Impact of Supervisory Support on Turnover Intention: The Mediating Role of Burnout and Job Satisfaction in a Longitudinal Study

  • Sadaaki FukuiEmail author
  • Wei Wu
  • Michelle P. Salyers
Original Article


High rates of provider turnover are problematic for our mental health system. Research indicates that supervisory support could alleviate some turnover intention by decreasing emotional exhaustion (a key component of burnout) as well as by increasing job satisfaction. However, the potential mediation mechanisms have not been rigorously tested. Longitudinal data collected from 195 direct clinical care providers at two community mental health centers identified positive effects of supervisory support on reduced turnover intention through reduced emotional exhaustion. Job satisfaction was not a significant mediator. Supervisory support may help mitigate turnover intention through work-related stress reduction.


Supervision Turnover intention Burnout Job satisfaction Mediation analysis 



The study was supported by Patient-Centered Outcomes Research Institute (Grant No. IH-1304-6597).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. Aarons, G. A., & Sawitzky, A. C. (2006). Organizational climate partially mediates the effect of culture on work attitudes and staff turnover in mental health services. Administration and Policy in Mental Health and Mental Health Services Research, 33(3), 289–301.Google Scholar
  2. Aarons, G. A., Sommerfeld, D. H., Hecht, D. B., Silovsky, J. F., & Chaffin, M. J. (2009). The impact of evidence-based practice implementation and fidelity monitoring on staff turnover: Evidence for a protective effect. Journal of Consulting and Clinical Psychology, 77(2), 270.Google Scholar
  3. Beidas, R. S., Marcus, S., Wolk, C. B., Powell, B., Aarons, G. A., Evans, A. C., … Babbar, S. (2016). A prospective examination of clinician and supervisor turnover within the context of implementation of evidence-based practices in a publicly-funded mental health system. Administration and Policy in Mental Health and Mental Health Services Research, 43(5), 640–649.Google Scholar
  4. Ben-Dror, R. (1994). Employee turnover in community mental health organization: A developmental stages study. Community Mental Health Journal, 30(3), 243–257.Google Scholar
  5. Bond, G. R., & Drake, R. E. (2017). New directions for psychiatric rehabilitation in the USA. Epidemiology and Psychiatric Sciences, 26(3), 223–227.Google Scholar
  6. Brandt, W. A., Bielitz, C. J., & Georgi, A. (2016). The impact of staff turnover and staff density on treatment quality in a psychiatric clinic. Frontiers in Psychology, 7, 457.Google Scholar
  7. Broome, K. M., Knight, D. K., Edwards, J. R., & Flynn, P. M. (2009). Leadership, burnout, and job satisfaction in outpatient drug-free treatment programs. Journal of Substance Abuse Treatment, 37(2), 160–170.Google Scholar
  8. Bukach, A. M., Ejaz, F. K., Dawson, N., & Gitter, R. J. (2015). Turnover among community mental health workers in Ohio. Administration and Policy in Mental Health and Mental Health Services Research. Scholar
  9. Carlson, L., Rapp, C., & Eichler, M. (2012). The experts rate: Supervisory behaviors that impact the implementation of evidence-based practices. Community Mental Health Journal, 48, 179–186.Google Scholar
  10. Cheong, J., MacKinnon, D. P., & Khoo, S.-T. (2003). Investigation of mediational processes using latent growth curve modeling. Structural Equation Modeling, 10, 238–262.Google Scholar
  11. Cho, Y. J., & Song, H. J. (2017). Determinants of turnover intention of social workers: Effects of emotional labor and organizational trust. Public Personnel Management, 46(1), 41–65.Google Scholar
  12. Cohen, G., Blake, R. S., & Goodman, D. (2016). Does turnover intention matter? Evaluating the usefulness of turnover intention rate as a predictor of actual turnover rate. Review of Public Personnel Administration, 36(3), 240–263.Google Scholar
