The association between rotating shift work and increased occupational stress in nurses

Risk factors for anxiety, depression, stress, and their comorbidities among nurses: a prospective cohort from 2020 to 2022

BACKGROUND

Nurses are at the forefront of healthcare delivery during the COVID-19, placing them at an increased risk for mental health issues. This study aimed to identify the risk factors for anxiety, depression, stress, and their comorbidities among nurses during the 2020-2022 period.

METHODS

A prospective cohort of nurses in Zunyi City, China, was followed from 2020 to 2022. The Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Perceived Stress Scale (PSS) were used to assess anxiety, depression, and stress, respectively. A self-reported questionnaire was utilized to collect data on demographic characteristics, lifestyle habits, socioeconomic status, work-related factors, and medical history. The Healthy Eating Index (HEI) was calculated to evaluate diet quality. Univariate and multivariate logistic regression analyses were conducted to examine the associations between risk factors and mental health outcomes.

RESULTS

Among the 516 participating nurses, the incidence rates of new-onset anxiety, depression, and stress were 27.1%, 33.9%, and 39.9%, respectively. Frontline experience with infected patients, night shift work, longer working hours, and higher body mass index were consistently associated with increased risks of anxiety, depression, and stress, whereas a higher healthy eating index score was linked to reduced odds of these mental health outcomes. Notably, higher BMI (≥ 28: OR = 1.67, 95% CI: 1.12-2.16, p = 0.011), night shifts (> 1/week: OR = 5.12, 95% CI: 3.64-5.99, p < 0.001), longer working hours (> 40/week: OR = 1.99, 95% CI: 1.66-2.89, p < 0.001), and frontline experience (OR = 6.11, 95% CI: 4.52-8.88, p < 0.001) significantly increased comorbidity risk, while higher HEI (> 3: OR = 0.51, 95% CI: 0.36-0.70, p < 0.001) reduced the risk.

CONCLUSION

Our study highlights the considerable mental health burden among nurses during the 2020-2022 period and identifies key risk factors associated with anxiety, depression, stress, and their comorbidities. These findings underscore the importance of providing targeted interventions and support for nurses, including workload management, work-life balance promotion, and healthy lifestyle encouragement, to mitigate the negative consequences of identified risk factors and improve mental health outcomes.

Effect of shift work on dietary habits and occupational stress among nurses in a tertiary care centre: An observational study

Introduction

Shift work comprises work hours other than 9 am to 5 pm. Healthcare jobs such as nursing have been associated with shift work, which can affect their overall health status. Due to excessive workload and instability in working hours, nurses are also prone to higher occupational stress.

Materials and Methods

A descriptive study, Cornell Medical Index (CMI) questionnaire, 24-h recall method, and occupational stress score (OSS) were used to assess overall health, calorie intake, and occupational stress among nurses working in a tertiary care centre in Central India.

Results

The mean age of participants in the control and study groups was 43.2 ± 6.059 years and 43.93 ± 5.20 years, respectively. Neither of the group's participants had poor nutritional status. CMI health scores revealed poor mental health among the study group. Severe occupational stress was observed in 57% of participants, and 33% had moderate occupational stress. Among the causes of occupational stress, 92% cited unfavourable work conditions, and 88% pointed out the workload. Poor peer relations and low status were cited by 77% and 57% of participants.

Conclusion

This study highlights the harmful effects of shift work on health of nurses. These negative effects are usually linked to poor diet and stress, which can be induced by overwork, poor sleep, or both. This study found that high workload is the main cause of occupational stress. Sleep disruption, lack of exercise and excess work load are major contributors for occupational stress and unhealthy eating habits. More awareness regarding importance of good diet and stress management may aid in improving health of nurses working in shifts.

General work stress and suicide cognitions in health-care workers: mediating effect of hopelessness and job satisfaction

Individuals with a satisfactory level of job satisfaction are much less likely to feel hopeless about their future and are more likely to perform efficiently in the workplace. General work stress (i.e., the work-related stress subjectively experienced) is a significant predictor of suicide cognitions. Furthermore, it has been posited that satisfaction and hope are fundamental to life from an existential perspective. We, therefore, tested a hypothetical model of general work stress, suicide cognitions, hopelessness, and job satisfaction. The data were collected from 416 health-care workers through a convenience sampling method. The mediation analysis results revealed significant negative and positive relationships among general work stress, suicide conceptions, hopelessness, and job satisfaction. The findings indicate that hopelessness and job satisfaction have a parallel mediating effect in the relationship between general work stress and suicide cognitions. The result of the study is of great importance, which suggests that interventions to alleviate hopelessness and work stress and to boost the job satisfaction of medical staff may help prevent suicide cognitions.

Spiritual Intelligence as a Coping Strategy to Manage Job Stress for Midwives in Northern Iran: A Cross-Sectional Study

This study aimed to explore whether spiritual intelligence could help midwives cope with job-related stress. A cross-sectional study was done with 143 midwives in Babol, Iran. The sampling method was non-random and convenience samples were used. Amram and Dreyer's spiritual intelligence and health and safety executive occupational stress questionnaires were used. The response rate of subjects was 90.51%. Results showed that the most predictors of job stress were total spiritual intelligence (β = 0.507, p = 0.001) and the ratio of midwives to patients on the night shift (β =  - 0.224, p = 0.033). High levels of spiritual intelligence were associated with a low level of stress, which could help midwives adapt to job-related challenges.

