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Original Articles
Effects of Loneliness on Stress in Middle-Aged and Older Adults: Sequential Dual Mediating Roles of Social Interaction Anxiety and Self-Control
Seung Chul Lee, Wonil Choi, SoYeong Yoon, Soo Rim Noh
STRESS. 2025;33(2):93-102.   Published online June 30, 2025
DOI: https://doi.org/10.17547/kjsr.2025.33.2.93
  • 1,343 View
  • 33 Download
Abstract PDF
Background
The aim of this study is to identify the psychological pathways linking loneliness to stress among middle-aged and older adults, focusing on the mediating roles of social interaction anxiety and self-control.
Methods
A total of 580 adults aged 40∼71 years completed an online self-report questionnaire. Structural equation modeling was used to test a sequential mediation model, and covariates such as age, sex, depression, and extraversion were controlled for.
Results
Loneliness was positively associated with stress and social interaction anxiety, and negatively with self-control. Social interaction anxiety and self-control each mediated the relationship between loneliness and stress. Moreover, a significant sequential mediation pathway was observed: loneliness was associated with higher levels of social interaction anxiety, which in turn was negatively related to self-control, and lower self-control was linked to heightened stress. After controlling for covariates, only the indirect effect via social interaction anxiety remained significant. This suggests that anxiety in social contexts may serve as a robust emotional mechanism underlying the association between loneliness and perceived stress.
Conclusions
This study empirically supports the sequential mediation model in which loneliness increases social interaction anxiety, which in turn reduces self-control, ultimately elevating stress. These findings highlight the importance of considering both interpersonal and intrapersonal factors in mental health interventions for aging populations. Addressing loneliness, reducing social interaction anxiety, and strengthening self-control may be effective targets for psychological intervention and community-based programs tailored to the needs of middle-aged and older adults.
Mediating Effect of Acceptance and Moderated Mediation by Emotional Reactivity in the Relationship Between Awareness and Anxiety
Chang Soo Han, Boyoung Kim
STRESS. 2025;33(2):103-110.   Published online June 30, 2025
DOI: https://doi.org/10.17547/kjsr.2025.33.2.103
  • 717 View
  • 34 Download
Abstract PDF
Background
This study aimed to examine the mediating effect of acceptance and the moderated mediation effect of emotional reactivity in the relationship between awareness and state anxiety.
Methods
A total of 395 Korean adults participated in this study. Participants completed self-report measures of awareness, state anxiety, acceptance, and emotional reactivity. Data were analyzed using PROCESS macro to test for mediation and moderated mediation effects.
Results
The findings indicated that acceptance significantly mediated the relationship between awareness and state anxiety. Moreover, emotional reactivity significantly moderated the association between awareness and acceptance. A significant moderated mediation effect was also observed, suggesting that the indirect effect of awareness on state anxiety through acceptance differed depending on levels of emotional reactivity.
Conclusions
These results elucidate the mechanisms underlying mindfulness, indicating that its anxiety-reducing effects via acceptance depend on individual differences in emotional reactivity. The study offers suggestions for the clinical application of mindfulness-based interventions, emphasizing the importance of tailoring strategies to clients’ emotional sensitivity.
Double Mediation Effect of Social Interaction Anxiety and Experiential Avoidance between Internalized Shame and Social Media Addiction Tendency
Kiyeon Nam, Myoung-Ho Hyun, Young-Sil Kwon
STRESS. 2025;33(1):45-52.   Published online March 28, 2025
DOI: https://doi.org/10.17547/kjsr.2025.33.1.45
  • 1,475 View
  • 78 Download
Abstract PDF
Background
This study examined the pathway by which internalized shame influences the tendency toward social media addiction through the mediating roles of social interaction anxiety and experiential avoidance.
Methods
Data were collected from 174 Korean adults who completed surveys measuring internalized shame, social interaction anxiety, experiential avoidance, and social media addiction. Linear regression and Process Macro were used for data analysis.
Results
Internalized shame affected social media addiction by mediating experiential avoidance, and the mediation effect of social interaction anxiety was not significant. However, the double mediating effect of social interaction anxiety and experiential avoidance on the relationship between internalized shame and social media addiction was significant.
Conclusions
People who chronically experience negative perceptions and shame about themselves seek stability through others; however, they experience anxiety in face-to-face interactions and use social media to control and avoid these anxieties. To effectively reduce the tendency toward social media addiction, intervention is required to avoid social interaction anxiety, rather than attempting to change maladaptive identity.
The Influence of Attention-Deficit/Hyperactivity on School Adjustment among Adolescents: Focusing on the Moderated Mediation Effect of Depression by Household Economic Status
RaeHyuck Lee
STRESS. 2025;33(1):13-21.   Published online March 28, 2025
DOI: https://doi.org/10.17547/kjsr.2025.33.1.13
  • 924 View
  • 45 Download
Abstract PDF
Background
This study examines the influence of attention-deficit/hyperactivity on school adjustment among adolescents and investigates the moderated mediation effect of depression on household economic status.
Methods
The research hypotheses were tested using data from the Korean Teenagers’ Mental Health Study and analyzed utilizing the PROCESS Macro method.
Results
Attention-deficit/hyperactivity had a significant negative impact on students’ school adjustment. Additionally, depression partially mediated the relationship between attention-deficit/hyperactivity and school adjustment. While household economic status did not moderate the influence of attention-deficit/hyperactivity on school adjustment, it did moderate the mediating effect of depression. Specifically, the mediating effect of depression on the relationship between attention-deficit/hyperactivity and school adjustment was more pronounced for adolescents from low-income households than for those from medium- or high- income households.
