Associations between night work and anxiety, depression, insomnia, sleepiness and fatigue in a sample of Norwegian nurses

Disrupted circadian rhythms and mental health

During the evolution of life, the temporal rhythm of our rotating planet was internalized in the form of circadian rhythms. Circadian rhythms are ~24h internal manifestations that drive daily patterns of physiology and behavior. These rhythms are entrained (synchronized) to the external environment, primarily by the light-dark cycle, and precisely controlled via molecular clocks located within the suprachiasmatic nucleus of the hypothalamus. Misalignment and/or disruption of circadian rhythms can have detrimental consequences for human health. Indeed, studies suggest strong associations between mental health and circadian rhythms. However, direct interactions between mood regulation and the circadian system are just beginning to be uncovered and appreciated. This chapter examines the relationship between disruption of circadian rhythms and mental health. The primary focus will be outlining the association between circadian disruption, in the form of night shift work, exposure to light at night, jet lag, and social jet lag, and psychiatric illness (i.e., anxiety, major depressive disorder, bipolar disorder, and schizophrenia). Additionally, we review animal models of disrupted circadian rhythms, which provide further evidence in support of a strong association between circadian disruption and affective responses. Finally, we discuss future directions for the field and suggest areas of study that require further investigation.

Prevalence of insomnia among university students in South Asian Region: a systematic review of studies

INTRODUCTION

Insomnia is a global health problem among university students which is associated with various psychiatric problems like depression and anxiety. While different developed and developing countries assessed the prevalence of insomnia in youth, currently there is hardly systematic review of studies found based on the prevalence of insomnia in South Asia.

AIMS

The aim of this study is to systematically review the evidence relating to the prevalence rate of insomnia in university students in South Asian countries.

METHODS

Electronic searches of three databases, PubMed, Cochrane library, and Worldwide science were performed from 2010 to 2020 before April. In total, seven studies were included for evaluating insomnia in South Asian region among university students.

RESULTS

The prevalence rates of insomnia of the seven studies ranged between 35.4% (95% CI: 32.4-38.5%) and 70% (95% CI: 65.7-74.1%). The pooled prevalence of insomnia among university students was 52.1% (95% CI: 41.1-63.1%).

CONCLUSIONS

This review emphasized that insomnia in university students might be a common health issue to give full concentration in their studies and academic performance. Thus, more attention should be given to the determinants of insomnia among university students, so that it could be helpful to identify the main causes of insomnia and effective measures could be taken.

Improving fatigue risk management in healthcare: A scoping review of sleep-related/ fatigue-management interventions for nurses and midwives (reprint)

BACKGROUND

Nurses and midwives make up almost 50% of the global healthcare shift working workforce. Shift work interferes with sleep and causes fatigue with adverse effects for nurses' and midwives' health, as well as on patient safety and care. Where other safety-critical sectors have developed Fatigue Risk Management Systems, healthcare is behind the curve; with published literature only focussing on the evaluation of discreet sleep-related/fatigue-management interventions. Little is known, however, about which interventions have been evaluated for nurses and midwives. Our review is a critical first step to building the evidence-base for healthcare organisations seeking to address this important operational issue.

OBJECTIVES

We address two questions: (1) what sleep-related/fatigue-management interventions have been assessed in nurses and midwives and what is their evidence-base? and (2) what measures are used by researchers to assess intervention effectiveness?

DESIGN AND DATA SOURCES

The following databases were searched in November, 2018 with no limit on publication dates: MEDLINE, PsychINFO and CINAHL.

REVIEW METHODS

We included: (1) studies conducted in adult samples of nurses and/or midwives that had evaluated a sleep-related/fatigue-management intervention; and (2) studies that reported intervention effects on fatigue, sleep, or performance at work, and on measures of attention or cognitive performance (as they relate to the impact of shift working on patient safety/care).

RESULTS

The search identified 798 potentially relevant articles, out of which 32 met our inclusion criteria. There were 8619 participants across the included studies and all were nurses (88.6% female). We did not find any studies conducted in midwives nor any studies conducted in the UK, with most studies conducted in the US, Italy and Taiwan. There was heterogeneity both in terms of the interventions evaluated and the measures used to assess effectiveness. Napping could be beneficial but there was wide variation regarding nap duration and timing, and we need to understand more about barriers to implementation. Longer shifts, shift patterns including nights, and inadequate recovery time between shifts (quick returns) were associated with poorer sleep, increased sleepiness and increased levels of fatigue. Light exposure and/or light attenuation interventions showed promise but the literature was dominated by small, potentially unrepresentative samples.

CONCLUSIONS

The literature related to sleep-related/fatigue-management interventions for nurses and midwives is fragmented and lacks cohesion. Further empirical work is warranted with a view to developing comprehensive Fatigue Risk Management Systems to protect against fatigue in nurses, midwives, and other shift working healthcare staff.

The Association Between Shift Work And Affective Disorders: A Systematic Review

Atypical working time patterns are known to be associated with adverse physical health consequences. The impact of chronic exposure to shift work on psychological wellbeing and mental health is also reported, but not fully appreciated. We conducted a systematic review of the literature on the association between shift work and affective disorders using the electronic databases Medline, PsycINFO, Embase, Web of Science and Google Scholar. Data extracted included detailed characteristics of shift work, the affective disorders under study, and the population targeted. Some 25 extracted articles satisfied all inclusion and exclusion criteria. Findings of these articles reveal shift work is associated with increases in depressive symptoms (12 studies), anxiety (2 studies), and depression and anxiety (7 studies). Only three studies found no association between shift work and depression. The findings of this review suggest that shift work increases the symptoms of depression and anxiety.

Effects of Work Environments and Occupational Fatigue on Care Left Undone in Rotating Shift Nurses

PURPOSE

This study aimed to examine the effects of work environments and occupational fatigue on care left undone in rotating shift nurses, and to identify the indirect (mediation) effect of work environments on care left undone through nurses' occupational fatigue in South Korean acute care hospitals.

DESIGN

This study employed a cross-sectional design using an online survey to collect data from 488 rotating shift nurses of acute care hospitals in Korea between November and December 2018.

METHODS

A mobile schedule management application for shift nurses was used to advertise the study and to send a link to the online survey. The survey included questions on the nurses' work environment characteristics, care left undone activities, and the Korean version of the Occupational Fatigue Exhaustion/Recovery scale. Poisson regression was used to explore the relationships among work environments, occupational fatigue, and care left undone. Hayes' Model 4 and a bootstrapping analysis were used to identify the mediating effect of occupational fatigue on the relationship between work environments and care left undone.

FINDINGS

The average number of tasks left undone was 3.45 (SD = 2.19). The higher the acute and chronic fatigue levels noted among nurses, the higher were the occurrences of care left undone. Conversely, the higher the intershift recovery level, the lower were the occurrences of care left undone. The results showed a positive relationship between care left undone and overtime hours and the number of patients per nurse. Moreover, nurses' occupational fatigue mediated the relationship between work environments and care left undone. Night shifts per month and the number of consecutive days off had an indirect effect on care left undone through occupational fatigue.

CONCLUSIONS

High levels of occupational fatigue and poor intershift recovery among nurses can lead to care left undone. Nurses' occupational fatigue mediates the effect of work environment on care left undone.

CLINICAL RELEVANCE

It is crucial for healthcare administrators and leaders to develop policies and mandatory regulations to facilitate better working conditions for nurses, consequently reducing their occupational fatigue and decreasing the occurrence of care left undone in acute care hospitals.

