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

Burden of sleep deprivation among healthcare professionals in India: The SNORE study

Background

SNORE (Sleep deprivation among Night shift health staff On Rotation- Evaluation) was a hospital-based observational study conducted to study the effects of sleep deprivation on healthcare professionals working night shifts on rotation.

Aim

This study determines the burden of sleep deprivation and daytime sleepiness and also the relation between hours of sleep and Epworth sleepiness scale scores in the study population.

Methodology

A comparative hospital-based observational study was conducted, including healthcare professionals working night shifts on rotation at a tertiary-level healthcare facility, using a semistructured questionnaire. Observations from 293 study participants are reported, selected based on stratified random sampling, after the exclusion of healthcare professionals with other factors which may interfere with sleep deprivation testing.

Results

The mean age in years of the study participants is 27.9 ± 4.3, with female composition being 68.9%. The mean duration of self-reported hours of sleep during the night shift period was 5.43 ± 1.38 hours, and 82.3% of the study participants were found to be sleep-deprived (<7 hours of sleep). The mean Epworth sleepiness scale (EPSS) score is 6.25 ± 3.15 with the burden of sleep deprivation being 30.7% and the burden of excessive daytime sleepiness being 16.4%. EPSS scores were found to decrease with an increase in hours of sleep, with 61% lesser odds of scoring 8-24 on EPSS.

Conclusion

This study highlights the significant burden of sleep deprivation among healthcare providers working rotational night shifts, emphasizing its impact on daytime functioning and wellbeing. The findings point to the need for strategies to improve sleep health in this population to enhance both personal and professional outcomes.

Level of Work-Related Anxiety and Potential Causes of Anxiety in Healthcare Workers in the Emergency Department

OBJECTIVE

The present study evaluated the work-related anxiety scores of healthcare workers in emergency departments (ED) and aimed to determine the factors affecting these scores.

METHODS

The data was obtained through a survey administered to the emergency staff. Beck's Anxiety Inventory (BAI) and the Mini-International Neuropsychiatric Interview (MINI) work anxiety interview were used to predict and determine the type of anxiety experienced by the participants. The survey was administered to 147 volunteers, and questionnaires from 130 participants were included in the study.

RESULTS

It was found that 43.8% of the participants had a BAI score greater than 7. The study results showed a negative correlation and a linear regression model between age and the BAI score. Additionally, the BAI score was significantly higher in female, singles, physicians, those who were dissatisfied with their jobs, and those who were dissatisfied with their salaries (p<0.05). The results also showed that having a history of anxiety disorder or depression, being a physician, and being dissatisfied with one's job were 6.277, 5.583, and 4.005 times higher, respectively, in terms of suspicion of anxiety (p<0.001). In the MINI job anxiety interview, work-related posttraumatic stress disorder (38.6%) was predicted most frequently, and indiscriminative work-related social phobia (5.3%) was predicted least frequently in participants at risk for anxiety according to the BAI score.

CONCLUSION

This study suggests that teaching healthcare workers how to cope with workplace trauma and workplace-related situational phobias can be an effective solution to prevent anxiety disorders in healthcare workers working in ED.

Alcohol Use Predicts Longer But More Fragmented Sleep: A Daily Diary Study of Alcohol, Sleep, and PTSD in Nurses

BACKGROUND

Due to the demanding nature of their profession, nurses are at risk of experiencing irregular sleep patterns, substance use, and fatigue. Evidence supports a reciprocal relationship between alcohol use and sleep disturbances; however, no research has examined such a link in a sample of nurses. One factor that may further impact the dynamic between alcohol and sleep patterns is posttraumatic stress disorder (PTSD) symptoms. We investigated the daily bidirectional associations between alcohol use and several sleep domains (i.e., self-report and actigraphy-determined sleep), and moderation by baseline PTSD symptom severity.

METHOD

Over a 14-day period, 392 nurses (92% female; 78% White) completed sleep diaries and actigraphy to assess alcohol use and sleep patterns. Within-person bidirectional associations between alcohol and sleep were examined using multilevel models, with symptoms of PTSD as a cross-level moderator.

RESULTS

Daily alcohol use (i.e., ≥ 1 alcoholic beverage; 25.76%) was associated with shorter self-reported sleep onset latency (b = -4.21, p = .003) but longer self-reported wake after sleep onset (b = 2.36, p = .009). Additionally, days with any alcohol use were associated with longer self-reported sleep duration (b = 15.60, p = .006) and actigraphy-determined sleep duration (b = 10.06, p = .037). No sleep variables were associated with next-day alcohol use. Bidirectional associations between alcohol consumption and sleep were similar regardless of baseline PTSD symptoms.

CONCLUSION

Our results suggested that on days when nurses drank alcohol, they experienced longer but also more fragmented sleep.

The effect of cumulative night shift duties on insomnia, fatigue, and mental health in intensive care unit

Background

Night shift duties are crucial in the ICU to ensure care continuity, where critically ill patients require round-the-clock care. However, cumulative night shift duties may disturb circadian rhythm, insomnia, fatigue, and depression, and require further elucidation.

Objectives

This study aims to examine the negative consequences of various night shift patterns on insomnia, fatigue, and mental health of ICU Workers.

Methods

A cross-sectional study examined how cumulative night shift duty affects insomnia, fatigue, and mental health in critical care providers (CCPs).

Results

A total of 1006 participants completed this study between June 2022 and March 2023, including 54.5 % males. About 35 % were between 20 and 30 years of age, and Respiratory Therapists accounted for approximately 46.5 % of the entire sample. Most of our respondents (476; 47 %) reported working night shifts, with a monthly range of 8-15 nights. The prevalence rates for moderate to severe clinical insomnia, fatigue, and moderate to severe depression were 42 %, 48 %, and 32 %, respectively. CCPs working 8-15 nights had a 2-fold risk of clinical insomnia than those working fewer than eight nights with (AOR) and 95 % (CI) of 2.12 and 1.41-3.20, while those working ≥16 nights per month had a greater incidence of clinical insomnia compared to those working <8 nights per month, AOR (CI): 3.09 (1.90-5.03). Only those working ≥16-night shifts per month had a substantially higher fatigue risk compared to those working < 8-night shifts per month, with an AOR (CI) of 1.92 (1.19-3.08). Working 8-15-night shifts per month increases depression risks by 34 % compared to the <8-night shifts group, AOR (CI): 1.34 (0.87-2.08). Those working ≥16-night shifts per month showed a higher depression risk than those working <8-night shifts, AOR (CI): 2.53 (1.53-4.19).

Conclusion

A cumulative night shift above eight nights per month is linked with an increased risk of insomnia, fatigue, and depression. The risk of these conditions was significantly directly proportional to the number of night shifts performed per month.

Sleep Deprivation and Fatigue among Nurses Working Consecutive Night Shifts: A Prospective Observational Study

PURPOSE

This study aimed to identify changes in sleep patterns and fatigue levels during consecutive night shifts among shift nurses and to determine the association between sleep parameters and increased fatigue levels during work.

METHODS

This prospective observational study employing ecological momentary assessments was conducted using data collected from 98 shift nurses working in Korean hospitals between June 2019 and February 2021. The sleep patterns were recorded using actigraphy. The participants reported their fatigue levels at the beginning and end of each night shift in real time via a mobile link. Linear mixed models were used for the analysis.

RESULTS

Nurses spent significantly less time in bed and had shorter sleep durations during consecutive night shifts than on off-duty days, whereas their wake times after sleep onset were much longer on off-duty days than on on-duty days. Fatigue levels were higher on the second and third night-shift days than on the first night-shift days. A shorter time spent in bed and asleep was associated with a greater increase in fatigue levels at the end of the shift than at the beginning.

CONCLUSION

Nurses experience significant sleep deprivation during consecutive night shifts compared with off-duty days, and this sleep shortage is associated with a considerable increase in fatigue levels at the end of shifts. Nurse managers and administrators must ensure sufficient intershift recovery time during consecutive night shifts to increase the time spent in bed and sleeping.