Conclusions
This study discusses the research implications and considerations.
The Effectiveness of an Imagery-Based Behavioral Activation Intervention for Depressive Symptoms
Sujeong Yun, Eun-Jung Shim
STRESS. 2024;32(4):204-213.   Published online December 27, 2024
DOI: https://doi.org/10.17547/kjsr.2024.32.4.204
  • 1,707 View
  • 46 Download
Abstract PDF
Background
Behavioral activation treatment (BAT) is an evidence-based treatment for depression. However, depressive symptoms can make it difficult to engage in activities crucial for the success of behavioral activation. Mental imagery may assist with activity engagement. This study examined the effectiveness of imagery-based BAT (BAT-I) compared to standard BAT in reducing depressive symptoms and improving behavioral activation, activity anticipation, activity motivation, and activity completion rates.
Methods
Thirty adults with moderate to severe depressive symptoms were randomly assigned to either the BAT-I or BAT groups. The participants received eight sessions of twice-weekly BAT intervention, with an additional four-eight mental imagery sessions provided for the BAT-I group.
Results
Repeated measures analysis of variance indicated that participants in both groups showed reductions in depressive symptoms and improvements in behavioral activation, activity anticipation, and activity motivation. However, the BAT-I group demonstrated significantly higher activity motivation (6.1> 5.1) and activity completion rates (93.17%>66.18%) than the BAT group.
Conclusions
While use of imagery appears to support activity engagement, further research is needed to explore how imagery can be utilized to enhance the BAT effectiveness.
The Dual Mediation Effect of Evaluative Concerns Perfectionism and Mindfulness in the Relationship between Temperament and Depression among Office Workers
SeoYeon Park, Yejin Cho, Myoung-Ho Hyun
STRESS. 2023;31(2):87-95.   Published online June 30, 2023
DOI: https://doi.org/10.17547/kjsr.2023.31.2.87
  • 3,334 View
  • 105 Download
Abstract PDF
Background
This study investigates the dual mediation effect of evaluative concerns perfectionism and mindfulness in the relationship between temperament and depression among office workers.
Methods
220 Korean office workers completed online surveys measuring levels of FCB-TI perseveration (PE) and emotional reactivity (ER), evaluative concerns perfectionism, mindfulness, and depression.
Results
The data analysis results showed that evaluative concerns perfectionism and mindfulness both mediated the relationship between temperament types and depression. Additionally, evaluative concerns perfectionism and mindfulness had dual mediating effect between temperament and depression.
Conclusions
Based on the results of this study, PE and ER temperament could increase the level of evaluative concerns perfectionism, decreasing the level of mindfulness and increasing the risk of depression. The findings highlight the potential value of mindfulness-based interventions focusing on alleviating perfectionism concerning others’ evaluation for preventing and treating depression in office settings.
The Double-Mediating Effect of Interpersonal Competence and Social Support on the Relationship between ADHD Traits and Depression in Early Adulthood
Jae Sun An
STRESS. 2023;31(1):44-50.   Published online March 31, 2023
DOI: https://doi.org/10.17547/kjsr.2023.31.1.44
  • 4,151 View
  • 192 Download
Abstract PDF
Background
This study aims to analyze the relationship between interpersonal competence, social support, ADHD traits, and depression in early adulthood, and by using the double-mediation model, to examine the effect of the first two variables on the last two.
Methods
The participants comprised 146 male and 155 female adults aged between 19 and 34, from whom data was collected through the Korean version of the WHO Adult ADHD Self-Report Scale, interpersonal competence and depression subscales of the mental health test developed by Suh et al., and social support scale developed by Iverson et al.
Results
The results showed that adult ADHD traits were negatively correlated with interpersonal competence and social support, and positively correlated with depression. In addition, interpersonal competence was positively correlated with social support and negatively correlated with depression, whereas social support was negatively correlated with depression. Finally, interpersonal competence and social support sequentially mediated adult ADHD traits and depression.
Conclusions
This sequential double-mediating effect is of great academic significance and suggests that improving interpersonal competence and social support may be effective in mitigating the negative effect of ADHD traits on depression in early adulthood.
Effects of Acceptance and Commitment Therapy on Job-Seeking Stress, Self-Efficacy, Experiential Avoidance, Depression, and Anxiety
Geon Min Lee, Hyun Kyun Shin
STRESS. 2022;30(4):277-287.   Published online December 30, 2022
DOI: https://doi.org/10.17547/kjsr.2022.30.4.277
  • 3,790 View
  • 121 Download
  • 1 Citations
Abstract PDF
Background
Acceptance and Commitment Therapy (ACT) is an effective intervention for stress, self-efficacy, and experiential avoidance. The purpose of this study was to examine the effects of ACT on job-seeking stress, self-efficacy, experiential avoidance, depression, and anxiety.
Methods
University students suffering from job-seeking stress were recruited for this study. They were randomly assigned to an experimental group (12 students) and a wait-list control group (10 students). The ACT program consisted of six 120-minute sessions conducted twice a week for three weeks. A pre-test, post-test, and follow-up test (4 weeks after the final session) were administered.
Results
In the experimental group, positive significant effects were identified for all variables, and these effects were maintained at the time of the follow-up test. In the wait-list control group, a temporary positive effect was identified for job-seeking stress and self-efficacy, but had disappeared by the follow-up test; no changes were identified for the remaining variables.
Conclusions
The significance of this study is confirmed that ACT is effective not only stress but also for job-seeking stress and other variables.

