Personality and Individual Differences 123 (2018) 205–208

Contents lists available at ScienceDirect

Personality and Individual Differences

journal homepage: www.elsevier.com/locate/paid

Short Communication

The association of gratitude with perceived stress and burnout among male T
firefighters in Korea
Ju-Yeon Leea,b, Seon-Young Kima, Kyung-Yeol Baea, Jae-Min Kima, Il-Seon Shina, Jin-Sang Yoona,
⁎
Sung-Wan Kima,b,
a
Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
b
Gwang-ju Mental Health Commission, Gwangju, Republic of Korea

A R T I C L E I N F O A B S T R A C T

Keywords: We examined the association of gratitude with perceived stress and burnout in firefighters. A total of 464 male
Firefighter firefighters completed a self-administered questionnaire including sociodemographic characteristics, the Korean
Gratitude version of the Gratitude Questionnaire (K-GQ-6), Perceived Stress Scale (PSS), Maslach Burnout Inventory-
Stress General Survey (MBI-GS), Big Five Inventory-10 (BFI-10), and the Hospital Anxiety and Depression Scale. The K-
Burnout
GQ-6 score was negatively correlated with the PSS and MBI-GS exhaustion and cynicism scores. The linear
Personality
regression analysis revealed that gratitude was negatively associated with perceived stress and the exhaustion
and cynicism burnout subscales after controlling for religiousness, personality variables, anxiety, and depression.
These findings suggest that gratitude acts as an independent protective factor against stress and burnout.
Gratitude should be incorporated into training and psychoeducation throughout the course of a firefighter's
career.

1. Introduction positive affect was associated with adaptation to stress in firefighters

As emergency service personnel, firefighters frequently experience
life-threatening and highly stressful events in their work. Several stu-
dies have shown that firefighters experience high levels of stress and
burnout, which have a negative impact on job performance (Ângelo &
Chambel, 2015; Harvey et al., 2016; Katsavouni, Bebetsos, Malliou, and
Beneka, 2016). In particular, as firefighters work in close proximity to
accident sites, these professionals are at the epicenters of trauma and
represent an at-risk posttraumatic stress disorder. Indeed, perceived
stress and burnout have been shown to be significant predictors of
posttraumatic stress disorder among firefighters (Jo et al., 2017; Lee,
Ahn, Jeong, Chae, and Choi, 2014). However, the resources needed to
cope with stress and burnout are not readily available for firefighters.
Recent studies have identified gratitude as a protective coping me-
chanism that can promote positive outcomes following a stressful event
(Ng & Wong, 2013; Vieselmeyer, Holguin, and Mezulis, 2016). Grati-
tude, which is a cognitive-affective state typically defined as an in-
dividual's tendency to respond with appreciation to perceived benefits
or positive aspects of his or her life, may interact with perceived stress
and reduced burnout (Chan, 2010; Fagley, 2012; McCullough, Emmons,
and Tsang, 2002). Gratitude involves a positive cognitive appraisal and
affect with regard to a situation or event. A recent study showed that
(Shrira et al., 2015). Likewise, in the context of positive psychology, we
tested whether gratitude could be predictors for stress and burnout in
firefighters and expect to obtain more valid data in the dependent
variables in a sample in which these are expect to occur in a high fre-
quency. Furthermore, gratitude is positively associated with adaptive
personality traits in the so-called Big Five domains and inversely related
to psychopathological states such as depression and anxiety (Wood,
Froh, & Geraghty, 2010; Wood, Joseph, and Maltby, 2008). Although
gratitude has been conceptualized as a personality trait, previous stu-
dies have demonstrated that the effect of gratitude on positive out-
comes is independent of the Big Five factors (Fagley, 2012). Thus, we
hypothesized that gratitude is an independent protective factor against
perceived stress and burnout after controlling for personality and psy-
chopathology in firefighters.
2. Methods
2.1. Study design and participants
Our cross-sectional survey was conducted between July 2015 and
June 2016. A self-administered questionnaire was delivered to 525
firefighters at fire stations in Gwangju in South Korea by the fire station

