Effect of resilience on stress, anxiety and depression in civil servants: the mediating and moderating model

Background: Civil servants are a special group in China, and there is limited research on how their resilience affects mental health, such as depression and anxiety. Therefore, the aim of the paper is to explore the role of resilience through the relationship between stress, depression and anxiety, and to further provide an explanation for how resilience interacts with stress, depression and anxiety in civil servants. Method: In a cross-sectional survey, 302 civil servants completed a battery of questionnaires. The Civil Servants Stress Scale (CSSS) was used to assess the stress of civil servants. The depression and anxiety of participants were evaluated by the Self-rating Depression Scale (SDS) and the Self-rating Anxiety Scale (SAS), respectively. The Conner-Davidson Resilience Scale (CD-RISC) was used to assess the stress of civil servants as well. We conducted the moderating and mediating models to the resilience, depression and anxiety in gross-roots civil servants. Results: The results have shown that resilience was related to stress, depression, and anxiety in civil servants at the basic level. Stress was positively correlated with resilience. On the contrary, stress was negatively associated with depression and anxiety. Conclusion: Resilience played the moderating and mediating roles for stress, depression and anxiety. Resilience can moderate the relationship between stress and depression, anxiety as a dynamic moderate mode. Improving resilience and reducing stress play a vital role in preventing depression and anxiety in gross-roots civil servants.


Background
The goal of building a moderately prosperous society in all respects in China, with the implementation of the accountability system and the reform of rank promotion, led to more rigorous assessment standards and the rare chance of promotion in civil servants [1]. In this case, civil servants constantly faced the pressure of occupation, individual and society [2]. Studies have shown that the special work pressure of civil servants is related to the mental health such as depression and anxiety of civil servants [3][4][5]. More than 50% of Japanese civil servants have received compensation for mental disorders since 2000 [2]. However, the mental health problems of gross-roots civil servants have not fully been explored. What is special about gross-roots civil servants is that many of them are clerks. Moreover, it is difficult for ordinary staff to be promoted, but their mental health condition is rarely reported and paid attention to. This reminded us that paying close attention to the mental health of civil servants is extremely essential.
Past research had shown that long-term exposure to stress hormones throughout the lifespan can affect brain structures involved recognition and mental health [6]. Chronic stress may result in the increasing prevalence of mental disorders, chronic diseases [7,8] and psychological problems are increased [9]. Although the pathogenesis of the depression and anxiety is not clear, some studies have found that there was a strong relationship between stress and depression[10], anxiety [11]. Furthermore, resilience has been found to mediate the associations between stress, depression, and anxiety among adolescents and the pregnant [12,13]. Also, resilience is an important protective factor that can moderate the development of psychiatric symptoms when an individual encounters some stressful events [14]. Civil servants face enormous pressure in work and life, which causes some psychological problems, such as depression, anxiety [3,4]. Resilience can be regarded as a protective factor within individuals, which is of great significance to relieve pressure and promote mental health [15,16]. Hence, we supposed that resilience can potentially improve coping strategies to avoid the negative effects of stress on mental health such as depression, anxiety among civil servants.
To data, the research on the impact of resilience on stress, depression and anxiety mainly focused on the adolescents and college students [17].
Stress and mental health in the civil servants are being increasingly recognized in China [5]. However, many studies provided results only from qualitative research studies or limited to stress with physical health [18,19].
Few attention has been given to the interrelationships of mental health problems with stress in the gross-roots civil servants [20].
The purpose of this study was to examine the moderating and mediating effects of resilience between stress and depression and anxiety in civil servants. The hypotheses were as follows: (1) Resilience will mediate the relationship between stress, depression and anxiety, respectively, and that (2) the relationship between stress, depression and anxiety will be modified by resilience. By exploring these hypotheses, we hope to understand the mechanisms of the influence of resilience on stress, depression and anxiety, and to further provide a scientific basis for the development and implementation of mental health improvement strategies for civil servants.