Citations

Citations to this article as recorded by  
  • Mediating effect of AI attitudes and AI literacy on the relationship between career self-efficacy and job-seeking anxiety
    Ruihua Li, Sha Ouyang, Jianwei Lin
    BMC Psychology.2025;[Epub]     CrossRef
Relationship between Stop Drinking Controllability, Hopelessness, Social Activity and Suicidality for Alcohol Use Disorder
Hye-Young Lee, Young-Sil Kwon, Myoung-Ho Hyun, Na-Rae Lee
STRESS. 2022;30(3):172-178.   Published online September 30, 2022
DOI: https://doi.org/10.17547/kjsr.2022.30.3.172
  • 3,169 View
  • 82 Download
  • 2 Citations
Abstract PDF
Background
This study aimed to examine the relationship between suicidality, stop drinking controllability, hopelessness, and social activity in a population sample of individuals with alcohol use disorder (AUD) and to determine how AUD contributes to suicidal behavior.
Methods
A total of 252 participants diagnosed with AUD were surveyed, and multiple regression analysis and hierarchical regression analysis were used to analyze the data.
Results
Hopelessness fully mediated the relationship between the ability to stop drinking and suicidality. At low levels of social engagement, the relationship between hopelessness and suicidality was significantly modified by social activity.
Conclusions
The results of this study suggest that patients with AUD who were unable to successfully address their drinking problem and abstain from drinking were more likely to experience hopelessness. In addition, we concluded that hopelessness can lead to suicidal ideation or suicide attempts.