⁎
Corresponding author at: Department of Psychiatry, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 501-746, Republic of Korea.
E-mail address: swkim@chonnam.ac.kr (S.-W. Kim).

https://doi.org/10.1016/j.paid.2017.11.010
Received 29 March 2017; Received in revised form 6 November 2017; Accepted 7 November 2017
Available online 22 November 2017
0191-8869/ © 2017 Elsevier Ltd. All rights reserved.
J.-Y. Lee et al.
management. The questionnaire was anonymous to protect respondent
privacy. Informed consent was obtained from all subjects before par-
ticipation in the study. The responses of the 37 female firefighters
(sample size was too small for an analysis according to sex) and those of
24 male firefighters whose questionnaires were incomplete were ex-
cluded from the analysis. In total, the responses of 464 (88.4%) of 525
firefighters were included in our study. The study was approved by the
Institutional Review Board.
2.2. Measures
Sociodemographic data were obtained from the firefighters in-
cluding marital status, education, religion, and work-related duties.
Grateful disposition was measured using the Korean version of the
Gratitude Questionnaire-6 (K-GQ-6) (Emmons & McCullough, 2004;
Kwon, Kim, & Lee, 2006; McCullough et al., 2002), which consists of six
items measuring gratitude on a 7-point Likert scale. Total scores range
from 6 to 42, with high scores indicating higher levels of grateful dis-
position.
Personality was assessed using the 10-item short version of the Big
Five Inventory (BFI-10) (Kim et al., 2010; McCrae & Costa, 1987;
Rammstedt and John, 2007). The BFI-10 is a self-assessment tool that
evaluates five personality dimensions: openness, conscientiousness,
neuroticism, extraversion, and agreeableness. Each domain item is
rated from strongly disagree (1) to strongly agree (5).
Anxiety and depression were measured using the Hospital Anxiety
and Depression Scale (HADS) (Oh, Min, & Park, 1999; Zigmond and
Snaith, 1983), which is composed of 14 items that measure symptoms
of anxiety and depression (7 items each). Each item is rated on a 4-point
Likert scale (range, 0–3) with higher scores indicating more severe
symptoms.
Perceived stress was measured using the Perceived Stress Scale
(PSS) (Cohen, Kamarck, & Mermelstein, 1983; Lee et al., 2012), which
consists of 10 items about specific feelings experienced in the last
month. Respondents were asked to rate the items on a 5-point Likert
scale with higher scores indicating greater psychological stress.
Burnout was measured using the Maslach Burnout Inventory-
General Survey (MBI-GS), which contains three dimensions: exhaus-
tion, cynicism, and professional efficacy (Maslach and Jackson, 1981).
We assessed exhaustion, which refers to the loss of emotional resources
caused by work, and cynicism, which reflects indifference or a distant
attitude toward work.
2.3. Statistical analyses
Mean scores for the individual variables in each category of per-
ceived stress and burnout were compared using independent t-tests for
binomial variables and analysis of variance (ANOVA) for multinomial
variables. Pearson's correlation coefficients were used to evaluate re-
lationships among continuous variables. We used hierarchical linear
regression analyses to determine associations between potential pre-
dictors and perceived stress and burnout, entering religiosity, gratitude,
personality variables, and emotional factors such as anxiety and de-
pression.
The Statistical Package for the Social Sciences for Windows ver.
21.0 (SPSS, Inc., Chicago, IL, USA) was used to conduct the statistical
tests. All statistical tests were two tailed, and p-values < 0.05 were
deemed to indicate statistical significance.
3. Results
The PSS and MBI-GS exhaustion and cynicism scores according to
sociodemographic characteristics presented that religious subjects were
less likely to experience perceived stress, exhaustion, and cynicism than
were non-religious participants.
Table 1 indicates the correlations among the various scales. The GQ-
206
Personality and Individual Differences 123 (2018) 205–208
6 score was significantly negatively correlated with the PSS, MBI-GS