Relationship between night work and health-related quality of life: an analysis based on profiles and cumulative duration of exposure to night work among French workers in the CONSTANCES cohort

OBJECTIVE

The aim of this study is to estimate the association between night work and health-related quality of life (HRQoL) among French workers. The association between cumulative duration of night work and HRQoL was also investigated.

METHODS

Three career-long night work exposure groups were defined at inclusion in the CONSTANCES cohort: permanent night workers, rotating night workers and former night workers. Day workers with no experience of night work were the reference group. HRQoL was assessed using the Short Form Health Survey (SF-12), in particular the physical component summary (PCS) and mental component summary (MCS) scores, with a higher score indicating better HRQoL. Several linear regression models were built to test the association between night work exposure and HRQoL. The relationship between cumulative duration of night work and HRQoL scores was analyzed using generalised additive models.

RESULTS

The sample consisted of 10,372 participants. Former night workers had a significantly lower PCS score than day workers (β [95% CI]: - 1.09 [- 1.73; - 0.45], p = 0.001), whereas permanent night workers had a significantly higher MCS score (β [95% CI]: 1.19 [0.009; 2.36], p = 0.048). A significant decrease in PCS score from 5 to 20 years of cumulative night work was observed among former night workers.

CONCLUSIONS

Former night workers had poorer physical HRQoL in contrast to permanent and rotating night workers who had similar or even better HRQoL than day workers, suggesting the well-known healthy worker survivor effect. Consequently, both current and former night workers require regular and specific follow-up focused on the physical components of their health.

Association between sleep health and rates of self-reported medical errors in intern physicians: an ancillary analysis of the Intern Health Study

STUDY OBJECTIVES

Reduced sleep duration and work hour variability contribute to medical error and physician burnout. This study assesses the relationships between physician performance, burnout, and the dimensions of sleep beyond hours slept.

METHODS

This was an ancillary analysis of 3 years of data from an international prospective cohort study: the Intern Health Study. Actigraphy data from 3,654 intern physicians capturing sleep timing, regularity, efficiency, and duration were used individually and combined as a composite sleep health index to measure the association of multidimensional sleep patterns on self-reported medical errors and burnout.

RESULTS

From 2017-2019, interns' work hours decreased by 4 hours per week and total sleep time also decreased (6.7 to 5.99 hours), and sleep efficiency, timing, and regularity all worsened (all P < .05). In the 21.2% of participants who committed an error, there was no difference in sleep duration, timing, or regularity. Lower sleep efficiency was associated with higher odds of committing an error (P = .003) and higher burnout scores (P < .001). Although overall sleep quality was poor in the entire cohort, interns in the lowest quintile of sleep duration, regularity, and efficiency had higher burnout scores than those in the best quintile.

CONCLUSIONS

Sleep efficiency, not duration, was associated with increased self-reported medical errors and burnout in intern physicians. Overall sleep quality and duration worsened despite fewer hours worked. Future studies on physician burnout should measure all aspects of sleep health.

CITATION

Hassinger AB, Velez C, Wang J, Mador MJ, Wilding GE, Mishra A. Association between sleep health and rates of self-reported medical errors in intern physicians: an ancillary analysis of the Intern Health Study. J Clin Sleep Med. 2024;20(2):221-227.

Anxiety Symptoms and Associated Psychological and Job-Related Factors Among Hospital Nurses

OBJECTIVE

Recently, burnout and mental health issues regarding nurses are reported increasingly. This study aimed to investigate the prevalence of anxiety symptoms among hospital nurses and determine their association with psychological and job-related factors.

METHODS

Data on demographics, job-related characteristics, burnout, Type A behavior patterns, self-esteem, and happiness were collected from 515 nurses working at a university hospital in Korea. Anxiety symptoms were assessed using the anxiety subscale of the Hospital Anxiety and Depression Scale, with scores of 8 or higher indicating the presence of anxiety symptoms. Demographic, job-related, and psychological factors were compared according to the presence of anxiety. Logistic regression was conducted to identify factors associated with anxiety symptoms.

RESULTS

Two hundred and four (39.6%) participants had anxiety symptoms. Self-esteem and happiness were associated with a lower risk of anxiety symptoms, whereas burnout was associated with a higher risk of anxiety symptoms. Furthermore, being female, having a career of less than five years, and requiring counseling due to stress were associated with a higher risk of anxiety symptoms. Being younger, female, or a basic nurse; having a career of less than five years; partaking in shift work; experiencing job dissatisfaction; requiring counseling due to stress; being exposed to higher levels of burnout; and having lower levels of self-esteem and happiness were all found to be significantly correlated with anxiety symptoms.

CONCLUSION

These findings suggest that promoting self-esteem and happiness while reducing burnout may be beneficial in preventing and managing anxiety symptoms among hospital nurses.

Synergistic interaction between long shifts and short rest periods on depression in shift workers: A cross-sectional study from Korea

BACKGROUND

Long shifts and short rest periods (SRP) between shifts are important factors that greatly affect shift workers' health. However, reports on the psychological effects of shift work, such as depression, have been inconsistent. Therefore, this study aimed to investigate the combined effect of long shifts and SRP on depression in shift workers.

METHODS

This cross-sectional study included 3295 shift workers in the sixth Korean Working Conditions Survey. The relative excess risk due to interaction (RERI) was computed to estimate the combined effect of long shifts and SRP on depression.

RESULTS

Depression in shift workers was not significantly associated with long shifts or SRP after adjustment, but the risk was significantly increased when exposed to both factors simultaneously (odds ratio 1.36, 95% confidence interval 1.03-1.79). The RERI between the two factors was statistically significant (p = 0.020), indicating a synergistic interaction with depression. Sensitivity analysis by occupation showed a significant interaction in the combined group of office and service workers (p = 0.034).

CONCLUSIONS

Simultaneous exposure to SRP and long shifts should be avoided when planning shift work schedules or devising health policies for shift workers. Special consideration is needed for healthcare and service workers, who may be particularly vulnerable to negative health impacts due to shift work.

Sleep analysis of hospital and out-of-hospital emergency professionals

INTRODUCTION

Sleep deprivation is associated with poorer cognitive functioning and a greater risk of serious diseases. Herein, we analyzed differences in the quality of sleep and excessive daytime sleepiness between hospital emergency services and out-of-hospital emergencies services, and investigated its association with sociodemographic and labor variables.

METHOD

This is a cross-sectional observational study carried out between April 2019 and February 2020, including healthcare professionals from different emergency departments, who were evaluated through the following instruments: "Pittsburgh Sleep Quality Index" and "Epworth Sleepiness Scale".

RESULTS

Four-hundred and four healthcare professionals were included (mean age 40.4 ± 11.1 years), predominantly women (61.4%) from hospital emergency departments (62.6%). A total of 65.3% of the workers had poor sleep quality and 27.7% had excessive sleepiness. Women had poorer sleep quality (p = 0.022) and higher sleepiness (p = 0.010) than men. Hospital emergency workers presented 2-fold increased risk of poor sleep quality (OR = 1.93, p = 0.003) and sleepiness (OR = 1.93, p = 0.009) than out-of-hospital emergency workers. The more optimistic were less likely to have poor sleep quality (OR = 0.73, p = 0.01) or sleepiness (OR = 0.70, p = 0.002). Nurses, emergency medical technicians and nursing assistants also had a higher risk of poor sleep quality compared to physicians (OR = 1.60; p = 0.043).

CONCLUSIONS

Emergency healthcare professionals working in hospital emergency departments had a two-times higher risk of poor sleep quality and sleepiness than out-of-hospital emergency healthcare professionals.

Fatigue and somatization in shift-workers: Effects of depression and sleep

OBJECTIVE

We investigated the differences in fatigue and somatization between shift and non-shift workers and explored the effects of sleep and depression on fatigue and somatization in shift workers.

METHODS

In total, 4543 shift workers and 2089 non-shift workers completed self-reported questionnaires. The Center for Epidemiologic Studies Depression Scale (CESD), Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), and Somatization subscale of the Symptom Checklist 90-item version (SCL-SOM) were used to measure depression, sleep quality, fatigue, and somatization, respectively. Fatigue and somatization were compared between shift and non-shift workers after controlling for different sets of covariates.

