Subjective Socioeconomic Status and Post-Traumatic Growth Among Doctors and Nurses during the COVID-19 Pandemic: The Mediating Roles of Perceived Social Support and Positive Psychological Capital

Subjective Socioeconomic Status and Post-Traumatic Growth Among Doctors and Nurses during the COVID-19 Pandemic: The Mediating Roles of Perceived Social Support and Positive Psychological Capital | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Subjective Socioeconomic Status and Post-Traumatic Growth Among Doctors and Nurses during the COVID-19 Pandemic: The Mediating Roles of Perceived Social Support and Positive Psychological Capital Chengzhi Bai, Fan Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7504643/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This study investigated the association between subjective socioeconomic status and post-traumatic growth among doctors and nurses during the COVID-19 pandemic, with a focus on the mediating roles of perceived social support and positive psychological capital. Two independent studies were conducted. Study 1 surveyed 369 doctors who completed validated measures of subjective socioeconomic status, perceived social support, positive psychological capital, and post-traumatic growth. Study 2 replicated the design with 692 nurses to confirm the robustness of the findings. Across both samples, perceived social support and positive psychological capital independently mediated the link between subjective socioeconomic status and post-traumatic growth. Moreover, a sequential mediation pathway was identified, whereby higher subjective socioeconomic status predicted greater post-traumatic growth through increased perceived social support and, in turn, enhanced positive psychological capital. These findings highlight the importance of social and psychological resources in translating healthcare workers’ socioeconomic background into resilience and growth during the COVID-19 crisis. Health sciences/Health care Biological sciences/Psychology Social science/Psychology Subjective Socioeconomic Status Post-Traumatic Growth Doctors Nurses Perceived Social Support Positive Psychological Capital Figures Figure 1 Introduction Recent research has highlighted the profound psychological impact of the COVID-19 pandemic on healthcare workers, particularly doctors and nurses. Studies have documented a range of mental health challenges faced by these individuals, including psychological distress and post-traumatic stress disorder (Al-Hanawi et al., 2020; Pappa et al., 2020). Despite these adversities, such experiences can catalyse post-traumatic growth (PTG), a positive psychological change that results from struggling with highly challenging life circumstances (Tedeschi & Calhoun, 2004). Evidence suggests that PTG not only improves quality of life, but also ameliorates trauma-related symptoms and reduces mental health problems (Feingold et al., 2022; Pietrzak et al., 2021). Existing research has identified a number of factors that influence PTG in healthcare workers, including psychological elements such as deliberate rumination and resilience, and demographic variables such as marital status and education level (Pan et al., 2021; Finstad et al., 2021; Okoli et al., 2021). However, the impact of subjective socio-economic status (SES) on PTG, particularly during the COVID-19 pandemic, remains underexplored. This study seeks to fill this gap by examining how healthcare workers’ perceptions of their economic status within society affect their PTG. Defined as an individual’s perceived position within the social hierarchy (Singh-Manoux et al., 2003), subjective SES influences access to resources and overall well-being (Navarro-Carrillo et al., 2020; Wang et al., 2023), which in turn may shape their growth experiences following trauma. Furthermore, our research aims to uncover the complex mechanisms through which socio-economic factors influence PTG, focusing on the pathways through which subjective SES influences this process among healthcare workers during the pandemic. We will examine the mediating roles of perceived social support and positive psychological capital (PsyCap), which are expected to link subjective SES and PTG. Understanding these relationships not only advances theoretical knowledge, but also has important practical implications, providing the basis for developing interventions and support strategies that are sensitive to the socioeconomic backgrounds of healthcare workers. Subjective SES and PTG We find that subjective SES is positively correlated with PTG among healthcare workers, a hypothesis supported by coping theory. According to this theory, individuals with higher subjective SES who have access to more resources and support are likely to use more effective coping strategies, thereby facilitating PTG (Biggs et al., 2017). Although few empirical studies support this relationship (Wang & Lu, 2020; Yang et al., 2023), its specific application to healthcare workers during the COVID-19 pandemic in China has not been extensively investigated. Therefore, we propose Hypothesis 1: Subjective SES is positively correlated with PTG among Chinese healthcare workers. Subjective SES, Perceived Social Support, and PTG Resource Conservation Theory suggests that perceived social support functions as a critical resource mediating the relationship between subjective SES and PTG. This theory posits that individuals with higher subjective SES have access to more abundant and diverse resources, including more extensive and supportive social networks (Hobfoll et al., 2018). This increased support is thought to significantly aid stress management and facilitate PTG. Perceived social support, defined as the belief that one is cared for and has access to help from one’s social network (Cohen & Syme, 1985), is enhanced by the broader, more resourceful networks that often accompany higher socioeconomic status (Wang & Liu, 2021; Yan et al., 2021). A substantial body of literature confirms that robust social support is essential for fostering PTG (Shang et al., 20–22; Yu et al., 2014; Zhou et al., 2017). For example, recent meta-analyses involving tens of thousands of participants across various studies have indicated a positive effect size between social support and PTG, underscoring its role in effective stress management, resilience building, and optimism cultivation—all vital for growth after traumatic experiences (Ning et al., 2023; Prati & Pietrantoni, 2009). Given this theoretical and empirical background, we propose the following: Hypothesis 2: Perceived social support mediates the relationship between subjective SES and PTG. Subjective SES, PsyCap, and PTG Drawing on social cognitive theory (Luszczynska & Schwarzer, 2015), we argue that PsyCap acts as a potential mediator linking subjective SES to PTG. According to this theory, individuals with higher subjective SES are often exposed to more positive social interactions and role models, creating an environment conducive to the development of PsyCap, a positive psychological state consisting of hope, resilience, optimism and self-efficacy. These components are critical for proactively engaging with challenges and enhancing stress management and resilience (Luthans et al., 2007). Empirical evidence supports this conceptualisation, suggesting that elevated subjective SES may contribute to an environment conducive to the growth of PsyCap, which subsequently enhances the personal resources necessary for PTG (Meyerson et al., 2011; Willey et al., 2022). Furthermore, numerous studies have documented that enhanced PsyCap positively influences PTG by improving coping skills, fostering a positive outlook, and promoting hope and resilience (Meng et al, 2024; Xu et al., 2016). Based on this theoretical and empirical foundation, we propose the following: Hypothesis 3. PsyCap mediates the relationship between subjective SES and PTG. The Serial Mediating Roles of Perceived Social Support and PsyCap We propose that perceived social support and PsyCap may function as sequential mediators between subjective SES and PTG. According to social support theory (Hobfoll et al., 2018), social support plays a crucial role in predicting psychological capital by providing emotional, informational, and practical assistance. This support helps mitigate stress and enhance an individual’s capacity to adapt to challenges. In turn, enhanced social support can bolster positive psychological states such as self-efficacy, hope, optimism, and resilience—collectively known as PsyCap—which are essential for effective coping and achieving goals (Sarason, 2013). Empirical evidence further supports this pathway, with studies demonstrating how social support promotes psychological resources such as PsyCap, which in turn promotes growth following adversity (Liu et al., 2021; Huang & Zhang, 2022). Therefore, we propose that the interaction between these factors occurs in a sequential manner, with increased subjective SES leading to greater social support, which enhances PsyCap and ultimately facilitates PTG. Based on this, we formulate Hypothesis 4: Perceived social support and PsyCap will sequentially mediate the relationship between subjective SES and PTG among healthcare workers during the COVID-19 pandemic. The Current Study This study examines the relationship between subjective SES, perceived social support, PsyCap and PTG during the COVID-19 pandemic among Chinese healthcare professionals. The study focuses on the pathway from subjective SES to PTG, emphasising the mediating roles of perceived social support and PsyCap. This approach uniquely links socio-economic status, support structures, psychological resources and PTG in the challenging context of a global health crisis. In Study 1, using a sample of Chinese doctors, we examine the mediating effects of perceived social support and PsyCap on the relationship between subjective SES and PTG. Study 2 replicates this framework but focuses on a sample of Chinese nurses to validate the findings and to observe