https://doi.org/10.35845/kmuj.2023.22017 ORIGINALARTICLE

Mediating role of emotion disclosure between emotion regulation and apprehension in healthcare professionals during COVID-19

Sadia Saleem ¹, Halima Khurshid ¹ , Sara Subhan ¹, Rabia Khadim ¹

1: Department of Clinical Psychology, School of Professional Psychology, University of Management and Technology, Lahore, Pakistan

Email : halima.khurshid@umt.edu.pk

Contact #: +92-335-7998139

Date Submitted: September 15, 2021

Date Revised: July 10, 2023

Date Accepted: August 19, 2023

THIS ARTICLE MAY BE CITED AS: Saleem S, Khurshid H, Subhan S, Khadim R. Mediating role of emotion disclosure between emotion regulation and apprehension in healthcare professionals during COVID-19. Khyber Med Univ J 2023;15(3):171-5. https://doi.org/10.35845/kmuj.2023.22017

ABSTRACT

OBJECTIVES: To identify the mediating role of emotional disclosure between emotion regulation and apprehension in health care professionals during Coronavirus Disease 2019 (Covid-19).

METHODS: This correlational study, spanning three months, involved seventy-six healthcare workers. These individuals, encompassing both paid and unpaid personnel serving in healthcare facilities, were selected through purposive sampling. They operated in various health-care settings across public and private sectors in Lahore, Pakistan, and had the potential for direct or indirect exposure to patients or their infectious secretions and materials. Three self-reported measures emotion regulation questionnaire, psychosocial reaction scale, and emotional self-disclosure scale were used along with one demographic sheet to collect data. Descriptive statistics, correlation method and mediation analysis were used to test the hypothesis.

RESULTS: Out of 76 participants, 41 (54%) were males. Mean age of participants was 29.68±8.14 years. Majority (n=58/76;76%) of participants were doctors; 26 (34%) had prior exposure to Covid virus. Correlation analysis revealed that cognitive reappraisal is positively associated with positive emotional disclosure (r=.35; p<.001), and expressive suppression is positively associated with negative emotional disclosure (r=.23; p<.05) and apprehension (r=.43; p<.001) in healthcare workers. Furthermore, negatively emotional disclosure is positively associated with apprehension. Mediation analysis showed that negative emotional disclosure partially mediates the association between expressive suppression and apprehension (β=0.33, SE=0.11, p < .001).

CONCLUSION: Findings suggest healthcare workers to be at greater risk of developing mental health conditions and they need to practice adaptive emotion regulation strategies such as acceptance, reappraisal, and problem solving especially during emergency situations like Covid.

KEYWORDS: Healthcare Workers (MeSH); Healthcare Personnel (MeSH); Emotion Regulation (MeSH); Emotion Disclosure (MeSH); Emotions (MeSH); Emotion regulation questionnaire (Non-MeSH); Psychosocial reaction scale (Non-MeSH); Emotional self-disclosure scale (Non-MeSH); Negotiating (MeSH).

INTRODUCTION

The Coronavirus Disease 2019 (COVID-19) is pathogenic and an exceedingly transmittable infection caused by acute respiratory syndrome coronavirus 2 (SARS-CoV-2), firstly reported in late December 2019. It caused global pandemic leading to a dramatic loss of human life worldwide.¹ Worldwide, healthcare professionals (HCPs) are currently going through foremost challenges because of global spread of COVID-19.² Although, they are aware with incessant variation and advances, but the COVID-19 situation made them vulnerable for various challenges, which many have certainly not experienced before,³ including greater threat of developing psychological, working in SARS units, being isolated, having family or friends septic with SARS, significantly having fear, post-traumatic stress and higher risk for emotional disturbances during infectious outbreaks.⁴ This is accompanying with psychological stress and anxiety among the general population, and more specifically, among HCPs.⁵

Literature also suggested increasing and alarming rate of mental health problems like depression and anxiety in healthcare workers during COVID-19 with the prevalence rate of 24.83% to 69.5%.^6,7 Considering the consequences of anxiety, there is need to identify the factor, playing an important role in its manifestation. Emotion regulation and emotional disclosure are the most prominent risk factors. Emotion regulation is referred as a process in which individuals are influenced with the emotions they have, when they have them, and lastly how they experience and express these emotions.⁸ Effective emotion regulation is essential to endure health, foster resilience, enable well-being, and prevent burnout or compassion fatigue. The emotional regulating strategies, particularly for negative emotions, tend to be robustly associated with several psychopathologies, such as anxiety or depression.⁹