RESULTS

Compared to non-shift workers, shift workers reported higher FSS (mean difference: 2.19 ± 0.30, p < 0.01) and SCL-SOM (mean difference: 1.77 ± 0.21, p < 0.01) scores after controlling for age, gender, presence of medical illness, occupational category, monthly income, length of service, and weekly working hours. The between-group difference in FSS score was no longer significant after additionally controlling for CES-D (p = 0.15) or PSQI (p = 0.18). The between-group difference in SCL-SOM score showed only non-significant trends after additionally controlling for CES-D (p = 0.09) or PSQI (p = 0.07). The group difference in SCL-SOM scores disappeared after controlling for both CES-D and PSQI scores (p = 0.99).

CONCLUSIONS

Shift workers had higher fatigue and somatization levels than non-shift workers and the group difference was associated with disturbed sleep and depressed mood in shift workers.

The Correlation Between Night Shift Work Schedules, Sleep Quality, and Depression Symptoms

Purpose

Poor sleep and depressive symptoms are two negative effects of night shift work on physical and mental health. This study evaluated the correlation between sleep quality and depression symptoms among nurses in Saudi Arabia. Specifically, we assessed depressive symptoms and sleep quality observed among nurses who worked night shifts and compared the outcomes with those who worked exclusively day shifts in hospital settings.

Patients and Methods

A total of 191 participants (55.5% men, 44.5% women) participated. The response rate was 63.6%. The hospital anxiety and depression scale (HADS) and Pittsburgh Sleep Quality Index (PSQI) were used to assess depression score and sleep quality, respectively.

Results

Nurses who worked night shifts had substantially higher PSQI ratings (p<0.05) than those who worked day shifts. In addition, there was a clear relationship between the HADS and PSQI scores. According to the binary logistic regression, longer working hours and inadequate sleep were both independently linked to depressive symptoms among nurses.

Conclusion

Poor sleep quality brought on by night shifts may explain why Saudi nurses who work night shifts experience higher rates of depression than those who work day shifts only.

The Relationship between Working Night Shifts and Depression among Nurses: A Systematic Review and Meta-Analysis

BACKGROUND

For many years, occupational physicians have debated whether there is a link between working the night shift and depression and other co-occurring mental health issues, with an emphasis on work-related, biological, individual, and environmental factors. We performed this systematic review and meta-analysis to estimate the overall association between sleep deprivation and depression among nurses working night shifts.

METHODS

A systematic search was carried out across the electronic databases PubMed, Scopus, and Web of Science from inception to 30 September 2022, for studies that reported a relationship between estimated night shift work and depression in nurses. The outcomes were measured using the odds ratio (OR) and matching 95% confidence interval (CI). The I² statistic was used to assess heterogeneity. The Grading of Recommendations Assessment, Development and Evaluation technique was used to evaluate the quality of the evidence, and the Newcastle-Ottawa Scale was utilized to assess the methodological quality of each of the included studies. We determined the overall relationship between working nights and the onset of depression.

RESULTS

A total of 20 studies were included in the systematic review. Furthermore, 8 studies were included in the meta-analysis due to their common use of the OR as an effect measure. The 8 studies gave an overall estimate indicating a statistically significant association between night shift work and depression among nurses (OR = 1.49 95% CI: 1.26, 1.76). The prediction interval for the overall estimate was (0.995, 2.231). This implies that the true OR in a future study would most likely fall within this range, with a 95% certainty.

CONCLUSIONS

The outcome of this systematic review and meta-analysis showed a significant association between night shift work, the circadian and sleep disruption it causes, and the risk of depression in nurses. This demonstrates that nurses who work night shifts are at risk of developing depression.

The relation between routines for shiftwork scheduling and sickness absence at a Norwegian hospital: A cross-sectional study

BACKGROUND

Shift work is associated with negative health outcomes. Routines for scheduling of shift work can help reduce negative health outcomes of shift work and improve work-life balance and social well-being for nurses working shift work.

OBJECTIVE

To investigate the association between organizational units' routines for shift work scheduling and nurses' sickness absence at the unit level.

DESIGN

Cross-sectional study design combining quantitative questionnaire data on shift work scheduling routines with data of mean percentage of sickness absence at the unit, mean level of exhaustion at the unit, mean age and percentage of women working at the unit.

PARTICIPANTS

A total of 126 leaders at organizational units with nurses working shift work schedule at Oslo University Hospital answered a questionnaire about shift work scheduling.

MEASURES

Three aspects of health-promoting shift work scheduling (fatigue-reducing scheduling, organizational health measures, and individual adaptation) and the extent to which operational considerations were made during shift work scheduling were used as independent variables. Covariates were mean age of nurses at each unit, mean percent female nurses, and mean exhaustion at unit level. Percent sickness absence was used as a dependent variable.

METHODS

Questionnaire data on shift work scheduling routines was merged with information on average age of employees in the unit, ratio female nurses, and units' average score on exhaustion. Multivariable linear regression analyses were used to assess the contribution of routines for shift work scheduling after controlling for mean level of exhaustion, average age, and proportion of women at each unit.

RESULTS

The factors "fatigue reducing scheduling", "organizational health measures" and "operational considerations" had no observed total effect on mean sickness absence. Individual adjustment in shift work scheduling had a direct negative association with sickness absence after controlling for other shift work scheduling routines, exhaustion, age, and gender.

CONCLUSIONS

There is a relationship between the units' routines for shift work scheduling and mean sickness absence at the unit, and the possibility of individual adjustment was the only aspect of shift work scheduling that had an above-zero association with sickness absence.

Tagesschläfrigkeit bei Pflegepersonal

Hintergrund

Aufgrund von Arbeitszeiten, die außerhalb der normalen Tagesarbeitszeit liegen, kann es bei Pflegepersonal zu Störungen der inneren Uhr kommen. Durch zusätzliche Verpflichtungen im familiären Bereich kann sich möglicherweise eine Normalisierung der zirkadianen Störung bei weiblichen Pflegenden erschweren, da sie zu Hause nicht genug Zeit für Schlaf und Erholung finden.

Fragestellung

In der vorliegenden Arbeit soll explorativ untersucht werden, ob Beschäftigte in der Pflege ein höheres Risiko für Tagesschläfrigkeit haben als andere Berufsgruppen, die nicht im Schichtdienst arbeiten. Darüber hinaus soll ebenfalls explorativ analysiert werden, inwiefern das Geschlecht in Verbindung mit der Beschäftigung im Schichtdienst eine Rolle hinsichtlich der Tagesschläfrigkeit spielt.

Material und Methoden

Aus der 10.000er Baselinestichprobe der Hamburg City Health Study (HCHS) wurden alle Proband:innen selektiert, die beruflich in der Pflege tätig waren. Anhand des Alters, des Geschlechts und des Chronotyps wurden aus dem HCHS-Datensatz aktiv Beschäftigte im Verhältnis 1:3 gezogen, die aus Branchen mit vorwiegend keiner Schichtarbeit stammen (Kontrollen). Die Tagesschläfrigkeit wurde anhand des Epworth-Sleepiness-Scale-Fragebogens (ESS) erhoben.

Ergebnisse

In der Gesamtstichprobe der HCHS waren 4646 Personen aktiv beschäftigt. Unter diesen befanden sich 134 Personen, die angaben, in der Pflege zu arbeiten. Anhand des Matchings von 1:3 wurde ein Datensatz von 536 Personen erzeugt. Insgesamt konnte für 19 % der Stichprobe eine exzessive Tagesschläfrigkeit beobachtet werden, davon betroffen waren 25 % der Pflegenden und 17 % der Beschäftigten anderer Branchen. Weibliche Beschäftigte in der Pflege hatten im Vergleich zu Männern aus anderen Branchen ein statistisch signifikant erhöhtes Risiko für exzessive Tagesschläfrigkeit (OR 3,5; 95 % KI 1,32–9,23).

Diskussion

Anhand der Ergebnisse der bevölkerungsbezogenen Untersuchung zeigt sich, dass Pflegepersonal im Vergleich zu Branchen ohne Schichtarbeit öfter von Tagesschläfrigkeit betroffen ist. Inwieweit Frauen, die in der Pflege arbeiten ein noch höheres Risiko für Tagesschläfrigkeit besitzen, sollte in weiteren Studien anhand zusätzlicher Merkmale präziser untersucht werden.

