0.050⁎ −0.031 −0.019⁎⁎ −0.036 0.062⁎

−0.115

0.051

0.345⁎⁎

0.072

0.229

−0.108⁎⁎

−0.005

0.026

−0.059⁎

△R2

R2

0.14⁎⁎

0.14⁎⁎

0.122⁎⁎

0.262⁎⁎

0.011⁎⁎

0.273⁎⁎

0.013⁎

0.286⁎

NOTE. WS: work satisfaction, B = unstandardized, beta = standardized coefficients derived from the final step; R2 = explanation rate, ΔR2 = change in explanation rate in each step. ⁎ p b 0.05. ⁎⁎ p b 0.01.

Please cite this article as: Xu, J., & Wu, W., Work Satisfaction and Posttraumatic Growth 1 Year After the 2008 Wenchuan Earthquake: The Perceived Stress as a Moderating Factor, Archives of Psychiatric Nursing (2014), http://dx.doi.org/10.1016/j.apnu.2013.12.006

J. Xu, W. Wu / Archives of Psychiatric Nursing xxx (2014) xxx–xxx

a lower educational level, consistent with other research findings where lower education was found to be related to higher psychological problems among earthquake survivors (Kilic & Ulusoy, 2003; Livanou, Bassoglu, Salcioglu, et al., 2002; Montazeri, Baradaran, Omidvari, et al., 2005). Survivors who were living in their original houses suffered the least perceived stress. Studies have shown that earthquakes may cause stress reactions in survivors who have had to adapt to new circumstances (Bodvarsdottir & Elklit, 2004; Karanci & Rustemly, 1995). Wenchuan earthquake caused damage to many homes leaving many families homeless and in need of temporary accommodation, so these poor or altered living conditions added to their stress. Second, we found that work satisfaction was an important factor in the prediction of PTG. The results of the bivariate correlation analyses indicated that there was a positive association between PTG and work satisfaction in the present study (r = 0.324, p b 0.01). Xu and Wu (2011) found the earthquake survivors' opinions on work satisfaction influenced their views on psychological pressure and psychological recovery. The earthquake caused significant changes to many survivor's work environments and status, such as damage or destruction of work facilities, lack of funds for rebuilding, a heavier work load or even job loss. In our small-scale telephone interview, the employees with a higher work satisfaction were found to have better interpersonal relationships, more confidence in their lives and the courage to overcome difficulties. We also found that the survivors' perceived stress was associated with their work satisfaction (r = − 0.556, p b 0.01). As the earthquake caused work problems, perceived stress was seen as a consequence of these work troubles (Farquharson et al., 2012). So those with higher work satisfaction evaluations had higher performances in the psychological aspects because of their better work status or working conditions. As a study of rescue workers after the Oklahoma City bombing reported, PTSD was found to be associated with reduced job satisfaction (North, Tivis, McMillen, et al., 2003), with the opinions on work influencing views on perceived stress and psychological recovery. Those with a higher work satisfaction showed higher psychological aspect performances. Third, the regression analysis demonstrated that stress functioned as a moderator between PTG and work satisfaction. The results of this study showed a positive association between work satisfaction and PTG while perceived stress contributed negatively. In Table 4, the coefficient of the interaction item WS × perceived stress is not zero (− 0.005) and is significant at 0.01 level, which indicates that perceived stress has a moderating effect on work satisfaction and PTG. This WS × perceived stress (ΔR 2 = 0.013, p b 0.01), also indicates that the more severity the perceived stress, the weaker the positive effect of work satisfaction on PTG. These findings suggest that perceived stress buffers the PTG-JSS intention linkage: from an individual's perspective, those having a higher work satisfaction had a better status and were better able to deal with their stress and recovery, which buffered the negative effects of stress on PTG. When an individual had severe stress, it may influence their mood at work and possibly conflicted with their work status, weakening the positive effect of work satisfaction on PTG. Some stresses such as power and water cuts, family troubles, and daily trifles may have existed before but didn’t influence work satisfaction because most survivors thought they were able to overcome this slight stress. However, because of the earthquake, some stresses in daily life would make them feel more pressure. This earthquake occurred in West China, a region which is underdeveloped and where the local residents are mostly poorly educated, so the impact of stress on their mental health was high. Prior to the earthquake, most of these people worked in peace (even though their jobs may not have been very good), but the occurrence of the earthquake broke this balance (destroyed their working equipment, worsened their working environment and even deprived them of their job.), so the stress resulting from the earthquake became serious,