Influence of Shift Work on The Health of Nursing Professionals

Shift work is increasingly common in health services, subjecting healthcare professionals to work schedules that can alter circadian rhythms and eating habits with consequent repercussions for the intestinal homeostasis. The objective of this study was to describe the relationship of rotating work shifts with the intestinal health, sleep quality, and emotional dimension of nursing professionals. In March and May 2019, an observational and comparative study was conducted among 380 nursing professionals from different Spanish cities and divided into fixed shift (n = 159) and rotating shift (n = 221). To carry out the present work, the variables measured were gastrointestinal symptoms, stool consistency and shape, anxiety, depression, sleep, as well as stress and work environment. Nurses with rotating shifts reported more abdominal pain and symptoms of depersonalization, as well as worse sleep efficiency and worse nursing practice environment. In addition, overall scores of the Gastrointestinal Symptom Rating Scale and Hospital Anxiety and Depression Scale were found to be significantly worse in nurses with these shifts. Rotating shift work by nursing staff may be associated with the occurrence of gastrointestinal and anxiety-related symptoms. These findings, together with the presence of negative and insensitive attitudes towards patients by nurses on rotating shifts, should be considered to maintain the quality of healthcare.

Sequence analysis of the combinations of work shifts and absences in health care - comparison of two years of administrative data

BACKGROUND

In health care, the shift work is arranged as irregular work shifts to provide operational hours for 24/7 care. We aimed to investigate working hour trends and turnover in health care via identification of time-related sequences of work shifts and absences among health care employees. The transitions between the work shifts (i.e., morning, day, evening, and night shifts), and absences (days off and other leaves) over time were analyzed and the predictors of change in irregular shift work were quantified.

METHODS

A longitudinal cohort study was conducted using employer-owned payroll-based register data of objective and day-to-day working hours and absences of one hospital district in Finland from 2014 to 2019 (n = 4931 employees). The working hour data included start and end of work shifts, any kind of absence from work (days off, sickness absence, parental leave), and employee's age, and sex. Daily work shifts and absences in 2014 and 2019 were used in sequence analysis. Generalized linear model was used to estimate how each identified sequence cluster was associated with sex and age.

RESULTS

We identified four sequence clusters: "Morning" (60% in 2014 and 56% in 2019), "Varying shift types" (22% both in 2014 and 2019), "Employee turnover" (13% in 2014 and 3% in 2019), and "Unstable employment (5% in 2014 and 19% in 2019). The analysis of transitions from one cluster to another between 2014 and 2019 indicated that most employees stayed in the same clusters, and most often in the "Varying shift types" (60%) and "Morning" (72%) clusters. The majority of those who moved, moved to the cluster "Morning" in 2019 from "Employee turnover" (43%), "Unstable employment" (46%) or "Varying shift types" (21%). Women were more often than men in the clusters "Employee turnover" and "Unstable employment", whereas older employees were more often in "Morning" and less often in the other cluster groups.

CONCLUSION

Four clusters with different combinations of work shifts and absences were identified. The transition rates between work shifts and absences with five years in between indicated that most employees stayed in the same clusters. The likelihood of a working hour pattern characterized by "Morning" seems to increase with age.

Burnout and coping strategies among nurses in Malaysia: a national-level cross-sectional study

OBJECTIVE

This national-level study aimed to determine the prevalence and risk factors of burnout, as well as the coping strategies among nurses in the Ministry of Health (MOH) Malaysia.

DESIGN

Using a complex sampling design, a two-stage stratified cluster sampling was performed to recruit MOH nurses between August and November 2019.

SETTING AND PARTICIPANTS

A total of 2428 nurses from 32 hospitals and 28 district health offices answered the questionnaires based on Maslach Burnout Inventory for Human Services and Brief COPE. Complex sampling analysis was applied.

OUTCOME MEASURES

The outcome of interest was the prevalence of burnout and its three domains of emotional exhaustion (EE), depersonalisation (DP) and low personal accomplishment. ORs using 95% CIs were calculated. Significant factors at the univariate level were entered into the multivariate logistic regression to identify independent predictors of burnout.

RESULTS

One in four (24.4%) nurses experienced burnout. Younger, single, and childless nurses had a higher prevalence of burnout. Shift working nurses were 1.6 times more likely to develop burnout. Those who performed >6 night shifts per month were 1.5 times more predisposed to burnout (95% CI 1.01 to 2.36; p<0.05). While encountering traumatic events at work led to 4.2 times (95% CI 2.31, 7.63; p<0.05) higher risk of burnout, those who received post-traumatic psychological support were better protected. The use of dysfunctional coping strategies was detrimental as it was positively correlated with EE and DP.

CONCLUSION

Addressing modifiable stressors of burnout at individual and institutional levels identified in this study can be potentially beneficial in reducing burnout and its undesirable effects among nurses. Interventions that promote positive coping strategies should be implemented. Organisational-driven efforts must target the improvement of work schedules for nurses and the establishment of a structured debriefing service for post-trauma counselling.

Job satisfaction and its related factors among emergency department physicians in China

Background

Job satisfaction is recognized as an important factor affecting the performance and quality of medical services of emergency department physicians. However, little is known about the status of job satisfaction among emergency department physicians in China. This study aimed to explore the current level of job satisfaction and its associated factors among emergency department physicians in China.

Methods

A nationwide cross-sectional survey was conducted in China from July to August 2018. A total of 10,457 emergency department physicians completed the questionnaire. The structured online questionnaire collected information on socio-demographic characteristics, work-related factors, work-family conflict, and job satisfaction. Student's t-test or ANOVA were used to compare the job satisfaction scores in different characters. The generalized linear model was used to investigate the related factors of job satisfaction among emergency department physicians.

Results

The respondents' job satisfaction average score was 12.2 ± 3.6, of which 42.01% were satisfied of which the job. The results showed that emergency department physicians over 41 years old, with a higher income and working in central and western regions were positively associated with job satisfaction. In contrast, bachelor degree and above, fixed posts, long years of service, a high frequency of night shift, perceived shortage of physicians, perceived medical errors, and higher work-family conflict scores were negatively correlated with job satisfaction among emergency department physicians.