Daily reactivity to stress and sleep disturbances: unique risk factors for insomnia

STUDY OBJECTIVES

To naturalistically measure sleep disturbances following stress exposure (i.e. sleep reactivity) and stress responses following sleep disturbances (i.e. stress reactivity) at the daily level and prospectively examine these reactivity measures as individual risk factors for insomnia.

METHODS

The study assessed 392 nurses' sleep and stress for 14 days using daily diaries and actigraphy. Self-reported insomnia symptoms were assessed at the end of the 14 days, as well as 6 and 11 months later.

RESULTS

In multilevel modeling, while negative fixed effects indicated that shorter total sleep time (TST) and lower sleep efficiency led to greater stress and vice versa, significant random effects indicated individual variability in sleep reactivity and stress reactivity. In latent score change modeling, greater sleep reactivity (lower diary-determined sleep efficiency following greater stress) and greater stress reactivity (greater stress following shorter diary-determined TST) at baseline were associated with greater insomnia symptoms at 11 months (b = 10.34, p = .026; b = 7.83, p = .03). Sleep reactivity and stress reactivity also interacted to predict insomnia symptoms, such that sleep reactivity was significantly associated with insomnia symptoms for those with high (+1 SD) stress reactivity (b = 17.23, p = .001), but not for those with low (-1 SD) stress reactivity (b = 5.16, p = .315).

CONCLUSIONS

Baseline stress reactivity and sleep reactivity independently as well as jointly predict greater insomnia symptoms 11 months later. The findings delineate processes underlying the stress-diathesis model of insomnia and highlight the utility of longitudinal and naturalistic measures of sleep and stress reactivity.

Women's Health and Working Life: A Scoping Review

Women's health matters for participation in working life. The objective of this study was to explore female physiology in a work-life context and to investigate possible associations between women's health, sickness absence and work ability. A scoping review was conducted to develop a systematic overview of the current research and to identify knowledge gaps. The search strategy was developed through a population, concept and context (PCC) model, and three areas of women's health were identified for investigation in the context of work. A total of 5798 articles were screened by title and abstract and 274 articles were screened by full text; 130 articles were included in the review. The material included research from 19 countries; the majority of the studies used quantitative methods. The results showed an impact on the occupational setting and an association between sickness absence, work ability and all three areas of women's health, but a holistic and overall perspective on female biology in the work context is missing. This review calls for more knowledge on health and work and possible gender differences in this regard. Women's health and working life involve a complex connection that has the potential to develop new knowledge.

Optimizing Pediatric Patient Safety in the Emergency Care Setting

Patient safety is the foundation of high-quality health care and remains a critical priority for all clinicians caring for children. There are numerous aspects of pediatric care that increase the risk of patient harm, including but not limited to risk from medication errors attributable to weight-dependent dosing and need for appropriate equipment and training. Of note, the majority of children who are ill and injured are brought to community hospital emergency departments. It is, therefore, imperative that all emergency departments practice patient safety principles, support a culture of safety, and adopt best practices to improve safety for all children seeking emergency care. This technical report outlined the challenges and resources necessary to minimize pediatric medical errors and to provide safe medical care for children of all ages in emergency care settings.

Optimizing Pediatric Patient Safety in the Emergency Care Setting

This is a revision of the previous American Academy of Pediatrics policy statement titled "Patient Safety in the Emergency Care Setting," and is the first joint policy statement by the American Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association to address pediatric patient safety in the emergency care setting. Caring for children in the emergency setting can be prone to medical errors because of a number of environmental and human factors. The emergency department (ED) has frequent workflow interruptions, multiple care transitions, and barriers to effective communication. In addition, the high volume of patients, high-decision density under time pressure, diagnostic uncertainty, and limited knowledge of patients' history and preexisting conditions make the safe care of critically ill and injured patients even more challenging. It is critical that all EDs, including general EDs who care for the majority of ill and injured children, understand the unique safety issues related to children. Furthermore, it is imperative that all EDs practice patient safety principles, support a culture of safety, and adopt best practices to improve safety for all children seeking emergency care. This policy statement outlines the recommendations necessary for EDs to minimize pediatric medical errors and to provide safe care for children of all ages.

Shift Work Disorder Index: initial validation and psychosocial associations in a sample of nurses

STUDY OBJECTIVES

Shift work is common yet does not always result in Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)-defined shift work sleep disorder (SWD). This study reports on the reliability and validity of the DSM-5 informed Shift Work Disorder Index (SWDI), the presence of probable SWD in nurses, and demographic, sleep, and psychosocial correlates.

METHODS

Nurses (n = 454) completed the SWDI, psychosocial, and demographic questionnaires. Of the sample, n = 400 completed 14 days of sleep diaries, actigraphy, and additional questionnaires.

RESULTS

The global SWDI demonstrated excellent internal consistency (α = .94), as well as good convergent and divergent validity in the nurse sample. Thirty-one percent of nurses were past-month shift workers, with 14% (ie, 44% of shift workers) having probable SWD based on SWDI. Nurses who worked shift work and/or met SWD criteria were more likely to be younger and unmarried and less likely to have children than day workers and reported greater evening chronotype, insomnia, nightmares, and sleep-related impairment, greater depression, anxiety, posttraumatic stress, and perceived stress symptoms, as well as later and more variable sleep midpoint (actigraphy), shorter sleep duration (actigraphy, diaries), and lower sleep efficiency (diaries).

CONCLUSIONS

The SWDI is an efficient and valid self-report assessment of DSM-5-defined SWD. Shift work and/or SWD were prevalent and associated with worse sleep and psychosocial health, particularly among nurses with probable SWD.

CITATION

Taylor DJ, Dietch JR, Wardle-Pinkston S, et al. Shift Work Disorder Index: initial validation and psychosocial associations in a sample of nurses. J Clin Sleep Med. 2022;18(10):2339-2351.

National strategy on the integration of sleep and circadian rhythms into public health research and policies: Report from the Canadian Sleep and Circadian Network

Scientists in sleep and circadian rhythms, public health experts, healthcare providers, partners, and stakeholders convened in 2020 for a 2-day meeting organized by the Canadian Sleep and Circadian Network to develop a national strategy for the integration of sleep and circadian rhythms into public health and policies in Canada. The objective of this paper is to present the national strategy that emerged from this meeting of 60 participants from across Canada. The meeting focused on 4 key target priorities: (1) atypical working schedules, (2) sleep and circadian rhythms of children and adolescents, (3) insomnia, and (4) impact of sleep apnea on health. Following constructive discussions over 2 days, it was decided that the following 4 strategic objectives should be prioritized to accelerate the integration of sleep and circadian rhythms into public health policies in Canada: (1) Increase public health sleep and circadian rhythm research, (2) Increase public health education and knowledge mobilization on sleep, (3) Inform and support public health sleep interventions and policies, and (4) Promote sleep health training. The participants recommended that research and public health efforts should address the needs along the continuum of sleep health. The committee noted that strategies and interventions could differ across contexts, settings, sectors, and jurisdictions. The national strategy also identified high-priority research questions in public health and recommended mechanisms to build research capacity, providing a path forward for the integration of sleep and circadian rhythms into public health research and policies.

Effects of Factors Related to Shift Work on Depression and Anxiety in Nurses

Background

Although shift work is the foundation of the provision of 24-h continuous care in hospitals, it can negatively impact mental health in hospital workers such as nurses. Despite the connection between mental health and overall health, little is known about the effect of shift work-related factors on mental health in this population.

Objectives

We investigated the effect of scheduling practices, physical and psychological characteristics related to shift work, and personal habits during shift work on depression and anxiety among nurses.

Methods

In this multi-center cross-sectional study, 11,061 nurses from 20 hospitals in the Shandong Province of China completed an online survey between December 2020 and February 2022. Multivariate ordered logistic regression analysis was performed to examine shift-related factors associated with depression and anxiety in the study population.