  13. Coomber, B., & Barriball, K. L. (2007). Impact of job satisfaction components on intent to leave and turnover for hospital-based nurses: A review of the research literature. International Journal of Nursing Studies, 44(2), 297–314.Google Scholar
  14. Dilonardo, J. (2011). Workforce issues in integrated behavioral healthcare: A background paper. Unpublished paper, National Council for Community Behavioral Healthcare.Google Scholar
  15. Eby, L. T., Burk, H., & Maher, C. P. (2010). How serious of a problem is staff turnover in substance abuse treatment? A longitudinal study of actual turnover. Journal of Substance Abuse Treatment, 39(3), 264–271.Google Scholar
  16. Eisenberger, R., Stinglhamber, F., Vandenberghe, C., Sucharski, I. L., & Rhoades, L. (2002). Perceived supervisor support: Contributions to perceived organizational support and employee retention. Journal of Applied Psychology, 87(3), 565.Google Scholar
  17. Enders, C. K. (2010). Applied missing data analysis. New York: Guilford Press.Google Scholar
  18. Evans, S., Huxley, P., Gately, C., Webber, M., Mears, A., Pajak, S., … Katona, C. (2006). Mental health, burnout and job satisfaction among mental health social workers in England and Wales. The British Journal of Psychiatry, 188(1), 75–80.Google Scholar
  19. Fritz, M. S., & MacKinnon, D. P. (2007). Required sample size to detect the mediated effect. Psychological Science, 18(3), 233–239.Google Scholar
  20. Fukui, S., Rapp, C. A., Goscha, R., Marty, D., & Ezell, M. (2014). The perceptions of supervisory support scale. Administration and Policy in Mental Health and Mental Health Services Research, 41(3), 353–359.Google Scholar
  21. Gabel Shemueli, R., Dolan, S. L., Suárez Ceretti, A., & Nuñez del Prado, P. (2016). Burnout and engagement as mediators in the relationship between work characteristics and turnover intentions across two Ibero-American nations. Stress and Health, 32(5), 597–606.Google Scholar
  22. Garner, B. R., & Hunter, B. D. (2014). Predictors of staff turnover and turnover intentions within addiction treatment settings: Change over time matters. Substance Abuse: Research and Treatment. Scholar
  23. Glisson, C., & Durick, M. (1988). Predictors of job satisfaction and organizational commitment in human service organizations. Administrative Science Quarterly. 33, 61–81.Google Scholar
  24. Green, A. E., Miller, E. A., & Aarons, G. A. (2013). Transformational leadership moderates the relationship between emotional exhaustion and turnover intention among community mental health providers. Community Mental Health Journal, 49(4), 373–379.Google Scholar
  25. Hawkins, A. J., Amato, P. R., & Kinghorn, A. (2013). Are government-supported healthy marriage initiatives affecting family demographics? A state-level analysis. Family Relations, 62(3), 501–513.Google Scholar
  26. Hoge, M., Morris, J., Daniels, A., Stuart, G., Huey, L., & Adams, N. (2007). An action plan on behavioral health workforce development. Rockville: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration.Google Scholar
  27. Hoge, M. A., Migdole, S., Cannata, E., & Powell, D. J. (2014). Strengthening supervision in systems of care: Exemplary practices in empirically supported treatments. Clinical Social Work Journal, 42(2), 171–181.Google Scholar
  28. Holtom, B. C., & Burch, T. C. (2016). A model of turnover-based disruption in customer services. Human Resource Management Review, 26(1), 25–36.Google Scholar
  29. Holtom, B. C., Mitchell, T. R., Lee, T. W., & Eberly, M. B. (2008). 5 turnover and retention research: A glance at the past, a closer review of the present, and a venture into the future. Academy of Management Annals, 2(1), 231–274.Google Scholar
  30. Holtom, B. C., Mitchell, T. R., Lee, T. W., & Inderrieden, E. J. (2005). Shocks as causes of turnover: What they are and how organizations can manage them. Human Resource Management, 44(3), 337–352.Google Scholar