Circadian misalignment increases mood vulnerability in simulated shift work

Night shift work can associate with an increased risk for depression. As night workers experience a 'misalignment' between their circadian system and daily sleep-wake behaviors, with negative health consequences, we investigated whether exposure to circadian misalignment underpins mood vulnerability in simulated shift work. We performed randomized within-subject crossover laboratory studies in non-shift workers and shift workers. Simulated night shifts were used to induce a misalignment between the endogenous circadian pacemaker and sleep/wake cycles (circadian misalignment), while environmental conditions and food intake were controlled. Circadian misalignment adversely impacted emotional state, such that mood and well-being levels were significantly decreased throughout 4 days of continuous exposure to circadian misalignment in non-shift workers, as compared to when they were under circadian alignment (interaction of "circadian alignment condition" vs. "day", mood: p < 0.001; well-being: p < 0.001; adjusted p-values). Similarly, in shift workers, mood and well-being levels were significantly reduced throughout days of misalignment, as compared to circadian alignment (interaction of "circadian alignment condition" vs. "day", mood: p = 0.002; well-being: p = 0.002; adjusted p-values). Our findings indicate that circadian misalignment is an important biological component for mood vulnerability, and that individuals who engage in shift work are susceptible to its deleterious mood effects.

The Psychological and Social Impact of Covid-19: New Perspectives of Well-Being

The recent Covid-19 pandemic has had significant psychological and social effects on the population. Research has highlighted the impact on psychological well-being of the most exposed groups, including children, college students, and health workers, who are more likely to develop post-traumatic stress disorder, anxiety, depression, and other symptoms of distress. The social distance and the security measures have affected the relationship among people and their perception of empathy toward others. From this perspective, telepsychology and technological devices assume important roles to decrease the negative effects of the pandemic. These tools present benefits that could improve psychological treatment of patients online, such as the possibility to meet from home or from the workplace, saving money and time and maintaining the relationship between therapists and patients. The aim of this paper is to show empirical data from recent studies on the effect of the pandemic and reflect on possible interventions based on technological tools.

Intraindividual Variability in Sleep and Levels of Systemic Inflammation in Nurses

OBJECTIVE

Disturbed sleep is common among nurses and is associated with morbidity and mortality. Inflammation may be one mechanism linking sleep and disease. However, most studies rely on retrospective questionnaires to assess sleep, which fail to account for night-to-night fluctuations in sleep across time (i.e., intraindividual variability [IIV]). We examined prospective associations between mean and IIV in sleep with inflammation markers in nurses.

METHODS

Participants were 392 nurses (mean age = 39.54 years, 92% female, 23% night-shift working) who completed 7 days of sleep diaries and actigraphy to assess mean and IIV in total sleep time and sleep efficiency. Blood was drawn on day 7 to assess inflammation markers C-reactive protein, interleukin (IL)-6, tumor necrosis factor α, and IL-1β.

RESULTS

Greater IIV in total sleep time-measured via both actigraphy and sleep diary-was associated with higher IL-6 (actigraphy: b = 0.05, p = .046, sr = 0.01; diary: b = 0.04, p = .030, sr = 0.01) and IL-1β (actigraphy: b = 0.12, p = .008, sr = 0.02; diary: b = 0.09, p = .025, sr = 0.01), but not C-reactive protein or tumor necrosis factor α. IIV in actigraphy- and sleep diary-determined sleep efficiency was not associated with inflammation biomarkers, nor were any mean sleep variables. Shift work did not moderate any associations.

CONCLUSIONS

Nurses with more variable sleep durations had elevated levels of inflammation, which may increase risk for development of inflammatory-related diseases. Research should investigate how sleep regularization may change levels of inflammation and improve health.

Sleep and Motion Disorders of Physicians and Nurses Working in Hospitals Facing the Pandemic of COVID 19

Introduction:

Several research studies have started to investigate the health conditions of medical doctors and nurses in order to find a relationship if any between their work environment, their usually heavy duties and the result of these two parametric on patients’ health

Aim:

The present research study is an effort to investigate the relationship between the physical activity and sleep disorders among health care professionals, particularly among medical doctors and nurses.

Methods:

Participants of the study were asked to fill a questionnaire which was a mixture of other internationally accredited questionnaires regarding physical activity level as well as sleeping functions. Data were collected among 204 physicians and nurses. The statistical analysis revealed a correlation between physical activity and some aspects of sleep disorders.

Results:

A total number of 204 questionnaires have been distributed to medical doctors and nurses working in public hospitals in Athens Greece from the middle of February until the middle of April 2020. The hospitals were assigned by the health authorities to the fight of the pandemic of COVID 19. The majority of the participants were women 71,3% and 28,7% were men. From a total of 204 half of them were medical doctors and half of them were nurses. 43% were married, 49% were single and 8% were divorced and there were no widows. Regarding the participant nurses, 43% had a university degree and 38,4% had a technological education degree. The results of the statistical analysis showed that there are positive correlations between the level of physical activity during the daily work and the free time of the participants with parameters that are related to sleep disorders.

Conclusion:

The sample of the study was not a large one but nevertheless a stressful situation such as is the epidemic of COVID19 can provide useful information in order to better understand the relationship between physical activity and sleeping disorders in such working conditions.

Analyzing the effect of social interaction on job demands and health in the example of flexible shiftwork

In the literature, shiftwork-related stress is often connected with health complaints. However, it has been shown that these are not equally distributed. Further reasons must exist as to why stress resulting from shiftwork only affects health in some cases. In a study with 653 employees working in highly flexible shiftwork conditions, an examination was made of the factors affecting the relationship between job demands and health status. The results show that satisfaction with leadership influences whether unevenly distributed work and time pressure have a significant impact on health. The factor of other people living in the household significantly influences whether time pressure and emotional stress lead to health complaints. The study concluded that the impact of social interaction as a resource is not limited to the workplace. Social interaction, as a personal resource, can be helpful in both the professional and private spheres.

Association of shift work with depression and anxiety in middle-aged adults: a large cross-sectional study among Iranian industrial manufacturing employees

Purpose

This study aimed to examine the association of shift work with depression and anxiety in a large sample of formal and contractual employees of a mill steel company, Isfahan, Iran.

Design/methodology/approach

This cross-sectional study was performed in 2014 among 3,060 formal and contractual employees of a mill steel company Isfahan, Iran, randomly selected from 16,000 people. Data gathering was done by some validated Iranian version of self-administered questionnaires including, International Physical Activity – Short Form, Effort–Reward Imbalance, Hospital Anxiety and Depression Scale. Logistic regression was used as the main statistical method.

Findings

The results showed individuals in the rotating shift compared with day shift had a higher risk of depression (OR: 1.43; 95% CI: 1.12–1.84). Whereas after adjustment for various confounders, this relationship was not significant (OR: 1.19; 95% CI: 0.81–1.76). Anxiety was not associated with shift work, both in crude and adjusted models (OR: 1.08; 95% CI: 0.81–1.44) and (OR: 0.90; 95% CI: 0.67–1.19), respectively.

Research limitations/implications

Owing to the cross-sectional design of this study, cause–effect relationships could not be inferred from our findings. All the data used in the present analysis were collected by self-administered questionnaires.

Practical implications

Although our findings did not show significant association between shift work and mental health, further studies are suggested for obtaining informative data worldwide in this regard among workforce particularly among industrial employees.

Originality/value

Few studies have addressed the effects of shift work on mental health among industrial employees worldwide, and there is no study in developing countries.