Results

The completion rate of all nurses' questionnaires was 83.00% (n = 9,181). Among the 9,181 respondents, 66.20% (n = 6,078) were shift nurses. Depression and anxiety were found in 58.82 and 62.08% of shift nurses, respectively, and these rates were influenced by fatigue during shift work, psychological stress before/during/after night shifts, feeling of being refreshed after resting before/after night shifts, using sleep medication before/after night shifts, physical discomfort during night shifts, busyness during night shifts, food intake during shift work, working > 40 h/week during shift work, and sleep quality before/after night shifts.

Conclusions

Depression and anxiety in shift nurses may be addressed by reducing their workload, sources of stress during night shifts, and facilitating rest and relaxation.

Health problems, turnover intention, and actual turnover among shift work female nurses: Analyzing data from a prospective longitudinal study

Aims

This study investigated health problems, turnover intention, and actual turnover among shift work nurses. While turnover intention is often used as a proxy variable for turnover, the relationship between these variables requires clarification. This study tested for relevant associations using prospective longitudinal data with a time lag of 12 months. We also tested for associations between health problems (sleep disturbance, fatigue, and depression) and turnover intentions/turnover, with a focus on the mediating role of turnover intention.

Methods

This study conducted a secondary analysis of data from the Shift Work Nurses’ Health and Turnover project, which is a prospective longitudinal cohort study. We analyzed health problems, turnover intention, and actual turnover. The data were analyzed via descriptive statistics, the Pearson’s chi-squared test, independent t-test, univariable logistic regression, multiple logistic regression, and causal mediation.

Results

Participants included 491 shift work female nurses. Of these, 112 (22.8%) had turnover intention, while 38 (7.7%) left their jobs within the 12-month period of investigation. Of the 112 with turnover intention, 22 left their jobs (OR 5.68. 95% CI 2.84–11.36). The logistic regression analysis showed that sleep disturbance and fatigue were associated with turnover intentions and actual turnover, while depression was only associated with turnover intention. The causal mediation analysis showed that turnover intention mediated the relationship between health problems (sleep disturbance and fatigue) and actual turnover (sleep disturbance OR 1.31, 95%CI = 1.02–1.60; fatigue OR 2.11, 95%CI = 1.50–2.68); sleep disturbance had a natural direct effect on actual turnover (OR 2.66, 95%CI,2.07–3.21).

Conclusion

Turnover intention strongly predicted actual turnover. Sleep disturbances may result in turnover, even in cases without existing turnover intention. These findings highlight the need for early interventions aimed at preventing and alleviating sleep disturbances for shift work female nurses.

Daily stress and sleep associations vary by work schedule: A between- and within-person analysis in nurses

Nurses experience poor sleep and high stress due to demanding work environments. Night shift work is common among nurses and may exacerbate stress-sleep associations. We examined bidirectional associations between daily stress and sleep, and moderation by recent shift worker status and daily work schedule among nurses. Participants were 392 nurses (92% female; 78% White, mean age = 39.54, SD = 11.15) who completed 14 days of electronic sleep diaries and actigraphy. They simultaneously completed assessments of daily stress and work schedule upon awakening (day shift vs. night shift [work between 9 p.m.-6 a.m.] vs. off work). Participants were classified as recent night shift workers if they worked at least one night shift during the past 14 days (n = 101; 26%). In the entire sample, greater daily stress predicted shorter self-reported total sleep time and lower self-reported sleep efficiency that night. Shorter self-reported and actigraphy total sleep time and lower self-reported sleep efficiency predicted higher next-day stress. Compared with recent night shift workers, day workers reported higher stress after nights with shorter total sleep time. Stress-sleep associations mostly did not vary by nurses' daily work schedule. Sleep disturbances and stress may unfold in a toxic cycle and are prime targets for tailored interventions among nurses. Night shift workers may be less susceptible to the effects of short sleep on next-day stress. Research is needed to understand the short- and long-term effects of shift work and address the unique sleep challenges nurses face.

Working Conditions and Long-Term Sickness Absence Due to Mental Disorders: A Prospective Record Linkage Cohort Study Among 19- to 39-Year-Old Female Municipal Employees

OBJECTIVE

We examined associations between working conditions and long-term sickness absence due to mental disorders (LTSA-MD) among younger female public sector employees from different employment sectors.

METHODS

Survey data collected in 2017 (n = 3048) among 19- to 39-year-old female employees of the City of Helsinki, Finland, were used to examine job demands, job control, physical workload, computer work, and covariates. Register data on LTSA-MD were used over 1-year follow-up. Negative binomial regression models were applied.

RESULTS

Adverse psychosocial and physical working conditions were associated with higher LTSA-MD during the follow-up. Health and social care workers had the highest number of days of LTSA-MD.

CONCLUSION

Working conditions are important factors when aiming to prevent LTSA-MD among younger employees, in the health and social care sector in particular.

Healthcare Professionals, Post-traumatic Stress Disorder, and COVID-19: A Review of the Literature

The recent COVID-19 pandemic impacted healthcare professionals psychologically. They were unprepared to handle such a powerful and unknown virus. Consequently, they had to face situations of extreme distress, developing vicarious traumatization and post-traumatic stress disorder (PTSD). The first one is associated with the "cost of caring" for others and affected persons who constantly are exposed to other sufferings. PTSD is a psychiatric disorder that could affect people who have experienced or witnessed a traumatic event. Post-traumatic stress disorder (PTSD) and correlated symptoms might impact the lives of healthcare professionals at the personal, professional, and relational levels. Furthermore, the pandemic could decrease the empathy of healthcare professionals, influencing their relationship with patients. This review aimed to describe the incidence of PTSD among HPs during the COVID-19 pandemic. We focused on the following aspects: (a) PTSD symptoms and correlated psychological issues, (b) repercussions at working and personal levels, (c) change in empathetic involvement of healthcare professionals.

Association between insomnia and constipation: A multicenter 3-year cross-sectional study using shift workers’ health check-up data

Background

Although insomnia and constipation are highly prevalent worldwide, studies examining a possible association between them are lacking. We examined the relationship between insomnia and constipation in shift workers who have a high prevalence of insomnia and other diseases.

Methods

This study had a multicenter cross-sectional design and conducted using health examination data including self-reported questionnaires. In total, 12,879 and 4,650 shift workers were enrolled in Severance Hospital and Wonju Severance Hospital, respectively, during 2015-2017. Multivariate logistic regression models and subgroup analysis were performed in each center with the same protocol, using a common data model.

Results

The mean age of the total population was 44.35 (standard deviation = 8.75); the proportion of males was 56.9%. Female sex, being underweight and non-smoker were strongly associated with an increased risk of constipation symptom (p < 0.001). Pooled odds ratios (ORs) were calculated using ORs of both centers with weights; there was a significant dose–response relationship (sub-threshold 1.76 [95% confidence interval [CI] 1.62–1.91]; moderate 2.28 [95% CI 2.01–2.60]; severe 4.15 [95% CI 3.18–5.41] in the final model, p for trend < 0.001). Subgroup analysis performed by stratifying sex and pooled ORs showed a similar trend to that of the entire group.

Conclusion

We observed a strong correlation between insomnia and constipation in this population. Our findings may help in formulating guidelines and policies to improve quality of life in shift workers through the management of sleep quality and proper bowel function. This study is the first to report this relationship among people working in shifts.

Dual orexin receptor antagonists for treatment of insomnia: A systematic review and meta-analysis on randomized, double-blind, placebo-controlled trials of suvorexant and lemborexant

STUDY OBJECTIVES

Recent treatment guidelines for chronic insomnia recommend pharmacological and non-pharmacological therapies. One of the contemporary drug options for insomnia includes dual orexin receptor antagonist (DORA), such as suvorexant and lemborexant. We conducted a systematic review and meta-analysis for the treatment of insomnia with suvorexant and lemborexant based on randomized, double-blind, placebo-controlled Trials.

METHODS

We conducted a comprehensive search on three databases (PubMed/Medline, Web of Science, and Cochrane Library) till August 14, 2021, without any restrictions to retrieve the relevant articles. The effect sizes were computed presenting the pooled mean difference or risk ratio along with 95% confidence interval of each outcome.