Conclusion

Job satisfaction of emergency department physicians in China is low. It is suggested that hospital administrators could improve the job satisfaction of emergency department physicians by establishing an acceptable shift system, ensuring adequate emergency department staffing, increasing their income appropriately and alleviating work-family conflict.

Occupational stress in industry setting in Benin 2019: A cross-sectional study

Background

Occupational stress is a psychosocial risk in the workplace. Working conditions in industrial settings may lead to occupational stress. In Benin, however, there is little epidemiological data on occupational stress in industrial settings. We aimed to determine the prevalence and factors associated with occupational stress in industrial settings in Benin in 2019.

Methods

This was a prospective, cross-sectional study conducted from January 31 to April 11, 2019, among 15 cotton ginning plants. Sampling was exhaustive for permanent workers and stratified in clusters by shift for occasional cotton gin workers. Data were collected through Karasek and Siegrist questionnaires. Data analysis was performed using R software. Binary multivariable logistic regression was performed. The significance level was p < 0.05.

Results

Of 1883 workers included, 90.8% were male. The median age was 38 years (IQR: 28 years to 49 years). The prevalence of occupational stress was 77.7% (95% CI: 75.8–79.6). Psychological demand was high in 93.0% of workers and 83.9% had low decision latitude. Among the workers, 16.3% had low social support and 89.9% had a low recognition score at work. Factors associated with occupational stress were: being an occasional vs. permanent worker (aOR 6.43, 95% CI 4.18 to 9.88); age less than 38 years (aOR 0.55, 95% CI 0.41 to 0.76); high intensity physical activity at work (aOR 1.33, 95% CI 1.03 to 1.73); working in production vs. administration (aOR 1.59, 95% CI 1.03 to 2.45); spending fewer than 4 years at the current work location (aOR 1.60, 95% CI 1.05 to 2.44); and scoring low for recognition at work (aOR 1.53, 95% CI 1.04 to 2.23). Noise exposure and being a shift worker were significant in univariable analysis, but not multivariable analysis.

Conclusion

Occupational stress is very common among workers in industrial settings. The implementation and evaluation of preventive measures against these risk factors is necessary.

Use of psychoactive substances by night-shift hospital healthcare workers during the first wave of the COVID-19 pandemic: a cross-sectional study based in Parisian public hospitals (ALADDIN)

OBJECTIVES

This study aimed to estimate the prevalence of psychoactive substance (PAS) use in night-shift healthcare workers (NSHW) during France's first COVID-19 wave (March-May 2020).

DESIGN

Observational cross-sectional online survey.

SETTING

39 public hospitals in the Assitance Publique des Hôpitaux de Paris (AP-HP) network in the Parisian area.

PARTICIPANTS

A total of 1238 nurses, assistant nurses, X-ray technicians, managers, lab technicians, midwives and childcare assistants working at night or alternating between days and nights answered the questionnaire.

INTERVENTION

Online survey.

OUTCOME MEASURES

PAS use prevalence after weighting data for sex, age and profession using calibration on margins, in order to be representative of all AP-HP NSHW. We used the Fagerström scale and the Alcohol Use Disorders Identification Test Concise to assess PAS use.

RESULTS

The weighted estimated prevalences of daily smoking, alcohol drinking and tranquilliser use in participating NSHW were 21.4, 1.3 and 2.4%, respectively. Twelve per cent (11.7%) of our study sample used opioids. During the first COVID-19 wave, PAS use remained stable except for tobacco use, with 8.6% of participants reporting an increase. Previous 3-month prevalences of tranquilliser and opioid use were significantly higher than in the general population.

CONCLUSION

Daily smoking (especially in younger men) and tranquilliser and opioid use were highly prevalent in NSHW in the AP-HP network during France's first COVID-19 wave. Specific interventions for quitting smoking and addressing determinants of tranquilliser and opioid use in NSHW need to be developed and evaluated to improve quality of life in these essential, underdiagnosed and undertreated health personnel.

Effort-Reward Imbalance in Emergency Department Physicians: Prevalence and Associated Factors

Objectives

To examine the prevalence of effort-reward imbalance and explore its associated factors among emergency department physicians in China.

Methods

A cross-sectional survey was conducted in the Chinese emergency department in 2018. A total of 10,457 emergency department physicians completed a structured questionnaire containing demographic characteristics, work-related data, and effort-reward imbalance scale. All the data were analyzed using descriptive analysis and stepwise logistic regression.

Results

The prevalence of effort-reward imbalance was 78.39% among emergency department physicians in China. The results showed that the male emergency department physicians with a bachelor's degree, an intermediate title, long years of service, a high frequency of night shift, and who suffered workplace violence were at a higher risk of effort-reward imbalance. In contrast, physicians with higher monthly income and perceived adequate staff were associated with a lower risk of effort-reward imbalance.

Conclusions

The situation of effort-reward imbalance was serious among emergency department physicians in China. Administrators should pay more attention to key groups and take measures from the perspectives of effort and reward to improve the effort-reward imbalance in emergency department physicians.

Occupational Fatigue and Associated Factors among Saudi Nurses Working 8-Hour Shifts at Public Hospitals

Introduction

Shift work and demanding work schedules contribute to occupational fatigue, negatively affecting patient safety and nurses' well-being, consequently placing nurses and patients at risk for injury and adverse health outcomes. For preventing fatigue and minimizing its negative consequences, information about its characteristics and associated factors is required.

Objectives

This study aimed to assess occupational fatigue "acute fatigue, chronic fatigue, and inter-shift recovery" among Saudi nurses working 8-h shifts. Further, we explored factors associated with fatigue from nurses' perspectives.