exhaustion and cynicism subscales, HADS, and BFI-10 neuroticism scale
scores, and positively correlated with the BFI-10 openness, con-
scientiousness, extraversion, and agreeableness scale scores. Based on
our final modeling of the results of Table 2, religion (β = −1.015,
P = 0.004), GQ-6 score (β = − 0.192, P < 0.001), conscientiousness
(β = −0.377, P = 0.021), and agreeableness (β = −0.527,
P = 0.005) (all of which are personality variables) negatively predicted
perceived stress. However, the BFI-10 neuroticism (β = 0.673,
P < 0.001), HADS anxiety (β = 0.262, P < 0.001), and depression
(β = 0.596, P < 0.001) subscales were significant (positive) pre-
dictors of perceived stress. Of the independent variables, gratitude
made the most significant contribution to the prediction of perceived
stress. In Table 3, religion (β = −1.439, P = 0.003) and gratitude
(β = −0.117, P = 0.011) negatively predicted MBI-GS exhaustion,
whereas the BFI-10 neuroticism (β = 0.829, P < 0.001), HADS an-
xiety (β = 0.426, P < 0.001), and depression (β = 0.639,
P < 0.001) subscales significantly (positively) predicted MBI-GS ex-
haustion. The results of Table 4 show that gratitude (β = −0.135,
P = 0.001) negatively predicted MBI-GS cynicism, whereas the HADS
anxiety (β = 0.246, P = 0.004) and depression (β = 0.489,
P < 0.001) subscales positively predicted such cynicism.
4. Discussion
We investigated the association of gratitude with perceived stress
and burnout among firefighters. We found that high levels of gratitude
predicted low levels of perceived stress and burnout, supporting a
protective role of gratitude against work-related stress and burnout
(Chan, 2010; Cheng, Tsui, & Lam, 2015; Clark, Northrop, and
Barkshire, 1988).
The burnout syndrome is characterized by emotional exhaustion
and alienation from work-related activities as a result of excessive stress
and dissatisfaction with life (Hozo, Sucic, and Zaja, 2015). Thus, our
results suggest that gratitude reduces burnout by fostering positive
emotions and improving satisfaction with life. Furthermore, we found
that the neuroticism subscale of the BFI-10 was positively associated
with exhaustion, which supports previous finings (Bühler and Land,
2004). However, we found no relationship between neuroticism and
cynicism. The adaptive domains of personality were not associated with
burnout, whereas gratitude was a significant protective factor against
burnout. Previous cross-sectional and longitudinal studies have found
that gratitude is a robust predictor of life satisfaction after controlling
for symptomatology and the Big Five personality domains (McCullough
et al., 2002; Wood et al., 2008).
Our finding that perceived stress and exhaustion were negatively
associated with religiousness is consistent with previous studies (Ho
et al., 2016; Meltzer and Huckabay, 2004). However, a previous study
found no association between religion and burnout (Shaddock, Hill, and
van Limbeek, 1998), and other studies found that the absence of re-
ligious beliefs was associated with stress and mental health problems
(Harrison, Koenig, Hays, Eme-Akwari, and Pargament, 2001). Thus, the
effect of religion on stress and burnout is controversial. Although re-
ligious coping strategies include gratitude and life satisfaction, our
findings suggest that the effect of gratitude on burnout may be in-
dependent of religious beliefs and personality traits. Specifically, the
gratitude scores on the K-GQ-6 instrument reflect individual differences
in how frequently and intensely people feel gratitude rather than offer
gratitude to God. Additionally, the stress-reducing effect of theocentric
gratitude was more pronounced among females than males (Krause,
2006). Therefore, the attitudes toward gratitude among the males in
our present study may be more strongly associated with their individual
spiritual experiences and sentiments than with any specific theological
orientation.
Effective use of coping strategies is associated with lower perceived
stress and improved ability to function professionally (Boey, 1999).
J.-Y. Lee et al. Personality and Individual Differences 123 (2018) 205–208

Table 1
Correlations among PSS, MBI-GS, GQ-6, BFI-10, and HADS.