The effectiveness of bright light exposure in shift-worker nurses: A systematic review and meta-analysis

Bright light exposure is as one of the non-pharmacological measures to sleep management in shift-worker. This study was conducted to determine the effectiveness of bright light exposure in shift-worker nurses. We performed a systematic review and meta-analysis according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and using existing literature in the following databases: Cochrane Library, Embase, PubMed, Scopus, Web of Science, to examine any eligible and relevant interventional (randomized controlled trial, experimental and quasi-experimental studies) which were published by December 31, 2018. The obtained documents were analyzed using Stata 14.1 and Cochrane Collaboration's RevMan 5.3. Five studies met eligibility criteria. Results from fixed-effect meta-analysis of the included studies revealed that the exposure could decrease the sleepiness levels, complaints related to shift-work, insomnia and increased the psychomotor error (95% confidence interval (CI): -0.87,-0.43, p=0.000, I²=98.6%), alertness and daytime sleep duration following night shifts (95% CI: 0.08,0.99, p=0.000, I²=92.7%). However, in the random effects model, none of them were statistically significant. Although the results of fixed-effect are in favor of beneficial effects of bright light exposure in shift-worker nurses, the random effects could not approve these findings. Maybe because of either large heterogeneity or insufficiency of the number of studies. Besides, because of the low number of studies, it was impossible to deal with high amount of heterogeneity using subgroup analysis or meta-regression. So the controversy on this topic continues to persist, which highlights the need for more well-designed randomized control trials with larger sample sizes in the future.

Association between Health Problems and Turnover Intention in Shift Work Nurses: Health Problem Clustering

Shift work nurses experience multiple health problems due to irregular shifts and heavy job demands. However, the comorbidity patterns of nurses’ health problems and the association between health problems and turnover intention have rarely been studied. This study aimed to identify and cluster shift work nurses’ health problems and to reveal the associations between health problems and turnover intention. In this cross-sectional study, we analyzed data from 500 nurses who worked at two tertiary hospitals in Seoul, South Korea. Data, including turnover intention and nine types of health issues, were collected between March 2018 and April 2019. Hierarchical clustering and multiple ordinal logistic regressions were used for the data analysis. Among the participants, 22.2% expressed turnover intention and the mean number of health problems was 4.5 (range 0–9). Using multiple ordinal logistic regressions analysis, it was shown that sleep disturbance, depression, fatigue, a gastrointestinal disorder, and leg or foot discomfort as a single health problem significantly increased turnover intention. After clustering the health problems, four clusters were identified and only the neuropsychological cluster—sleep disturbance, fatigue, and depression—significantly increased turnover intention. We propose that health problems within the neuropsychological cluster must receive close attention and be addressed simultaneously to decrease nurse’s turnover intentions.

Napping and cognitive performance during night shifts: a systematic review and meta-analysis

Study Objectives

To examine the benefits of napping during night shifts on cognitive performance.

Methods

Medline, Cochrane Library, Science direct, and Embase databases were searched up to July 1, 2019. Cognitive performance during night shifts, both before and following napping or under control conditions (no nap), in working-aged adults, were analyzed by time and by type of cognitive function (executive function, attention, instrumental function, and memory). Estimates were pooled using random-effects meta-analysis.

Results

A total of 18 articles (6 in real-work and 12 in laboratory) with a total of 494 participants were included. The mean nap duration was 41.6 ± 28.3 min, occurring between 12.00 am and 4.10 am, with a mean time set at 2.12 am. Cognitive performance did not differ at baseline between the groups (effect size 0.02, 95% CI −0.09 to 0.13). There was an overall improvement in performance following a nap compared to the control condition without a nap (0.25, 0.10 to 0.41). Positioning naps early in the night and activity (simulated work tasks) tended to improve cognitive performance (−0.57, −1.16 to 0.002, and 0.082, −0.04 to 0.33, respectively). The improvements were primarily seen 30 min after awakening. Only memory deteriorated immediately after awakening without an overall change in global cognitive performance.

Conclusion

Napping during night shifts seems to improve cognitive performance. Napping early in the night and activity may benefit cognitive performance over time. Considering lack of data in real work environments, further studies are warranted before preconizing napping during night shifts as a preventive strategy (safety, health, and economic outcomes).

Improving fatigue risk management in healthcare: A systematic scoping review of sleep-related/fatigue-management interventions for nurses and midwives

BACKGROUND

Nurses and midwives make up almost 50% of the global healthcare shift working workforce. Shift work interferes with sleep and causes fatigue with adverse effects for nurses' and midwives' health, as well as on patient safety and care. Where other safety-critical sectors have developed Fatigue Risk Management Systems, healthcare is behind the curve; with published literature only focussing on the evaluation of discreet sleep-related/fatigue-management interventions. Little is known, however, about which interventions have been evaluated for nurses and midwives. Our review is a critical first step to building the evidence-base for healthcare organisations seeking to address this important operational issue.

OBJECTIVES

We address two questions: (1) what sleep-related/fatigue-management interventions have been assessed in nurses and midwives and what is their evidence-base? and (2) what measures are used by researchers to assess intervention effectiveness?

DESIGN AND DATA SOURCES

The following databases were searched in November, 2018 with no limit on publication dates: MEDLINE, PsychINFO and CINAHL.

REVIEW METHODS

We included: (1) studies conducted in adult samples of nurses and/or midwives that had evaluated a sleep-related/fatigue-management intervention; and (2) studies that reported intervention effects on fatigue, sleep, or performance at work, and on measures of attention or cognitive performance (as they relate to the impact of shift working on patient safety/care).

RESULTS

The search identified 798 potentially relevant articles, out of which 32 met our inclusion criteria. There were 8619 participants across the included studies and all were nurses (88.6% female). We did not find any studies conducted in midwives nor any studies conducted in the UK, with most studies conducted in the US, Italy and Taiwan. There was heterogeneity both in terms of the interventions evaluated and the measures used to assess effectiveness. Napping could be beneficial but there was wide variation regarding nap duration and timing, and we need to understand more about barriers to implementation. Longer shifts, shift patterns including nights, and inadequate recovery time between shifts (quick returns) were associated with poorer sleep, increased sleepiness and increased levels of fatigue. Light exposure and/or light attenuation interventions showed promise but the literature was dominated by small, potentially unrepresentative samples.

CONCLUSIONS

The literature related to sleep-related/fatigue-management interventions for nurses and midwives is fragmented and lacks cohesion. Further empirical work is warranted with a view to developing comprehensive Fatigue Risk Management Systems to protect against fatigue in nurses, midwives, and other shift working healthcare staff.

Relationship of patient safety culture with factors influencing working environment such as working hours, the number of night shifts, and the number of days off among healthcare workers in Japan: a cross-sectional study

Background

Patient safety culture is defined as a product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization’s health and safety management. Factors influencing healthcare workers’ working environment such as working hours, the number of night shifts, and the number of days off may be associated with patient safety culture, and the association pattern may differ by profession. This study aimed to examine the relationship between patient safety culture and working environment.

Methods

Questionnaire surveys were conducted in 2015 and 2016. The first survey was conducted in hospitals in Japan to investigate their patient safety management system and activities and intention to participate in the second survey. The second survey was conducted in 40 hospitals; 100 healthcare workers from each hospital answered a questionnaire that was the Japanese version of the Hospital Survey on Patient Safety Culture for measuring patient safety culture. The relationship of patient safety culture with working hours in a week, the number of night shifts in a month, and the number of days off in a month was analyzed.

Results

Response rates for the first and second surveys were 22.4% (731/3270) and 94.2% (3768/4000), respectively. Long working hours, numerous night shifts, and few days off were associated with low patient safety culture. Despite adjusting the working hours, the number of event reports increased with an increase in the number of night shifts. Physicians worked longer and had fewer days off than nurses. However, physicians had fewer composites of patient safety culture score related to working hours, the number of night shifts, and the number of days off than nurses.

Conclusions

This study suggested a possibility of improving the patient safety culture by managing the working environment of healthcare workers. High number of night shifts may lead to high number of event reports. Working hours, the number of night shifts, and the number of days off may differently influence patient safety culture in physicians and nurses.