Methods

We conducted a mixed-method study with a convenience sample of Saudi nurses (N = 282) working in four public hospitals in Saudi Arabia. Data were collected using the nurses' profile form; the occupational fatigue exhaustion recovery (OFER) scale, for relevant quantitative data; and open-ended questions for qualitative data. We used descriptive and inferential statistics for analysing the quantitative data and content analysis of the qualitative data.

Results

The results showed that Saudi nurses rated themselves moderately fatigued with working 8-h shifts. The inter-shift recovery subscale showed a negative correlation with chronic fatigue and acute fatigue (r = -0.518, r = -0.356, P < 0.001). Sleeping problems, meals per day, and frequency of exercise showed significant relations with chronic fatigue among nurses (p < 0.05). In addition, three categories were derived from the qualitative content analysis. Saudi nurses reported work-related, psychosocial, and individual factors as major contributors to fatigue and recovery.

Conclusion

Occupational fatigue is a multidimensional issue, and nurses and nurse managers are challenged with reducing its prevalence and negative impact on nurses and patients. Our quantitative and qualitative findings suggest the need for a comprehensive approach to fatigue management and mitigation, including organizational support, creative workforce planning, flexible work schedules, and psychosocial support. Fatigue reduction and prevention policies and educational programs are vital strategies to improve nurses' well-being and inter-shift recovery.

Influence of sleep difficulty on post-traumatic stress symptoms among frontline medical staff during COVID-19 pandemic in China

Being a nurse was demonstrated to be a risk factor for post-traumatic stress symptoms (PTS) and insomnia among frontline staff during COVID-19 pandemic. The unidirectional relationship between insomnia and PTS highly suggested that insomnia could mediate the increasing risk of PTS among frontline nurses. However, no study had tried to clarify this mediation effect of insomnia during COVID-19 pandemic. This study aimed to investigate prevalence of insomnia and PTS among frontline doctors and nurses and to clarify the relationship between career (doctor/nurses), insomnia and PTS. A total of 211 frontline doctors and nurses completed the investigation. Insomnia was measured using a self-drafted questionnaire and PTS was assessed using primary care post-traumatic stress disorder screen (PC-PTSD). Three logistics regression models and one mediation model were performed to explore relationships between career, insomnia and PTS. The prevalence of PTS (PC-PTSD≥2) and insomnia (with 1 item in self-drafted insomnia questionnaire≥2) was 24.17% and 36.97%, respectively. Being a nurse was a shared risk factor of insomnia (OR = 4.16, 95%CI: 1.30 ~ 5.77, P = 0.023) and PTS (OR = 7.51, 95%CI: 1.89 ~ 40.50, P = 0.008). Compared to doctors, nurses had significantly higher prevalence of insomnia (46.32% vs. 20%, χ² = 13.27, P < 0.001) and PTS (30.14% vs. 13.33%, χ² = 6.57, P = 0.011). Insomnia was a significant partial mediator (B = 0.101, P = 0.026), which explained 32.53% proportions of relationship between being a nurse and PTS. PTS and insomnia were common symptoms, which should be considered in psychological aids among frontline medical staff. Insomnia might be a possible target of PTS intervention.

Association of shift work with cardiovascular disease risk among Chinese workers

To evaluate the association of shift work with 10-year cardiovascular disease (CVD) risk among Chinese workers. We included 23,064 workers in the first follow-up of the Dongfeng-Tongji cohort study. Questionnaires and physical examinations were conducted to collect data for all participants. Framingham Risk Score was calculated according to the multivariable risk algorithms, and used to evaluate 10-year CVD risk. Logistic regression models were used to assess the relationship between shift work and 10-year CVD risk. Among 23,064 individuals, 51.92% of workers suffered shift work, and the proportions of shift work duration of 1-<10, 10-<20, and ≥20 years were 17.29%, 17.35% and 17.30%, respectively. Compared with individuals without a shift work history, the odds ratios (ORs) and 95% confidence intervals (CIs) of 10-year CVD were 1.027 (0.900-1.173), 1.058 (0.927-1.206) and 1.191 (1.036-1.368) for individuals with shift work duration of 1-<10 years, 10-<20 years, and ≥20 years, respectively, after adjusting for potential confounders. And the association was more obvious in males. When shift work and obesity were combined, the OR (95%CI) of high 10-year CVD risk (3.373, 2.390-4.761) was significantly increased for obese individuals with shift work of ≥20 years. Besides, the OR (95%CI) for higher 10-year CVD risk associated with shift work decreased as the leaving shift work duration prolonged. Shift work is associated with a higher 10-year CVD risk, especially among males. Obesity has a synergistic effect on such association while leaving shift work reduces such association.

Predictors of Effort-Reward Imbalance Among Employees Providing Three Types of Long-Term Care Services in Japan: Implications for Employee Well-Being

The purpose of this study was to identify predictive factors of effort-reward imbalance (ERI) among employees in multiple long-term care settings in Japan. This cross-sectional study by convenience sampling included 944 participants providing three types of long-term care: home-based (n = 201), community-based (n = 128), and institutional (n = 615). Multiple logistic regression analysis was used to identify factors associated with self-reported ERI. Low job satisfaction, being a care manager, holding a position of department head, working long hours, and having family-related stress were the common factors associated with ERI in employees across all three types of long-term care setting. Long-term care providers should consider the needs of care recipients and their family, as well as the needs of care employees, maximizing rewards so that turnover can be reduced and the diversity of individual work-family needs can be accommodated across multiple forms of long-term care settings.