Variable 1 2 3 4 5 6 7 8 9 10 11

1. PSS 1
2. MBI-GS-Exhaustion 0.666⁎ 1
3. MBI-GS-Cynicism 0.589⁎ 0.807⁎ 1
4. GQ-6 − 0.543⁎ − 0.399⁎ −0.403⁎ 1
5. BFI-10-Openness − 0.256⁎ − 0.179⁎ −0.181⁎ 0.384⁎ 1
6. BFI-10-Conscientiousness − 0.421⁎ − 0.288⁎ −0.323⁎ 0.334⁎ 0.373 1
7. BFI-10-Neuroticism 0.540⁎ 0.482⁎ 0.403⁎ − 0.370⁎ − 0.185⁎ − 0.257⁎ 1
8. BFI-10-Extraversion − 0.374⁎ − 0.316⁎ −0.342⁎ 0.323⁎ 0.357⁎ 0.424⁎ − 0.360⁎ 1
9. BFI-10-Agreeableness − 0.500⁎ − 0.337⁎ −0.356⁎ 0.408⁎ 0.296⁎ 0.603⁎ − 0.415⁎ 0.440⁎ 1
10. HADS-Anxiety 0.598⁎ 0.577⁎ 0.501⁎ − 0.402⁎ − 0.204⁎ − 0.341⁎ 0.474⁎ −0.334⁎ − 0.352⁎ 1
11. HADS-Depression 0.644⁎ 0.586⁎ 0.528⁎ − 0.449⁎ − 0.252⁎ − 0.307⁎ 0.456⁎ −0.342⁎ − 0.378⁎ 0.635⁎ 1

PSS: Perceived Stress Scale, MBI-GS = Maslach Burnout Inventory-General Survey, GQ-6: Gratitude Questionnaire-6, BFI-10: Big Five Inventory-10, HADS: Hospital Anxiety and
Depression Scale.
⁎
P < 0.001.

Table 2
Hierarchical multiple regression displaying associations between religion, gratitude, personality variables, anxiety, and depression effects on PSS.

Step 1 Step 2 Step 3 Step 4

β β β β Partial correlation

⁎⁎ ⁎⁎ ⁎⁎ ⁎⁎
Religion − 1.732 −1.585 − 1.264 − 1.015 −0.088⁎⁎
GQ-6 −0.475⁎⁎⁎ − 0.289⁎⁎⁎ − 0.192⁎⁎⁎ −0.178⁎⁎⁎
Openness 0.166 0.182 0.038
Conscientiousness − 0.531⁎⁎ − 0.377⁎ −0.071⁎
Neuroticism 1.222⁎⁎⁎ 0.673⁎⁎⁎ 0.134⁎⁎⁎
Extraversion − 0.199 − 0.010 −0.002
Agreeableness − 0.640⁎⁎ − 0.527⁎⁎ −0.085⁎⁎
Anxiety 0.262⁎⁎⁎ 0.119⁎⁎⁎
Depression 0.596⁎⁎⁎ 0.220⁎⁎⁎
Adjusted R2 0.021 0.314 0.483 0.594

PSS: Perceived Stress Scale, β = unstandardized regression coefficients, R2: percent variance explained by each variable.
⁎
P < 0.05.
⁎⁎
p < 0.01.
⁎⁎⁎
p < 0.001.

Table 3
Hierarchical multiple regression displaying associations between religion, gratitude, personality variables, anxiety, and depression effects on MBI-GS, exhaustion.