Preventing Shift Work Disorder in Shift Health-care Workers

The occurrence of the shift work disorder (SWD) in health-care workers (HCWs) employed in 24/7 hospital wards is a major concern through the world. In accordance with literature, SWD is the most frequent work-related disturb in HCWs working on shift schedules including night shift. In agreement with the Luxembourg Declaration on workplace health promotion (WHP) in the European Union, a WHP program has been developed in a large Hospital, involving both individual-oriented and organizational-oriented measures, with the aim to prevent the occurrence of SWD in nurses working on shifts including night shift. The objective assessment of rotating shift work risk and the excessive sleepiness were detected before and after the implementation of the WHP program, by using the Rotating Shiftwork-questionnaire and the Epworth Sleepiness Scale. The findings of this study showed the effectiveness of the implemented WHP program in minimizing the impact of shift work on workers' health and in preventing the misalignment between sleep-wake rhythm and shift working.

Insomnia Symptoms and Mood Disturbances in Shift Workers with Different Chronotypes and Working Schedules

Background and Purpose

Shift workers frequently suffer from insomnia and mood disturbances, but little is known about the relationships of these conditions with the chronotypes and different working schedules of shift workers. We hypothesized that different shift-work schedules are associated with different severities of sleep and mood disturbances, and that the individual chronotype plays a role in sleep disturbances in shift workers.

Methods

This study enrolled 276 participants, comprising 77 nurses working in a three-shift schedule (3S, 27.9%), 60 firefighters working in a 24-h-every-other-day shift schedule (EOD, 21.7%), and 139 day workers (DW, 50.4%). All of the participants completed the following questionnaires to assess their sleep disturbances, mood, and chronotype: Insomnia Severity Index (ISI), Epworth Sleepiness Scale, Hospital Anxiety and Depression Scale, and Morningness-Eveningness Questionnaire.

Results

ISI questionnaires were worse in both shift workers compare to DW, 35.1% of 3S, 23% of EOD had clinically significant insomnia (ISI score >14). Depressive mood and anxiety symptom were significantly worse in 3S compare to EOD. The sleep disturbance by ISI score had significant correlations with depressive mood and anxiety symptoms for both EOD and 3S (EOD: rho=0.57, rho=0.57, 3S: rho=0.37, rho=0.33 respectively). Chronotype type in shift workers had no significant correlation with sleep disturbance, depressive mood, nor anxiety symptom. However, after adjustment, the eveningness chronotype have relationship to the depressive mood in shift workers.

Conclusions

Sleep disturbances are more frequent in shift workers than DW. Depressive mood and anxiety symptoms were frequently reported in 3S, then EOD. Different shift schedules cab be a determinant of depressive mood and anxiety symptom.

Risk factors of chronic urticaria among nurses with insomnia: A nationwide population-based study

Chronic urticaria has a high economic burden and reduces patient's quality of life. Nurses experience insomnia because of their shifting work, especially if they work night shifts and 3-shift rotational schedules. This study aimed to examine whether insomnia is a risk factor of chronic urticaria in nurses.Data were obtained from the Registry for Medical Personnel, which contains all registered medical staff between 2007 and 2008. All study subjects were divided into those with insomnia and without insomnia. The primary exposure of interest was chronic urticaria. In addition, potential comorbidities including diabetes mellitus, hypertension, hyperlipidemia, anxiety, and depression were estimated.A total of 103,242 registered nurses between 2007 and 2008 were enrolled. Around 97,899 (94.8%) nurses did not have insomnia, and 5343 (5.2%) had insomnia. The proportion of chronic urticaria in nurses with insomnia was significantly higher than those without (0.92% vs 0.50%, P < .0001). The odds ratio of chronic urticaria in nurses with insomnia was 1.67 (95% confidence interval: 1.22-2.29, P = 0.0014) compared to those without insomnia after adjusting for age, sex, hospital level, and comorbidities.The risk of chronic urticaria was higher in nurses with insomnia than in those without insomnia. The relationship between insomnia and chronic urticaria might not be a direct causal association. Other contributing factors of insomnia include different perceptions of stress from night shift work, stress coping and adaptation, positive self-image, and emotional equilibrium related to person's capacity to adapt to change. The same situation may have different effects on different individuals.

Burnout as a predictor of depression: a cross-sectional study of the sociodemographic and clinical predictors of depression amongst nurses in Cameroon

Background

Depression is a debilitating mental health condition which affects an estimated 350 million people worldwide annually. Nurses are twice as likely to suffer from depression than professionals in other professions. This leads to a considerable loss of efficiency and productivity. We sought to determine the prevalence and predictors of depression among nurses in Cameroon.

Methods

Cross-sectional analysis carried out over 6 months (January – June 2018) using nurses from public and private healthcare institutions sampled consecutively in the two English-speaking regions (North west and South west regions) of Cameroon. The nurses were handed a structured, printed, self-administered questionnaire to fill and hand in at their earliest convenience. Depression and burnout were assessed using the Patient Health Questionnaire – 9 and the Oldenburg Burnout Inventory respectively.

Results

A total of 143 nurses were recruited (mean age: 29.75 ± 6.55 years; age range: 20–55 years, 32.87% male). The overall prevalence of depression was 62.24%. Independent predictors of depression after multivariable analysis were: Number of night shifts a week (adjusted odds ratio: 1.58; p value: 0.045, 95% CI; 1.01, 2.48) and Total Oldenburg Burnout Inventory score (adjusted odds ratio: 1.21, p value: 0.001; 95% CI; 1.08, 1.35). Recreational drug use was also found to perfectly predict the outcome – depression.

Conclusion

Depression is highly prevalent among nurses in the English-speaking regions of Cameroon. Accurate predictors could prove vital for early detection and management of affected individuals. Predictors presented herein require further investigation via multicentric nationwide studies, to obtain more generalizable results.

Effects of individual characteristics on insomnia severity trajectory among nurses: A prospective longitudinal study

AIMS

To examine the longitudinal effects of individual characteristics on the change pattern of insomnia and the association of occupational stress with insomnia over time in newly graduated nurses.

BACKGROUND

The association between individual factors and insomnia in nurses is inconclusive. Longitudinal research on insomnia in newly graduated nurses is limited.

METHODS

This prospective longitudinal study included 200 participants generating 800 observations of insomnia severity during their first year of nursing. We employed growth mixture modelling for data analyses. Both time-varying covariate (occupational stress) and time-invariant covariates (nurses' characteristics) were entered into the model simultaneously.

RESULTS

Nurses had a homogeneous insomnia trajectory during the whole year of survey. The educational level significantly predicted the growth rate of insomnia severity among nurses. Occupational stress at each time point was significantly associated with worse insomnia across time points (all p < .001).

CONCLUSIONS

Nurses with a baccalaureate degree were more resilient to the development of severe insomnia. Additional studies have an opportunity to investigate the reason for the effects of the educational level on the pattern of insomnia.

IMPLICATIONS FOR NURSING MANAGEMENT

Considering nurses' occupational stress and educational level would lead more effective management of stress and insomnia in newly graduated nurses.

Sleep disturbances and related factors among nurses

The aim of this study was to describe patterns and potential risk factors for sleep disturbances, including that of sleep apnea, among Thai registered nurses. A descriptive, cross-sectional design was implemented. A sample of 233 registered nurses was recruited from 10 nursing departments from a tertiary hospital. Participants completed a one-time, self-report questionnaire and a 1 week-long sleep diary. Descriptive and logistic regression statistics were used for the analysis. Approximately 76% of nurses slept less than 7 h, 12.3% had difficulty initiating sleep, and 5% had difficulty maintaining sleep. Short sleep duration was prevalent, and night shift work schedules that exceeded 10 episodes/month were perceived as contributing to difficulties with initiating sleep. After excluding males from the analysis, the risk for depression related to short sleep duration becomes statistically significant. Organizational policies for registered nurses' shift work should include effective management of night shift assignments, as well as interventional strategies and policy directions, to promote sleep quality and mental health to ensure nurse well-being and patient safety.