potential differences between the two professions. After a comprehensive review of the existing literature, we developed four hypotheses: (1) Subjective SES is positively correlated with PTG among Chinese healthcare workers. (2) Subjective SES has an indirect effect on PTG by influencing perceived social support. (3) PsyCap plays a mediating role in the relationship between subjective SES and PTG. (4) Perceived social support and PsyCap act as sequential mediators in the subjective SES and PTG link. Study 1 Methods Study Design and Participants This research was conducted across several hospitals in Fujian Province, located in the southern region of China, between September and October 2020. In collaboration with hospital administrators, we distributed our survey via WeChat, the leading messaging and social media platform in China, to reach a broad audience of healthcare professionals. Out of the initial responses, 374 were from doctors. After a meticulous review to ensure data quality, we excluded 5 responses due to their incomplete or non-serious nature, resulting in a total of 369 valid entries for analysis. Measures MacArthur Scale of Subjective Social Status Developed by Adler et al. (2000), the MacArthur Scale of Subjective Social Status assesses individuals’ perceived socioeconomic standing. Participants rate themselves on a 10-rung ladder, which represents a spectrum of socioeconomic positions within the Chinese context, categorized based on criteria such as income, education, and occupation. This scale has been extensively validated within Chinese populations (Yan et al., 2022), demonstrating strong test-retest reliability and significant convergent validity (Hu et al., 2012). Multi-Dimensional Scale of Perceived Social Support Perceived social support was quantified using the Multi-Dimensional Scale of Perceived Social Support, developed by Zimet et al. (1990). This scale includes 12 items that capture three key dimensions of support: familial, friendship, and support from significant others. Participants rate each item on a 5-point Likert scale, where 1 indicates 'strongly disagree' and 5 indicates 'strongly agree.' A higher cumulative score indicates greater perceived social support. Among Chinese participants, the scale has demonstrated excellent reliability and validity (Yan et al., 2022), achieving a Cronbach’s alpha of .964 in this study. Positive Psychological Capital Participants’ levels of Psychological Capital were assessed using the Chinese adaptation of the PsyCap Questionnaire developed by Zhang et al. (2010). This questionnaire measures four domains: self-efficacy, hope, resilience, and optimism. Each item is rated on a 5-point Likert scale, ranging from 1 ('strongly disagree') to 5 ('strongly agree'). Higher scores indicate elevated levels of psychological capital. The scale has shown good reliability and validity in Chinese culture (Bai & Bai, 2023; Bai et al., 2023), with a Cronbach's alpha of .954 in this study. Post-traumatic Related to the COVID-19 Pandemic To assess the extent of PTG experienced due to the COVID-19 pandemic, the study utilized the PTG Inventory (PTGI, Tedeschi et al., 2017). Participants rated the degree of change they have experienced across five domains: relationships with others, personal strengths, new possibilities, appreciation of life, and spiritual and existential change. Ratings were made on a 6-point Likert scale, from 0 ("not changed at all") to 5 ("changed very much"). Earlier studies have confirmed the reliability and construct validity of this measure within a Chinese setting (Bai et al., 2023; Bai & Bai, 2024). In the present study, with a Cronbach’s alpha of .968. Data Analysis For descriptive and correlational analyses, we used SPSS version 25.0. To explore the mediating roles of resilience and stress in the relationship between gratitude and job satisfaction, we utilized model 6 of the PROCESS Macro V3.00 within SPSS. This methodological approach is supported by Hayes (2013), which provides a robust framework for such analyses. The strength of the mediating effects was examined using the PROCESS procedure, involving 5000 bootstrap samples to ensure reliability. A mediating effect is considered statistically significant if its 95% confidence interval (CI) does not include zero, following the criteria set by Preacher & Hayes (2008). Ethical Considerations This study was approved by the Ethics Committee of the Department of Psychology, School of Philosophy, Wuhan University (approval number: 2020071601; date of approval: July 16, 2020). Written informed consent was obtained from all participants prior to data collection, which was conducted between September 1 and October 30, 2020. Participation was entirely voluntary, and participants could withdraw from the study at any time without penalty. All data were collected and analyzed anonymously to ensure confidentiality. The study was conducted in accordance with the ethical standards of the institutional research committee, the APA Ethical Principles of Psychologists, and the Declaration of Helsinki and its later amendments. Results Descriptive Statistics and Correlation Analysis The demographic breakdown of the participants was as follows: 242 (65.6%) were male, and 127 (34.4%) were female. The mean age of the participants was 34.6 years, with a standard deviation of 7.48. Regarding marital status, 106 participants (28.7%) were unmarried, 261 (70.7%) were married, and 2 (0.5%) were divorced. In terms of educational attainment, the distribution was as follows: 1 participant (0.3%) held a diploma from a junior college, 57 (15.4%) had completed associate degree programs, the majority, 235 (63.7%), held a bachelor's degree in medicine, and 76 (20.6%) had attained a Master’s degree or higher. Table 1 presents that subjective SES, perceived social support, and PsyCap were all significantly and positively correlated with PTG (ps < .001). The mean scores for Subjective SES, perceived social support, PsyCap, and PTG were 4.76 (SD = 1.70), 3.57 (SD = 0.73), 3.37 (SD = 0.57), and 72.74 (SD = 23.38), respectively. Table 1 Descriptive statistics and correlations among the key variables Variables M SD Correlation 1 2 3 4 1. SES 4.76 1.69 — 2. perceived social support 3.57 .73 .194*** — 3. positive psychological capital 3.37 .57 .288*** .697*** — 4. PTG 72.74 23.38 .294*** .546*** .617*** — Note: *** p < 0.001, SES = subjective socioeconomic status, PTG = post-traumatic growt Multiple Mediation Analysis To assess the independent contributions of perceived social support and PsyCap to the subjective SES–PTG relationship, a multiple mediation analysis was conducted. The results indicated that Subjective SES explained 9.0% of the variance in PTG, with the overall model accounting for 42.5%. The total effect of Subjective SES on PTG was significant (β = .167, p < .001). Even after accounting for the mediators, subjective SES continued to exert a significant direct effect on PTG (β = .007, p = .003), indicating partial mediation by perceived social support and PsyCap. Thus, Hypothesis 1 was supported. Bootstrap analyses, as shown in Table 2 , confirmed the mediating roles of both perceived social support (β = .042, 95% CI = [.011, .084]) and PsyCap (β = .066, 95% CI = [.028, .105]), as their 95% confidence intervals did not include zero. This supports Hypotheses 2 and 3. Furthermore, the serial mediation path linking subjective SES to PTG via perceived social support and PsyCap was significant (β = .058, 95% CI = [.021, .106]), supporting Hypothesis 4(see Fig. 1 ). Table 2 The effects and 95% Confidence Intervals. Model pathways Estimated 95% CI Lower Upper Direct effect SES→PTG .070 a .024 .115 Standardized indirect effect SES→PTG .167 a .090 .244 SES→perceived social support→ PTG .042 a .011 .084 SES→ positive psychological capital→ PTG .066 a .028 .105 SES→perceived social support→ PsyCap→ PTG .058 a .021 .106 IndEff (perceived social support) minus IndEff (PsyCap) − .024 − .076 .034 a Empirical 95% confidence interval does not overlap with zero. IndEff = Indirect effect. SES = subjective socioeconomic status, PTG = post-traumatic growth, PsyCap = positive psychological capital Lastly, a comparison of indirect effects indicated no significant difference in the strength of mediation between perceived social support and PsyCap in the subjective SES–PTG relationship. The confidence interval for the difference in indirect effects included zero (95% CI = [-.076, .034]), suggesting that the mediating effects of PsyCap and perceived social support are comparably influential in explaining the relationship between subjective SES and PTG. Study 2 Methods Study Design and Participants To reinforce the findings of Study 1, Study 2 was designed to further validate and establish the relationships explored, adhering to the rigorous standards of scientific inquiry recommended by the Open Science Collaboration (2015) and Pashler & Wagenmakers (2012). This follow-up study mirrored the methodology of Study 1 but focused on a distinct demographic group to assess consistency across different healthcare roles. Building upon the methodology of Study 1, Study 2 was conducted in October 2020 in collaboration with hospital administrators across Fujian Province, China. This phase of the research utilized data from a total of 740 nurses, initially gathered concurrently with the doctor data used in Study 1 during the same period of the COVID-19 pandemic. After meticulous screening to exclude incomplete or non-serious responses, the valid dataset comprised 692 nurses. Although this dataset was previously utilized in another study (Bai & Bai, 2024), the variables analyzed in the current research differ, except for PTG, which is a consistent measure across both studies. This strategic approach was chosen to make the most of the valuable data collected during a critical time when data collection opportunities were severely limited by the ongoing pandemic. A rigorous process was implemented to ensure the accuracy and integrity of the