Emotion Dysregulation and Workplace Satisfaction in Direct Care Worker Burnout and Abuse Risk



      Direct care workers frequently encounter difficult interactions with the patients they serve and experience frustration and burnout. The current study tested a hypothesized model in which predictors of caregiver abuse risk (emotional dysregulation, difficulty managing patient behavior, and workplace satisfaction) were mediated by symptoms of burnout.


      The study used an online cross-sectional survey design.

      Setting and Participants

      The study was implemented online via Qualtrics. Participants were 206 direct care workers (eg, certified nursing assistants, patient care technicians, home health aides, and medical assistants).


      All respondents completed the Caregiver Abuse Screen (CASE), Difficulty with Emotional Regulation Scale (DERS-SF), and the Abbreviated Maslach Burnout Inventory. Demographic data and employment history were also collected. Correlational methods, including path analysis, were used to assess associations between study variables.


      More than half of this heterogenous sample endorsed significant risk for engaging in patient abuse. Path analysis suggested emotional dysregulation and low workplace satisfaction were associated with greater risk of patient abuse, and these associations were partially and simultaneously mediated by burnout facets of depersonalization and emotional exhaustion.

      Conclusions and Implications

      This study provided preliminary support for a model of caregiver abuse in which underlying difficulties regulating emotions convey risk for caregiver abuse via burnout facets including emotional exhaustion and depersonalization. Enhancing basic emotion regulation skills and reducing burnout in direct care staff may reduce the risk of abuse for older adults. Thus, providing training necessary to help direct care workers manage their own emotions in order to better recognize, understand, and respond effectively to the needs of older adults may reduce staff burnout and, consequently, lower the risk of abuse for older adults.