Exploring the associations between shift work disorder, depression, anxiety and sick leave taken amongst nurses

This study aimed to evaluate the association between shift work disorder and mental health in hospital-based nurses. Staff completed an online survey comprising demographic questions, the Shift Work Disorder Questionnaire, Patient Health-9 and the General Anxiety Disorder-7 scale. Sick leave data were collected from archival records from the Human Resources Department. Two hundred and two nurses (95% female; age M = 35.28 years ± SD = 12) participated (42% of eligible staff). Those at high risk of shift work disorder had higher depression (M = 7.54 ± SD = 4.28 vs. M = 3.78 ± SD = 3.24; p < 0.001) and anxiety (M = 5.66 ± SD = 3.82 vs. M = 2.83 ± SD = 3.33, p < 0.001) compared to those at low risk. Linear regression models showed that being at high risk of shift work disorder was the most significant predictor of depression, explaining 18.8% of the variance in depression (R²  = 0.188, adjusted R²  = 0.184, F(1, 200) = 46.20, p < 0.001). Shift work disorder combined with the number of night shifts and alcoholic drinks on non-work days accounted for 49.7% of the variance in anxiety scores (R²  = 0.497, adjusted R²  = 0.453, F(3, 35) = 11.51, p < 0.001). Mean sick leave in those with high risk of shift work disorder was 136.17 hr (SD = 113.11) versus 103.98 hr (SD = 94.46) in others (p = 0.057). Depression and years of shift work accounted for 18.9% of the variance in sick leave taken (R²  = 0.189, adjusted R²  = 0.180, F(2, 175) = 20.36, p < 0.001). Shift work disorder is strongly associated with depression and anxiety, providing a potential target to improve mental health in shift workers. Depression, in turn, is a significant contributing factor to sick leave.

Relationship between family history of alcohol problems and different clusters of depressive symptoms

Objectives:

Major depressive disorder (MDD) is a multifactorial syndrome with significant interactions between genetic and environmental factors. This study specifically investigates the association between family history of alcohol problems (FHAP) and family history of depression (FHD), and how these relate to different clusters of depressive symptoms.

Methods:

Correlations between FHAP and FHD and different clusters of the Beck Depression Inventory (BDI) were studied. We sampled 333 employees from a general hospital who had been receiving a psychiatric consultation between 2005 and 2012. Analysis of variance (ANOVA) and Analysis of covariance (ANCOVA) models were conducted to explore these correlations.

Results:

There was a significant positive correlation between FHAP and BDI affective score. This result remained significant even after the adjustment for other variables considered as important factors for MDD, such as gender, age, marital status, education, ethnic group and FHD. More specifically, FHAP was correlated with dissatisfaction and episodes of crying among the affective symptoms. FHAP showed no statistical difference in any of the other clusters score or in the BDI total score. Moreover, as expected, we found a correlation between FHD and BDI total score and Somatic and Cognitive clusters.

Conclusion:

FHAP should be routinely investigated in individuals presenting with depressive symptoms. This is especially important in cases presenting with dissatisfaction and episodes of crying in patients who do not endorse criteria for MDD. Due to study limitations, the findings require replication by neurobiological, epidemiological and clinical studies.

The effect of night shift on sleep quality and depressive symptoms among Chinese nurses

PURPOSE

Night shift is associated with adverse physical and psychological health outcomes such as poor sleep quality and depressive symptoms. We aimed to compare sleep quality as well as depressive symptoms in nurses working night shifts to those working day shifts only and explore the association between sleep quality and depressive symptoms among nurses.

PATIENTS AND METHODS

Eight hundred sixty-five nurses were enrolled in the current study. Sleep quality and depressive symptoms among nurses were evaluated by the Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depressive Disorders Rating Scale (HADS), respectively.

RESULTS

PSQI and HADS scores were both significantly higher in the nurses working night shifts (P<0.05) than in those working day shifts only. Besides, there was a positive correlation between PSQI and HADS scores. Binary logistic regression showed that night shift and poor sleep quality were independent risk factors of depressive symptoms among nurses.

CONCLUSION

Higher rates of depression among Chinese nurses working night shifts may be associated with poor sleep quality induced by night shift.

Impact of morning and rotational duties on physical health of nurses working in tertiary care hospitals of Karachi

Background & Objectives:

In the system related to health care, shifting duties are considered essential and obligatory to make sure the stability of care in hospitals. Scheduling and shifting are the key uniqueness of shift work and nurses are mostly bounded into different schedules that facilitate 24-hour care. Our objective was to identify the impact of morning and rotational duties on physical health of nurses working in tertiary care hospitals.

Methods:

A total of 154 nurses from two tertiary care hospitals in Karachi were included in this study. Data were collected through the Short Form Health Servay-26 between May to June 2017. Questionnaire form consisted of five domains including Physical functioning, Role limitations due to physical health, Energy/Fatigue, Pain and General health.

Results:

Most of the study participants were staff nurses (66.9%) and few were head nurse and assistant head nurses 13.6% and 8.4% respectively. Nurses’ characteristics such as gender, age, educational level, designation and monthly income were found significant with duty shift with p-values 0.049, 0.007, <0.001 and 0.017 respectively. Energy/Fatigue was only domain of SF-26 which showed significant mean difference (p-value <0.001) between morning and rotational duties.

Conclusion:

This research concludes that nurses working in rotational duties were more prone to develop physical problem as compared to morning duties. Energy/Fatigue showed significant mean difference.

Work-related injury and illness in the Victorian healthcare sector: a retrospective analysis of workers' compensation claim records

Objective Health and social care workers have a significantly higher rate of work-related injury and illness than workers in other industries. The objective of this study was to examine the rate and distribution of work-related injury and illness in the Victorian health and social care sector by demographic, occupation and injury characteristics. Methods A retrospective cohort analysis was conducted of population-level workers' compensation claim records, including 43910 claims from the Victorian health and social care over a 10-year period from 2006 to 2015. Negative binomial regression was used to compare claim rates between occupation categories. Results The 55-64 year age group had the highest injury rate compared with the 15-24 year age group (rate ratio 2.26; 95% confidence interval 1.91-2.68). Ambulance officers had the highest overall injury claim rates and had a fluctuating trend of musculoskeletal, psychological and neurological injury claims during the study period. Social workers had the second highest rate of psychological injury and up to threefold the risk of psychological injury compared with nurse professionals. Conclusions Although the greatest volume of claims was observed in nurses, ambulance officers and paramedics were at higher risk for injury, followed by social workers. The differential patterns of injury and illness among occupation groups suggests a need for primary and secondary prevention responses tailored by occupation. What is known about the topic? The health and social care industry is a large and diverse industry. Health and social care workers encounter unique occupational health risks, with exposure varying by occupation. What does this paper add? This study provides evidence of a high rate of work-related injury and illness among health and social care workers, with ambulance officers and social workers at highest risk. Notably, there are also high rates of psychological injury claims among these two occupations. What are the implications for policy makers? This study compares rates of compensable injury and illness in the Victorian health and social care sector by occupation. The study provides guidance on which occupations and which health conditions require greatest attention.

Migraine, tension-type headache and medication-overuse headache in a large population of shift working nurses: a cross-sectional study in Norway

OBJECTIVES

To investigate associations between different types of headaches and shift work.