Step 1 Step 2 Step 3 Step 4

β β β β Partial correlation

Religion − 2.350⁎⁎⁎ − 2.219⁎⁎⁎ − 1.798⁎⁎ −1.439⁎⁎ −0.103⁎⁎

GQ-6 − 0.433⁎⁎⁎ − 0.252⁎⁎⁎ −0.117⁎ −0.090⁎
Openness 0.203 0.219 0.038
Conscientiousness − 0.428⁎⁎ −0.180⁎ −0.028⁎
Neuroticism 1.594⁎⁎⁎ 0.829⁎⁎⁎ 0.139⁎⁎⁎
Extraversion − 0.416 −0.153 −0.025
Agreeableness − 0.131 −0.002 0.000
Anxiety 0.426⁎⁎⁎ 0.160⁎⁎⁎
Depression 0.639⁎⁎⁎ 0.231⁎⁎⁎
Adjusted R2 0.027 0.193 0.321 0.465

MBI-GS = Maslach Burnout Inventory-General Survey, β: unstandardized regression coefficient, R : percent variance explained by each variable.
2

⁎
P < 0.05.
⁎⁎
p < 0.01.
⁎⁎⁎
p < 0.001.

Previous studies have shown that individuals who display gratitude are
more likely to seek emotional and social support as a means of adaptive
coping than to employ disengagement strategies in stressful situations
(Watkins, Woodward, Stone, & Kolts, 2003; Wood, Joseph, and Linley,
2007). Although we did not assess coping strategies, our finding that
gratitude fostered positive emotions and reduced stress during a crisis is
consistent with previous studies indicating that gratitude is an effective
coping mechanism. Our regression analysis showed that gratitude, an-
xiety, and depression were common predictors of perceived stress and
two-dimensional burnout. Our results imply that firefighters with gra-
titude reinterpreted their world view, reframing negative memories and
experiences, suggesting that gratitude helped restore a positive mood
following a stressful event. Such a positive impact of gratitude ulti-
mately contributed to happiness, a positive psychological parameter.
Several recent studies have evaluated and validated the effect of
cultivating gratitude across a range of clinically relevant outcomes.
Furthermore, the effects of gratitude intervention techniques, such as
gratitude listing, grateful contemplation, and behavioral expression of