responses before they were processed for detailed analysis. Measures The same subjective SES, perceived social support, psychological capital and PTG were used in Study 2. The Cronbach’s alphas for the perceived social support, psychological capital and PTG measures in this study were 0.963, 0.952, and 0.967 respectively. Ensuring consistent tools across Study 1 and Study 2 provides a direct comparison, thus enabling a comprehensive evaluation of the experiences of healthcare workers from Fujian Province during the pandemic. Data analysis The analysis method for Study 2 mirrored the approach taken in the initial study. Results Descriptive statistics and correlation analysis Of the 692 nurses who participated in our research, 625 (90.3%) were female. With respect to age distribution, 310 (44.8%) were in the 20–29 age bracket, 268 (38.7%) fell between 30 and 39 years, 92 (13.3%) were in the 40–49 age range, and 22 (3.2%) were 50 years or older. As detailed in Table 3 , significant positive correlations (ps < .01) were observed between subjective SES, perceived social support, PsyCap, and PTG. Table 3 Descriptive statistics and correlations among the key variables Variables M SD Correlation 1 2 3 4 5. SES 4.80 1.55 — 6. perceived social support 3.60 .75 .304*** — 7. positive psychological capital 3.25 .56 .354*** .644*** — 8. PTG 73.92 22.12 .308*** .546*** .695*** — Note: *** p < 0.001, SES = subjective socioeconomic status, PTG = post-traumatic growth Multiple mediation analysis Similarly, we also conducted a multiple mediation analysis to explore the relationship between subjective SES and PTG, while adjusting for age and gender. This analysis specifically focused on the mediating roles of perceived social support and PsyCap. As shown in Table 4 , the results indicated that both perceived social support and PsyCap significantly mediated the relationship between subjective SES and PTG. Specifically, the effects of perceived social support (estimate = .047, 95% CI = [.021, .076]) and PsyCap (estimate = .091, 95% CI = [.051, .134]) were found to be statistically significant. Additionally, the relationship between subjective SES and PTG was mediated through a sequential pathway involving both perceived social support and PsyCap, with a significant combined mediating effect (estimate = .109, 95% CI = [.080, .140]). Furthermore, consistent with findings from the initial study, contrast tests indicated no significant difference between the mediation effects of perceived social support and PsyCap. The estimate of the difference in their effects was − .044, with a 95% confidence interval ranging from − .103 to .012, suggesting that the strengths of their mediating effects were comparable. Table 4 The effects and 95% Confidence Intervals. Model pathways Estimated 95% CI Lower Upper Direct effect SES→PTG .042 a .008 .077 Standardized indirect effect SES→PTG .246 a .197 .297 SES→perceived social support→ PTG .047 a .021 .076 SES→ positive psychological capital→ PTG .091 a .051 .134 SES→perceived social support→ PsyCap→ PTG .109 a .080 .140 IndEff (perceived social support) minus IndEff (PsyCap) − .044 − .103 .012 a Empirical 95% confidence interval does not overlap with zero. IndEff = Indirect effect. SES = subjective socioeconomic status, PTG = post-traumatic growth, PsyCap = positive psychological capital Discussion The primary aim of this study was to examine the relationship between subjective SES and PTG among healthcare workers during the COVID-19 pandemic. In particular, we examined the mediating role of perceived social support and PsyCap in this context. Our results confirm a positive correlation between Subjective SES and PTG. Importantly, both Perceived Social Support and PsyCap not only independently mediate this relationship, but also act sequentially, underscoring their crucial role in facilitating PTG among healthcare workers facing pandemic-related challenges. This study contributes significantly to existing research in several important ways. First, it adds to the literature on factors contributing to PTG by providing empirical evidence that an individual’s socioeconomic status (subjective SES) is strongly correlated with PTG outcomes (Wang & Lu, 2020; Yang et al., 2023). This highlights that how an individual perceives their position in society, along with other factors such as demographics, personality traits and the external environment, plays a role in PTG. Our findings are consistent with Bandura’s (1991) social cognitive theory, which suggests that individuals with higher subjective SES and greater self-efficacy are more likely to experience PTG. This finding also suggests that addressing socioeconomic inequalities in healthcare settings could enhance the psychological resilience of healthcare providers. Second, our research innovatively delineates the pathways through which subjective SES positively influences PTG. We found that higher subjective SES is associated with increased perceived social support, which subsequently enhances PTG. This finding is consistent with previous research highlighting the critical role of social support in facilitating PTG (Shang et al., 20–22; Yu et al., 2014; Zhou et al., 2017). In addition, PsyCap, which includes hope, resilience, optimism and self-efficacy, also acts as a significant mediator. Our findings suggest that individuals with higher subjective SES are more likely to cultivate robust PsyCap, which in turn strengthens their coping abilities and promotes PTG (Tedeschi & Calhoun, 2004). These findings not only validate existing theories, but also highlight the importance of socio-economic factors in psychological recovery processes, suggesting that enhancing social support systems and fostering psychological capital may be effective strategies for promoting resilience and growth in healthcare workers. Interestingly, Our study provides insights into the mediating roles of PsyCap and perceived social support in the relationship between subjective SES and PTG among healthcare workers during the COVID-19 pandemic. Interestingly, our findings suggest that PsyCap and perceived social support have a similar mediating effect, without significant differences between the two. This suggests that both internal psychological resources—like hope, resilience, optimism, and self-efficacy—and external social support play equally important roles in helping healthcare workers manage the heightened stress and uncertainty during the pandemic. Finally, our research makes a significant contribution to the field by detailing the sequential mediating roles of perceived social support and PsyCap. We found that healthcare workers with higher subjective SES are more likely to perceive better social support, which in turn serves as a foundation for the development of PsyCap. These interrelated factors work synergistically to enhance PTG and form a robust psychological defence against stress. This pathway provides critical insights for the development of targeted interventions aimed at enhancing the resilience and well-being of healthcare professionals. By strategically enhancing social support and psychological resources, interventions can be tailored to create a supportive environment that effectively promotes PTG. Implications for Practice The results of this study have important implications for health care management and policy, particularly in the aftermath of the COVID-19 pandemic and amidst ongoing health care challenges. First, recognising the influence of subjective SES in predicting PTG, healthcare institutions should implement interventions such as financial education and counselling programmes. These can help healthcare workers adjust their perceptions of their socioeconomic status, potentially fostering greater personal growth and resilience. Second, given the importance of perceived social support, particularly for nurses, it is advisable for healthcare institutions to strengthen their support systems. This could include the establishment of mentoring programmes, peer support groups and expanded professional development opportunities to provide both emotional and professional support. Third, given the significant impact of PsyCap on physician PTG, healthcare institutions should focus on developing resilience training, coping strategy workshops, and positive leadership initiatives. These programmes are designed to strengthen the internal psychological resources that are crucial for coping with the demands and stresses of the medical profession. Fourth, an integrated approach should be adopted that combines efforts to strengthen both social networks and psychological resilience. This strategy should be tailored to the different needs of doctors and nurses to ensure that interventions are effective and relevant to the specific challenges faced by each group. These steps highlight the need for a comprehensive, multidimensional approach to improving the well-being and resilience of health workers, particularly in times of crisis. By addressing both external and internal factors, healthcare institutions can more effectively support their staff to achieve PTG. Limitations and Future Directions Although this study provides valuable insights into the relationships between subjective SES, perceived social support, PsyCap and PTG among healthcare workers, several limitations must be acknowledged, which point the way for future research directions. First, the cross-sectional design of this study limits our ability to draw causal inferences. Future studies might benefit from using longitudinal designs to track changes over time and better establish causal relationships between the variables involved. Second, the use of self-reported measures, while necessary and valuable, may introduce response biases such as social desirability or self-report bias. Future research could include more objective measures or third party assessments to validate and extend the findings. Third, although our study included healthcare professionals from several hospitals in Fujian Province, the