A field investigation of the relationship between rotating shifts, sleep, mental health and physical activity of Australian paramedics

Paramedics working on a rotating shift are at an increased risk of developing chronic health issues due to continuous circadian rhythm disruption. The acute effects of shift rotation and objectively measured sleep have rarely been reported in paramedics. This study investigated the relationships between a rotating shift schedule and sleep (using actigraphy), subjective reports of sleepiness, mood, stress and fatigue. Galvanic Skin Response, energy expenditure and physical activity (BodyMedia SenseWear Armband) were also recorded across the shift schedule. Paramedics were monitored for a period of eight consecutive days across pre-shift, day shift, night shift, and 2 days off. Fifteen paramedics (M age = 39.5 and SD = 10.7 years) who worked rotational shifts experienced sleep restriction during night shift compared to pre-shift, day shift and days off (p < 0.001). Night shift was also associated with higher levels of stress (p < 0.05), fatigue (p < 0.05), and sleepiness (p < 0.05). One day off was related to a return to pre-shift functioning. Such shift-related issues have a compounding negative impact on an already stressful occupation with high rates of physical and mental health issues. Therefore, there is an urgent need to investigate methods to reduce rotating shift burden on the health of paramedics. This could be through further research aimed at providing recommendations for shift work schedules with sufficient periods for sleep and recovery from stress.

Why so stressed? A comparative study on stressors and stress between hospital and non-hospital nurses

Background

Stress, which can be attributed to household and workplace stressors, is prevalent among nurses. However, these stressors’ attribution may differ between hospital and non-hospital nurses. It is currently unknown whether there are significant differences in the sociodemographic and occupational characteristics between hospital and non-hospital nurses which may potentially influence the type and magnitude of stressors, and subsequently the stress status. Therefore, this study aims to estimate the prevalence of stress and compare the roles of sociodemograhic characteristics, occupational profiles, workplace stressors and household stressors in determining the stress status between hospital and non-hospital female nurses in Malaysia.

Methods

This cross-sectional study was conducted among randomly-selected 715 female nurses in Malaysia using pencil-and-paper self-reported questionnaires.

Results

The majority of participants were ever married (87.0%), having children (76.2%), and work in hospital setting (64.8%). The level of household stressors was generally similar between hospital and non-hospital nurses. However, hospital nurses significantly perceived higher level of workplace stressors. Shift work is significantly associated with higher level of household and workplace stressors among nurses in both groups. The level of stress was significantly higher among hospital nurses. Both household and workplace stressors explained about 40% of stress status in both hospital and non-hospital nurses.

Conclusion

Hospital nurses are at higher risk of having stressors and stress as compared to non-hospital nurses, probably due to higher proportion of them involved in shift work. Hospital nurses should be given high priority in mitigating stress among nurses.

More Depression-Related Public Concern After the Suicide of a Pop Star in China: Evidence From the Online Big Data Platform

Background: In China, we have seen dramatic increases in public concern over depression and mental health after the suicide of some famous persons. The objective of this study is to investigate the changes of search-engine query patterns to monitor this phenomenon based on the tragic suicide of a young Chinese pop star, Kimi Qiao. Methods: The daily search volume for depression was retrieved from both the Baidu Index (BDI) and the Sina MicroBlog Index (SMI). Besides, the daily BDI for suicide, schizophrenia, obsessive-compulsive disorder, common cold, stomach cancer, and liver cancer were collected for comparison. According to the time of Qiao's suicide, all data were divided into two periods (i.e., Period One from 1 September 2015 to 31 August 2016 while Period Two ranged from 1 October 2016 to 30 September 2017). The paired t-test was used to compare the differences in search volumes between two periods. The Pearson correlation analysis was used to estimate correlations between the BDI and SMI for depression. Results: The average BDI for depression, BDI for suicide, and SMI for depression in Period Two were significantly higher than in Period One (p < 0.05). There was a strong positive correlation between the BDI and SMI for depression (r = 0.97, p < 0.001). And no significant difference in BDI for other diseases between the two periods was found. Conclusions: The changes of search-engine query patterns indicated that the celebrity's suicide might be able to improve the netizens' concern about depression in China. The study suggests publishing more practical knowledge and advice on depression through the Internet and social media, to improve the public's mental health literacy and help people to cope with their depressive symptoms appropriately.

Work-Related Stress and Associated Factors Among Textile Factory Employees in Northwest Ethiopia: A Cross-Sectional Study

Background

Work-related stress is becoming an alarmingly growing public health concern worldwide. Textile factories are among the most common manufacturing industries that have a higher rate of work-related stress. Investigating the prevalence and factors associated with work-related stress will help planners and decision-makers at every level in planning, managing, and evaluating the health status of the employees. Research evidence is limited for work-related stress in Northwest Ethiopia. Therefore, this study was aimed to assess work-related stress and associated factors among textile factory employees in Northwest Ethiopia.

Methods

A cross-sectional study design was employed among 403 employees in Bahir Dar Textile Factory. Data were collected using an interviewer administered questionnaire, then entered into EpiData version 3.1, and analyzed using SPSS version 22 software. Descriptive statistics, bivariate and multivariate logistic regressions were carried out. In logistic regression analysis, adjusted odds ratio (AOR), along with 95% confidence interval (CI), was used to identify the associated factors of work-related stress. A P-value<0.05 was considered as statistically significant.

Results

The prevalence of work-related stress was 45.2%, with 95% CI=40.0–50.1%. Working in rotational shifts (AOR=2.33, 95% CI=1.34–4.03), current substance use (AOR=5.67, 95% CI=3.38–9.52), poor and medium social support (AOR=3.75, 95% CI=1.71–8.21 and AOR=3.26, 95% CI=1.39–7.64) were significantly associated factors with work-related stress, respectively.

Conclusion and Recommendation

Near to half of the study participants had work-related stress. Work shift, substance use, and social support were among the factors which affect work-related stress. Thus, interventions that could reduce work-related stress such as stress management programs should be considered.

