Toxic Leadership and Employee Outcomes Among Mental Health Nurses: Examining the Associations with Psychological Distress, Somatic Symptoms, and Organizational Citizenship Behavior Through Structural Equation Modeling.

Background: Mental health nurses work in high-pressure environments where leadership styles strongly influence well-being and job performance. Toxic leadership, including abusive and authoritarian behaviors, can contribute to psychological distress, somatic symptoms, reduced job satisfaction, and lower organizational effectiveness. It may also decrease Organizational Citizenship Behavior (OCB), which reflects voluntary positive workplace behaviors. Intrinsic motivation may help buffer these negative effects by enhancing employees' internal drive and resilience. Therefore, this study examines the associations between toxic leadership, psychological distress, somatic symptoms, and organizational citizenship behavior among mental health nurses while exploring the potential role of intrinsic motivation. Methods: This descriptive-correlational study, based on Structural Equation Modeling (SEM), was conducted at the Psychiatric Inpatient Department of Mansoura University Hospital. A total of 117 mental health nurses were recruited through simple random samplings. Data were collected using four standardized tools: the Toxic Leadership Scale, the Brief Symptom Inventory (BSI), the Intrinsic Motivation Inventory (IMI), and the Organizational Citizenship Behavior (OCB) Scale, starting from the end of May and completed by the end of June 2024. Data analysis was conducted using IBM SPSS 22 and AMOS 22, employing descriptive statistics, Pearson's correlations, independent t-tests, and Structural Equation Modeling (SEM). Results: Toxic leadership was positively associated with psychological distress (β = 0.46, p < 0.001). Psychological distress was strongly associated with somatic symptoms (β = 0.99, p < 0.001). Intrinsic motivation was positively associated with organizational citizenship behavior (β = 0.31, p < 0.001). However, intrinsic motivation was not significantly associated with psychological distress or somatic symptoms, and no significant direct association was observed between toxic leadership and organizational citizenship behavior. Conclusions: Toxic leadership was significantly associated with higher levels of psychological distress among mental health nurses, while psychological distress was strongly associated with somatic symptoms. Intrinsic motivation was positively associated with organizational citizenship behavior. However, the hypothesized mediating role of intrinsic motivation was not supported by the structural model. These findings highlight the importance of addressing toxic leadership and promoting supportive workplace environments to enhance nurses' well-being and organizational outcomes. Relevance for Clinical Practice: Addressing toxic leadership is essential for enhancing nurses' well-being and organizational outcomes. Interventions targeting leadership behaviors and promoting supportive workplace environments may help reduce psychological distress and its associated somatic symptoms among mental health nurses. In addition, creating workplace conditions that support intrinsic motivation may encourage organizational citizenship behavior and professional engagement, ultimately benefiting clinical practice and patient care quality.