Economic Hardship and Work Intensity Predict Job Burnout Among Chinese Medical Residents: The Chain Mediating Role of Sleep Disturbance and Professional Identity, and Implications for Standardized Residency Training

Economic Hardship and Work Intensity Predict Job Burnout Among Chinese Medical Residents: The Chain Mediating Role of Sleep Disturbance and Professional Identity, and Implications for Standardized Residency Training | 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 Research Article Economic Hardship and Work Intensity Predict Job Burnout Among Chinese Medical Residents: The Chain Mediating Role of Sleep Disturbance and Professional Identity, and Implications for Standardized Residency Training Xiajin Ren, Xin Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8719287/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Objective This study aimed to construct and verify a moderated chain mediation model to explore the chain mediating role of sleep disturbance (assessed by the Insomnia Severity Index, ISI) and professional identity (measured by the Professional Identity Scale, PIS) between economic hardship/work intensity and job burnout (evaluated by the Maslach Burnout Inventory, MBI) among Chinese medical residents, and to examine the moderating effect of perceived organizational support (assessed by the Perceived Organizational Support Scale, POS) on the chain mediation path. Methods A cross-sectional survey was conducted among 469 medical residents using standardized scales (MBI, ISI, PIS, POS) and self-designed questionnaires on economic hardship and work intensity. SPSS 26.0 and Mplus 8.3 were used for common method bias test, correlation analysis, and moderated chain mediation model verification. Results ①The moderated chain mediation model showed good fit (χ²/df=2.136, RMSEA=0.049, CFI=0.935, TLI=0.924, SRMR=0.046). ②Sleep disturbance and professional identity played a significant chain mediating role in the relationship between economic hardship and job burnout (indirect effect=0.127, 95%CI: 0.089-0.165) and between work intensity and job burnout (indirect effect=0.183, 95%CI: 0.138-0.229), accounting for 32.6% and 39.1% of the total effect respectively. ③Perceived organizational support significantly moderated the path from sleep disturbance to professional identity in the total sample, such that the negative impact of sleep disturbance on professional identity was weaker in the high perceived organizational support group (standardized β=-0.214, p<0.001) than in the low group (standardized β=-0.386, p<0.001). Conclusion Economic hardship and work intensity affect job burnout of medical residents through the chain mediation of "sleep disturbance→professional identity", and perceived organizational support can buffer the negative link between sleep disturbance and professional identity. These findings clarify the multi-path influence mechanism of job burnout among medical residents, providing actionable implications for optimizing China's standardized residency training—including economic support enhancement, workload management, and professional identity education—to improve residents' occupational well-being. Standardized Residency Training (SRT) Job Burnout Economic Hardship Work Intensity Sleep Disturbance Professional Identity Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 04 Feb, 2026 Editor assigned by journal 04 Feb, 2026 Editor invited by journal 02 Feb, 2026 Submission checks completed at journal 01 Feb, 2026 First submitted to journal 01 Feb, 2026 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. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8719287","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":587685567,"identity":"65f1c662-ff45-453e-8deb-3bc907987c55","order_by":0,"name":"Xiajin Ren","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAx0lEQVRIiWNgGAWjYLCCBAY2Hgb2xsYHH0jTwnO42XAGaVZJpLdJcxCj0Ly995jEgxo+GXPJhw3SDAx2croNBLTInDmXbJBwjI3HcnZig3EBQ7Kx2QFCzpHIMXyQwMbGY3A7sSF5BsOBxG0Etci/MTiQ8A+o5ebBhsM8RGmR4DF8kNgG1HKDsbGZOC08OcYGiX1ALWcSmxlnGBDjF/YzZpI/vh2zNzh+/PmPDxV2cgS1QMExKG1AnHIQqCFe6SgYBaNgFIw8AACG4T7V/1cVggAAAABJRU5ErkJggg==","orcid":"","institution":"Second Hospital of Shanxi Medical University","correspondingAuthor":true,"prefix":"","firstName":"Xiajin","middleName":"","lastName":"Ren","suffix":""},{"id":587685568,"identity":"8dec0272-20e7-47aa-9bc2-96bd68639c60","order_by":1,"name":"Xin Wang","email":"","orcid":"","institution":"Second Hospital of Shanxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xin","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2026-01-28 10:26:47","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8719287/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8719287/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102191449,"identity":"70c24d11-c3a1-4c7a-a40e-59c161cffb43","added_by":"auto","created_at":"2026-02-09 09:14:20","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":733826,"visible":true,"origin":"","legend":"","description":"","filename":"ECONOM1.DOC.