Psychological emotion regulation strategies foster the resilience which help individuals to cope with stressful experiences of COVID-19 challenges and protect them from various internal and external stressors.¹⁰ If the health care professionals regulate their emotions in healthy way, it positively affect their psychological well-being but in case of failure emotional suppression, or poorly regulating emotions in terms of anger, frustration, hostility etc. they experience greater distress, burnout, anxiety and lower resilience.¹¹

Literature suggests that another variable, playing important role in mental health of HCPs, is emotion regulation. Emotion regulation strategies are considered significant to counteract the negative health outcomes and the disclosure of emotions is also essential for sustaining the mental health. If positive emotions are disclosed, it facilitates the mental health but if more negative emotions as hostility, frustration etc. are disclosed, it contributes towards mental health problems.¹² Doctors struggle to cope with the symptoms of mental health issues, unable to self-manage lead towards lack of disclosure. Briefly, significant improvement in the mental well-being of adolescents is linked with emotional self-disclosure.¹³ Considering the increased prevalence and adverse consequences associated with mental health problems in HCPs, it is needed to identify the risk and protective factors of mental health problems. For the purpose, the current study investigated the association of emotion regulation, emotional disclosure and apprehension. Further, it was also aimed to find out the mediating role of Emotional Disclosure in the association of emotion regulation and apprehension. Emotion regulation refers to the ability of managing one’s emotions to adapt to work demands specifically during COVID-19 it played a significant role to better cope with the psychosocial challenges in a healthcare setting. Furthermore, most of the researches covered the general psychosocial impact of pandemic in healthcare workers in Pakistan and but the current research was more problem specific in highlighting the role of emotion regulation and apprehension with the mediating role of emotional disclosure.

METHODS

The current study used a correlational research design with survey method. The approval was taken from institutional ethical review board. The study included participants employed in public or private healthcare settings, possessing internet access, and having proficiency in the English language. Data was collected from March 2019 to May 2019, coinciding with the initial wave of Covid in Pakistan. Seventy-six healthcare workers were approached using purposive sampling. Inclusion criteria comprised any paid or unpaid individual serving in a healthcare facility with the potential for direct or indirect exposure to patients, as well as their infectious secretions and materials.

Total three scales were used along with one demographic sheet. The following three measures were used to collect data from the participants.

Emotion Regulation Questionnaire

This scale a 10-item scale designed to measure respondents’ tendency to regulate their emotions.¹⁴ It assesses the participant’s ability to control (that is, regulate and manage) emotions. It comprises of two basic emotional aspects from person’s life; cognitive reappraisal and expressive suppression. It is a 7-point Likert scale ranging from 1 (strongly disagrees) to 7 (strongly agrees). The scoring range of the first sub-scale cognitive reappraisal is between 6 to 42 and that of the Expressive Suppression it is between 4 to 28. The Cronbach alpha of the scale came out to be 0.87.

Psychosocial Reaction Scale

The scale consists a total of 27 items primarily based on the presenting complaints of 39 students self-referred at the Counselling Service Centre during the first wave of COVID-19 lockdown period in Pakistan.¹⁵ The scale contains two subscales; Depression Symptomatology and Apprehension. It is a 4-point Likert scale, response ranging from 0 (not at all), 1 (a little), 2 (to some extent), and 3 (a lot). 0 – 81 is the scoring range where higher score reflects more psychosocial reactions. The Cronbach alpha of the scale came out to be 0.92.

Emotional Self-Disclosure Scale

The scale is a 10-item scale consisted of multiple subscales which were devised to find out the interpersonal emotional disclosure of different emotions such as depression, happiness, jealousy, anxiety, anger, calmness, apathy, and fear.¹⁶ The scoring options for this scale was 0 (not at all), 1 (sometimes), 2 (often), 3 (to some extent), and 4 (always). The scoring range High scored depicted more emotional self-disclosure while low scores scored lack of emotional disclosure. The Cronbach alpha of the scale came out to be 0.72.

Procedure

After getting permission from the Institutional Review Board (IRB), School of Professional Psychology, University of Management and Technology, Lahore, Pakistan, healthcare workers were approached online and they were further briefly informed about the aims and objective of the research. After their permission, they were requested to fill the online google survey form. Data was collected online and the healthcare professionals were approached on email and on different social media platforms. Participants of the study were assured the privacy and confidentiality of the data that was obtained from them. Participants were also encouraged to ask queries if any and to give feedback in the end of the form. Statistical analysis was carried out though Statistical Package for Social Sciences version 25. Sample characteristics was determined through descriptive analysis. Pearson Product Moment Correlation was used to find out the relationship among emotion regulation, emotional disclosure and anxiety proneness. Mediation analysis was run by Hayes¹⁷ bootstrapping approach was conducted to explore the role of emotional disclosure as a mediator between emotion regulation and apprehension.