Work stress, family stress, and suicide ideation: A cross-sectional survey among working women in Shenzhen, China

BACKGROUND

This study aimed to explore the associations of work characteristics, work stress, and family stress with suicide ideation among working women, further to detect potential joint effects between different types of stress.

METHODS

From March to June in 2015, a cross-sectional survey on working women were conducted in Shenzhen, China. Demographic and work characteristics, work stress, family stress, and suicide ideation were collected. Multivariate logistic regression models were applied to assess possible associations by calculating the odds ratios (OR) and 95% confident intervals (CI).

RESULTS

Totally 968 working women were included with a mean age of 31.62 (standard deviation: 7.43) years. The prevalence of suicide ideation was 19.4%. We found that night shift work, sickness absence, work stress, and family stress were positively associated with suicide ideation, after adjusting for age, education level, marital status, and occupation type. None joint effect on multiplicative or additive scale of work stress and family stress on suicide ideation was found (P for multiplicative and additive interaction: 0.736 and 0.595, respectively), however, women with both high work stress and high family stress appeared more than five-time odds of suicide ideation (OR: 5.253, 95%CI: 2.982∼9.252).

LIMITATIONS

We did not collect information on other psychosocial profiles and failed to explore potential mediated effects within current associations.

CONCLUSIONS

This study lends support to suicide prevention that immediate relief allocated to working women with both high level of work stress and family stress is warranted of necessity.

Night work for hospital nurses and sickness absence: a retrospective study using electronic rostering systems

There is conflicting evidence on the effect of night work on sickness absence. Most previous studies used self-reporting to identify shift patterns and measure levels of sickness absence. In contrast, this study used objective data from electronic rosters to explore the association of nurses' patterns of night work and sickness absence. This was a retrospective longitudinal study of nurse roster data from 32 general medical and surgical wards in a large acute hospital in England. We used data from 3 years and included both registered nurses and unregistered nursing assistants. We used generalized linear-mixed models to explore the association between night work and the subsequent occurrence of sickness absence. Of 601,282 shifts worked by 1944 nursing staff, 38,051 shifts were lost due to sickness absence. After controlling for potential confounders including proportion of long (≥12 h) shifts worked, proportion of overtime shifts, proportion of shifts worked in the past 7 days, and staff grade, we found that staff working more than 75% of their shifts in the past 7 days as night shifts were more likely to experience sickness absence (aOR = 1.12; 95% CI: 1.03-1.21), compared to staff working on day only schedules. Sub-group analysis found that an association between a high proportion of night shifts worked and long-term sickness (aOR = 1.31; 95% CI: 1.15-1.50), but not short-term sickness. Working high proportions of night shifts, likely representing permanent night work schedules, is associated with a higher risk of long-term sickness absence for nurses working in inpatient adult wards in acute hospitals. The higher sickness absence rates associated with permanent night shifts could result in additional costs or loss of productivity for hospitals. This study challenges the assumption that permanent night schedules maximize circadian adjustment and, therefore, reduce health problems.

Rituals, ghosts and glorified babysitters: A narrative analysis of stories nurses shared about working the night shift

Working the night shift can be fraught and experienced as demanding and, yet, is often dismissed as babysitting. Few researchers have explored the social and cultural meanings of night nursing, including storytelling rituals. In 2019, a narrative study was undertaken. The aim was to explore the stories recalled by nurses about working night shifts. Thirteen Australian nurses participated. Data were gathered using the Biographical Narrative Interview Method, and narrative analysis produced forty stories and three themes: strange and challenging experiences; colleagues can be mentors (or not); and textbook knowledge is only part of what is needed on night shift. Nursing students who engage with these stories may come to understand the challenges of the night shift, and the valuable work that nurses engage in throughout a 24-hr period, work that involves adept psychosocial and interpersonal skills alongside technical and physical competence.

Restorative yoga for occupational stress among Japanese female nurses working night shift: Randomized crossover trial

OBJECTIVES

To determine whether restorative yoga is an effective method for relieving occupational stress among female nurses working the night shift in Japan.

METHODS

From July 2017 to May 2018, 20 female nurses aged in their 20s to 30s who were working the night shift at a university hospital participated in a randomized crossover trial, consisting of a 1-hour guided group yoga session followed by 4 weeks of at-home practice and 4 weeks of usual stress relief methods. The level of stress was assessed by the Brief Job Stress Questionnaire of the Ministry of Health, Labour and Welfare before and after performing restorative yoga. Descriptive statistics were calculated and data were analyzed by Student's t test, one-way analysis of variance (with repeated measures), or Bonferroni's multiple comparison test.

RESULTS

Vital signs showed no significant differences from before to after the group yoga session, and there was no change of weight after 4 weeks of at-home practice. The mean questionnaire score for "psychological and physical stress reactions" was significantly reduced after the group yoga session. In addition, the mean score was significantly lower after 4 weeks of at-home practice than before or after group yoga, or after 4 weeks of the usual stress relief methods.

CONCLUSIONS

These findings suggest that restorative yoga may be effective for alleviating occupational stress among female nurses working the night shift.

The importance of return to work: How to achieve optimal reintegration in ACS patients

The vocational reintegration of patients after an acute coronary syndrome is a crucial step towards complete convalescence from the social as well as the individual point of view. Return to work rates are determined by medical parameters such as left ventricular function, residual ischaemia and heart rhythm stability, as well as by occupational requirement profile such as blue or white collar work, night shifts and the ability to commute (which is, in part, determined by physical fitness). Psychosocial factors including depression, self-perceived health situation and pre-existing cognitive impairment determine the reintegration rate to a significant extent. Patients at risk of poor vocational outcomes should be identified in the early period of rehabilitation to avoid a reintegration failure and to prevent socio-professional exclusion with adverse psychological and financial consequences. A comprehensive healthcare pathway of acute coronary syndrome patients is initiated by cardiac rehabilitation, which includes specific algorithms and assessment tools for risk stratification and occupational restitution. As the first in its kind, this review addresses determinants and legal aspects of reintegration of patients experiencing an acute coronary syndrome, and offers practical advice on reintegration strategies particularly for vulnerable patients. It presents different approaches and scientific findings in the European countries and serves as a recommendation for action.

