Emotional Blackmail and Depression Among Taiwanese Nurses: A Cross-Sectional Study Using the Stress Process Model With Coping Strategies as Mediator and Social Support as Moderator

Abstract

Introduction: Emotional blackmail is a persistent workplace stressor that can negatively influence nurses' psychological well-being.

Aims: The present study examined the relationship between emotional blackmail and depression among Taiwanese nurses, incorporating the Stress Process Model (SPM) to explore the mediating role of coping strategies and the moderating effect of social support.

Methods: A cross-sectional survey was conducted with 297 nurses at a regional hospital in Taiwan. Self-reported questionnaires were used to assess emotional blackmail, coping strategies, social support, and depressive symptoms. Data analyses included correlation, mediation, and moderation models.

Results: Among 297 nurses, negative emotional blackmail was indirectly associated with depression through negative coping (B = 0.09, 95% CI [0.03, 0.16]), while positive emotional blackmail showed a direct inverse association with depression (B = -1.11, 95% CI [-2.17, -0.45]). Social support was directly associated with lower depression (B = -0.33, 95% CI [-0.47, -0.18]) and moderated the association between positive emotional blackmail and depression (B = 0.01, 95% CI [0.002, 0.02]). However, in the negative emotional blackmail model, social support had a marginal direct association with depression (B = -0.14, 95% CI [-0.31, 0.02]) but did not moderate the association between passive emotional blackmail and depression.

Discussion: Coping strategies and social support significantly influence how emotional blackmail affects nurses' mental health. The findings partially support the SPM, suggesting its contextual relevance.

Limitations: Single-site design and self-reported data may limit generalisability and introduce bias.

Implications: Mental health interventions in nursing must consider contextual and interpersonal dynamics of stress.

Recommendations: Tailored support systems and coping-skills training are essential, as social support may not uniformly buffer stress.

Reporting method: The study followed STROBE guidelines for cross-sectional studies.

Relevance statement: The present study addresses an underexplored workplace issue-emotional blackmail-and its impact on nurses' mental health. Using the Stress Process Model, it highlights how coping and social support influence outcomes. Findings support the development of targeted interventions such as coping-skills training and context-specific support. This research informs mental health nurses and managers on recognizing and addressing subtle interpersonal stressors that affect staff well-being in clinical settings.

Keywords: coping strategies; depression; emotional blackmail; nurses; occupational stress; social support; stress process model.