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Aavaan adverse personal outcomes Aldag Angeles County associated behavior boundary position categorical variables CES-D scores clinical conflict and ambiguity conflict and role conflicting expectations Continuous Demographic Variables coping strategies defined depressive symptom groups depressive symptomatology DEPRESSIVE SYMPTOMS CES-D Director of Nursing effects evaluation factor analysis FTEs high depressive symptom high symptom group hospital identified included individuals institution size factor job satisfaction job stressor Journal Kahn level nurse administrators low and high low symptom group major measure mediating mediating variables nursing service administrators nursing staff oo oo organization overload stressor P-value potential present position probed problems professional quality concern stressor quality of patient questionnaires Rizzo role ambiguity role senders role set diversity role strain role stress role theory sample scale Scalzi Schuler social support network somatic stage subjects survey top level nurse values Weissman