Citations

Citations to this article as recorded by  
  • The process of losing meaning in life among alcoholics
    Seong-Jun Maeng, Jun-Hyeok Kang, Sun Kyung Kang, Dong-Jun Lee
    Asia Pacific Journal of Social Work and Development.2025; 35(2): 125.     CrossRef
  • Study of the Emergence Process of Suicidal Ideation Among People with Alcohol Use Disorder in South Korea
    Seong-Jun Maeng, Jun-Hyeok Kang, Sun Kyung Kang
    Journal of Social Service Research.2025; : 1.     CrossRef
Factors Affecting Smartphone Overdependence among Older Adults
Ji-Eun Park, Nayoon Lee
STRESS. 2022;30(1):37-44.   Published online March 31, 2022
DOI: https://doi.org/10.17547/kjsr.2022.30.1.37
  • 4,261 View
  • 167 Download
Abstract PDF
Background
This study aimed to identify the factors affecting smartphone overdependence among older adults.
Methods
A cross-sectional descriptive study was conducted with 179 older adults using smartphones in B metropolitan city. A multiple regression analysis was performed to identify the effect of physical activity, social support, and depression on smartphone overdependence.
Results
Factors that affect smartphone overdependence among the participants were as follows: (a) purpose of using smartphone (β=.23, p=.001), (b) age (β=.23, p=.002), (c) smartphone use time (β=.20, p=.004), (d) educational level (β=−.15, p=.027), and (e) social support (β=−.14, p=.048). The model explained for 19.0% (F=9.30, p<.001).
Conclusions
The findings of this study can be used as evidence to develop intervention programs and policy measures to prevent and manage smartphone overdependence, which has negative effects on the physical and mental health of older adults.
Influences of Physical Symptoms, Sleep Quality, Fatigue and Health Promoting Behaviors on Job Satisfaction of Shift Nurses
Young Eun Ahn
STRESS. 2021;29(4):262-270.   Published online December 31, 2021
DOI: https://doi.org/10.17547/kjsr.2021.29.4.262
  • 6,616 View
  • 471 Download
  • 6 Citations
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Citations

Citations to this article as recorded by  
  • Impact of Medical Technologist’s Working Environment on Health Problems: Using Data from the 6th Korean National Health and Nutrition Examination Survey
    Taewon JUNG, Miran LEE, Sang-ha KIM, Sunghyun KIM, Young-Kwon KIM
    Korean Journal of Clinical Laboratory Science.2025; 57(2): 189.     CrossRef
  • Factors Influencing the Perception of Decent Work by Nurses
    Chung Hee Woo, Yu Jin Lee
    Journal of Korean Academy of Nursing Administration.2025; 31(3): 227.     CrossRef
  • Effects of Gamitaeeumjowee-tang for Weight Loss in Overweight and Obese Shift Workers: A Retrospective Chart Review
    Yunjin Lee, Hyojoo Choi, Jeong-In Kang, Young-Woo Lim, Eunjoo Kim
    Journal of Korean Medicine.2025; 46(3): 1.     CrossRef
  • Mediating effects of fatigue on the relationship between sleep quality and the quality of life of shift-working nurses
    Jeongwon Yeom, Insun Yeom
    Chronobiology International.2023; 40(4): 450.     CrossRef
  • Effects of perceived spiritual management, work engagement, and organizational commitment on job satisfaction among clinical nurses: the mediating role of perceived spiritual management
    Eun-Hye Lee, Hea-Jin Yu
    BMC Nursing.2023;[Epub]     CrossRef
  • The Effects of Optometrist’s Job Satisfaction on Fatigue Symptoms
    Hye-Kyung Hwang, Jeong-Yun Lee
    Journal of Korean Ophthalmic Optics Society.2022; 27(3): 153.     CrossRef
Distractive Emotion Regulation: The Construct and Its Measurement
Dohyeon Kim, Hae Youn Choi
STRESS. 2021;29(1):11-20.   Published online March 31, 2021
DOI: https://doi.org/10.17547/kjsr.2021.29.1.11
  • 4,903 View
  • 62 Download
Abstract PDF
Background

Distractive emotion regulation, which relieves arousal through attention shift, protects individuals from strong stress. Distractive emotion regulation is widely used in everyday life and although it has great implications in the context of adaptation such as to addiction, it is generally not considered separately from avoidant regulation, it has neither been clearly defined nor measured.

Methods

Through a literature review and qualitative analysis, we selected adults’ distractive emotion regulation behaviors. We explored the construct by developing measurement on the distractive behaviors that adults use to regulate emotion.

Results

Factor analysis revealed that distractive emotion regulation consisted of four factors: “consumption distraction” concerned with activities such as shopping, internet use, and TV viewing; “arousal control distraction” related to activities such as exercise, bathing, and deep breathing; “reserving distraction” pertaining to activities such as eating, sleeping, and listening to music; and “aggressive distraction” involving behaviors such as bullying, physical destructiveness, or cursing. Each factor had a different correlation with stress coping dimensions and subjective well-being.

Conclusions

Distractive emotion regulation is a multidimensional concept composed of sub-factors with different functions and clinical implications in daily life.