DESIGN, PARTICIPANTS AND OUTCOME MEASURES

Nurses with different work schedules (day work, two-shift rotation, night work, three-shift rotation) participated in a cohort study with annual surveys that started in 2008/2009. In 2014 (wave 6), a comprehensive headache instrument was included in the survey, in which 1585 nurses participated. Headaches were assessed according to the International Classification of Headache Disorders IIIb. Frequent headache (≥1 day per month), migraine, tension-type headache, chronic headache (headache >14 days per month) and medication-overuse headache (chronic headache + acute headache medication ≥10 days last month) comprised the dependent variables. Adjusted (for sex, age, percentage of full-time equivalent, marital status, children living at home) logistic regression analyses were conducted with work schedule, number of night shifts worked last year, number of quick returns (<11 hours in-between shifts) last year, shift work disorder and insomnia disorder as predictors.

RESULTS

Frequent headache, migraine and chronic headache were associated with shift work disorder (OR 2.04, 95% CI 1.62 to 2.59; 1.60, 1.21 to 2.12; 2.45, 1.25 to 4.80, respectively) and insomnia disorder (OR 1.79, 95% CI 1.43 to 2.23; 1.55, 1.18 to 2.02; 3.03, 1.54 to 5.95, respectively), but not with work schedule, number of night shifts or number of quick returns. Tension-type headache was only associated with >20 night shifts last year (OR 1.41, 95% CI 1.07 to 1.86). Medication-overuse headache was only associated with insomnia disorder (OR 7.62, 95% CI 2.48 to 23.41).

CONCLUSIONS

We did not find any association between different types of headaches and work schedule. However, tension-type headache was associated with high number of night shifts. Nurses with sleep disorders (insomnia disorder and shift work disorder) reported higher prevalence of frequent headaches, migraine, chronic headache and medication-overuse headache (only insomnia) compared with nurses not having insomnia disorder and shift work disorder, respectively.

Using the Analytic Network Process Method for Prioritizing and Weighing Shift Work Disorders Among the Personnel of Hospitals of Kerman University of Medical Sciences

Introduction:

Increasing population, the need for services, and industrialization of societies have led to a growing demand for shift work. Shiftwork causes several disorders, and determining the weight of each disorders is important for their prevention and treatment. Therefore, the purpose of the present study was to use Analytic Network Process (ANP) to prioritize and weigh shift work disorders among the personnel of hospitals of Kerman University of Medical Sciences.

Methods:

This cross-sectional, descriptive-analytical study was conducted in 2017 among 300 shift work personnel of 10 public hospitals affiliated with Kerman University of Medical Sciences. ANP was used to prioritize and weigh shift work disorders. To this end, the criteria, sub-criteria, and alternatives were initially identified. Then, shift work disorders were categorized into 7 general criteria, 20 sub-criteria, and 3 alternatives. After designing the ANP and determining the effect of each criterion on the sub-criteria, the ANP questionnaire was developed and administered among the shift work personnel, who filled it out based on ANP. Super Decisions was subsequently used to weigh and prioritize shift work disorders.

Results:

The results indicated that shift work disorders among the nurses included sleep disorders (0.297), psychological disorders (0.275), digestive disorders (0.137), personal life disorders (0.122), etc., in that order of weighing. With respect to the support staff, the major shift work disorders involved sleep disorders (0.252), digestive disorders (0.198), personal life disorders (0.168), and psychological disorders (0.164). Considering security personnel, the top four shift work disorders were sleep disorders (0.201), digestive disorders (0.186), psychological disorders (0.174), and personal life disorders (0.145).

Conclusion:

According to the findings, sleep disorders had the highest weight in the three studied groups. Moreover, the night shift had the most profound effect on shift work disorders among the personnel in the three groups. It was followed by the evening shift. Morning shift had the lowest influence on shift work disorders. Therefore, the schedules should be taken to prevent these complications in the shift workers. It is suggested that work shift complications be included in the periodic examination program and, in case of discovery of any rhythmic disorder in each shift workers, the person should not remain in the shiftwork group for some time.

Individual vulnerability to insomnia, excessive sleepiness and shift work disorder amongst healthcare shift workers. A systematic review

Shift workers often experience reduced sleep quality, duration and/or excessive sleepiness due to the imposed conflict between work and their circadian system. About 20-30% of shift workers experience prominent insomnia symptoms and excessive daytime sleepiness consistent with the circadian rhythm sleep disorder known as shift work disorder. Individual factors may influence this vulnerability to shift work disorder or sleep-related impairment associated with shift work. This paper was registered with Prospero and was conducted using recommended standards for systematic reviews and meta-analyses. Published literature that measured sleep-related impairment associated with shift work including reduced sleep quality and duration and increased daytime sleepiness amongst healthcare shift workers and explored characteristics associated with individual variability were reviewed. Fifty-eight studies were included. Older age, morning-type, circadian flexibility, being married or having children, increased caffeine intake, higher scores on neuroticism and lower on hardiness were related to a higher risk of sleep-related impairment in response to shift work, whereas physical activity was a protective factor. The review highlights the diverse range of measurement tools used to evaluate the impact of shift work on sleep. Use of standardised and validated tools would enable cross-study comparisons. Longitudinal studies are required to establish causal relationships between individual factors and the development of shift work disorder.

Who is sleepier on the night shift? The influence of bio-psycho-social factors on subjective sleepiness of female nurses during the night shift

Sleepiness is a common complaint during the night shift and may impair performance. The current study aims to identify bio-psycho-social factors associated with subjective sleepiness during the night shift. Ninety-two female nurses working rotating shifts completed a sociodemographic questionnaire, the Munich ChronoType Questionaire for shift workers, the Pittsburg Sleep Quality Index, and the Pre-sleep Arousal Scale. Subjective sleepiness was measured hourly during two night shifts using the Karolinska Sleepiness Scale, and activity monitors assessed sleep duration 24-h before each shift. Findings showed that increased sleepiness was associated with increased age in nurses with early chronotypes and with more children. High cognitive pre-sleep arousal, but not sleep, was associated with increased sleepiness, especially in late chronotypes. The impact of bio-psycho-social factors on night shift sleepiness is complex, and depends on mutual interactions between these factors. Nurses most prone to increased sleepiness must develop personal strategies for maintaining vigilance on the night shift. Practitioner Summary: This study aims to identify bio-psycho-social factors associated with subjective sleepiness of female nurses during the night shift. Increasing sleepiness was associated with increased age in nurses with early chronotypes and with more children. Increased cognitive pre-sleep arousal, but not sleep, was associated with increased sleepiness, especially in late chronotypes.

Mental disorders among workers in the healthcare industry: 2014 national health insurance data

Background

Numerous studies have shown that healthcare professionals are exposed to psychological distress. However, since most of these studies assessed psychological distress using self-reporting questionnaires, the magnitude of the problem is largely unknown. We evaluated the risks of mood disorders, anxiety disorders, sleep disorders, and any psychiatric disorders in workers in healthcare industry using Korea National Health Insurance (NHI) claims data from 2014, which are based on actual diagnoses instead of self-evaluation.

Methods

We used Korea 2014 NHI claims data and classified employees as workers in the healthcare industry, based on companies in the NHI database that were registered with hospitals, clinics, public healthcare, and other medical services. To estimate the standardized prevalence of the selected mental health disorders, we calculated the prevalence of diseases in each age group and sex using the age distribution of the Korea population. To compare the risk of selected mental disorders among workers in the healthcare industry with those in other industries, we considered age, sex, and income quartile characteristics and conducted propensity scored matching.

Results

In the matching study, workers in healthcare industry had higher odds ratios for mood disorders (1.13, 95% CI: 1.11–1.15), anxiety disorders (1.15, 95% CI: 1.13–1.17), sleep disorders (2.21, 95% CI: 2.18–2.24), and any psychiatric disorders (1.44, 95% CI: 1.43–1.46) than the reference group did. Among workers in healthcare industry, females had higher prevalence of psychiatric disorders than males, but the odds ratios for psychiatric disorders, compared to the reference group, were higher in male workers in healthcare industry than in females.