  31. Hom, P. W., Lee, T. W., Shaw, J. D., & Hausknecht, J. P. (2017). One hundred years of employee turnover theory and research. Journal of Applied Psychology, 102(3), 530.Google Scholar
  32. Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55.Google Scholar
  33. Hyrkäs, K., Appelqvist-Schmidlechner, K., & Haataja, R. (2006). Efficacy of clinical supervision: Influence on job satisfaction, burnout and quality of care. Journal of Advanced Nursing, 55(4), 521–535.Google Scholar
  34. Jayaratne, S., & Chess, W. A. (1984). Job satisfaction, burnout, and turnover: A national study. Social Work, 29(5), 448–453.Google Scholar
  35. Kadushin, A., & Harkness, D. (2014). Supervision in social work. New York: Columbia University Press.Google Scholar
  36. Kilminster, S. M., & Jolly, B. C. (2000). Effective supervision in clinical practice settings: A literature review. Medical Education, 34(10), 827–840.Google Scholar
  37. Kim, H., & Lee, S. Y. (2009). Supervisory communication, burnout, and turnover intention among social workers in health care settings. Social Work in Health Care, 48(4), 364–385.Google Scholar
  38. Knight, D. K., Becan, J. E., & Flynn, P. M. (2012). Organizational consequences of staff turnover in outpatient substance abuse treatment programs. Journal of Substance Abuse Treatment, 42(2), 143–150.Google Scholar
  39. Knight, D. K., Becan, J. E., & Flynn, P. M. (2013). The impact of staff turnover on workplace demands and coworker relationships. Counselor (Deerfield Beach, Fla.), 14(3), 20.Google Scholar
  40. Knudsen, H. K., Ducharme, L. J., & Roman, P. M. (2008). Clinical supervision, emotional exhaustion, and turnover intention: A study of substance abuse treatment counselors in the Clinical Trials Network of the National Institute on Drug Abuse. Journal of Substance Abuse Treatment, 35(4), 387–395.Google Scholar
  41. Landsman, M. J. (2001). Commitment in public child welfare. Social Service Review, 75(3), 386–419.Google Scholar
  42. Leiter, M. P., & Maslach, C. (2009). Nurse turnover: The mediating role of burnout. Journal of Nursing Management, 17(3), 331–339.Google Scholar
  43. Little, R. J. A. (2009). Selection and pattern-mixture models. In G. Fitzmaurice, M. Davidian, G. Verbeke & G. Monlenberghs (Eds.), Longitudinal data analysis (pp. 409–431). Boca Raton: Chapman & Hall/CRC.Google Scholar
  44. Locke, E. A. (1969). What is job satisfaction? Organizational Behavior and Human Performance, 4(4), 309–336.Google Scholar
  45. Luther, L., Gearhart, T., Fukui, S., Morse, G., Rollins, A. L., & Salyers, M. P. (2017). Working overtime in community mental health: Associations with clinician burnout and perceived quality of care. Psychiatric Rehabilitation Journal, 40(2), 252–259.Google Scholar
  46. MacKinnon, D. P. (2008). Introduction to statistical mediation analysis. New York: Lawrence Erlbaum.Google Scholar
  47. MacKinnon, D. P., Lockwood, C. M., & Williams, J. (2004). Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivariate Behavioral Research, 39(1), 99–128.Google Scholar
  48. Martin, U., & Schinke, S. P. (1998). Organizational and individual factors influencing job satisfaction and burnout of mental health workers. Social Work in Health Care, 28(2), 51–62.Google Scholar
  49. Maslach, C., & Jackson, S. E. (1984). Burnout in organizational settings. In S. Oskamp (Ed.), Applied social psychology annual: Applications in organizational settings (Vol. 5, pp. 133–153). Beverly Hills: Sage.Google Scholar
  50. Maslach, C., Jackson, S. E., & Leiter, M. P. (1996). Maslach burnout inventory manual (3rd ed.). Palo Alto: Consulting Psychologists Press.Google Scholar
  51. Maxwell, S. E., & Cole, D. A. (2007). Bias in cross-sectional analyses of longitudinal mediation. Psychological Methods, 12(1), 23.Google Scholar
  52. McEvoy, G. M., & Cascio, W. F. (1987). Do good or poor performers leave? A meta-analysis of the relationship between performance and turnover. Academy of Management Journal, 30(4), 744–762.Google Scholar
