Zixin Li

All Publications

• Nurse Burnout and Patient Safety, Satisfaction, and Quality of Care: A Systematic Review and Meta-Analysis. JAMA network open Li, L. Z., Yang, P., Singer, S. J., Pfeffer, J., Mathur, M. B., Shanafelt, T. 2024; 7 (11): e2443059

  Abstract

  Occupational burnout syndrome is characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment and is prevalent among nurses. Although previous meta-analyses have explored the correlates of nurse burnout, none have estimated their association with health care quality and safety and patient morbidity and mortality.To evaluate the magnitude and moderators of the association between nurse burnout and patient safety, patient satisfaction, and quality of care.The Web of Science, Scopus, MEDLINE, Embase, PsycINFO, CINAHL, and ProQuest databases were searched from January 1, 1994, to February 29, 2024.Two reviewers independently identified studies that reported a quantifiable association between nurse burnout and any of the outcomes of patient safety, patient satisfaction, or quality of health care.The PRISMA 2020 guideline was followed. Two reviewers independently extracted the standardized mean difference (SMD) (Cohen d) estimates for a random-effects meta-analysis. Subgroup analyses and meta-regressions were conducted using prespecified variables.Any measure of patient safety, patient satisfaction, or quality of health care previously associated with nurse burnout.A total of 85 studies (81 cross-sectional and 4 longitudinal) involving 288 581 nurses from 32 countries (mean [SD] age, 33.9 (2.1) years; 82.7% female; mean [SD] burnout prevalence rate with study-specific ascertainments, 30.7% [9.7%]) were included. Nurse burnout was associated with a lower safety climate or culture (SMD, -0.68; 95% CI, -0.83 to -0.54), lower safety grade (SMD, -0.53; 95% CI, -0.72 to -0.34), and more frequent nosocomial infections (SMD, -0.20; 95% CI, -0.36 to -0.04), patient falls (SMD, -0.12; 95% CI, -0.22 to -0.03), medication errors (SMD, -0.30; 95% CI, -0.48 to -0.11), adverse events or patient safety incidents (SMD, -0.42; 95% CI, -0.76 to -0.07), and missed care or care left undone (SMD, -0.58; 95% CI, -0.91 to -0.26) but not with the frequency of pressure ulcers. Nurse burnout was also associated with lower patient satisfaction ratings (SMD, -0.51; 95% CI, -0.86 to -0.17) but not with the frequencies of patient complaints or patient abuse. Finally, nurse burnout was associated with lower nurse-assessed quality of care (SMD, -0.44; 95% CI, -0.57 to -0.30) but not with standardized mortality rate. The associations were consistent across nurses' age, sex, work experience, and geography and persistent over time. For patient safety outcomes, the association was smaller for the low personal accomplishment subcomponent of burnout than for emotional exhaustion or depersonalization, as well as for nurses with a college education.In this systematic review and meta-analysis, nurse burnout was found to be associated with lower health care quality and safety and lower patient satisfaction. This association was consistent across nurse and study characteristics.

  View details for DOI 10.1001/jamanetworkopen.2024.43059

  View details for PubMedID 39499515

• Artificial intelligence for neurodiversity BMJ Li, L., Yang, P. 2024; BMJ 2024;386:q1384

  View details for DOI 10.1136/bmj.q1384

• National survey of mental health and life satisfaction of gig workers: the role of loneliness and financial precarity. BMJ open Wang, S., Li, L. Z., Coutts, A. 2022; 12 (12): e066389

  Abstract

  To compare the mental health and life satisfaction of those employed in the gig work and contingent work with those in full-time or part-time work and the unemployed in the UK during the COVID-19 pandemic. To explore the possible mechanisms of latent and manifest benefits of employment, such as financial precarity and loneliness.Cross-sectional survey.A representative sample of 17 722 employed and unemployed British adults, including 429 gig workers. People with disability, retirees and full-time students are not included in the sample.Mental health (General Health Questionnaire-12 score) and life satisfaction (a direct question from UK Household Longitudinal Study (UKHLS)) as outcomes. Self-reported loneliness (four widely used questions from UKHLS) and financial precarity (a direct question from UKHLS) as mediators.Gig workers reported mental health and life satisfaction worse than those employed full time and part time, but better than the unemployed. Mediation analyses showed that gig workers' worse mental health and life satisfaction than other workers were explained by their higher levels of loneliness and financial precarity, while gig workers' better mental health and life satisfaction than the unemployed were explained by their less financial precarity.Informal and freelance economy provided manifest benefits of employment to gig workers compared with unemployment but lacked latent benefits of employment. Public policies should provide social support to freelance and contingent workers to reduce their loneliness and improve their psychological well-being, especially during the COVID-19 pandemic.