findings may not be generalisable to other regions or countries with different cultural and socioeconomic backgrounds. Future studies should consider a more diverse and broader geographical sample to improve the generalisability of the findings. Fourth, this study primarily focused on the mediating role of perceived social support and PsyCap. Future research could explore other potential mediators or moderators, such as personal resilience, organisational climate, or specific stressors related to different healthcare roles, to provide a more comprehensive understanding of the factors influencing PTG. Fifth, the differential impact of perceived social support and PsyCap between doctors and nurses suggests role-specific dynamics. Future studies should explore these differences in more depth, possibly examining other healthcare professions, to more clearly delineate role-specific interventions. Conclusions The findings confirm a positive correlation between higher Subjective SES and PTG, with significant mediation from perceived social support and PsyCap. These results underscore the pivotal role of socioeconomic factors and psychological resources in bolstering the resilience and growth of healthcare workers during crises. Specifically, the research suggests that interventions designed to enhance perceived social support and PsyCap could yield substantial benefits for healthcare professionals, although the focus might vary for doctors and nurses due to their distinct professional challenges. For healthcare management and policy, this study highlights the necessity of creating supportive environments that foster both personal and professional well-being. Targeted strategies such as financial education, resilience training, and enhanced support networks are likely to be effective in promoting PTG. Overall, this research provides critical insights into the intersection of socioeconomic status and psychological support mechanisms, facilitating growth and resilience among frontline medical personnel. It emphasizes a comprehensive approach to supporting healthcare workers both during and after the pandemic. Declarations Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Acknowledgments The authors would like to thank the everyone who participated in this study. Declaration of conflicting interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Ethical statement This study was approved by the Ethics Committee of the Department of Psychology, School of Philosophy, Wuhan University (approval number: 2020071601; date of approval: July 16, 2020). Written informed consent was obtained from all participants prior to data collection, which was conducted between September 1 and October 30, 2020. Participation was entirely voluntary, and participants could withdraw from the study at any time without penalty. All data were collected and analyzed anonymously to ensure confidentiality. The study was conducted in accordance with the ethical standards of the institutional research committee, the APA Ethical Principles of Psychologists, and the Declaration of Helsinki and its later amendments. Author contributions: Study design: Fan Li, Chengzhi Bai Data collection: Chengzhi Bai Data analysis: Chengzhi Bai Study supervision: Fan Li Manuscript writing: Chengzhi Bai, Fan Li Critical revisions for important intellectual content: Chengzhi Bai, Fan Li Data availability statement The datasets generated during and/or analyzed during the present study are available from the corresponding author on reasonable request. References Adler, N. E., Epel, E. S., Castellazzo, G., & Ickovics, J. R. (2000). Relationship of subjective and objective social status with psychological and physiological functioning: Preliminary data in healthy, White women. Health psychology, 19(6), 586. https://doi.org/10.1037/0278-6133.19.6.586 Al-Hanawi, M. K., Mwale, M. L., Alshareef, N., Qattan, A. M., Angawi, K., Almubark, R., & Alsharqi, O. (2020). Psychological distress amongst health workers and the general public during the COVID-19 pandemic in Saudi Arabia. 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Positive psychological capital, post-traumatic growth, social support, and quality of life in patients with systemic lupus erythematosus: A cross-sectional study. Lupus, 33(5), 470-480. https://doi.org/10.1177/09612033241238051 Meyerson, D. A., Grant, K. E., Carter, J. S., & Kilmer, R. P. (2011). Posttraumatic growth among children and adolescents: A systematic review. Clinical psychology review, 31(6), 949-964. https://doi.org/10.1016/j.cpr.2011.06.003 Navarro-Carrillo, G., Alonso-Ferres, M., Moya, M., & Valor-Segura, I. (2020). Socioeconomic Status and Psychological Well-Being: Revisiting the Role of Subjective Socioeconomic Status. Frontiers in psychology, 11, 1303. https://doi.org/10.3389/fpsyg.2020.01303 Ning, J., Tang, X., Shi, H., Yao, D., Zhao, Z., & Li, J. (2023). Social support and posttraumatic growth: A meta-analysis. Journal of Affective Disorders, 320, 117-132. https://doi.org/10.1016/j.jad.2022.09.114 Okoli, C. T., Seng, S., Lykins, A., & Higgins, J. T. (2021). 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Journal of interpersonal violence, 36(23-24), 11165-11187. https://doi.org/10.1177/0886260519897346 Willey, B., Mimmack, K., Gagliardi, G., Dossett, M. L., Wang, S., Udeogu, O. J., ... & Vannini, P. (2022). Racial and socioeconomic status differences in stress, posttraumatic growth, and mental health in an older adult cohort during the COVID-19 pandemic. EClinicalMedicine, 45. https://doi.org/10.1016/j.eclinm.2022.101343 Xu, X., Hu, M. L., Song, Y., Lu, Z. X., Chen, Y. Q., Wu, D. X., & Xiao, T. (2016). Effect of positive psychological intervention on posttraumatic growth among primary healthcare workers in China: A preliminary prospective study. Scientific reports, 6(1), 39189. https://doi.org/10.1038/srep39189 Yan, W., Zhang, L., Li, W., & Kong, F. (2022). How is subjective family socioeconomic status related to life satisfaction in Chinese adolescents? The mediating role of resilience, self-esteem and hope. Child Indicators Research, 15(5), 1565-1581. https://doi.org/10.1007/s12187-022-09936-2 Yang, L., Yang, Z., & Cheng, Y. (2023). How fear of COVID-19 promotes posttraumatic growth during COVID-19 epidemic: A moderated mediation model. Psychological Trauma: Theory, Research, Practice, and Policy. https://doi.org/10.1037/tra0001603 Yu, Y., Peng, L., Chen, L., Long, L., He, W., Li, M., & Wang, T. (2014). Resilience and social support promote posttraumatic growth of women with infertility: The mediating role of positive coping. Psychiatry research, 215(2), 401-405. https://doi.org/10.1016/j.psychres.2013.10.032 Zhang, K., Zhang, S., & Dong, Y. H. (2010). Positive psychological capital: Measurement and its association with mental health [In Chinese]. Studies of Psychology and Behavior, 8, 58-64. Zhou, X., Wu, X., & Zhen, R. (2017). Understanding the relationship between social support and posttraumatic stress disorder/posttraumatic growth among adolescents after Ya’an earthquake: The role of emotion regulation. Psychological trauma: theory, research, practice, and policy, 9(2), 214. https://doi.org/10.1037/tra0000213 Zimet, G. D., Powell, S. S., Farley, G. K., Werkman, S., & Berkoff, K. (1990). Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 55(3–4), 610–617. https://doi.org/10.1207/s15327752jpa5503&4_17 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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1","display":"","copyAsset":false,"role":"figure","size":107833,"visible":true,"origin":"","legend":"\u003cp\u003eThe mediating effects of perceived social support and positive psychological capital between subjective socioeconomic status(SES) and post-traumatic growth (PTG). Note: ***\u003cem\u003ep \u003c/em\u003e\u0026lt; 0.001, **\u003cem\u003ep \u003c/em\u003e\u0026lt; 0.01.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7504643/v1/b51c0ac497f19f5a67647a1c.png"},{"id":99319272,"identity":"e3ab65b6-fe01-4c45-ab3f-a195f84e0ac0","added_by":"auto","created_at":"2025-12-31 16:36:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1009271,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7504643/v1/6a919143-6458-40d5-b7d9-41873a694ee8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Subjective Socioeconomic Status and Post-Traumatic Growth Among Doctors and Nurses during the COVID-19 Pandemic: The Mediating Roles of Perceived Social Support and Positive Psychological Capital","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRecent research has highlighted the profound psychological impact of the COVID-19 pandemic on healthcare workers, particularly doctors and nurses. Studies have documented a range of mental health challenges faced by these individuals, including psychological distress and post-traumatic stress disorder (Al-Hanawi et al., 2020; Pappa et al., 2020). Despite these adversities, such experiences can catalyse post-traumatic growth (PTG), a positive psychological change that results from struggling with highly challenging life circumstances (Tedeschi \u0026amp; Calhoun, 2004). Evidence suggests that PTG not only improves quality of life, but also ameliorates trauma-related symptoms and reduces mental health problems (Feingold et al., 2022; Pietrzak et al., 2021).