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

A call for Applied Knowledge and Lived Interdisciplinarity in the medical care of depressed employees: a cross-sectional survey with German occupational physicians and psychotherapists

OBJECTIVES

To identify approaches for an effective patient-centred care of depressed employees, we investigated occupational physicians' (OPs) and psychotherapists' (PTs) knowledge about job stressors on the development of depression, application of this knowledge, interdisciplinary cooperation and perceived barriers.

STUDY DESIGN

A cross-sectional online survey.

PARTICIPANTS

OPs (163; 48.5% male) and PTs (69; 43.5% male) providing complete data on the survey out of 257 OPs and 112 PTs who started the survey. There have been 458 (OPs) and 821 (PTs) initial clicks.

METHODS

Main outcome measures were the importance ratings of specific job stressors, the frequency of asking patients about those stressors, the need for interdisciplinary cooperation, as well as perceived barriers for cooperation. We performed multivariate analysis of variance, intraclass correlation coefficients (ICCs) and Spearman's rank-order correlations.

RESULTS

The achieved response rate for OPs was 56.1% and for PTs 13.6%. Both disciplines agreed on the importance of job stressors regarding depression (ICC=0.90; 95% CI: 0.54 to 0.98), but both ranked these factors differently from the current state of research. As to knowledge application, OPs showed positive associations between the importance of job stressors and the frequency of asking employees about them (eg, job insecurity (r_s=0.20, p=0.005)) and PTs for social stressors (eg, interpersonal conflicts (r_s=0.38, p=0.001)). OPs (mean=3.41) reported a higher necessity of interdisciplinary cooperation than PTs (mean=3.17; F(1,230)=7.02, p=0.009). Furthermore, cooperation was reported as difficult to implement. PTs perceived barriers (eg, time restriction) as more hindering (mean=3.2) than OPs (mean=2.8; F(1,171)=8.16, p=0.005).

CONCLUSIONS

Both disciplines are aware of the relevance of job stressors as risk factors for depression, but should be encouraged to ask employees more frequently about them. The need for interdisciplinary cooperation and possible barriers are discussed. It is crucial to emphasise the meaning of sufficient cooperation, since closing this gap for improving patient-centred care especially for employees suffering from depression is necessary.

Night shift preparation, performance, and perception: are there differences between emergency medicine nurses, residents, and faculty?

Objective

Determine differences between faculty, residents, and nurses regarding night shift preparation, performance, recovery, and perception of emotional and physical health effects.

Methods

Survey study performed at an urban university medical center emergency department with an accredited residency program in emergency medicine.

Results

Forty-seven faculty, 37 residents, and 90 nurses completed the survey. There was no difference in use of physical sleep aids between groups, except nurses utilized blackout curtains more (69%) than residents (60%) and faculty (45%). Bedroom temperature preference was similar. The routine use of pharmacologic sleep aids differed: nurses and residents (both 38%) compared to faculty (13%). Residents routinely used melatonin more (79%) than did faculty (33%) and nurses (38%). Faculty preferred not to eat (45%), whereas residents (24%) preferred a full meal. The majority (>72%) in all groups drank coffee before their night shift and reported feeling tired despite their routine, with 4:00 a.m. as median nadir. Faculty reported a higher rate (41%) of falling asleep while driving compared to residents (14%) and nurses (32%), but the accident rate (3% to 6%) did not differ significantly. All had similar opinions regarding night shift-associated health effects. However, faculty reported lower level of satisfaction working night shifts, whereas nurses agreed less than the other groups regarding increased risk of drug and alcohol dependence.

Conclusion

Faculty, residents, and nurses shared many characteristics. Faculty tended to not use pharmacologic sleep aids, not eat before their shift, fall asleep at a higher rate while driving home, and enjoy night shift work less.

Does non-standard work mean non-standard health? Exploring links between non-standard work schedules, health behavior, and well-being

The last century has seen dramatic shifts in population work circumstances, leading to an increasing normalization of non-standard work schedules (NSWSs), defined as non-daytime, irregular hours. An ever-growing body of evidence links NSWSs to a host of non-communicable chronic conditions; yet, these associations primarily concentrate on the physiologic mechanisms created by circadian disruption and insufficient sleep. While important, not all NSWSs create such chronobiologic disruption, and other aspects of working time and synchronization could be important to the relationships between work schedules and chronic disease. Leveraging survey data from Project EAT, a population-based study with health-related behavioral and psychological data from U.S. adults aged 25-36 years, this study explored the risks for a broad range of less healthful behavioral and well-being outcomes among NSWS workers compared to standard schedule workers (n = 1402). Variations across different NSWSs (evening, night/rotating, and irregular schedules) were also explored. Results indicated that, relative to standard schedule workers, workers with NSWSs are at increased risk for non-optimal sleep, substance use, greater recreational screen time, worse dietary practices, obesity, and depression. There was minimal evidence to support differences in relative risks across workers with different types of NSWSs. The findings provide insight into the potential links between NSWSs and chronic disease and indicate the relevancy social disruption and daily health practices may play in the production of health and well-being outcomes among working populations.