  53. Miller, W. R., & Rollnick, S. (2002). Preparing people for change. Motivational interviewing (2nd ed.). New York: Guilford Press.Google Scholar
  54. Moeller, J., Ivcevic, Z., White, A. E., Menges, J. I., & Brackett, M. A. (2018). Highly engaged but burned out: Intra-individual profiles in the US workforce. Career Development International, 23(1), 86–105.Google Scholar
  55. Morazes, J. L., Benton, A. D., Clark, S. J., & Jacquet, S. E. (2010). Views of specially-trained child welfare social workers: A qualitative study of their motivations, perceptions, and retention. Qualitative Social Work, 9(2), 227–247.Google Scholar
  56. Morse, G., Salyers, M. P., Rollins, A. L., Monroe-DeVita, M., & Pfahler, C. (2012). Burnout in mental health services: A review of the problem and its remediation. Administration and Policy in Mental Health and Mental Health Services Research, 39(5), 341–352.Google Scholar
  57. Muthén, L. K., & Muthén, B. O. (1998–2017). Mplus user’s guide (8th ed.). Los Angeles: Muthén & Muthén.Google Scholar
  58. Nagy, M. S. (2002). Using a single-item approach to measure facet job satisfaction. Journal of Occupational and Organizational Psychology, 75, 77–86.Google Scholar
  59. O’Donoghue, K., & Tsui, M. S. (2013). Social work supervision research (1970–2010): The way we were and the way ahead. The British Journal of Social Work, 45(2), 616–633.Google Scholar
  60. Ogresta, J., Rusac, S., & Zorec, L. (2008). Relation between burnout syndrome and job satisfaction among mental health workers. Croatian Medical Journal, 49(3), 364–374.Google Scholar
  61. Paris, M., & Hoge, M. A. (2010). Burnout in the mental health workforce: A review. The Journal of Behavioral Health Services & Research, 37(4), 519–528.Google Scholar
  62. Poghosyan, L., Clarke, S. P., Finlayson, M., & Aiken, L. H. (2010). Nurse burnout and quality of care: Cross-national investigation in six countries. Research in Nursing & Health, 33(4), 288–298.Google Scholar
  63. Pritschet, L., Powell, D., & Horne, Z. (2016). Marginally significant effects as evidence for hypotheses: Changing attitudes over four decades. Psychological Science, 27(7), 1036–1042.Google Scholar
  64. Rollins, A. L., Kukla, M., Morse, G., Davis, L., Leiter, M., Monroe-DeVita, M., … Collins, L. (2016). Comparative effectiveness of a burnout reduction intervention for behavioral health providers. Psychiatric Services, 67(8), 920–923.Google Scholar
  65. Rollins, A. L., Salyers, M. P., Tsai, J., & Lydick, J. M. (2010). Staff turnover in statewide implementation of ACT: Relationship with ACT fidelity and other team characteristics. Administration and Policy in Mental Health and Mental Health Services Research, 37(5), 417–426.Google Scholar
  66. Salyers, M. P., Bonfils, K. A., Luther, L., Firmin, R. L., White, D. A., Adams, E. L., & Rollins, A. L. (2016). The relationship between professional burnout and quality and safety in healthcare: A meta-analysis. Journal of General Internal Medicine. Scholar
  67. Salyers, M. P., Fukui, S., Rollins, A. L., Firmin, R., Gearhart, T., Noll, J. P., … Davis, C. J. (2015). Burnout and self-reported quality of care in community mental health. Administration and Policy in Mental Health and Mental Health Services Research, 42, 61–69.Google Scholar
  68. Salyers, M. P., Garabrant, J., Luther, L., Henry, N., Fukui, S., Shimp, D., … Rollins, A. (2019). A comparative effectiveness trial to reduce burnout and improve quality of care. Administration and Policy in Mental Health Services Research, 46(2), 238–254.Google Scholar
  69. Salyers, M. P., Hudson, C., Morse, G., Rollins, A. L., Monroe-DeVita, M., Wilson, C., & Freeland, L. (2011). BREATHE: A pilot study of a one-day retreat to reduce burnout among mental health professionals. Psychiatric Services, 62, 214–217.Google Scholar