\u003c/p\u003e\u003cp\u003eExisting research has identified a number of factors that influence PTG in healthcare workers, including psychological elements such as deliberate rumination and resilience, and demographic variables such as marital status and education level (Pan et al., 2021; Finstad et al., 2021; Okoli et al., 2021). However, the impact of subjective socio-economic status (SES) on PTG, particularly during the COVID-19 pandemic, remains underexplored. This study seeks to fill this gap by examining how healthcare workers’ perceptions of their economic status within society affect their PTG. Defined as an individual’s perceived position within the social hierarchy (Singh-Manoux et al., 2003), subjective SES influences access to resources and overall well-being (Navarro-Carrillo et al., 2020; Wang et al., 2023), which in turn may shape their growth experiences following trauma. Furthermore, our research aims to uncover the complex mechanisms through which socio-economic factors influence PTG, focusing on the pathways through which subjective SES influences this process among healthcare workers during the pandemic. We will examine the mediating roles of perceived social support and positive psychological capital (PsyCap), which are expected to link subjective SES and PTG. Understanding these relationships not only advances theoretical knowledge, but also has important practical implications, providing the basis for developing interventions and support strategies that are sensitive to the socioeconomic backgrounds of healthcare workers.\u003c/p\u003e\n\u003ch3\u003eSubjective SES and PTG\u003c/h3\u003e\n\u003cp\u003eWe find that subjective SES is positively correlated with PTG among healthcare workers, a hypothesis supported by coping theory. According to this theory, individuals with higher subjective SES who have access to more resources and support are likely to use more effective coping strategies, thereby facilitating PTG (Biggs et al., 2017). Although few empirical studies support this relationship (Wang \u0026amp; Lu, 2020; Yang et al., 2023), its specific application to healthcare workers during the COVID-19 pandemic in China has not been extensively investigated. Therefore, we propose Hypothesis 1: Subjective SES is positively correlated with PTG among Chinese healthcare workers.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eSubjective SES, Perceived Social Support, and PTG\u003c/h2\u003e\u003cp\u003eResource Conservation Theory suggests that perceived social support functions as a critical resource mediating the relationship between subjective SES and PTG. This theory posits that individuals with higher subjective SES have access to more abundant and diverse resources, including more extensive and supportive social networks (Hobfoll et al., 2018). This increased support is thought to significantly aid stress management and facilitate PTG. Perceived social support, defined as the belief that one is cared for and has access to help from one’s social network (Cohen \u0026amp; Syme, 1985), is enhanced by the broader, more resourceful networks that often accompany higher socioeconomic status (Wang \u0026amp; Liu, 2021; Yan et al., 2021).\u003c/p\u003e\u003cp\u003eA substantial body of literature confirms that robust social support is essential for fostering PTG (Shang et al., 20–22; Yu et al., 2014; Zhou et al., 2017). For example, recent meta-analyses involving tens of thousands of participants across various studies have indicated a positive effect size between social support and PTG, underscoring its role in effective stress management, resilience building, and optimism cultivation—all vital for growth after traumatic experiences (Ning et al., 2023; Prati \u0026amp; Pietrantoni, 2009). Given this theoretical and empirical background, we propose the following: Hypothesis 2: Perceived social support mediates the relationship between subjective SES and PTG.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSubjective SES, PsyCap, and PTG\u003c/h3\u003e\n\u003cp\u003eDrawing on social cognitive theory (Luszczynska \u0026amp; Schwarzer, 2015), we argue that PsyCap acts as a potential mediator linking subjective SES to PTG. According to this theory, individuals with higher subjective SES are often exposed to more positive social interactions and role models, creating an environment conducive to the development of PsyCap, a positive psychological state consisting of hope, resilience, optimism and self-efficacy. These components are critical for proactively engaging with challenges and enhancing stress management and resilience (Luthans et al., 2007).\u003c/p\u003e\u003cp\u003eEmpirical evidence supports this conceptualisation, suggesting that elevated subjective SES may contribute to an environment conducive to the growth of PsyCap, which subsequently enhances the personal resources necessary for PTG (Meyerson et al., 2011; Willey et al., 2022). Furthermore, numerous studies have documented that enhanced PsyCap positively influences PTG by improving coping skills, fostering a positive outlook, and promoting hope and resilience (Meng et al, 2024; Xu et al., 2016). Based on this theoretical and empirical foundation, we propose the following: Hypothesis 3. PsyCap mediates the relationship between subjective SES and PTG.\u003c/p\u003e\n\u003ch3\u003eThe Serial Mediating Roles of Perceived Social Support and PsyCap\u003c/h3\u003e\n\u003cp\u003eWe propose that perceived social support and PsyCap may function as sequential mediators between subjective SES and PTG. According to social support theory (Hobfoll et al., 2018), social support plays a crucial role in predicting psychological capital by providing emotional, informational, and practical assistance. This support helps mitigate stress and enhance an individual’s capacity to adapt to challenges. In turn, enhanced social support can bolster positive psychological states such as self-efficacy, hope, optimism, and resilience—collectively known as PsyCap—which are essential for effective coping and achieving goals (Sarason, 2013).\u003c/p\u003e\u003cp\u003eEmpirical evidence further supports this pathway, with studies demonstrating how social support promotes psychological resources such as PsyCap, which in turn promotes growth following adversity (Liu et al., 2021; Huang \u0026amp; Zhang, 2022). Therefore, we propose that the interaction between these factors occurs in a sequential manner, with increased subjective SES leading to greater social support, which enhances PsyCap and ultimately facilitates PTG. Based on this, we formulate Hypothesis 4: Perceived social support and PsyCap will sequentially mediate the relationship between subjective SES and PTG among healthcare workers during the COVID-19 pandemic.\u003c/p\u003e\n\u003ch3\u003eThe Current Study\u003c/h3\u003e\n\u003cp\u003eThis study examines the relationship between subjective SES, perceived social support, PsyCap and PTG during the COVID-19 pandemic among Chinese healthcare professionals. The study focuses on the pathway from subjective SES to PTG, emphasising the mediating roles of perceived social support and PsyCap. This approach uniquely links socio-economic status, support structures, psychological resources and PTG in the challenging context of a global health crisis.\u003c/p\u003e\u003cp\u003eIn Study 1, using a sample of Chinese doctors, we examine the mediating effects of perceived social support and PsyCap on the relationship between subjective SES and PTG. Study 2 replicates this framework but focuses on a sample of Chinese nurses to validate the findings and to observe potential differences between the two professions.\u003c/p\u003e\u003cp\u003eAfter a comprehensive review of the existing literature, we developed four hypotheses: (1) Subjective SES is positively correlated with PTG among Chinese healthcare workers. (2) Subjective SES has an indirect effect on PTG by influencing perceived social support. (3) PsyCap plays a mediating role in the relationship between subjective SES and PTG. (4) Perceived social support and PsyCap act as sequential mediators in the subjective SES and PTG link.\u003c/p\u003e"},{"header":"Study 1","content":"\u003ch2\u003eMethods\u003c/h2\u003e\u003ch2\u003eStudy Design and Participants\u003c/h2\u003e\u003cp\u003eThis research was conducted across several hospitals in Fujian Province, located in the southern region of China, between September and October 2020. In collaboration with hospital administrators, we distributed our survey via WeChat, the leading messaging and social media platform in China, to reach a broad audience of healthcare professionals. Out of the initial responses, 374 were from doctors. After a meticulous review to ensure data quality, we excluded 5 responses due to their incomplete or non-serious nature, resulting in a total of 369 valid entries for analysis.\u003c/p\u003e\u003ch3\u003eMeasures\u003c/h3\u003e\u003ch2\u003eMacArthur Scale of Subjective Social Status\u003c/h2\u003e\u003cp\u003eDeveloped by Adler et al. (2000), the MacArthur Scale of Subjective Social Status assesses individuals’ perceived socioeconomic standing. Participants rate themselves on a 10-rung ladder, which represents a spectrum of socioeconomic positions within the Chinese context, categorized based on criteria such as income, education, and occupation. This scale has been extensively validated within Chinese populations (Yan et al., 2022), demonstrating strong test-retest reliability and significant convergent validity (Hu et al., 2012).\u003c/p\u003e\u003ch2\u003eMulti-Dimensional Scale of Perceived Social Support\u003c/h2\u003e\u003cp\u003ePerceived social support was quantified using the Multi-Dimensional Scale of Perceived Social Support, developed by Zimet et al. (1990). This scale includes 12 items that capture three key dimensions of support: familial, friendship, and support from significant others. Participants rate each item on a 5-point Likert scale, where 1 indicates 'strongly disagree' and 5 indicates 'strongly agree.' A higher cumulative score indicates greater perceived social support. Among Chinese participants, the scale has demonstrated excellent reliability and validity (Yan et al., 2022), achieving a Cronbach’s alpha of .964 in this study.\u003c/p\u003e\u003ch2\u003ePositive Psychological Capital\u003c/h2\u003e\u003cp\u003eParticipants’ levels of Psychological Capital were assessed using the Chinese adaptation of the PsyCap Questionnaire developed by Zhang et al. (2010). This questionnaire measures four domains: self-efficacy, hope, resilience, and optimism. Each item is rated on a 5-point Likert scale, ranging from 1 ('strongly disagree') to 5 ('strongly agree'). Higher scores indicate elevated levels of psychological capital. The scale has shown good reliability and validity in Chinese culture (Bai \u0026amp; Bai, 2023; Bai et al., 2023), with a Cronbach's alpha of .954 in this study.