How Gratitude Shapes Positive Mental Health in Nurses: Uncovering the Mediating Roles of Self-Acceptance and Stress Control Beliefs

This study examined the association between gratitude and positive mental health among nurses and tested whether self-acceptance and control beliefs about stress mediate this relationship. A total of 1,523 registered nurses in China completed validated measures of gratitude, self-acceptance, control beliefs about stress, and positive mental health. Multiple mediation was analysed in SPSS 26.0 using Hayes’ PROCESS macro (Model 6), controlling for demographic variables. Results indicated that gratitude was positively associated with positive mental health (r = .455, p < .001), self-acceptance (r = .549, p < .001), and control beliefs about stress (r = .382, p < .001). Both self-acceptance and control beliefs significantly mediated the gratitude–positive mental health link. The indirect effect via self-acceptance was strongest (β = .320), followed by control beliefs (β = .082); the serial indirect effect through both mediators was also significant (β = .040). When the mediators were included, the direct effect of gratitude on positive mental health became non-significant, consistent with full mediation. These findings underscore gratitude as a psychological resource in nursing and highlight self-acceptance and control beliefs about stress as key mechanisms to target in interventions aimed at enhancing resilience and mental well-being.