Participants
The cross-sectional study enrolled 350 participants from a county in Henan. The research has been approved by the Science Ethics Committee of Zhengzhou University. Written informed consent was obtained from each participant before starting any investigation related study.

Demographic data
Demographic characteristics included gender, age, an only child, marital status, degree of education, seniority, position, relationship with colleagues, physical exercise, and monthly income.

Civil Servants Stress Scale (CSSS)
The CSSS is a 38-item self-report scale, which is divided into 6 dimensions as follows: which are management and development, life relationships, work relationships, health and responsibility, economic stress, and workload. The CSSS is scored on a 10-point with response categories ranging from 1 (no stress) to 10(extremely stress). Total score ranges from 0 to

Self-rating Depression Scale (SDS)
The SDS [22] is a 20-item self-report scale, which is scored on a 4-point with ranging 1(occasionally) from to 4 (constantly). Then add up the scores of 20 items to get the total rough score, and multiply the total rough score by 1.25 to get the standard score. The higher total standard scores indicate more severity of depression. The Cronbach'S α coefficient and Split-half reliability are 0.784 and 0.92, respectively [23].
2.5 Self-rating Anxiety Scale (SAS) The SAS [22] is a 20-item self-report scale, which is scored on a 4-point with ranging 1(occasionally) from to 4(constantly). Then add up the scores of to get the standard score. The higher total standard score indicates more severity of anxiety. Cronbach'S α coefficient is 0.767 [24].

Connor-Davidson Resilience Scale (CD-RISC)
The CD-RISC is a 25-item self-report scale, which is scored on a 5-point with ranging 1(never) from to 5(all the time). The higher score reflects greater resilience. The Cronbach'S α coefficient of the English version is 0.89, and the coefficient of retest reliability is 0.87 [25]. The CD-RSCI scale with good reliability validity has been widely used in predicting mental resilience.

Statistical analyses
All statistical analyses were performed using the SPSS software, and  Table 1 provides descriptive statistics of the detailed demographic of the participants in this study. The participants were aged between 17 and 56 years (M=30.80, SD=7.85) and 61.3% were male, 38.7% were female, and the sex ratio was close to 6:4. The general demographic of participants mainly included gender, age, home address, the one-child family, marital status, education, physical exercise, somatic diseases and close relative diseases, and job characteristics including seniority, position, relationship with coworkers, monthly income. There were significant differences in gender, education, position, relationship with coworkers, physical exercise and monthly income for  The differences in stress, depression, anxiety and resilience of gross-roots the civil servants in different positions were shown in table 2. There were statistically significant differences on stress (P = 0.024) and resilience (P < 0.0001). However, although there was no statistical significance in depression (P = 0.063) and anxiety (P = 0.059) among civil servants of different positions, the P values were all close to 0.05. The results suggested that the stress, depression and anxiety of the clerk were higher than that of the cadres, and the difference was statistically significant. However, the resilience of the clerk was lower than that of the cadres, and difference was also statistically significant.   depression and anxiety is valid. Table 5 Moderating effects of resilience in the relationship between stress and depression, anxiety

Demographic characteristics
To further analyze the moderating effect of resilience on the relationship between depression and anxiety, two simple slope analyses were performed.
Stress and resilience were classified as high (M+SD) and low (M-SD). Firstly,  Figure 2. Standardized simple regression lines for the association between stress and depression at low (one SD below the mean) and high resilience (one SD high the mean).