\u003c/p\u003e\u003ch2\u003ePost-traumatic Related to the COVID-19 Pandemic\u003c/h2\u003e\u003cp\u003eTo assess the extent of PTG experienced due to the COVID-19 pandemic, the study utilized the PTG Inventory (PTGI, Tedeschi et al., 2017). Participants rated the degree of change they have experienced across five domains: relationships with others, personal strengths, new possibilities, appreciation of life, and spiritual and existential change. Ratings were made on a 6-point Likert scale, from 0 (\"not changed at all\") to 5 (\"changed very much\"). Earlier studies have confirmed the reliability and construct validity of this measure within a Chinese setting (Bai et al., 2023; Bai \u0026amp; Bai, 2024). In the present study, with a Cronbach’s alpha of .968.\u003c/p\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eFor descriptive and correlational analyses, we used SPSS version 25.0. To explore the mediating roles of resilience and stress in the relationship between gratitude and job satisfaction, we utilized model 6 of the PROCESS Macro V3.00 within SPSS. This methodological approach is supported by Hayes (2013), which provides a robust framework for such analyses. The strength of the mediating effects was examined using the PROCESS procedure, involving 5000 bootstrap samples to ensure reliability. A mediating effect is considered statistically significant if its 95% confidence interval (CI) does not include zero, following the criteria set by Preacher \u0026amp; Hayes (2008).\u003c/p\u003e\u003ch2\u003eEthical Considerations\u003c/h2\u003e\u003cp\u003e This study was approved by the Ethics Committee of the Department of Psychology, School of Philosophy, Wuhan University (approval number: 2020071601; date of approval: July 16, 2020). Written informed consent was obtained from all participants prior to data collection, which was conducted between September 1 and October 30, 2020. Participation was entirely voluntary, and participants could withdraw from the study at any time without penalty. All data were collected and analyzed anonymously to ensure confidentiality. The study was conducted in accordance with the ethical standards of the institutional research committee, the APA Ethical Principles of Psychologists, and the Declaration of Helsinki and its later amendments.\u003c/p\u003e\u003ch3\u003eResults\u003c/h3\u003e\u003ch2\u003eDescriptive Statistics and Correlation Analysis\u003c/h2\u003e\u003cp\u003eThe demographic breakdown of the participants was as follows: 242 (65.6%) were male, and 127 (34.4%) were female. The mean age of the participants was 34.6 years, with a standard deviation of 7.48. Regarding marital status, 106 participants (28.7%) were unmarried, 261 (70.7%) were married, and 2 (0.5%) were divorced. In terms of educational attainment, the distribution was as follows: 1 participant (0.3%) held a diploma from a junior college, 57 (15.4%) had completed associate degree programs, the majority, 235 (63.7%), held a bachelor's degree in medicine, and 76 (20.6%) had attained a Master’s degree or higher.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents that subjective SES, perceived social support, and PsyCap were all significantly and positively correlated with PTG (ps \u0026lt; .001). The mean scores for Subjective SES, perceived social support, PsyCap, and PTG were 4.76 (SD = 1.70), 3.57 (SD = 0.73), 3.37 (SD = 0.57), and 72.74 (SD = 23.38), respectively.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive statistics and correlations among the key variables\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e\u003cp\u003eCorrelation\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. SES\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e—\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. perceived social support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.194***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e—\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. positive psychological capital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.288***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.697***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e—\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. PTG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e72.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.294***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.546***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.617***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e—\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote: ***\u003cem\u003ep \u0026lt;\u003c/em\u003e 0.001, SES = subjective socioeconomic status, PTG = post-traumatic growt\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003ch2\u003eMultiple Mediation Analysis\u003c/h2\u003e\u003cp\u003eTo assess the independent contributions of perceived social support and PsyCap to the subjective SES–PTG relationship, a multiple mediation analysis was conducted. The results indicated that Subjective SES explained 9.0% of the variance in PTG, with the overall model accounting for 42.5%. The total effect of Subjective SES on PTG was significant (β = .167, p \u0026lt; .001). Even after accounting for the mediators, subjective SES continued to exert a significant direct effect on PTG (β = .007, p = .003), indicating partial mediation by perceived social support and PsyCap. Thus, Hypothesis 1 was supported.\u003c/p\u003e\u003cp\u003eBootstrap analyses, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, confirmed the mediating roles of both perceived social support (β = .042, 95% CI = [.011, .084]) and PsyCap (β = .066, 95% CI = [.028, .105]), as their 95% confidence intervals did not include zero. This supports Hypotheses 2 and 3. Furthermore, the serial mediation path linking subjective SES to PTG via perceived social support and PsyCap was significant (β = .058, 95% CI = [.021, .106]), supporting Hypothesis 4(see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe effects and 95% Confidence Intervals.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eModel pathways\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEstimated\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLower\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUpper\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDirect effect\u003c/p\u003e\u003cp\u003eSES→PTG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.070\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.115\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStandardized indirect effect\u003c/p\u003e\u003cp\u003eSES→PTG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.167\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.090\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.244\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSES→perceived social support→ PTG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.042 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.084\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSES→ positive psychological capital→ PTG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.066\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.028\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.105\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSES→perceived social support→ PsyCap→ PTG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.058\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.106\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndEff (perceived social support) minus IndEff (PsyCap)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e− .024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e− .076\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.034\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003ea\u003c/sup\u003e Empirical 95% confidence interval does not overlap with zero. IndEff = Indirect effect. SES = subjective socioeconomic status, PTG = post-traumatic growth, PsyCap = positive psychological capital\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eLastly, a comparison of indirect effects indicated no significant difference in the strength of mediation between perceived social support and PsyCap in the subjective SES–PTG relationship. The confidence interval for the difference in indirect effects included zero (95% CI = [-.076, .034]), suggesting that the mediating effects of PsyCap and perceived social support are comparably influential in explaining the relationship between subjective SES and PTG.\u003c/p\u003e"},{"header":"Study 2","content":"\u003ch2\u003eMethods\u003c/h2\u003e\u003ch2\u003eStudy Design and Participants\u003c/h2\u003e\u003cp\u003eTo reinforce the findings of Study 1, Study 2 was designed to further validate and establish the relationships explored, adhering to the rigorous standards of scientific inquiry recommended by the Open Science Collaboration (2015) and Pashler \u0026amp; Wagenmakers (2012). This follow-up study mirrored the methodology of Study 1 but focused on a distinct demographic group to assess consistency across different healthcare roles.\u003c/p\u003e\u003cp\u003eBuilding upon the methodology of Study 1, Study 2 was conducted in October 2020 in collaboration with hospital administrators across Fujian Province, China. This phase of the research utilized data from a total of 740 nurses, initially gathered concurrently with the doctor data used in Study 1 during the same period of the COVID-19 pandemic. After meticulous screening to exclude incomplete or non-serious responses, the valid dataset comprised 692 nurses. Although this dataset was previously utilized in another study (Bai \u0026amp; Bai, 2024), the variables analyzed in the current research differ, except for PTG, which is a consistent measure across both studies. This strategic approach was chosen to make the most of the valuable data collected during a critical time when data collection opportunities were severely limited by the ongoing pandemic. A rigorous process was implemented to ensure the accuracy and integrity of the responses before they were processed for detailed analysis.