207
J.-Y. Lee et al. Personality and Individual Differences 123 (2018) 205–208

Table 4 Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress.
Hierarchical multiple regression displaying associations between religion, gratitude, Journal of Health and Social Behavior, 24, 385–396.
personality variables, anxiety, and depression effects on MBI-GS, cynicism. Emmons, R. A., & McCullough, M. E. (2004). The psychology of gratitude. New York:
Oxford University Press2004.
Step 1 Step 2 Step 3 Step 4 Fagley, N. S. (2012). Appreciation uniquely predicts life satisfaction above demographics,
the Big 5 personality factors, and gratitude. Personality and Individual Differerences,
53, 59–63.
β β β β Partial
Harrison, M. O., Koenig, H. G., Hays, J. C., Eme-Akwari, A. G., & Pargament, K. I. (2001).
correlation
The epidemiology of religious coping: A review of recent literature. International
Review of Psychiatry, 13, 86–93.
Religion −1.050 −0.931 − 0.645 − 0.410 − 0.088
Harvey, S. B., Milligan-Saville, J. S., Paterson, H. M., Harkness, E. L., Marsh, A. M.,
GQ-6 −0.367⁎⁎⁎ − 0.228⁎⁎⁎ − 0.135⁎⁎ − 0.178⁎⁎ Dobson, M., et al. (2016). The mental health of fire-fighters: An examination of the
Openness 0.280 0.288 0.038 impact of repeated trauma exposure. Australian and New Zealand Journal of Psychiatry,
Conscientiousness − 0.497⁎ − 0.333 − 0.071 50, 649–658.
Neuroticism 0.890⁎⁎⁎ 0.367 0.134 Ho, R. T., Sing, C. Y., Fong, T. C., Au-Yeung, F. S., Law, K. Y., Lee, L. F., et al. (2016).
Extraversion − 0.548⁎ − 0.370 − 0.002 Underlying spirituality and mental health: The role of burnout. Journal of
Agreeableness − 0.224 − 0.121 − 0.085 Occupational Health, 58, 66–71.
Anxiety 0.246⁎⁎ 0.119⁎⁎ Hozo, E. R., Sucic, G., & Zaja, I. (2015). Burnout syndrome among educators in pre-school
Depression 0.489⁎⁎⁎ 0.220⁎⁎⁎ institutions. Materia Socio Medica, 27, 399–403.
Adjusted R2 0.006 0.177 0.278 0.377 Jo, I., Lee, S., Sung, G., Kim, M., Lee, S., Park, J., et al. (2017). Relationship between
burnout and PTSD symptoms in firefighters: The moderating effects of a sense of
calling to firefighting. International Archives of Occupational and Environmental
MBI-GS = Maslach Burnout Inventory-General Survey, β: unstandardized regression
Health, 3.
coefficient, R2: percent variance explained by each variable. Kashdan, T. B., Mishra, A., Breen, W. E., & Froh, J. J. (2009). Gender differences in
⁎
P < 0.05. gratitude: Examining appraisals, narratives, the willingness to express emotions, and
⁎⁎
p < 0.01. changes in psychological needs. Journal of Personality, 77, 691–730.
⁎⁎⁎
p < 0.001. Katsavouni, F., Bebetsos, E., Malliou, P., & Beneka, A. (2016). The relationship between
burnout, PTSD symptoms and injuries in firefighters. Occupational Medicine (London),
66, 32–37.
gratitude, on wellbeing have been investigated (Wood et al., 2010). Kim, S. Y., Kim, J. M., Yoo, J. A., Bae, K. Y., Kim, S. W., Yang, S. J., et al. (2010).
These skills do not require specialist expertise and can be readily in- Standardization and validation of Big Five inventory-Korean version (BFI-K) in el-
corporated into existing coping resources. However, previous studies ders. Korean Journal of Biological Psychiatry, 17, 15–25.
Krause, N. (2006). Gratitude toward God, stress, and health in late life. Research on Aging,
have shown that males tend to devalue gratitude and are less comfor- 28, 163–183.
table expressing the emotion than are females (Kashdan, Mishra, Breen, Kwon, S. J., Kim, K. H., & Lee, H. S. (2006). Validation of the Korean version of gratitude
and Froh, 2009). Given these sex differences, gratitude interventions questionnaire. The Korean Journal of Health Psychology, 11, 177–190.
Lee, J., Shin, C., Ko, Y. H., Lim, J., Joe, S. H., Kim, S., et al. (2012). The reliability and
targeting male-dominated occupations, such as firefighting, may re-
validity studies of the Korean version of the perceived stress scale. Korean Journal of
quire psychoeducation about the benefits of gratitude before im- Psychosomatic Medicine, 20, 127–134.
plementation of the procedure. Lee, J. S., Ahn, Y. S., Jeong, K. S., Chae, J. H., & Choi, K. S. (2014). Resilience buffers the
The primary limitation of our study is the cross-sectional design, impact of traumatic events on the development of PTSD symptoms in firefighters.
Journal of Affective Disorders, 162, 128–133.
which did not allow us to establish causal relationships. Moreover, care Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of
should be taken in generalizing our results to females and individuals in Occupational Behaviour, 2, 99–113.