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        • Meek K.P.
        • Bergeron C.D.
        • Towne S.D.
        • Ahn S.N.
        • Ory M.G.
        • Smith M.L.
        Restricted social engagement among adults living with chronic conditions.
        Int J Environ Res Public Health. 2018; 15: 1-13
        • Suso-Ribera C.
        • Jornet-Gibert M.
        • Ribera Canudas M.V.
        • McCracken L.M.
        • Maydeu-Olivares A.
        • Gallardo-Pujol D.
        There’s more than catastrophizing in chronic pain: low frustration tolerance and self-downing also predict mental health in chronic pain patients.
        J Clin Psychol Med Settings. 2016; 23: 192-206
        • Smith M.L.
        • Bergeron C.D.
        • Adler C.H.
        • et al.
        Factors associated with healthcare-related frustrations among adults with chronic conditions.
        Patient Educ Couns. 2017; 100: 1185-1193
        • World Health Organization
        Elder abuse.
        • Demerouti E.
        • Nachreiner F.
        • Bakker A.B.
        • Schaufeli W.B.
        The job demands-resources model of burnout.
        J Appl Psychol. 2001; 86: 499-512
        • Gerhart J.I.
        • Canetti D.
        • Hobfoll S.E.
        Traumatic Stress in Overview: Definition, Context, Scope, and Long-Term Outcomes.
        in: Cherry K.E. Traumatic Stress and Long-Term Recovery: Coping with Disasters and Other Negative Life Events; 3-24. Springer International Publishing, 2015: 3-15
        • Hobfoll S.E.
        Stress, Culture, and Community.
        Springer US, 1998
        • Elpers K.
        • Amano T.
        • DeCoster V.
        • Johnson M.
        Effectiveness of a psycho-educational staff training program on attitudes of staff in a long-term care facility: a pilot study and framework.
        Educ Gerontol. 2017; 43: 431-439
        • Que J.
        • Shi L.
        • Deng J.
        • et al.
        Psychological impact of the COVID-19 pandemic on healthcare workers: a cross-sectional study in China.
        Gen Psychiatry. 2020; 33
        • Ohue T.
        • Togo E.
        • Ohue Y.
        • Mitoku K.
        Mental health of nurses involved with COVID-19 patients in Japan, intention to resign, and influencing factors.
        Medicine. 2021; 100: e26828
        • Cimarolli V.R.
        • Bryant N.S.
        • Falzarano F.
        • Stone R.
        Job resignation in nursing homes during the COVID-19 pandemic: the role of quality of employer communication.
        J Appl Gerontol. 2022; 41: 12-21
        • Zerbini G.
        • Ebigbo A.
        • Reicherts P.
        • Kunz M.
        • Messman H.
        Psychosocial burden of healthcare professionals in times of COVID-19-a survey conducted at the University Hospital Augsburg.
        Ger Med Sci. 2020; 18: 1-9
        • Torrente M.
        • Sousa P.A.C.
        • Sánchez-Ramos A.
        • et al.
        To burn-out or not to burn-out: a cross-sectional study in healthcare professionals in Spain during COVID-19 pandemic.
        BMJ Open. 2021; 11: e044945
        • Trumello C.
        • Bramanti S.M.
        • Ballarotto G.
        • et al.
        Psychological adjustment of healthcare workers in Italy during the COVID-19 pandemic: differences in stress, anxiety, depression, burnout, secondary trauma, and compassion satisfaction between frontline and non-frontline professionals.
        Int J Environ Res Public Health. 2020; 17: 1-13
        • Martínez-López J.Á.
        • Lázaro-Pérez C.
        • Gómez-Galán J.
        Burnout among direct-care workers in nursing homes during the COVID-19 pandemic in Spain: a preventive and educational focus for sustainable workplaces.
        Sustainability. 2021; 13: 2782
        • Schaufeli W.B.
        • Taris T.W.
        A critical review of the job demands-resources model: Implications for improving work and health.
        in: Bridging Occupational, Organizational and Public Health: A Transdisciplinary Approach. Springer, 2014: 43-68
        • Hobfoll S.E.
        • Tirone V.
        • Holmgreen L.
        • Gerhart J.
        Conservation of resources theory applied to major stress.
        in: Stress: Concepts, Cognition, Emotion, and Behavior. Elsevier, 2016: 65-71
        • Bianchi R.
        • Schonfeld I.S.
        • Laurent E.
        Burnout-depression overlap: a review.
        Clin Psychol Rev. 2015; 36: 28-41
        • McRae K.
        • Gross J.J.
        Emotion regulation.
        Emotion. 2020; 20: 1
        • Gratz K.L.
        • Roemer L.
        Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale.
        J Psychopathol Behav Assess. 2004; 26: 41-54
        • Kaufman E.A.
        • Xia M.
        • Fosco G.
        • Yaptangco M.
        • Skidmore C.R.
        • Crowell S.E.
        The Difficulties in Emotion Regulation Scale Short Form (DERS-SF): validation and replication in adolescent and adult samples.
        J Psychopathol Behav Assess. 2015; 38: 443-455
        • Gabbe S.G.
        • Melville J.
        • Mandel L.
        • Walker E.
        Burnout in chairs of obstetrics and gynecology: diagnosis, treatment, and prevention.
        Am J Obstet Gynecol. 2002; 186: 601-612
        • Reis M.
        • Nahmiash D.
        Validation of the Caregiver Abuse Screen (CASE).
        Can J Aging. 1995; 14: 45-60
        • Love J.
        • Selker R.
        • Marsman M.
        • et al.
        JASP: Graphical Statistical Software for Common Statistical Designs.
        J Stat Softw. 2019; 88: 1-17
        • Yeatts D.E.
        • Seckin G.
        • Shen Y.
        • Thompson M.
        • Auden D.
        • Cready C.M.
        Burnout among direct-care workers in nursing homes: influences of organisational, workplace, interpersonal and personal characteristics.
        J Clin Nurs. 2018; 27: 3652-3665
        • Woodhead E.L.
        • Northrop L.
        • Edelstein B.
        Stress, social support, and burnout among long-term care nursing staff.
        J Appl Gerontol. 2016; 35: 84-105
        • Bamonti P.
        • Conti E.
        • Cavanagh C.
        • et al.
        Coping, cognitive emotion regulation, and burnout in long-term care nursing staff: a preliminary study.
        J Appl Gerontol. 2019; 38: 92-111
        • Salyers M.P.
        • Bonfils K.A.
        • Luther L.
        • et al.
        The relationship between professional burnout and quality and safety in healthcare: a meta-analysis.
        J Gen Intern Med. 2017; 32: 475-482
        • Dyrbye L.N.
        • Major-Elechi B.
        • Thapa P.
        • et al.
        Characterization of nonphysician health care workers’ burnout and subsequent changes in work effort.
        JAMA Netw Open. 2021; 4: e2121435
        • Berk R.
        Derogatory and cynical humour in clinical teaching and the workplace: the need for professionalism.
        Med Educ. 2009; 43: 7-9
        • Neuberg M.
        • Železnik D.
        • Meštrovic T.
        • Ribic R.
        • Kozina G.
        Is the burnout syndrome associated with elder mistreatment in nursing homes: results of a cross-sectional study among nurses.
        Arhiv za higijenu rada i toksikologiju. 2017; 68: 190-197
        • Linehan M.M.
        • Wilks C.R.
        The course and evolution of dialectical behavior therapy.
        Am J Psychother. 2015; 69: 97-110

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