\u003c/p\u003e\u003ch2\u003eMeasures\u003c/h2\u003e\u003cp\u003eThe same subjective SES, perceived social support, psychological capital and PTG were used in Study 2. The Cronbach’s alphas for the perceived social support, psychological capital and PTG measures in this study were 0.963, 0.952, and 0.967 respectively.\u003c/p\u003e\u003cp\u003eEnsuring consistent tools across Study 1 and Study 2 provides a direct comparison, thus enabling a comprehensive evaluation of the experiences of healthcare workers from Fujian Province during the pandemic.\u003c/p\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eThe analysis method for Study 2 mirrored the approach taken in the initial study.\u003c/p\u003e\n\u003ch3\u003eResults\u003c/h3\u003e\n\u003cdiv id=\"Sec26\" class=\"Section2\"\u003e\u003ch2\u003eDescriptive statistics and correlation analysis\u003c/h2\u003e\u003cp\u003eOf the 692 nurses who participated in our research, 625 (90.3%) were female. With respect to age distribution, 310 (44.8%) were in the 20\u0026ndash;29 age bracket, 268 (38.7%) fell between 30 and 39 years, 92 (13.3%) were in the 40\u0026ndash;49 age range, and 22 (3.2%) were 50 years or older.\u003c/p\u003e\u003cp\u003eAs detailed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, significant positive correlations (ps\u0026thinsp;\u0026lt;\u0026thinsp;.01) were observed between subjective SES, perceived social support, PsyCap, and PTG.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive statistics and correlations among the key variables\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e\u003cp\u003eCorrelation\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. SES\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6. perceived social support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.304***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7. positive psychological capital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.354***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.644***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8. PTG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e73.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.308***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.546***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.695***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote: ***\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001, SES\u0026thinsp;=\u0026thinsp;subjective socioeconomic status, PTG\u0026thinsp;=\u0026thinsp;post-traumatic growth\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\u003ch2\u003eMultiple mediation analysis\u003c/h2\u003e\u003cp\u003eSimilarly, we also conducted a multiple mediation analysis to explore the relationship between subjective SES and PTG, while adjusting for age and gender. This analysis specifically focused on the mediating roles of perceived social support and PsyCap. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, the results indicated that both perceived social support and PsyCap significantly mediated the relationship between subjective SES and PTG. Specifically, the effects of perceived social support (estimate\u0026thinsp;=\u0026thinsp;.047, 95% CI = [.021, .076]) and PsyCap (estimate\u0026thinsp;=\u0026thinsp;.091, 95% CI = [.051, .134]) were found to be statistically significant.\u003c/p\u003e\u003cp\u003eAdditionally, the relationship between subjective SES and PTG was mediated through a sequential pathway involving both perceived social support and PsyCap, with a significant combined mediating effect (estimate\u0026thinsp;=\u0026thinsp;.109, 95% CI = [.080, .140]). Furthermore, consistent with findings from the initial study, contrast tests indicated no significant difference between the mediation effects of perceived social support and PsyCap. The estimate of the difference in their effects was \u0026minus;\u0026thinsp;.044, with a 95% confidence interval ranging from \u0026minus;\u0026thinsp;.103 to .012, suggesting that the strengths of their mediating effects were comparable.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe effects and 95% Confidence Intervals.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eModel pathways\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEstimated\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLower\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUpper\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDirect effect\u003c/p\u003e\u003cp\u003eSES\u0026rarr;PTG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.042\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.077\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStandardized indirect effect\u003c/p\u003e\u003cp\u003eSES\u0026rarr;PTG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.246\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.197\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.297\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSES\u0026rarr;perceived social support\u0026rarr; PTG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.047 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.076\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSES\u0026rarr; positive psychological capital\u0026rarr; PTG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.091\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.051\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.134\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSES\u0026rarr;perceived social support\u0026rarr; PsyCap\u0026rarr; PTG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.109\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.080\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.140\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndEff (perceived social support) minus IndEff (PsyCap)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.044\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003ea\u003c/sup\u003e Empirical 95% confidence interval does not overlap with zero. IndEff\u0026thinsp;=\u0026thinsp;Indirect effect. SES\u0026thinsp;=\u0026thinsp;subjective socioeconomic status, PTG\u0026thinsp;=\u0026thinsp;post-traumatic growth, PsyCap\u0026thinsp;=\u0026thinsp;positive psychological capital\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe primary aim of this study was to examine the relationship between subjective SES and PTG among healthcare workers during the COVID-19 pandemic. In particular, we examined the mediating role of perceived social support and PsyCap in this context. Our results confirm a positive correlation between Subjective SES and PTG. Importantly, both Perceived Social Support and PsyCap not only independently mediate this relationship, but also act sequentially, underscoring their crucial role in facilitating PTG among healthcare workers facing pandemic-related challenges.\u003c/p\u003e\u003cp\u003eThis study contributes significantly to existing research in several important ways. First, it adds to the literature on factors contributing to PTG by providing empirical evidence that an individual\u0026rsquo;s socioeconomic status (subjective SES) is strongly correlated with PTG outcomes (Wang \u0026amp; Lu, 2020; Yang et al., 2023). This highlights that how an individual perceives their position in society, along with other factors such as demographics, personality traits and the external environment, plays a role in PTG. Our findings are consistent with Bandura\u0026rsquo;s (1991) social cognitive theory, which suggests that individuals with higher subjective SES and greater self-efficacy are more likely to experience PTG. This finding also suggests that addressing socioeconomic inequalities in healthcare settings could enhance the psychological resilience of healthcare providers.\u003c/p\u003e\u003cp\u003eSecond, our research innovatively delineates the pathways through which subjective SES positively influences PTG. We found that higher subjective SES is associated with increased perceived social support, which subsequently enhances PTG. This finding is consistent with previous research highlighting the critical role of social support in facilitating PTG (Shang et al., 20\u0026ndash;22; Yu et al., 2014; Zhou et al., 2017). In addition, PsyCap, which includes hope, resilience, optimism and self-efficacy, also acts as a significant mediator. Our findings suggest that individuals with higher subjective SES are more likely to cultivate robust PsyCap, which in turn strengthens their coping abilities and promotes PTG (Tedeschi \u0026amp; Calhoun, 2004). These findings not only validate existing theories, but also highlight the importance of socio-economic factors in psychological recovery processes, suggesting that enhancing social support systems and fostering psychological capital may be effective strategies for promoting resilience and growth in healthcare workers.\u003c/p\u003e\u003cp\u003eInterestingly, Our study provides insights into the mediating roles of PsyCap and perceived social support in the relationship between subjective SES and PTG among healthcare workers during the COVID-19 pandemic. Interestingly, our findings suggest that PsyCap and perceived social support have a similar mediating effect, without significant differences between the two. This suggests that both internal psychological resources\u0026mdash;like hope, resilience, optimism, and self-efficacy\u0026mdash;and external social support play equally important roles in helping healthcare workers manage the heightened stress and uncertainty during the pandemic.