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8719287/v1_covered_3f5c61a0-ba73-4faf-b0cf-e95b7e9311f3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Economic Hardship and Work Intensity Predict Job Burnout Among Chinese Medical Residents: The Chain Mediating Role of Sleep Disturbance and Professional Identity, and Implications for Standardized Residency Training","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Standardized Residency Training (SRT), Job Burnout, Economic Hardship, Work Intensity, Sleep Disturbance, Professional Identity","lastPublishedDoi":"10.21203/rs.3.rs-8719287/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8719287/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective \u003c/strong\u003eThis study aimed to construct and verify a moderated chain mediation model to explore the chain mediating role of sleep disturbance (assessed by the Insomnia Severity Index, ISI) and professional identity (measured by the Professional Identity Scale, PIS) between economic hardship/work intensity and job burnout (evaluated by the Maslach Burnout Inventory, MBI) among Chinese medical residents, and to examine the moderating effect of perceived organizational support (assessed by the Perceived Organizational Support Scale, POS) on the chain mediation path.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eA cross-sectional survey was conducted among 469 medical residents using standardized scales (MBI, ISI, PIS, POS) and self-designed questionnaires on economic hardship and work intensity. SPSS 26.0 and Mplus 8.3 were used for common method bias test, correlation analysis, and moderated chain mediation model verification.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003e①The moderated chain mediation model showed good fit (χ²/df=2.136, RMSEA=0.049, CFI=0.935, TLI=0.924, SRMR=0.046). ②Sleep disturbance and professional identity played a significant chain mediating role in the relationship between economic hardship and job burnout (indirect effect=0.127, 95%CI: 0.089-0.165) and between work intensity and job burnout (indirect effect=0.183, 95%CI: 0.138-0.229), accounting for 32.6% and 39.1% of the total effect respectively. ③Perceived organizational support significantly moderated the path from sleep disturbance to professional identity in the total sample, such that the negative impact of sleep disturbance on professional identity was weaker in the high perceived organizational support group (standardized β=-0.214, p\u0026lt;0.001) than in the low group (standardized β=-0.386, p\u0026lt;0.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion \u003c/strong\u003eEconomic hardship and work intensity affect job burnout of medical residents through the chain mediation of \"sleep disturbance→professional identity\", and perceived organizational support can buffer the negative link between sleep disturbance and professional identity. These findings clarify the multi-path influence mechanism of job burnout among medical residents, providing actionable implications for optimizing China's standardized residency training—including economic support enhancement, workload management, and professional identity education—to improve residents' occupational well-being.\u003c/p\u003e","manuscriptTitle":"Economic Hardship and Work Intensity Predict Job Burnout Among Chinese Medical Residents: The Chain Mediating Role of Sleep Disturbance and Professional Identity, and Implications for Standardized Residency Training","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-09 09:14:00","doi":"10.21203/rs.3.rs-8719287/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-02-04T13:39:36+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-04T13:37:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-02T12:59:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-02T00:33:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-02-02T00:26:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"214e83d1-4a60-4b64-b5c6-8704c7c6e119","owner":[],"postedDate":"February 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T09:14:01+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-09 09:14:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8719287","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8719287","identity":"rs-8719287","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}