Working Time Society consensus statements: Psychosocial stressors relevant to the health and wellbeing of night and shift workers

This consensus report summarizes the negative impact of work-related psychosocial factors and job stressors on the health and wellbeing of shift workers. Psychosocial factors may (a) directly affect work schedules or (b) mediate or moderate relationships between work schedules, circadian factors, and health. In this paper, prominent psychosocial models (e.g. Job Strain and Effort-Reward Imbalance) are used to help assess detrimental effects, including pathophysiologic outcomes. Several studies indicate the psychosocial environment can be more problematic for shift workers compared to regular day workers. This is likely due to shift worker's experiencing greater risks of low job control, high physical work demands, lower support from supervisors, and greater levels of over-commitment. Workplace violence is another frequently encountered psychosocial stressor for shift workers more likely to be in regular contact with the general public, such as police officers, security personnel, professional drivers, and other service employees being at elevated risk. A large body of literature confirms night and irregular shift schedules increase risk for injury. Non-diurnal schedules can trigger and worsen such incidents, especially under unsafe conditions. The problem of workplace violence for shift workers, in terms of severity and consequences, is probably underestimated, especially when present among other occupational stressors. Practical considerations and recommendations for action to mitigate the detrimental effects of psychosocial stressors on night and shift workers are presented.

Exposure to working-hour characteristics and short sickness absence in hospital workers: A case-crossover study using objective data

INTRODUCTION

Shift work characteristics, such as the number of night shifts or quick returns, are linked to disturbed sleep and greater work-life conflict, but little is known about their association with short sickness absences. Studies utilizing objective working-hour characteristic data can provide knowledge on specific shift work characteristics that may associate with sick leave. We investigated the association between working-hour characteristics in shift work and the incidence of short (1-3 days) sickness absences.

PARTICIPANTS AND METHODS

The individual-level data were collected from the employers' electronic working time records of the Finnish Public Sector study. The final analytical sample was restricted to the first incidence of short sickness absence (1-3 days) from January 1, 2008 to the end of 2015. We studied employees with shift work contracts (n = 12 156) and day work contracts (n = 6225). Of these, 89% were female workers, with a mean age of 37.1 years, and 12% worked part-time. We calculated type of shift (morning, day, evening, and night), quick returns (< 11 h between two work shifts), length of work shift and weekly working time. We utilized case-crossover study design to compare the working-hour characteristics of the 28 days preceding sickness absence (exposure window) and those of the 28 days before the exposure window (control window), using conditional logistic regression models for odds ratios with 95% Confidence Intervals (95%CI).

RESULTS

Exposure to ≥ 2, and especially ≥ 4 consecutive night shifts associated with an increased likelihood of short sickness absence (OR 1.24, 95%CI 1.12-1.38 and OR 1.54, 95%CI 1.10-2.15, respectively) among shift workers, whereas a high number (> 25%) of evening shifts and having ≥ 2 consecutive evening shifts associated with lower odds of sickness absence. Over 40-hour weeks (OR 1.29, 95%CI 1.20-1.39), over 48-hour weeks (OR 1.24, 95%CI 1.01-1.54) and quick returns (OR 1.02, 95%CI 1.01-1.02) increased the likelihood of sickness absence. Having only a few (0-1 or 2-3) quick returns over 28 days decreased the likelihood of sickness absence (ORs 0.46 and 0.67), whereas having ≥ 5 quick returns over 28 days increased it (OR 1.88, 95%CI 1.76-1.99). These associations were similar among both shift and day workers.

CONCLUSIONS

Long working hours, several consecutive night shifts and quick returns increase the risk of short sickness absence. These working-hour characteristics should be avoided in shift scheduling to minimize sickness absence and increased costs for the employer.

Shift work and risk of cardiovascular disease morbidity and mortality: A dose–response meta-analysis of cohort studies

Background

Previous studies have suggested that shift work is associated with a higher risk of cardiovascular disease. However, the quantitative dose–response relationship between duration of shift work and cardiovascular disease risk is still unknown. We aimed to evaluate the dose–response association between duration of shift work and risk of cardiovascular disease morbidity and mortality.

Design

A systematic review and meta-analysis.

Methods

PubMed and Embase were searched from inception to 1 December 2017. Prospective cohort studies that reported the associations between duration of shift work and cardiovascular disease risk with at least three categories were included. Data were pooled by using fixed or random effect models. The continuous dose–response associations were assessed by using fixed effect restricted cubic splines with four knots.

Results

Five prospective cohort studies with 10 reports were included. No evidence of a curvilinear association was observed between duration of shift work and risk of cardiovascular disease, similar findings were observed in cardiovascular disease morbidity and mortality. The summary relative risk (RR) of an increase of 5 years of shift work was 1.05 (1.04–1.07) with moderate heterogeneity ( P = 0.142, I2 = 33.2%) for cardiovascular disease, 1.06 (1.04–1.08) with low heterogeneity ( P = 0.279, I2 = 21.7%) for cardiovascular disease morbidity, and 1.04 (1.02–1.06) with moderate heterogeneity ( P = 0.135, I2 = 38.5%) for cardiovascular disease mortality, respectively.