RESULTS

Our search showed eight articles (five for suvorexant and three for lemborexant). Results of diary measures, rating scales, polysomnography results, treatment discontinuation, and adverse events were measured. All efficacy outcome measures favorably and significantly differed in the suvorexant compared to placebo. Safety profile did not differ significantly except for somnolence, excessive daytime sleepiness/sedation, fatigue, back pain, dry mouth, and abnormal dreams. Important adverse events including hallucinations, suicidal ideation/behavior and motor vehicle accidents did not differ between suvorexant and placebo. All the efficacy outcomes significantly differed between lemborexant 5 and lemborexant 10 compared to placebo. Somnolence rate for lemborexant 5 and lemborexant 10 and nightmare for lemborexant 10 were significantly higher than placebo.

CONCLUSION

The present meta-analysis reported that suvorexant and lemborexant are efficacious and safe agents for the patients with insomnia. Further data in patients with insomnia and various comorbid conditions are needed.

Alertness during working hours among eight-hour rotating-shift nurses: An observational study

PURPOSE

The aim of this study was to identify the patterns of the decline in the alertness of rotating-shift nurses during working hours across different shift types (day, evening, and night) using an objective measure.

DESIGN

An observational study using ReadiBand wrist actigraphs was conducted.

METHODS

Data were collected from June 2019 to February 2020. Participants were rotating-shift nurses (N = 82) who provided direct nursing care for patients in acute care hospitals in South Korea. Nurses wore actigraphs continuously for 14 days on their non-dominant hand to identify sleep-wake cycles and predict their alertness scores hourly. All participants completed a sleep diary.

FINDINGS

Nurses working during night shifts had lower average alertness scores (mean = 77.12) than nurses working during day (mean = 79.05) and evening (mean = 91.21). Overall, alertness showed a declining trend and the specific patterns of decline differed across shifts. Participants with alertness scores less than 70 or 80 demonstrated a significant decline in alertness across all shifts.

CONCLUSIONS

Distinct patterns of decline in alertness per nursing shift were revealed. Each shift feature should be considered when developing interventions to increase nurses' alertness, promote high-quality care provision, and ensure patient safety.

CLINICAL RELEVANCE

The implementation of interventions to increase alertness among shift nurses is needed at the organizational level, and the cooperation of nursing managers and administrators is required.

Comparing risk of depression between day and night/shift workers using the PHQ-9: a study utilizing the 2014, 2016, and 2018 Korea National Health and Nutrition Examination Survey data

Background

In today's work scenario, the number of shift workers, including those in night shifts, is increasing. Shift work can adversely affect workers' health in the long run, but studies on the relationship between shift work and depression have shown inconsistent results. This study aimed to determine whether the number of night/shift workers at risk of depression, as predicted by the Patient Health Questionnaire-9 (PHQ-9), is higher than that of day workers.

Methods

This study was conducted based on data from the 6th and 7th Korea National Health and Nutrition Examination Survey, 2014, 2016, and 2018. Work schedules were classified into 2 types: day work and night/shift work. This study used the PHQ-9, a self-reported depression screening test, to identify workers at risk of depression. Statistical analysis was performed using SPSS 26.0, and descriptive statistics, χ² test, and logistic regression analysis were employed.

Results

After adjusting for age, educational level, working hours per week, and income, men engaging in night/shift work were at a higher risk of depression (odds ratio [OR]: 1.407, 95% confidence interval [CI]: 0.937-2.113). The same was confirmed for women (OR: 1.564, 95% CI: 1.176-2.081).

Conclusions

Our results showed that the OR for those engaged in night/shift work with a PHQ-9 score of 10 or more increased. Considering the large volume of psychiatric history and symptoms in Korea, additional research is needed. Additionally, further discussion on ways to provide realistic help to night/shift workers is warranted.

Sleep medication and melatonin use among Norwegian nurses - A cross-sectional study

Aim

To estimate the prevalence of sleep medication and melatonin use among nurses and to assess if factors related to work, sleep or mental health, were associated with such use.

Design

A cross‐sectional study.

Methods

A questionnaire survey including 2,798 Norwegian nurses. Associations were estimated using a modified Poisson regression model.

Results

In total, 7.5%, 4.6% and 2.0% of the nurses included in the present study reported prescribed sleep medication, over‐the‐counter sleep medication or melatonin use in the last year, respectively. Short sleep duration, sleep problems and psychological conditions were strongly associated with both prescribed and over‐the‐counter sleep medication use. Nurses who worked more than 60 night shifts in the last year were at increased risk of sleep medication use.

Sociodemographic Factors and Depressive Symptoms Among Cardiac Nurses: A Cross-Sectional Study

Background: The nursing profession is predisposed toward depressed mood and depressive symptoms. The multidirectionality and intensity of stressors in the nurses' occupational environment are of great significance in this respect. The study aimed to evaluate the impact of selected sociodemographic factors on depressive symptoms among cardiac nurses.

Methods: This cross-sectional study included 336 cardiac nurses (302 women and 34 men) and was conducted between December 2019 and September 2020 in four hospital cardiac units in Wroclaw, Poland. Sociodemographic data were collected using a self-developed survey. The following standardized instruments were used for the study outcomes: Patient Health Questionnaire-9 (PHQ-9) and Beck Depression Inventory (BDI).

Results: The study among cardiac nurses showed mild depression in 11.61%, moderate depression in 5.06%, and severe depression in 2.68%. Linear regression models showed that significant (p < 0.05) predictors of the PHQ-9 score included (1) higher occupational education (bachelor's degree), graduation “only” from medical high school or “other” education; (2) work experience of 16–20 years; (3) living in a relationship; (4) living in a rural area. Linear regression models showed that significant (p < 0.05) predictors of the BDI score included (1) higher occupational education (bachelor's degree); (2) graduation “only” from medical high school or “other” education; (3) living in a relationship.

Conclusions: Depressive symptoms are a significant problem among Polish cardiac nurses. The prevalence of depressive symptoms is affected by the education level, employment form, marital status, and place of residence.

The association between mental health and shift work: Findings from the Atlantic PATH study

We evaluated the relationship between mental health and shift work in the Atlantic Partnership for Tomorrow's Health (PATH) cohort study. In a matched study with 12,413 participants, including 4155 shift workers and 8258 non-shift workers, we utilized general linear models and logistic regression models to assess the differences in depression, anxiety, and self-rated health. Shift workers reported higher levels of each of the mental health-related domains compared to non-shift workers. There was a significant increased risk of depression (OR = 1.13, 95% CI, 1.00-1.27) and poor self-rated health (OR = 1.13, 95% CI, 1.14-1.55) among shift workers compared to non-shift workers. Shift workers were more likely to have increased rates of depression and poor self-rated health, as well as depressive and anxiety symptom scores compared to non-shift workers. As a result, shift workers may be at increased risk of comorbidity, poor quality of life, missed work, and early retirement.

Sleep, fatigue and alertness during working hours among rotating-shift nurses in Korea: An observational study

AIMS

To determine the effects of sleep parameters and fatigue on the decline in alertness of nurses across shifts.

BACKGROUND

Shift work can lead to nurse fatigue owing to insufficient sleep and inadequate recovery time between shifts. Nurse fatigue has adverse effects on alertness and can affect provision of quality care.

METHODS

An observational study using wrist actigraphs was conducted from 2019 to 2020. Participants were 82 rotating-shift nurses who provided direct nursing care in acute hospitals in South Korea. They wore actigraphs for 14 days to measure sleep parameters and predict hourly alertness and reported subjective fatigue before and after every shift.

RESULTS

Nurses demonstrated shorter sleep hours, lower sleep efficiency and longer sleep latency before night shifts compared with other shifts. Fatigue was the highest before day shifts. Sleep parameters and fatigue significantly affected the steep decline in alertness in participants with alertness scores below 70.

CONCLUSIONS

Sleep parameters and fatigue level contributed to the differences in decline in alertness across shifts.

IMPLICATION FOR NURSING MANAGEMENT

Findings inform nurse managers, administrators to develop interventions to reduce fatigue, improve sleep quantity and quality and increase alertness among rotating-shift nurses. Management, institutional and individual factors should be considered when developing interventions.