RESULTS

A cohort of 76 healthcare workers distributed across various departments, including 32% in emergency, 30% in outpatient departments, and 38% in wards, was gathered from diverse healthcare settings in Lahore, Pakistan.  Out of 76 participants, 41 (54%) were males and 35 (46%) were females. Mean age of participants was 29.68±8.14 years. Majority (n=58/76; 76%) of participants were doctors; 52/76 (68%) were working in public sector and 26 (34%) had prior exposure to Covid virus.

.

Table I: Frequencies and percentages of sociodemographic characteristics of the participants

Variables		Frequency (n=76)	Percentage
Gender	Male	41	54
	Female	35	46
Age in years	20-26	35	46
	27-46	41	54
Profession	Doctor	58	76
	Nurse	10	13
	Other	8	11
Setting	Emergency	24	32
	Outpatient	23	30
	Department / Ward	29	38
Job Experience (years)	0-3	41	54
	4-22	33	43
Working Sector	Government	52	68
	Private	24	32
Marital Status	Married	38	50
	Unmarried	38	50
Family System	Nuclear	38	50
	Joint	38	50
Prior exposure to Covid-19 virus	Yes	26	34
	No	50	66

Table II shows that the emotion regulation mechanism; cognitive reappraisal is significantly positively associated with positive emotional disclosure in healthcare workers. However, positive emotional disclosure did not come out to be associative with apprehension in healthcare workers. Furthermore, expressive suppression is significantly positively associated with negative emotional disclosure and apprehension in healthcare workers. Furthermore, negatively emotional disclosure is significantly positively associated with apprehension. This means that healthcare workers having higher expressive suppression will also higher negative emotional disclosure and consequently more apprehension related to COVID-19. Moreover, a higher negative emotional disclosure is also associated with elevated level of apprehension.

Table II: Inter-correlations among expressive suppression, negative emotional disclosure and

apprehension in healthcare workers (n=76)

Variables	M	SD	Cognitive Reappraisal	Expressive Suppression	Positive Emotional Disclosure	Negative Emotional Disclosure	Apprehension
Cognitive Reappraisal	24.32	9.34	-	.64***	.35***	.16	.22*
Expressive Suppression	15.36	5.39	-	-	.11	.23*	.43***
Positive Emotional Disclosure	18.19	4.72	-	-	-	.08	.02
Negative Emotional Disclosure	13.46	4.25	-	-	-	-	.52***
Apprehension	13.46	6.15	-	-	-	-	-

^{Note. M=Mean, SD=Standard Derivation, *p< 0.05, **p< 0.01, ***p< 0.001}

Table III  The findings of Pearson Product-Moment Correlation showed significant relationships among expressive suppression, negative emotional disclosure and apprehension; therefore, the mediating role of negative emotional disclosure was investigated using Hayes ¹⁴ bootstrapping approach

Table III:  Regression Analysis: Impact of Negative Emotional Disclosure and Expressive Suppression on Apprehension in healthcare workers (n=76)

Antecedent	Outcome
	NED (M)				A (Y)
	β	SE	p		β	SE	p
ES (X)	.23	.09	.043*	c`	.33	.11	.001***
NED (M)	---	---	---	b	.44	.14	.001***
	R^2 =.05				R^2 =.37
	F (1,74) = 4.22, p = .043*				F (2,73) = 21.26, p =.001***

^{Note. ES= Expressive Suppression, NED= Negative Emotional Disclosure, A= Apprehension. *p<.05, ***p<.001}

AUTHORS' CONTRIBUTIONS

Following authors have made substantial contributions to the manuscript as under:

SS: Concept and study design, analysis and interpretation of data, critical review, approval of the final version to be published

HK & RK: Acquisition of data, drafting the manuscript, approval of the final version to be published

SS: Analysis and interpretation of data, drafting the manuscript, approval of the final version to be published

Authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

CONFLICT OF INTEREST

Authors declared no conflict of interest

GRANT SUPPORT AND FINANCIAL DISCLOSURE

Authors declared no specific grant for this research from any funding agency in the public, commercial or non-profit sectors

DATA SHARING STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request

This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial 2.0 Generic License.

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