Anxiety, depression, work-related stress and psychological flexibility in nurses: A correlational-comparative study
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The publication are distributed under the Creative Commons Attribution 4.0 International license (CC BY 4.0). The rights of the works published in this journal are the property of the author and they are free to distribute and disseminate them, as long as the source is correctly cited.
Main Article Content
Abstract
Nursing is exposed to a variety of occupational stress affecting their psychological health and productivity. Psychological flexibility has been shown to have beneficial effects on mental health of general population. The aims of this study were to analyze in nursing staff the relationship between the exposure to work-related stressors and psychological flexibility; and between emotional symptomatology and psychological flexibility; and the differences of the exposure to work-related stressors and emotional symptomatology among different work areas and different shift work. A correlational-comparative study has been developed. In addition to sociodemographic and work variables, the NSS, DASS-21, AAQ-II questionnaires were used to measure the work-related stressors, stress, anxiety, depression, and psychological flexibility, respectively. The prevalence of moderate-very severe levels of depression, anxiety and stress was 17.6%, 29.9% and 23.3%, respectively. A significant negative correlation was observed between work-related stressors and psychological flexibility; between occupational stress and psychological flexibility; between emotional symptomatology and psychological flexibility; between anxiety, stress and age; between work-related stressors and age. Nurses working rotating shifts reported significantly higher levels of emotional symptomatology, stress and anxiety than those working day shifts. Psychological flexibility seems to explain a significant prevalence of emotional symptomatology in nurses. Community nurses showed the lowest levels of anxiety, depression and stress when compared to hospital nurses working in different areas.
References
Ariapooran, S. (2019). Sleep problems and depression in Iranian nurses: the predictive role of workaholism. Iranian Journal of Nursing and Midwifery Research, 24(1), 30–37. doi: 10.4103/ijnmr.IJNMR_188_17
Borges, E., Fonseca, C., Baptista, P., Queirós, C., Baldonedo-Mosteiro, M., & Mosteiro-Diaz,M. P. (2019). Compassion fatigue among nurses working on an adult emergency and urgent care unit. Fadiga por compaixão em enfermeiros de urgência e emergência hospitalar de adultos. Revista latino-americana de Enfermagem, 27, e3175. https://doi.org/10.1590/1518-8345.2973.3175
Bond, F. W., & Bunce, D. (2003). The role of acceptance and job control in mental health, job satisfaction, and work performance. Journal of Applied Psychology, 88, 1057–1067 Doi: 10.1037/0021-9010.88.6.1057
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire – II: A revised measure of psychological inflexibility and experiential avoidance. Behavioural Therapy, 42, 676–688
Caruso C. C. (2014). Negative impacts of shift work and long work hours. Rehabilitation nursing: the official journal of the Association of Rehabilitation Nurses, 39(1), 16–25. https://doi.org/10.1002/rnj.107
Chegini Z. (2019). Occupational Stress among Critical Care Nurses: A Comparative Study of Public and Private Sector. Iranian journal of nursing and midwifery research, 24(4), 306–309. https://doi.org/10.4103/ijnmr.IJNMR_218_18
Cheung, T., & Yip, P. (2015). Depression, Anxiety and Symptoms of Stress among Hong Kong Nurses: A Cross-sectional Study. International Journal of Environmental Research and Public Health, 12(9), 11072–11100 doi: 10.3390/ijerph120911072
Díaz Tobajas, M. C., Juarros Ortiz, N., García Martínez, B., & Sáez Gavilán, C. (2017). Study on anxiety in intensive care nursing professionals facing the process of death. Enfermería Global, 16(1), 246–265 https://doi.org/10.6018/eglobal.16.1.232221
Gray-Toft, P., & Anderson, J. G. (1981). The Nursing Stress Scale: Development of an instrument. Journal of Behavioural Assessment, 3, 11–23 https://doi.org/10.1007/BF01321348
Gu, B., Tan, Q., & Zhao, S. (2019). The association between occupational stress and psychosomatic wellbeing among Chinese nurses: A cross-sectional survey. Medicine (Baltimore), 98(22), e15836. doi: 10.1097/MD.0000000000015836
Hasan, A., & Tumah, H. (2018). The correlation between occupational stress, coping strategies, and the levels of psychological distress among nurses working in mental health hospital in Jordan. Perspectives in Psyquiatric Care, 55(6). doi:10.1111/ppc.12292
Hayes, S. C., Luoma, J., Bond, F., Masuda, A., & Lillis J. (2006). Acceptance and Commitment Therapy: model, processes, and outcomes. Behaviour Research and Therapy, 44, 1–25.