The Relationship between Borderline Personality Traits and Reactive Aggression: The Mediating Effect of Experiential Avoidance
Jiyeon Lee, Myoung-Ho Hyun
STRESS. 2020;28(4):262-268.   Published online December 31, 2020
DOI: https://doi.org/10.17547/kjsr.2020.28.4.262
  • 5,299 View
  • 117 Download
Abstract PDF
Background

The purpose of this study was to investigate the effects of experiential avoidance in the relationship between borderline personality traits and reactive aggression.

Methods

In total, 160 participants (male N=57, female N=103, mean age 25.3 years) completed the questionnaires measuring levels of borderline personality traits, experiential avoidance, and reactive aggression.

Results

First, borderline personality traits had a significantly positive effect on experiential avoidance and reactive aggression. Experiential avoidance also had a positive effect on reactive aggression. Second, experiential avoidance had mediating effect between borderline personality traits and reactive aggression.

Conclusions

Based on the results of this study, it was confirmed that borderline personality traits could activate experiential avoidance, which leads to an increase in reactive aggression. Furthermore, current results suggested that in the treatment of reactive aggression in borderline personality traits, it was important to deal with experiential avoidance.

The Moderating Role of Cultural and Leisure Activities in the Effects of Subjective Health Status on Life Satisfaction: Focus on Middle and Old-aged Single Households with Persons with Disabilities
Jongnam Lee
STRESS. 2020;28(4):230-236.   Published online December 31, 2020
DOI: https://doi.org/10.17547/kjsr.2020.28.4.230
  • 2,951 View
  • 61 Download
Abstract PDF
Background

The purpose of this study is to verify how participation in cultural and leisure activities by middle- and old-aged households with people with disabilities affects subjective health status and life satisfaction.

Methods

Secondary analyses were conducted with 1,223 persons aged 50 years or over and living alone with disabilities, using the raw data from the 2017 National Survey on Persons with Disabilities.

Results

The results indicated that participation in cultural and leisure activities moderates the effects of subjective health status on life satisfaction.

Conclusions

This study revealed that policies and programs to encourage participation in cultural and leisure activities for persons with disabilities are needed for enhancing life satisfaction.

Effects of Patient Safety Culture on Nurse Burnout in the Operating Room
Ye Sol Lee, Chin Kang Koh
STRESS. 2020;28(3):118-124.   Published online September 30, 2020
DOI: https://doi.org/10.17547/kjsr.2020.28.3.118
  • 4,759 View
  • 257 Download
  • 2 Citations
Abstract PDF
Background

The occurrence of nurse burnout, which could affect the quality of nursing, largely depends on the characteristics of a hospital department. An operating room (OR) environment comes with a high possibility of nurses committing errors, and OR nurses respect the value of patient safety and perform their safety management duties as needed. Although patient safety culture in an OR might affect OR nurse burnout, there is insufficient evidence to show such an association.

Methods

This cross-sectional study was conducted in a hospital in Seoul, South Korea in 2019. One-hundred and twenty-two OR nurses completed the Safety Attitude Questionnaire Korean version 2 and Maslach Burnout Inventory that measured perceived levels of patient safety culture and burnout, respectively.

Results

Correlation analyses found that lower burnout was significantly associated with better patient safety culture. Through a multiple regression, the predictors of emotional exhaustion in patient safety culture identified were job satisfaction (β=−.524, p=.000) and working conditions (β=−.282, p=.015). Working conditions predicted depersonalization (β=−.323, p=.009), while job satisfaction predicted lack of personal accomplishment (β=−.250, p=.004). Meanwhile, years in the unit (β=−.397, p=.001) predicted lack of personal accomplishment.

Conclusions

These results suggest an important role for two dimensions of patient safety culture in mitigating burnout among OR nurses. It would be effective to improve working conditions in ORs by reducing the nurse-patient ratio, and to enhance job satisfaction among OR nurses by securing resources introduced by the conservation of resources theory.

Citations

Citations to this article as recorded by  
  • The Influence of Professional Self-Concept and Patient Safety Culture on Burnout among Nurses in a Cancer Hospital
    Soyoon Do, Eunjung Ryu
    Asian Oncology Nursing.2024; 24(2): 53.     CrossRef
  • Influences of Teamwork and Job Burnout on Patient Safety Management Activities among Operating Room Nurses
    Ayoung Kim, Haein Lee
    Journal of Korean Academy of Nursing Administration.2022; 28(5): 605.     CrossRef

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