Age-dependent associations among insomnia, depression, and inflammation in nurses

OBJECTIVE

Insomnia and depression have been inconsistently associated with inflammation. Age may be one important moderator of these associations. This study examined associations between insomnia and depression with inflammatory biomarkers in nurses and how these associations varied by age. Design: Participants were 392 nurses ages 18-65 (Mage = 39.54 years ± 11.15, 92% female) recruited from two hospitals. Main outcome measures: Participants completed surveys to assess insomnia and depression symptoms. Serum samples were obtained and analysed for inflammatory biomarkers interleukin-6 (IL-6), C-reactive protein (CRP), interleukin-1 beta (IL-1β), and tumour necrosis factor alpha (TNF-α). Results: Neither insomnia nor depression symptoms were associated with inflammatory biomarkers. Older age was associated with higher IL-1β, and age moderated the effects of depression symptoms on CRP and TNF-α: Greater depression symptoms were associated with higher CRP (b = .14, p = .017) and TNF-α (b = .008, p = .165) among older nurses only. Conclusion: Results suggest older nurses with higher depression symptoms may be at increased risk for elevated inflammation. Interventions should consider the role of age-related processes in modifying health and well-being. Given relatively low levels of depression in the current sample, future studies should replicate results in clinical and non-nurse samples.

Mental ill-health among health and social care professionals: an analysis using administrative data

OBJECTIVE

Health and Social Care (HSC) workers are at high risk of job-related stress, burnout and mental ill-health. This study examines differences in self-reported mental health and psychotropic medication uptake across HSC occupational groups.

METHOD

Northern Ireland (NI) data linkage study of people working in the Health and Care sector, aged between twenty and sixty-four years, enumerated at the 2011 Northern Ireland Census and living in private households, and their uptake of prescribed psychotropic medications during 2011-2012 (using data derived from routine electronically captured information on prescriptions issued within the NHS and linked at an individual level using a NI-specific Health and Care key identifier). Comparing HSC workers with all those professionals not involved in HSC occupations, we used multinomial logistic regression to examine (a) self-reported chronic mental illness and (b) uptake of psychotropic medication by occupational groups adjusting for age, sex and socio-demographic circumstance.

RESULTS

When compared against other professionals highest risks for mental health problems (associated with psychotropic prescription uptake) were associated with nursing/midwifery (OR = 1.25: 95%CI = 1.17-1.33; OR = 1.84: 1.58-2.15 for females and males respectively), welfare (OR = 1.34: 1.21-1.48; OR = 1.71: 1.44-2.03) and formal caregiving roles (OR = 1.42: 1.31-1.53; OR = 1.70: 1.50-1.91), again for females/males respectively). These higher risk professions record notable increases in psychotropic medication use.

CONCLUSION

Working in the Health and Social Care sector, irrespective of gender, may be more stressful than other jobs. Additionally, self-reported mental ill-health and psychotropic medication treatment both appear to be associated with social class inequity.

A multimodal analysis of physical activity, sleep, and work shift in nurses with wearable sensor data

Night shift workers are often associated with circadian misalignment and physical discomfort, which may lead to burnout and decreased work performance. Moreover, the irregular work hours can lead to significant negative health outcomes such as poor eating habits, smoking, and being sedentary more often. This paper uses commercial wearable sensors to explore correlates and differences in the level of physical activity, sleep, and circadian misalignment indicators among day shift nurses and night shift nurses. We identify which self-reported assessments of affect, life satisfaction, and sleep quality, are associated with physiological and behavioral signals captured by wearable sensors. The results using data collected from 113 nurses in a large hospital setting, over a period of 10 weeks, indicate that night shift nurses are more sedentary, and report lower levels of life satisfaction than day-shift nurses. Moreover, night shift nurses report poorer sleep quality, which may be correlated with challenges in their attempts to fall asleep on off-days.

Health Effects of Night and Irregular Shiftwork: A Longitudinal Cohort Study of US Workers

OBJECTIVES

Evidence suggests that shiftwork results in adverse occupational health outcomes. This paper contributes to the literature by estimating the separate health effects of night and irregular shiftwork on a longitudinal panel of US workers.

METHODS

Data from a 20-year panel of worker surveys from the 1979 National Longitudinal Survey of Youth were used to predict self-reported health limitations related to night and irregular shiftwork using a series of random effects logit models.

RESULTS

Separate and combined specifications of shiftwork as night and irregular effort significantly increase the odds of health limitations compared with working a regular daytime schedule, with more pronounced effects for irregular work (odds ratio [OR] = 1.09 to 1.52) over night shift (OR = 1.03 to 1.14).

CONCLUSIONS

The results suggest that both night and irregular shiftwork may have important negative implications on occupational health, with the deleterious effects particularly pronounced for irregularly scheduled work effort.

Sleep complaints in former and current night shift workers: findings from two cross-sectional studies in Austria

Sleep impairment is highly prevalent in night shift workers, but evidence on the association of former night shift work (NSW) and its metrics (duration and frequency) in relation to sleep complaints is lacking. We evaluated the association of former and current NSW with chronic insomnia or circadian rhythm sleep disorder in a sample of the general worker (GW) population and in hospital workers (HW) in Austria. Information on sleep, NSW history, sociodemographic, and lifestyle factors was collected through an online cross-sectional survey in a representative sample of GW (N= 1,004) and a sample of HW (N= 799) between 2017 and 2019. Multi-variable adjusted logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for various measures of sleep (including chronic insomnia, daytime sleepiness, sleep duration, napping habits) and doctor-diagnosed chronic insomnia across NSW exposure (never night shift work; ever; ever/former; ever/current) and related metrics (cumulative duration, average frequency), compared to never NSW. Effect modification by chronotype and daytime napping was investigated. Former NSW was associated with higher odds of chronic insomnia in both samples (GW: OR = 2.28, 95% CI = 1.07-4.83; HW: OR = 1.17, 95% CI = 0.60-2.27). Chronic insomnia odds tended to increase among current night shift workers (HW: OR = 1.50, 95% CI = 0.79-2.83), compared to day workers. Higher NSW frequency (shifts/month) was associated with higher chronic insomnia odds in former night shift workers in both samples (GW: OR_{per shift/month} = 1.06, 95% CI = 1.00-1.12; HW: OR_{per shift/month} = 1.12, 95% CI = 1.00-1.25). Former NSW was also associated with increased daytime sleepiness among GW (OR = 2.26, 95% CI 1.28-3.99). Associations were more pronounced among early chronotypes and participants who reported no daytime naps. Our results suggest that NSW is associated with chronic insomnia even in the years after cessation of involvement in working it.

Sleep-Related Problems in Night Shift Nurses: Towards an Individualized Interventional Practice

Rotating shifts (mostly 8- or 12-h) are common among nurses to ensure continuity of care. This scheduling system encompasses several adverse health and performance consequences. One of the most injurious effects of night-time shift work is the deterioration of sleep patterns due to both circadian rhythm disruption and increased sleep homeostatic pressure. Sleep problems lead to secondary effects on other aspects of wellbeing and cognitive functioning, increasing the risk of errors and workplace accidents. A wide range of interventions has been proposed to improve the sleep quality of nurses and promote an increase in attention levels. In recent years, particular attention has been paid to individual and environmental factors mediating the subjective ability to cope with sleep deprivation during the night shift. Given the predictive role of these factors on the negative impact of a night shift, an individualized intervention could represent an effective countermeasure by ensuring suitable management of shift schedules. Therefore, the aims of this mini-review are to: (a) provide an updated overview of the literature on sleep problems in night shift nurses and their adverse consequences; and (b) critically analyze the psychosocial factors that mediate the negative impact of shift work with the ultimate goal of defining an effective countermeasure based on an individualized approach.