Conclusions

Shift work could probably increase the risk of cardiovascular disease and cardiovascular disease mortality in a dose–response way. These findings could have implications for guideline recommendations regarding the risk related to shift schedules.

Emotional Distress as a Predictor of Work-Related Musculoskeletal Disorders in Malaysian Nursing Professionals

BACKGROUND

Emotional distress is becoming a great concern and is more common in both developed and developing countries. It is associated with several disease conditions.

OBJECTIVE

To determine the prevalence of self-perceived emotional distress and its relation to work-related musculoskeletal disorders (WRMSDs) in nurses.

METHODS

A self-administered questionnaire survey was carried out on 660 female nurses working in public hospitals in the Klang Valley, Malaysia. The validated Malay version of the standardized Nordic musculoskeletal questionnaire (M-SNMQ) was used to identify the annual prevalence of WRMSDs; perceived emotional distress was assessed using the validated Malay short version, depression, anxiety, and stress (M-DASS) instrument. In addition, socio-demographic and occupational profiles of the participants were considered. Factors associated with WRMSDs were identified using logistic regression analysis.

RESULTS

A total of 376 nurses completed the survey (response rate 83.3%). 73.1% of the nursing staffs experienced WRMSDs in at least one anatomical site 12 months prior to the study. 75% of nurses expressed emotional distress. Of these, over half also reported anxiety and stress. Multiple logistic regression analysis showed that stress and anxiety significantly increased the risk of WRMSDs by approximately twofold.

CONCLUSION

There were significant associations between emotional distress and WRMSDs. Future longitudinal studies are therefore needed to investigate and identify the sources of emotional distress (non-occupational and occupational) to be used to establish preventive strategies to reduce the risk of WRMSDs.

Psychosocial work environment and oxidative stress among nurses'

Background:

Work stress among nurses has increased in recent years due to the demands of clinical nursing.

Objectives:

To investigate psychosocial work stress among nurses using the effort-reward imbalance (ERI) model with assessment malondialdehyde (MDA) as an oxidative stress marker and total antioxidants.

Methods:

The present study was conducted on 204 registered nurses worked at two tertiary hospitals in Menoufia governorate, Egypt through the period from the 1st of February to the end of July 2016. Two questionnaires were applied including general demographic and occupational histories as well as effort-reward questionnaire. Blood analysis was performed to assess MDA and total antioxidant levels.

Results:

ERI was prevalent among the study participants (72.5%). ERI was more prevalent among young married nurses who worked more than 10 years. Nurses that worked at ICUs complained more of ERI (43.2%) while nurses that worked at operation rooms complained more of overcommitment (62.5%). MDA levels were significantly positively correlated with E/R ratios (rho = 0.350, P ≤ 0.001).

Conclusions:

Work stress was prevalent among the studied nurses as revealed by the high ERI and MDA levels. Young married female nurses complained more of work stress. ICUs and operating rooms were the most stressful departments at the studied hospitals. Hence, implementing programs and strategies that eliminate stressful working conditions at hospitals is critical to the reduction and prevention of work stress among nurses.

Mediating pathways and gender differences between shift work and subjective cognitive function

OBJECTIVES

Increased injury risk among shift workers is often attributed to cognitive function deficits that come about as a result of sleep disruptions. However, little is known about the intermediate influences of other factors (eg, work stress, health) which may affect this relationship. In addition, gender differences in these the complex relationships have not been fully explored. The purpose of this study is to (1) identify the extent to which work and non-work factors mediate the relationship between shift work, sleep and subsequent subjective cognitive function; and (2) determine if the mediating pathways differ for men and women.

METHODS

Data from the 2010 National Population Health Survey was used to create a cross-sectional sample of 4255 employed Canadians. Using path modelling, we examined the direct and indirect relationships between shift work, sleep duration, sleep quality and subjective cognitive function. Multigroup analyses tested for significantly different pathways between men and women. Potential confounding effects of age and self-reported health and potential mediating effects of work stress were simultaneously examined.

RESULTS

Work stress and sleep quality significantly mediated the effects of shift work on cognition. Age and health confounded the relationship between sleep quality and subjective cognition. No differences were found between men and women.

CONCLUSIONS

Occupational health and safety programmes are needed to address stress and health factors, in addition to sleep hygiene, to effectively address cognitive function among shift workers.

Assessment of stress and autonomic nervous activity in Japanese female ambulance paramedics working 24-hour shifts

OBJECTIVES

We studied the physical and mental conditions of 8 healthy young female ambulance paramedics working 24-hour shifts during their menstrual cycle, including assessment of cardiac autonomic nervous system activity by heart rate variability power spectral analysis.

METHODS

The autonomic activity during the awake period of on- and off-duty days in the follicular, late luteal, and menstruation phases was measured. Questionnaires regarding fatigue and menstrual distress were administered and correlated with the autonomic profile.

RESULTS

While degrees of fatigue significantly increased after work, the changes in autonomic activity during the awake period on on-duty days were not significantly different from those on off-duty days (LF/HF, p=0.123; HF/(HF+LF), p=0.153). As for the sleeping period, there were no significant differences. Although the Menstrual Distress Questionnaire (MDQ) revealed the presence of mild menstrual discomfort in the late luteal and menstruation phases, no significant difference was observed in the autonomic profile of the three menstrual cycle phases. No significant correlation was observed between the degree of menstrual distress and autonomic profile, though there was a significant correlation in the late luteal phase between degree of menstrual distress and fatigue after work (p<0.01).

CONCLUSION

These results showed that, while subjects experienced menstrual discomfort and fatigue after work, their autonomic profile did not alter in the menstrual cycle. It is suggested that healthy young female ambulance paramedics may tolerate 24-hour shifts, though attention should be paid to subjective menstrual symptoms and fatigue.