\u003c/p\u003e\u003cp\u003eFinally, our research makes a significant contribution to the field by detailing the sequential mediating roles of perceived social support and PsyCap. We found that healthcare workers with higher subjective SES are more likely to perceive better social support, which in turn serves as a foundation for the development of PsyCap. These interrelated factors work synergistically to enhance PTG and form a robust psychological defence against stress. This pathway provides critical insights for the development of targeted interventions aimed at enhancing the resilience and well-being of healthcare professionals. By strategically enhancing social support and psychological resources, interventions can be tailored to create a supportive environment that effectively promotes PTG.\u003c/p\u003e\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\u003ch2\u003eImplications for Practice\u003c/h2\u003e\u003cp\u003eThe results of this study have important implications for health care management and policy, particularly in the aftermath of the COVID-19 pandemic and amidst ongoing health care challenges.\u003c/p\u003e\u003cp\u003eFirst, recognising the influence of subjective SES in predicting PTG, healthcare institutions should implement interventions such as financial education and counselling programmes. These can help healthcare workers adjust their perceptions of their socioeconomic status, potentially fostering greater personal growth and resilience.\u003c/p\u003e\u003cp\u003eSecond, given the importance of perceived social support, particularly for nurses, it is advisable for healthcare institutions to strengthen their support systems. This could include the establishment of mentoring programmes, peer support groups and expanded professional development opportunities to provide both emotional and professional support.\u003c/p\u003e\u003cp\u003eThird, given the significant impact of PsyCap on physician PTG, healthcare institutions should focus on developing resilience training, coping strategy workshops, and positive leadership initiatives. These programmes are designed to strengthen the internal psychological resources that are crucial for coping with the demands and stresses of the medical profession.\u003c/p\u003e\u003cp\u003eFourth, an integrated approach should be adopted that combines efforts to strengthen both social networks and psychological resilience. This strategy should be tailored to the different needs of doctors and nurses to ensure that interventions are effective and relevant to the specific challenges faced by each group.\u003c/p\u003e\u003cp\u003eThese steps highlight the need for a comprehensive, multidimensional approach to improving the well-being and resilience of health workers, particularly in times of crisis. By addressing both external and internal factors, healthcare institutions can more effectively support their staff to achieve PTG.\u003c/p\u003e\u003c/div\u003e"},{"header":"Limitations and Future Directions","content":"\u003cp\u003eAlthough this study provides valuable insights into the relationships between subjective SES, perceived social support, PsyCap and PTG among healthcare workers, several limitations must be acknowledged, which point the way for future research directions.\u003c/p\u003e\u003cp\u003eFirst, the cross-sectional design of this study limits our ability to draw causal inferences. Future studies might benefit from using longitudinal designs to track changes over time and better establish causal relationships between the variables involved. Second, the use of self-reported measures, while necessary and valuable, may introduce response biases such as social desirability or self-report bias. Future research could include more objective measures or third party assessments to validate and extend the findings. Third, although our study included healthcare professionals from several hospitals in Fujian Province, the findings may not be generalisable to other regions or countries with different cultural and socioeconomic backgrounds. Future studies should consider a more diverse and broader geographical sample to improve the generalisability of the findings. Fourth, this study primarily focused on the mediating role of perceived social support and PsyCap. Future research could explore other potential mediators or moderators, such as personal resilience, organisational climate, or specific stressors related to different healthcare roles, to provide a more comprehensive understanding of the factors influencing PTG. Fifth, the differential impact of perceived social support and PsyCap between doctors and nurses suggests role-specific dynamics. Future studies should explore these differences in more depth, possibly examining other healthcare professions, to more clearly delineate role-specific interventions.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe findings confirm a positive correlation between higher Subjective SES and PTG, with significant mediation from perceived social support and PsyCap. These results underscore the pivotal role of socioeconomic factors and psychological resources in bolstering the resilience and growth of healthcare workers during crises. Specifically, the research suggests that interventions designed to enhance perceived social support and PsyCap could yield substantial benefits for healthcare professionals, although the focus might vary for doctors and nurses due to their distinct professional challenges.\u003c/p\u003e\u003cp\u003eFor healthcare management and policy, this study highlights the necessity of creating supportive environments that foster both personal and professional well-being. Targeted strategies such as financial education, resilience training, and enhanced support networks are likely to be effective in promoting PTG.\u003c/p\u003e\u003cp\u003eOverall, this research provides critical insights into the intersection of socioeconomic status and psychological support mechanisms, facilitating growth and resilience among frontline medical personnel. It emphasizes a comprehensive approach to supporting healthcare workers both during and after the pandemic.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the everyone who participated in this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of conflicting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the Department of Psychology, School of Philosophy, Wuhan University (approval number: 2020071601; date of approval: July 16, 2020). Written informed consent was obtained from all participants prior to data collection, which was conducted between September 1 and October 30, 2020. Participation was entirely voluntary, and participants could withdraw from the study at any time without penalty. All data were collected and analyzed anonymously to ensure confidentiality. The study was conducted in accordance with the ethical standards of the institutional research committee, the APA Ethical Principles of Psychologists, and the Declaration of Helsinki and its later amendments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy design: Fan Li, Chengzhi Bai\u003c/p\u003e\n\u003cp\u003eData collection: Chengzhi Bai\u003c/p\u003e\n\u003cp\u003eData analysis: Chengzhi Bai\u003c/p\u003e\n\u003cp\u003eStudy supervision: Fan Li\u003c/p\u003e\n\u003cp\u003eManuscript writing: Chengzhi Bai, Fan Li\u003c/p\u003e\n\u003cp\u003eCritical revisions for important intellectual content: Chengzhi Bai, Fan Li\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analyzed during the present study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAdler, N. 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Journal of Personality Assessment, 55(3–4), 610–617. https://doi.org/10.1207/s15327752jpa5503\u0026amp;4_17\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Subjective Socioeconomic Status, Post-Traumatic Growth, Doctors, Nurses, Perceived Social Support, Positive Psychological Capital","lastPublishedDoi":"10.21203/rs.3.rs-7504643/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7504643/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study investigated the association between subjective socioeconomic status and post-traumatic growth among doctors and nurses during the COVID-19 pandemic, with a focus on the mediating roles of perceived social support and positive psychological capital. Two independent studies were conducted. Study 1 surveyed 369 doctors who completed validated measures of subjective socioeconomic status, perceived social support, positive psychological capital, and post-traumatic growth. Study 2 replicated the design with 692 nurses to confirm the robustness of the findings. Across both samples, perceived social support and positive psychological capital independently mediated the link between subjective socioeconomic status and post-traumatic growth. Moreover, a sequential mediation pathway was identified, whereby higher subjective socioeconomic status predicted greater post-traumatic growth through increased perceived social support and, in turn, enhanced positive psychological capital. These findings highlight the importance of social and psychological resources in translating healthcare workers\u0026rsquo; socioeconomic background into resilience and growth during the COVID-19 crisis.\u003c/p\u003e","manuscriptTitle":"Subjective Socioeconomic Status and Post-Traumatic Growth Among Doctors and Nurses during the COVID-19 Pandemic: The Mediating Roles of Perceived Social Support and Positive Psychological Capital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-23 00:20:05","doi":"10.21203/rs.3.rs-7504643/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9c1ba029-e295-4397-b989-05274a801cc7","owner":[],"postedDate":"October 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":56631156,"name":"Health sciences/Health care"},{"id":56631157,"name":"Biological sciences/Psychology"},{"id":56631158,"name":"Social science/Psychology"}],"tags":[],"updatedAt":"2025-12-31T05:24:08+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-23 00:20:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7504643","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7504643","identity":"rs-7504643","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}