Effects of work organization on the occurrence and resolution of sleep disturbances among night shift workers: a longitudinal observational study

This study aimed to investigate the association between work organization and the trajectories of insomnia patterns among night shift workers in a hospital. The health examination data of hospital workers, recorded from January 2014 to December 2018, were collected; 6765 records of 2615 night shift workers were included. Insomnia was defined as a score of ≥ 15 on the Insomnia Severity Index (ISI). Participants were categorized into five groups according to insomnia patterns derived from the analysis of their ISI scores. Work organization and socio-demographic characteristics were also investigated. Generalized estimating equation models and linear mixed models were constructed to analyze the longitudinal data. Of the total participants, 53.0% reported insomnia at least once during the follow-up period. The lack of nap opportunities and work-time control was associated with the occurrence of insomnia, whereas more than 5 years of shift work experience was related to the resolution of insomnia. All work-related factors were significantly related to insomnia risk; however, the effects were not significant in the sustained insomnia group. Although sleep problems are inevitable in night shift workers, well-designed work schedules and better work organization can help reduce the occurrence of insomnia among them.

Relationship Between Shift Intensity and Insomnia Among Hospital Nurses in Korea: A Cross-sectional Study

Objectives

This study explored the relationship between shift intensity and insomnia among hospital nurses.

Methods

The participants were 386 female hospital nurses who underwent a special health examination for night workers in 2015. The Korean Insomnia Severity Index (ISI), indices of shift work intensity, and other covariates such as amount of exercise, level of alcohol consumption, employment duration, and hours worked were extracted from the health examination data. The indices for shift intensity were (1) number of 3 consecutive night shifts and (2) number of short recovery periods after a previous shift, both assessed over the prior 3 months. Multiple logistic regression analysis adjusted for the aforementioned covariates was performed to evaluate the association of shift intensity with insomnia, defined as an ISI score of ≥8.

Results

The nurses with insomnia tended to be younger (p=0.029), to have worked 3 consecutive night shifts more frequently (p<0.001), to have experienced a greater number of short recovery periods after the previous shift (p=0.021), and to have worked for more hours (p=0.006) than the nurses without insomnia. Among the other variables, no statistically significant differences between groups were observed. Experiences of 3 or more consecutive night shifts (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.29 to 4.20) and 3 or more short recovery periods (OR, 2.01; 95% CI, 1.08 to 3.73) were associated with increased odds of insomnia.

Conclusions

The results suggest that decreasing the shift intensity may reduce insomnia among hospital nurses working rotating shifts.

Sleep disturbance and its association with quality of life among psychiatric nurses in China

Background

Sleep disturbance is associated with a number of negative adverse outcomes. This study examined the prevalence of sleep disturbance and its association with demographic and clinical characteristics and quality of life (QOL) in psychiatric nurses in China.

Methods

This is a multi-center, cross-sectional study involving 11 psychiatric hospitals in China. Three types of sleep disturbance (difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS) and early-morning awakening (EMA)) and QOL were measured by standardized questions or instruments.

Results

A total of 1,847 psychiatric nurses participated. The overall prevalence of at least one type of sleep disturbance was 71.5% (95% CI [69.3–73.5]); the prevalence of DIS, DMS and EMA was 58.5% (95% CI [56.2–60.8]), 53.7% (95% CI [51.4–56.0]) and 54.6% (95% CI [52.3–56.9]), respectively. Nurses with sleep disturbance had significantly lower QOL in physical (F_{(1, 1,846)} = 219.12, P < 0.001), psychological (F_{(1, 1,846)} = 72.18, P < 0.001), social (F_{(1, 1,846)} = 37.57, P < 0.001) and environmental domains (F_{(1, 1,846)} = 95.45, P < 0.001). Multivariable logistic regression analyses revealed that shift work (DIS, OR = 1.6, 95% CI [1.28–1.98]; DMS, OR = 1.2, 95% CI [1.001–1.54]; EMA, OR = 1.3, 95% CI [1.02–1.58]) and alcohol use (DIS, OR = 1.8, 95% CI [1.46–2.32]; DMS, OR = 1.8, 95% CI [1.43–2.23]; EMA, OR = 1.7, 95% CI [1.33–2.07]) were positively associated with sleep disturbance, while higher monthly income (DIS, OR = 0.5, 95% CI [0.38–0.75]; DMS, OR = 0.7, 95% CI [0.51–0.98]) was negatively associated with sleep disturbance.

Conclusion

Sleep disturbance was common among nurses in psychiatric hospitals in China, particularly those on shifts and having alcohol use. Health authorities should develop effective measures to reduce risk of sleep disturbance in this population.

Are depressive disorders caused by psychosocial stressors at work? A systematic review with metaanalysis

In the last decade, many studies have examined associations between poor psychosocial work environment and depression. We aimed to assess the evidence for a causal association between psychosocial factors at work and depressive disorders. We conducted a systematic literature search from 1980 to March 2019. For all exposures other than night and shift work and long working hours, we limited our selection of studies to those with a longitudinal design. We extracted available risk estimates for each of 19 psychosocial exposures, from which we calculated summary risk estimates with 95% confidence intervals (PROSPERO, identifier CRD42019130266). 54 studies were included, addressing 19 exposures and 11 different measures of depression. Only data on depressive episodes were sufficient for evaluation. Heterogeneity of exposure definitions and ascertainment, outcome measures, risk parameterization and effect contrasts limited the validity of meta-analyses. Summary risk estimates were above unity for all but one exposure, and below 1.60 for all but another. Outcome measures were liable to high rates of false positives, control of relevant confounding was mostly inadequate, and common method bias was likely in a large proportion of studies. The combination of resulting biases is likely to have inflated observed effect estimates. When statistical uncertainties and the potential for bias and confounding are taken into account, it is not possible to conclude with confidence that any of the psychosocial exposures at work included in this review is either likely or unlikely to cause depressive episodes or recurrent depressive disorders.

[Sleep disorders and psycho-affective problems in paramedical personnel working an atypical schedule]

INTRODUCTION

Shift work can cause health problems and sleep disorders and therefore affect mental health. These psycho-affective disorders can, in return, worsen sleep disorders and thus establish a vicious circle. The aims of our study were to assess the frequency of sleep and psycho-affective disorders among paramedical personnel doing shift work and to screen them for obstructive sleep apnoea-hypopnoea syndrome (OSA).

METHODS

It was a cross-sectional study carried out among paramedical staff at the University Hospital Center Mongi Slim La Marsa in Tunis. Three questionnaires translated into Arabic (the Berlin questionnaire, the Spiegel questionnaire and the Hospital Anxiety and Depression Scale [HAD]) were presented by the same investigator during the survey.

RESULTS

One hundred and fifty-eight paramedics were interviewed (46.2% were nurses, 23.4% were blue-collar workers, 19% were senior technicians and 11.4% were health care aides, midwives and physiotherapists). The average duration of shift work was 10.27 years, the average age was 36.48 years and there was a female prevalence of 70.9%. Sleep disorders were detected in 40.5% of the cases, OSA in 24%, anxiety in 53.2% and depression in 17.1%.

CONCLUSION

Sleep and psycho-affective disorders are frequent among paramedical personnel undertaking shift work in hospitals. Screening consultations in occupational medicine are necessary in order to detect these disorders at an early stage.

Risk and Protective Factors for the Mental Health of Brazilian Healthcare Workers in the Frontline of COVID-19 Pandemic

The objective was to compare the mental health indicators of health workers providing care to individuals with COVID-19 in Brazil, considering sociodemographic and occupational variables and the risk perception of contamination by the Sars-CoV-2 of workers from different professions, identifying risk and protective factors. A sample of 916 health workers was assessed: physicians, nursing workers, and workers from other professions (psychologists, physical therapists, nutritionists, speech therapists, occupational therapists, dentists, pharmacists, and social workers). REDCAP software was used to collect data online, using standardized instruments to assess anxiety, depression, posttraumatic stress, and insomnia, and one questionnaire addressed risk and protective variables. Statistical techniques for comparing groups were used along with logistic regression analysis. The results revealed that all the groups presented indicators of significant mental health problems (>36%), especially the nursing group. A larger percentage of participants, regardless of the profession, presented a high rate of insomnia disorders, while posttraumatic stress was the least expressive. Occupational variables stand out as risk factors for mental health, with specificities among the different groups. A protective factor for all the groups was having positive professional prospects. The protective factors for the physicians group included support provided by co-workers, being older and a man, while being satisfied with physical protective measures implemented by the employing institution was a protective factor for the groups composed of nursing workers and other professionals. These findings are relevant for devising mental health care strategies.