Conclusions

The prevalence of mood disorders, anxiety disorders, sleep disorders, and all psychiatric disorders for workers in the healthcare industry was higher than that of other Korean workers. The strikingly high prevalence of sleep disorders could be related to the frequent night-shifts in these professions. The high prevalence of mental health problems among workers in healthcare industry is alarming and requires prompt action to protect the health of the “protectors.”

High psychosocial burden in relatives of malignant brain tumor patients

OBJECTIVE

Not only tumor patients suffer enormously from their disease, also the caregivers are massively affected by the disease of their relatives. In this study, we investigate the psychological burden in caregivers of outpatient malignant brain tumor patients.

PATIENTS AND METHODS

Fifty caregivers of patients with primary malignant brain tumors were included in our study. Study participants filled in a form with demographic details, a self-established questionnaire concerning general well-being and three established psychological questionnaires to assess anxiety, depression, stress and social support: The "Hospital Anxiety and Depression Scale" (HADS), the "Perceived Stress Scale" (PSS-10) and the "Social Support Questionnaire" (F-SozU).

RESULTS

Caregivers of patients with primary malignant brain tumors showed in the HADS clinically relevant anxiety in 49% and depression in 20% of the cases. The stress level of the caregivers was increased (mean: 18 points) compared to the general population mean: 13 points), although they felt well supported by their social environment (mean: 4.25 points; general population 3.99 points). There was a significant positive correlation between anxiety and depression (p < 0.001). Female caregivers suffered significantly more from anxiety (p = 0.017) and stress (p = 0.012) than their male counterparts. No correlation was found between tumor grade, age of relatives and patients or the state of living together with the patient and anxiety or depression.

CONCLUSIONS

Although the caregivers felt well supported by their social environment, stress, anxiety and depression are common phenomena in caregivers of patients with malignant brain tumors. Especially female ones have an increased risk for developing these comorbidities.

Povezava med neprespanostjo in delazmožnostjo zaposlenih v zdravstveni negi

Uvod: Spanje je aktivni proces, ki pomembno vpliva na kakovost delovnega življenja. V ta namen je bila izvedena raziskava o odnosu med neprespanostjo in delazmožnostjo zaposlenih v zdravstveni negi.Metode: V kvantitativni opisni raziskavi so bili v letih 2014 in 2015 obravnavani zaposleni iz ene splošne bolnišnice in dveh domov upokojencev v Sloveniji. Z enostavnim slučajnostnim izborom je bilo v stratificiran vzorec vključenih 21,26 % (n = 81) v zdravstveni negi zaposlenih žensk iz teh treh zavodov. Podatki, pridobljeni z anketo (Cronbach α = 0,624), so bili analizirani z deskriptivno statistiko in s korelacijsko analizo.Rezultati: Večina anketirank opravlja od tri do sedem nočnih izmen mesečno (x = 3,76, s = 2,51). Vse anketiranke imajo težave z nespečnostjo (n = 81, 100 %), večina jih s težavo ostaja budnih na delovnem mestu (n = 52, 64,2 %). Težave z budnostjo na delovnem mestu se povezujejo s slabšim splošnim počutjem (r = 0,236, p = 0,034) in so pogostejše ob večjem številu nočnih izmen v mesecu (r = −0,322, p = 0,003). Anketiranke so mnenja, da neprespanost povečuje verjetnost napak pri delu (n = 60, 74,1 %), upočasnjuje hitrost odzivanja na nepričakovane urgentne situacije na delovnem mestu (n = 58, 71,6 %) ter slabo vpliva na njihovo komunikacijo s pacienti (n = 48, 59,2 %).Diskusija in zaključek: Podobno kot druge tuje raziskave o zaposlenih v zdravstveni negi tudi ta potrjuje, da se neprespanost zaradi nočnega dela povezuje s slabšim počutjem, utrujenostjo in zmanjšano delazmožnostjo.

Assessing and managing the shift work disorder in healthcare workers

Background:

Shift work disorder (SWD) is a major concern for both healthcare workers (HCWs) employed in hospital wards and healthcare organizations. The consequences of SWD may lead to increased service costs and lower standards of care.

Objectives:

To identify and evaluate the latest developments in assessing and managing the occupational risk of SWD in shift-HCWs through a search of the literature published in the last five years.

Methods:

We performed a search of the literature starting from June 2012, using MEDLINE/Pubmed. The articles were reviewed and categorized into one or more of the following categories based on their subject matter: Risk assessment, Risk management, Occurrence rates.

Results:

A total of 25 publications matched the inclusion criteria. The topics discussed, in order of frequency (from the highest to the lowest), were: “Risk Assessment” (84%), “Occurrence Rates” (64%) and “Risk Management” (48%). Number of nights worked per year, long night-time working hours, frequent missing of nap opportunities during night-shift, quick returns and unhealthy workplace were found as organizational determinants of SWD that should be prioritized in the risk assessment of shift work in the healthcare sector.

Conclusions:

Organizational interventions targeted on both healthy shift-work scheduling and improvement of the workplace safety are proposed to moderate the occurrence of SWD and, consequently, to ensure HCWs’ wellness and suitable standards of patient care. Further studies aimed to investigate the effectiveness of such interventions in minimizing SWD occurrence are needed.

The relationship between shift work and mental health among electronics workers in South Korea: A cross-sectional study

Objective

To determine the relationship between shift work and mental health, particularly insomnia, depression, and suicidal ideation, among electronics production workers.

Methods

A survey was conducted with 14,226 workers from an electronics manufacturer in South Korea. After excluding 112 individuals with incomplete responses, 14,114 respondents were analyzed. As part of a larger project, we collected data on respondents’ general characteristics, work-related characteristics, and health status; however, in this study, we focused on the data related to shift work and mental health. Insomnia, depression, and suicidal ideation were set as dependent variables and working schedule as set as the independent variable. We performed multiple logistic regression analysis with daytime workers as the reference group. The model was adjusted for age, gender, body mass index, workplace, educational level, and marital status with or without children under 6 years of age.

Results

Relative to daytime workers, shift workers had 2.35, 1.23, and 1.17 greater odds of insomnia, depression, and suicidal ideation, respectively. Within the shift worker group, we found that the odds of depression and suicidal ideation increased dramatically when respondents had insomnia. The ORs for depression and suicidal ideation were 4.899 and 7.934, respectively.

Conclusions

Our findings suggest that shift work is related to an increased risk of mental health problems in production workers, and the sleep disturbance related with shift work is a central mechanism for this relationship. Since these results suggest that proactive management of sleep problems might attenuate their detrimental effects on shift worker’s mental health.