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and significantly influenced their work satisfaction. The fear of the earthquake amplified the stress, which may not have influenced their previous work satisfaction. Thus, the moderating mechanism may have affected this in some way: that is, the survivors were working normally until they felt the stress resulting from the earthquake, so the daily stress was amplified by the earthquake, and when the pressure reached a certain degree, the people had feelings of dissatisfaction, which affected their experience of PTG. For adults, the status of their work has been found to play an important role after trauma, and research has demonstrated that having paid work is significantly associated with PTG after a severe trauma (Powell et al., 2012). With this in mind, therefore, we feel that this may be the reason why perceived stress moderates PTG and work satisfaction. Employers in the disaster-hit areas need to attach importance to their employees' psychological state and the stress caused by the trauma. As disasters generally cause a negative influence on working conditions in the disaster area, employers need to take action to recover facilities and restore the environment to maintain work satisfaction. Special efforts need to be focused on removing elements at work which may cause employees to recall the stresses and terrors of the earthquake. For example, employers could engage government policy and financial support to assist in reconstruction, while for stress management, allocating workloads appropriately, assisting in the resolution of work–family conflicts, conducting stress relieving activities and providing psychological counseling channels would assist in alleviating worker stress and elevating worker satisfaction. For posttraumatic psychological rehabilitation, mental health service providers need to minimize survivors' victimization experiences, improve their regulatory abilities, and promote alternatives to negative coping in victims following disasters (Terranova, Boxer, & Morris, 2009). Mental health recovery intervention like early identification, ongoing monitoring, sustained psychosocial support and mental health services are required for high-risk populations. Our study particularly focused on the survivors as employees, and emphasizes the importance of work status and stress relief for posttraumatic patients. Medical workers need to be aware of the importance of job satisfaction and perceived stress on PTG, and put more effort into survivors' mental health care, such as improving psychological debriefing. The limitations of this study are that no comparisons were made due to a lack of pre-disaster data, so it is difficult to confidently discern the true extent of the earthquake's effect. Our participants were mainly workers from different fields. However, a survey of affected populations in rural and remote areas was unavailable. More representative samples are needed to examine the generalizability of these findings. The current endeavor was limited by its crosssectional design as the survey did not cover the broader areas of the countryside, and all questionnaires were self-reporting, so there was no objective measure of availability or quality, and hence it was not possible to evaluate the accuracy and insightfulness of an individual's perceptions. In addition, as the interview sample was very large, the measurements were unable to cover all participants, and were limited by the objective condition, so a skewing in the findings is inevitable. Despite these limitations, the results from the study still initially support the concept that posttraumatic growth relates to work satisfaction through perceived stress. In particular, the findings of the moderating effects of perceived stress suggest the need to focus future research and practice on organizational stress management. Future research must analyze additional possible mediating and moderating factors on the relationship between PTG, perceived stress, and work satisfaction, as other factors may also account for these effects. Acknowledgment The research is supported by the Major Program of National Social Science Foundation of China (Grant No. 12 & ZD217), Sichuan Provincial

Please cite this article as: Xu, J., & Wu, W., Work Satisfaction and Posttraumatic Growth 1 Year After the 2008 Wenchuan Earthquake: The Perceived Stress as a Moderating Factor, Archives of Psychiatric Nursing (2014), http://dx.doi.org/10.1016/j.apnu.2013.12.006

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Please cite this article as: Xu, J., & Wu, W., Work Satisfaction and Posttraumatic Growth 1 Year After the 2008 Wenchuan Earthquake: The Perceived Stress as a Moderating Factor, Archives of Psychiatric Nursing (2014), http://dx.doi.org/10.1016/j.apnu.2013.12.006