occupations other than firefighting. Future longitudinal studies are McCrae, R. R., & Costa, P. T. (1987). Validation of the five-factor model of personality
across instruments and observers. Journal of Personality and Social Psychology, 52,
needed to investigate which aspects of gratitude effect perceived stress 81–90.
and burnout in firefighters. Additionally, further research is needed to McCullough, M. E., Emmons, R. A., & Tsang, J. A. (2002). The grateful disposition: A
develop hypothesis regarding the variables in addition to gratitude that conceptual and empirical topography. Journal of Personality and Social Psychology, 82,
112–127.
should be evaluated to determine whether gratitude has a direct or a Meltzer, L. S., & Huckabay, L. M. (2004). Critical care nurses' perceptions of futile care
mediated relationship with perceived stress and burnout. and its effect on burnout. American Journal of Critical Care, 13, 202–208.
In conclusion, our study is the first to show a strong association Ng, M. Y., & Wong, W. S. (2013). The differential effects of gratitude and sleep on psy-
chological distress in patients with chronic pain. Journal of Health Psychology, 18,
between gratitude and subjective stress and burnout in firefighters. Our 263–271.
findings suggest that gratitude-generating interventions may reduce Oh, S. M., Min, K. J., & Park, D. B. (1999). A study on the standardization of the hospital
stress and burnout among males in this profession. anxiety and depression scale for Koreans: A comparison of normal, depressed and
anxious groups. Journal of Korean Neuropsychiatric Association, 38, 289–296.
Rammstedt, B., & John, O. P. (2007). Measuring personality in one minute or less: A 10-
Acknowledgement item short version of the Big Five Inventory in English and German. Journal of
Research in Personality, 41, 203–212.
This research was supported by Gwangju Mental Health Shaddock, A. J., Hill, M., & van Limbeek, C. A. H. (1998). Factors associated with burnout
in workers in residential facilities for people with an intellectual disability. Journal of
Commissioin funded by Ministry of Health & Welfare, Republic of Intellectual Developmental Disability, 23, 309–319.
Korea. Shrira, A., Shmotkin, D., Shmotkin, D., Palgi, Y., Soffer, Y., Hamama, R. Y., et al. (2015).
How do meaning in life and positive affect related to adaption to stress? The case of
firefighters following the Mount Carmel Forest fire. The Israel Journal of Psychiatry
References and Related Sciences, 52, 68–70.
Vieselmeyer, J., Holguin, J., & Mezulis, A. (2016). The role of resilience and gratitude in
Ângelo, R. P., & Chambel, M. J. (2015). The reciprocal relationship between work posttraumatic stress and growth following a campus shooting. Psychological Trauma,
characteristics and employee burnout and engagement: A longitudinal study of 9, 62–69.
firefighters. Stress and Health, 31, 106–114. Watkins, P. C., Woodward, K., Stone, T., & Kolts, R. L. (2003). Gratitude and happiness:
Boey, K. W. (1999). Distressed and stress resistant nurses. Issues in Mental Health Nursing, Development of a measure of gratitude and relationships with subjective well-being.
20, 33–54. Social Behavior and Personality, 31, 431–452.
Bühler, K. E., & Land, T. (2004). Burnout and personality in extreme nursing: An em- Wood, A. M., Froh, J. J., & Geraghty, A. W. (2010). Gratitude and well-being: A review
pirical study. Schweizer Archiv für Neurologie und Psychiatrie, 155, 35–42. and theoretical integration. Clinical Psychology Review, 30, 890–905.
Chan, D. W. (2010). Gratitude, gratitude intervention and subjective well-being among Wood, A. M., Joseph, S., & Linley, P. A. (2007). Coping style as a psychological resource
Chinese school teachers in Hong Kong. Educational Psychology, 30, 139–153. of grateful people. Journal of Social and Clinical Psychology, 26, 1076–1093.
Cheng, S. T., Tsui, P. K., & Lam, J. H. (2015). Improving mental health in health care Wood, A. M., Joseph, S., & Maltby, J. (2008). Gratitude uniquely predicts satisfaction
practitioners: Randomized controlled trial of a gratitude intervention. Journal of with life: Incremental validity above the domains and facets of the five factor model.
Consulting and Clinical Psychology, 83, 177–186. Personality and Individual Differences, 45, 49–54.
Clark, H. B., Northrop, J. T., & Barkshire, C. T. (1988). The effects of contingent thank you Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta
notes on case managers' visiting residential clients. Education and Treatment of Psychiatrica Scandinavica, 67, 361–370.
Children, 11, 45–51.

208