  View details for DOI 10.1136/bmjopen-2022-066389

  View details for PubMedID 36600336

  View details for PubMedCentralID PMC9743407

• Work Schedule Control and Allostatic Load Biomarkers: Disparities Between and Within Gender SOCIAL INDICATORS RESEARCH Wang, S., Li, L., Lu, Z., Li, S., Rehkopf, D. 2022

  View details for DOI 10.1007/s11205-022-02940-7

  View details for Web of Science ID 000797262900001

• Do work-family initiatives improve employee mental health? Longitudinal evidence from a nationally representative cohort. Journal of affective disorders Li, L. Z., Wang, S. 2022; 297: 407-414

  Abstract

  Work stress and work-family conflict are important correlates of affective disorders. The article explored (1) whether the wide adoption of work-family initiatives improve a national workforce's mental health; (2) whether the potential benefits differ between the initiatives that give employees autonomy over job quality (flexible schedule and telework) or job quantity (work hours); (3) whether the effects depend on employee's perceived availability or actual usage of the initiatives, and if so, what are the respective mechanisms; and (4) whether there are gender differences in the mental health effects.Fixed-effects analyses of five-wave panel surveys from 2010 to 2020 on a probability sample of 34,484 British workers, which measured mental health with the GHQ-12 scale. Job satisfaction and leisure time satisfaction were tested as mediators.Perceived availability of work-family initiatives improved men and women's mental health by increasing their job satisfaction. Actual usage of work-family initiatives improved women's, but not men's, mental health by increasing their job satisfaction and leisure time satisfaction. The mental health benefits of flexible schedule and telework initiatives are larger than reduced work hours initiatives.The exploratory study used a broad mental health outcome and did not measure work-family initiatives' effects on specific affective disorders such as anxiety and depression. The study could not eliminate time-varying confounders.Actual and perceived job quality are important in workplace mental health promotion. Organizational leaders and policymakers can offer flexible work time and place to reduce work-family conflict and prevent employees' affective disorders.

  View details for DOI 10.1016/j.jad.2021.10.112

  View details for PubMedID 34718041

• Double Jeopardy: The Roles of Job Autonomy and Spousal Gender Ideology in Employed Women's Mental Health. Applied research in quality of life Wang, S., Li, L. Z. 2023; 18 (1): 473-490

  Abstract

  Employed women persistently suffer in mental health despite more family-friendly workplaces. The job demand-control theory argues that employed women's mental health depends on their job autonomy, while sociological research on the gender division of household labor locates the cause in how much they are expected by husbands to contribute to housework. The article integrates the two streams of literature by arguing that employed women's job autonomy and their spousal gender ideology interact to shape their mental health. Using nationally representative household-level panel survey and fixed effects models, the study showed that job autonomy improved employed women's mental health, but the benefits depended on their spousal gender ideologies. Specifically, women suffered a "double jeopardy" in mental health when they lacked job autonomy and had traditional husbands. In contrast, when women's husbands had an egalitarian gender ideology, they enjoyed mental health regardless of job autonomy. In addition, women's self-gender ideology did not predict their own or their husbands' mental health. The results point to a societal-level change in men's gender ideology as a fundamental way to improve employed women's family well-being.The online version contains supplementary material available at 10.1007/s11482-022-10090-8.

  View details for DOI 10.1007/s11482-022-10090-8

  View details for PubMedID 35966806

  View details for PubMedCentralID PMC9361897

• The PR Power of Fessing Up MIT SLOAN MANAGEMENT REVIEW Soule, S. A., Li, L. 2023; 64 (3): 13-14

  View details for Web of Science ID 001126752000009

• Moving beyond family: unequal burden across mental health patients' social networks. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation Li, L. Z., Bian, J. Y., Wang, S. 2021; 30 (7): 1873-1879

  Abstract

  Although the family burden of mental health problems on patients' close relatives was widely acknowledged, little was known about how mental health problems affected the quality of life of other types of social relationships of patients, through what mechanisms, and under what conditions. The study aims to explore the burden on all types of relationships of mental health patients and explain why and when the burden is unequal across different relationships.The association between different types of relationships and the levels of burden was examined with dyadic data of 1178 patient-acquaintance relationships in the United States and random effects multilevel models. Frequency of contacts was tested as a mediator. The severity of mental health problems was tested as a moderator.All types of relationships of patients borne a significant burden. Close relatives including parents, spouses, children, and siblings suffered a greater burden than distant relatives and non-relatives. The unequal burden was partly explained by the frequency of contacts with patients. The burden of close relatives significantly increased when patients' mental health problems were more severe.Mental health patients put a burden on their frequent contacts outside core families, especially when their problems were more severe. Public health policies should attend to the quality of life of mental health patients' all types of acquaintances in the wider society.

  View details for DOI 10.1007/s11136-021-02782-9

  View details for PubMedID 33566303

  View details for PubMedCentralID 2749816

• Prevalence and predictors of general psychiatric disorders and loneliness during COVID-19 in the United Kingdom PSYCHIATRY RESEARCH Li, L., Wang, S. 2020; 291: 113267

  Abstract

  Despite ample research on the prevalence of specific psychiatric disorders during COVID-19, we know little about the broader psychological impact of the pandemic on a wider population. The study investigates the prevalence and predictors of general psychiatric disorders measured by the 12-item General Health Questionnaire (GHQ-12) and frequency of loneliness during COVID-19 in the United Kingdom, a country heavily hit by the pandemic. We analyzed 15,530 respondents of the first large-scale, nationally representative survey of COVID-19 in a developed country, the first wave of Understanding Society COVID-19 Study. Results show that 29.2% of the respondents score 4 or more, the caseness threshold, on the general psychiatric disorder measure, and 35.86% of the respondents sometimes or often feel lonely. Regression analyses show that those who have or had COVID-19-related symptoms are more likely to develop general psychiatric disorders and are lonelier. Women and young people have higher risks of general psychiatric disorders and loneliness, while having a job and living with a partner are protective factors. This study showcases the psychological impact, including general psychiatric disorders and loneliness, of broader members of the society during COVID-19 and the underlying social inequalities.

  View details for DOI 10.1016/j.psychres.2020.113267

  View details for Web of Science ID 000566871300002

  View details for PubMedID 32623266

  View details for PubMedCentralID PMC7326403