No Escaping the Rat Race: Simulated Night Shift Work Alters the Time-of-Day Variation in BMAL1 Translational Activity in the Prefrontal Cortex

Millions of people worldwide work during the night, resulting in disturbed circadian rhythms and sleep loss. This may cause deficits in cognitive functions, impaired alertness and increased risk of errors and accidents. Disturbed circadian rhythmicity resulting from night shift work could impair brain function and cognition through disrupted synthesis of proteins involved in synaptic plasticity and neuronal function. Recently, the circadian transcription factor brain-and-muscle arnt-like protein 1 (BMAL1) has been identified as a promoter of mRNA translation initiation, the most highly regulated step in protein synthesis, through binding to the mRNA “cap”. In this study we investigated the effects of simulated shift work on protein synthesis markers. Male rats (n = 40) were exposed to forced activity, either in their rest phase (simulated night shift work) or in their active phase (simulated day shift work) for 3 days. Following the third work shift, experimental animals and time-matched undisturbed controls were euthanized (rest work at ZT12; active work at ZT0). Tissue lysates from two brain regions (prefrontal cortex, PFC and hippocampus) implicated in cognition and sleep loss, were analyzed with m⁷GTP (cap) pull-down to examine time-of-day variation and effects of simulated shift work on cap-bound protein translation. The results show time-of-day variation of protein synthesis markers in PFC, with increased protein synthesis at ZT12. In the hippocampus there was little difference between ZT0 and ZT12. Active phase work did not induce statistically significant changes in protein synthesis markers at ZT0 compared to time-matched undisturbed controls. Rest work, however, resulted in distinct brain-region specific changes of protein synthesis markers compared to time-matched controls at ZT12. While no changes were observed in the hippocampus, phosphorylation of cap-bound BMAL1 and its regulator S6 kinase beta-1 (S6K1) was significantly reduced in the PFC, together with significant reduction in the synaptic plasticity associated protein activity-regulatedcytoskeleton-associated protein (Arc). Our results indicate considerable time-of-day and brain-region specific variation in cap-dependent translation initiation. We concludethat simulated night shift work in rats disrupts the pathways regulating the circadian component of the translation of mRNA in the PFC, and that this may partly explain impaired waking function during night shift work.

The Relationship Between Working Time and Ill Health

Abstract: Several studies have investigated the relationship between working time and health; however, an adequate comparison of this relationship among full-time and part-time workers is still missing. Therefore, this study aimed to fill this gap in the literature. We investigated several aspects of working time: weekly overtime, monthly on-call duties, monthly shift work, and adherence to breaks. To assess health, we investigated sleeping problems, cognitive irritation, and emotional exhaustion. Data were collected from 812 hospital physicians. We tested our assumptions with a group comparison using structural equation modeling. Overtime and adherence to breaks were shown to be health-relevant factors, particularly for full-time workers, whereas night and weekend shifts were more relevant for part-time workers’ health. On-call duties were less relevant for both groups. The inclusion of time pressure and autonomy caused different changes. The results of this study illustrate that personal needs should be considered when scheduling working time to promote health.

High fatigue and its associations with health and work related factors among female medical personnel at 54 hospitals in Zhuhai, China

The present study aimed to investigate the prevalence of fatigue and determine factors associated with fatigue in female medical personnel. Based on a cross-sectional study, a total of 1608 female medical personnel at 54 hospitals in Zhuhai, China were recruited by a multistage stratified cluster sampling method. The Symptoms Checklist-90-Revised and Chalder Fatigue Scale were used to assess psychiatric symptoms and fatigue, respectively. Data regarding demographic, health, and work related variables were also collected. Multivariate logistic regression model was constructed to determine the influencing factors of fatigue. Approximately 83% of participants had experienced fatigue in the past week. The risk of fatigue was higher in aged 30-39 years old than older or younger participants; Longer sleeping time predicted a lower prevalence of fatigue (OR = .35), while tense physician-patient relationship predicted a higher prevalence of fatigue (OR = 1.77). Depression (OR = 1.76) and anxiety (OR = 1.96) were found related to fatigue. Additionally, fatigue was associated with marital status, occupation, health related factors (exercise, regular diet, and health status), and work related factors (hospital rank and turnover intention). These study findings might facilitate development and implementation of targeted interventions and preventive measures.

Adverse metabolic and mental health outcomes associated with shiftwork in a population-based study of 277,168 workers in UK biobank<sup/>

BACKGROUND

Reported associations between shiftwork and health have largely been based on occupation-specific, or single sex studies that might not be generalizable to the entire working population. The objective of this study was to investigate whether shiftwork was independently associated with obesity, diabetes, poor sleep, and well-being in a large, UK general population cohort.

METHODS

Participants of the UK Biobank study who were employed at the time of assessment were included. Exposure variables were self-reported shiftwork (any shiftwork and night shiftwork); and outcomes were objectively measured obesity, inflammation and physical activity and self-reported lifestyle, sleep and well-being variables, including mental health.

RESULTS

Shiftwork was reported by 17% of the 277,168 employed participants. Shiftworkers were more likely to be male, socioeconomically deprived and smokers, and to have higher levels of physical activity. Univariately, and following adjustment for lifestyle and work-related confounders, shiftworkers were more likely to be obese, depressed, to report disturbed sleep, and to have neurotic traits.

CONCLUSIONS

Shiftwork was independently associated with multiple indicators of poor health and wellbeing, despite higher physical activity, and even in shiftworkers that did not work nights. Shiftwork is an emerging social factor that contributes to disease in the urban environment across the working population. Key messages Studies have linked shiftwork to obesity and diabetes in nurses and industry workers, but little is known about the implications of shiftwork for the general workforce In this large cross sectional study of UK workers, shiftwork was associated with obesity, depression and sleep disturbance, despite higher levels of physical activity. Shiftwork was associated with multiple indicators of compromised health and wellbeing and were more likely to report neurotic traits and evening preference.

Night Shift Work and Risk of Depression: Meta-analysis of Observational Studies

This study aimed to assess whether night shift work is associated with the risk of depression by using a meta-analysis of observational studies. We searched PubMed and EMBASE in August, 2016 to locate eligible studies and investigated the association between night shift work and the risk of depression, reporting outcome measures with adjusted odds ratios (ORs) or relative risks (RRs) and 95% confidence intervals (CIs). In the meta-analysis of a total of 11 observational studies with 9 cross-sectional study, 1 longitudinal study, and 1 cohort study, night shift work was significantly associated with an increased risk of depression (OR/RR, 1.43; 95% CI, 1.24-1.64; I² = 78.0%). Also, subgroup meta-analyses by gender, night shift work duration, type of occupation, continent, and type of publication showed that night shift work was consistently associated with the increased risk of depression. The current meta-analysis suggests that night shift work is associated with the increased risk of depression. However, further large prospective cohort studies are needed to confirm this association.

Study on emotion by rest time in mice with repetitive sleep deprivation

Sleep deprivation (SD) inhibits normal biorhythms, causing physical and mental problems. To solve the problems caused by SD, fundamental measures are needed. I investigated change of recovery by rest time in psychological aspect after repetitive SD. The mice were divided into four groups: control 24-hr rest after 24-hr SD group, 48-hr rest after 24-hr SD group, and 72-hr rest after 24-hr SD group (n=20 in each group). I carried out SD in the water cage included multiple platforms. Repetitive SD executes for 36 days. I measured weight every week after SD for 6 weeks. To check emotional condition, I carried out intruder-evoked aggression test and modified forced swimming test. In the present results, group treated 24-hr rest and 48-hr rest after 24-hr SD showed lower natural aggressiveness and high depression. However, group treated 72-hr rest after 24-hr SD indicated emotional changes to recover the normal conditions. In the weight change, all group showed significant decrease compared to control for 6 weeks. I suggest that appropriate rest time after SD can help to restore emotional change.

Effect of color temperature on melatonin production for illumination of working environments

We studied the influence of correlated color temperature (CCT) of 7 polychromatic white light illuminations (1600 K-14,000 K, 200 lx) in two experiments. Visual performance was tested in 17 students (8 men) during daytime. Visual acuity, contrast sensitivity and sleepiness did not vary with illuminations but polychromatic white light of <2000 K impaired color discrimination. Melatonin synthesis was tested with weekly intervals in 8 trials from 10pm to 2am (7 polychromatic illuminations and a dim light reference (<0.1 lx)) in 16 students (9 men, semi-recumbent position). Melatonin suppression was almost negligible for CCT <2000 K but increased with increasing CCT.

CONCLUSIONS

CCTs <2000 K are not suitable for work places. Polychromatic white light with higher CCTs and significant melatonin suppression is expected to shift the circadian rhythm and to accelerate the adaptation to night work. This effect should be enhanced with elevation of luminance.