Discussion and Limitations
In this study, we reported that there were statistically differences in gender, leads to higher depression level [7]. At the gross-roots civil servants, cadres are generally responsible for the assignment and acceptance of tasks, while clerks are responsible for the specific implementation of tasks.
Compared with cadres, the general staff not only have the pressure of work but also the pressure of promotion. Civil servants who have a good relationship with their colleagues have lower stress levels than average.
Good relationships with colleagues promote better cooperation and make work easier [34]. Some studies have shown a link between physical activity and stress, exercise can reduce stress appropriately [35,36]. The results were consistent with previous studies, which shown that people who exercise occasionally or never felt more stressed than civil servants who exercise regularly [37]. Their stress is relieved by physical exercise, which is related to the positive impact of exercise on mood states through physiological and biochemical mechanisms [3,7]. For the gross-roots civil servants, monthly income below 2500 CNY can make their stress relatively higher than average. Perhaps because they work at the gross-roots level, 2500 CNY is enough to cover their daily living expenses.
In this study, we focused on this special group of civil servants. The P value of depression and anxiety of different position of the gross-roots civil servants were close to 0.05. That may be because the sample size was relatively small. The P value was approach even surpass 0.05 when the sample size was increased. The differences in stress, depression, anxiety and resilience of the gross-roots civil servants in different positions shown that clerks felt more stress, depression and anxiety than cadres, and their resilience was relatively low. The mental health status of clerk in the gross-roots civil servants is relatively poor and their resilience needs to be improved. At the same time, long-term relatively high stress, depression and anxiety will not only reduce work efficiency but also affect physical health [38,39]. So the mental health of the gross-roots civil servants needs to be widely concerned and addressed.
As expected, stress of the gross-roots civil servants is positively correlated with depression and anxiety, while resilience is negatively corrected with stress, depression and anxiety, which indicated that stress in the gross-roots civil servants is a risk factor for depression and anxiety, while resilience is a protective factor for depression and anxiety. This is consistent with previous studies of depression and anxiety [3,4,12,16].
Stress is a risk factor for depression and anxiety. To some extent, stress can cause and aggravate depression and anxiety. It can also be said that the gross-roots civil servants with depression and anxiety, to a certain extent, have relatively low ability to face and negotiate pressure to overcome adverse consequences. Furthermore, resilience is a protective factor for depression and anxiety. The hypothesis that resilience modified the relationship between stress, depression and anxiety has been confirmed. To some extent, resilience can relieve depression and anxiety caused or aggravated by stress. Interestingly, the gross-roots civil servants with high resilience may have more ability to deal with the stress in life and work than those with low resilience, thereby reducing the risk of depression and anxiety. Previous studies have also found that resilience can partially moderate stress and other psychological and emotional problems [5,15].
Through moderating and mediating analysis, it is found that stress can not only directly affect mental health, causing depression and anxiety, but also indirectly affect mental health level of the gross-roots civil servants through resilience. Resilience can directly block the negative impact of stress on mental health and thus become a protective factor of mental health under stress. The reason why resilience can be an intrinsic protective factor may be that individuals with higher resilience are better at assessing stressful events in a positive cognitive way in the face of the same stress. They tend to adjust the relationship between the environment and individuals more actively, stimulate and promote their own potential, make full use of various resources, face pressure, and achieve a good state of adaptation and development. This is also consistent with the results of previous resilience model studies [5,15].
The mediation analysis found that resilience had more than three times of the effect on depression than anxiety, suggesting that resilience was more important than anxiety in explaining depression. The simple slope analysis showed that the effect of stress on depression of the gross-roots civil servants with higher resilience scores was lower, while those with lower resilience scores were significantly higher in the relationship between stress and depressive. The gross-roots civil servants in the high resilience group scores were lower on the relationship between stress and anxiety than those in the low resilience group. In the present study, resilience accounting for an important part of the variation in anxiety but even larger variations in depression may suggest interventions should target ways to enhance resilience and at the same time minimize the effects of stress. When considering interventions that promote resilience, it may be more relevant to the gross-roots civil servants who show anxiety and depression as a result of the direct effects of stress.
There are some limitations to this study. First, it is a cross-sectional study, which means that causality cannot be determined. Second, because of the self-reporting questionnaire used in the current study, the results may be constrained by memory bias and individual subjective consciousness.
Finally, the sample size of this article is too small, with only one county, to