  70. Scanlan, J. N., & Still, M. (2013). Job satisfaction, burnout and turnover intention in occupational therapists working in mental health. Australian Occupational Therapy Journal, 60(5), 310–318.Google Scholar
  71. Schumm, W. R., Pratt, K. K., Hartenstein, J. L., Jenkins, B. A., & Johnson, G. A. (2013). Determining statistical significance (alpha) and reporting statistical trends: Controversies, issues, and facts. Comprehensive Psychology. Scholar
  72. Selig, J. P., & Preacher, K. J. (2009). Mediation models for longitudinal data in developmental research. Research in Human Development, 6(2–3), 144–164.Google Scholar
  73. Smith, B. D. (2005). Job retention in child welfare: Effects of perceived organizational support, supervisor support, and intrinsic job value. Children and Youth Services Review, 27(2), 153–169.Google Scholar
  74. Tett, R. P., & Meyer, J. P. (1993). Job satisfaction, organizational commitment, turnover intention, and turnover: Path analyses based on meta-analytic findings. Personnel Psychology, 46(2), 259–293.Google Scholar
  75. Tziner, A., Rabenu, E., Radomski, R., & Belkin, A. (2015). Work stress and turnover intentions among hospital physicians: The mediating role of burnout and work satisfaction. Revista de Psicología del Trabajo y de las Organizaciones, 31(3), 207–213.Google Scholar
  76. Verhaeghe, M., & Bracke, P. (2012). Associative stigma among mental health professionals: Implications for professional and service user well-being. Journal of Health and Social Behavior, 53(1), 17–32.Google Scholar
  77. Wanous, J. P., Reichers, A. E., & Hudy, M. J. (1997). Overall job satisfaction: How good are single-item measures? Journal of Applied Psychology, 82, 247–252.Google Scholar
  78. Wright, T. A., & Bonett, D. G. (1992). The effect of turnover on work satisfaction and mental health: Support for a situational perspective. Journal of Organizational Behavior, 13(6), 603–615.Google Scholar
  79. Wright, T. A., & Cropanzano, R. (1998). Emotional exhaustion as a predictor of job performance and voluntary turnover. Journal of Applied Psychology, 83(3), 486.Google Scholar
  80. Wu, W., & Jia, F. (2013). A new procedure to test mediation with missing data through nonparametric bootstrapping and multiple imputation. Multivariate Behavioral Research, 48(5), 663–691.Google Scholar
  81. Wu, W., Selig, J. N., & Little, T. D. (2013). Longitudinal data analysis. In T. D. Little (Ed.), Handbook of quantitative methods. Oxford: Oxford University Press.Google Scholar
  82. Yanchus, N. J., Periard, D., Moore, S. C., Carle, A. C., & Osatuke, K. (2015). Predictors of job satisfaction and turnover intention in VHA mental health employees: A comparison between psychiatrists, psychologists, social workers, and mental health nurses. Human Service Organizations: Management, Leadership & Governance, 39(3), 219–244.Google Scholar
  83. Yanchus, N. J., Periard, D., & Osatuke, K. (2017). Further examination of predictors of turnover intention among mental health professionals. Journal of Psychiatric and Mental Health Nursing, 24(1), 41–56.Google Scholar
  84. Yanos, P. T., Vayshenker, B., DeLuca, J. S., & O’Connor, L. K. (2017). Development and validation of a scale assessing mental health clinicians’ experiences of associative stigma. Psychiatric Services, 68(10), 1053–1060.Google Scholar
  85. Zhang, Y., & Feng, X. (2011). The relationship between job satisfaction, burnout, and turnover intention among physicians from urban state-owned medical institutions in Hubei, China: A cross-sectional study. BMC Health Services Research, 11(1), 235.Google Scholar

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Authors and Affiliations

  1. 1.Indiana University School of Social WorkIndianapolisUSA
  2. 2.Department of PsychologyIndiana University-Purdue University IndianapolisIndianapolisUSA
  3. 3.Department of PsychologyIndiana University-Purdue University IndianapolisIndianapolisUSA

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