Huang, C., Wu, M., Ho, C., & Wang, J. (2018). Risks of treated anxiety, depression, and insomnia among nurses: A nationwide longitudinal cohort study. PLoS ONE, 13(9), e0204224 https://doi.org/10.1371/journal.pone.0204224
Karanikola, M., Giannakopoulou, M., Kalafati, M., Kaite, C., Patiraki, E., Mpouzika, M., Papathanassoglou, E., & Middleton, N. (2016). Anxiety symptoms and quality of interaction among oncology nurses: A correlational and cross-sectional study. Revista da Escola de Enfermagem da USP., 50(5), 800–807 http://dx.doi.org/10.1590/S0080- 623420160000600013
Kashdan, T. B., & Rottenberg J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 30(4), 865–878 doi: 10.1016/j.cpr.2010.03.001
Kashdan, T. B., Barrios, V., Forsyth, J. P., & Steger, M. F. (2006). Experiential avoidance as a generalized psychological vulnerability: Comparisons with coping and emotion regulation strategies. Behaviour Research and Therapy, 44(9):1301±20 https://doi.org/10.1016/j.brat.2005.10.003
Khamisa, N., Oldenburg, B., Peltzer, K., & Ilic D. (2015). Work Related Stress, Burnout, Job Satisfaction and General Health of Nurses. International Journal of Environmental Research and Public Health, 12, 652-666 doi: 10.3390/ijerph120100652
Khodadadi, E., Hosseinzadeh, M., Azimzadeh R., & Fooladi M. (2016). The relation of depression, anxiety and stress with personal characteristics of nurses in hospitals of Tabriz, Iran. International Journal of Medical Research & Health Sciences, 5(5), 140– 148.
Ko, W., & Kiser-Larson N. (2016). Stress Levels of Nurses in Oncology Outpatient Unit.
Clinical Journal of Oncology Nursing, 20(2), 158-64 doi: 10.1188/16
Kourakos, M. (2017). Mental health and coping strategies among nursing staff in public health services. Progress in Health Sciences, 7(2), 67–73 doi: 10.5604/01.3001.0010.7852
Kupfer D. J. (2015). Anxiety and DSM-5. Dialogues in clinical neuroscience, 17(3), 245–246.
Lee, H., Kim, M. S., Kim, O., Lee, I. H., & Kim, H. K. (2015). Association between shift work and severity of depressive symptoms among female nurses: the Korea Nurses’ Health Study. Journal of Nursing Management, 24(2), 192–200 doi: 10.1111/jonm.12298
Leka, S., Griffiths, A., & Cox T. (2004). La organización del trabajo y el estrés. Institute of work, health & Organizations. Organización Mundial de la salud.
Lin, S. H., Liao, W. C., Chen, M. Y., & Fan, J. Y. (2014). The impact of shift work on nurses' job stress, sleep quality and self-perceived health status. Journal of nursing management, 22 (5), 604–612. https://doi.org/10.1111/jonm.12020
Manzini, J. L. (2000). Declaración de Helsinki: Principios éticos para la investigación médica sobre sujetos humanos. Acta Bioethica, 6, 321–334.
Más R., & Escribà V. (1988). La versión castellana de la escala «The Nursing Stress Scale». Proceso de adaptación transcultural. Revista Española de Salud Pública, 72, 529–538
Meyer, E., Bash, H., DeBeer, B., Kimbrel, N., Gulliver, S., & Morissette, S. (2019). Psychological inflexibility predicts PTSD symptom severity in war veterans after accounting for established PTSD risk factors and personality. Psychological Trauma: Theory, Research, Practice, and Policy, 11(4), 383–390 doi: 10.1037/tra0000358
Michael, T., Zetsche, U., & Margraf J. (2007). Epidemiology of anxiety disorders. Psychiatry, 6 (4) pp: 136-142 doi: 10.1016/j.mppsy.2007.01.007
Munnangi, S., Dupiton, L., Boutin, A., & Angus L. (2018). Burnout, perceived stress, and job satisfaction among trauma nurses at a Level i safety-net trauma centre. Journal of Trauma Nursing, 25 (1), 4–13 doi: 10.1097/JTN.0000000000000335
Nascimento, J., Santos, J., Meira, K., Pierin, A., & Souza-Talarico J. (2019). Shift work of nursing professionals and blood pressure, burnout and common mental disorders. Revista da Escola de Enfermagem da USP, 53, e03443 http://dx.doi.org/10.1590/S1980- 220X2018002103443
Perry, L., Lamont, S., Brunero, S., Gallagher, R., & Duffield, C. (2015). The mental health of nurses in acute teaching hospital settings: a cross-sectional survey. BMC Nursing, 14, 15 doi: 10.1186/s12912-015-0068-8
Plumb, J. C., Orsillo, S. M., & Luterek, J. A. (2004). A preliminary test of the role of experiential avoidance in post-event functioning. Journal of Behaviour Therapy and Experimental Psychiatry, 35, 245–257 doi: 10.1016/j.jbtep.2004.04.011
Puolakanaho, A., Tolvanen, A., Kinnunen, S., & Lappalainen, R. (2020). A psychological flexibility -based intervention for Burnout: A randomized controlled trial. Journal of Contextual Behavioural Science, 15, 52-67. doi: 10.1016/j.jcbs.2019.11.007
Ramírez-Baena, L., Ortega-Campos, E., Gómez-Urquiza, J. L., Cañadas-De la Fuente, G. R., De la Fuente-Solana, E. I., & Cañadas-De la Fuente, G. A. (2019). A Multicentre Study of Burnout Prevalence and Related Psychological Variables in Medical Area Hospital Nurses. Journal of clinical medicine, 8(1), 92 https://doi.org/10.3390/jcm8010092
Ruiz, F. J., García-Martín, M. B., Suárez-Falcón, J. C., & Odriozola-González, P. (2017). The hierarchical factor structure of the Spanish version of Depression Anxiety and Stress Scale–21. International Journal of Psychology and Psychological Therapy, 17, 97–105
Ruiz, F. J., Langer-Herrera, A. I., Luciano, C., & Cangas, A. J. (2013). Measuring experiential avoidance and psychological inflexibility: The Spanish version of the Acceptance and Action Questionnaire – II. Psicothema, 25(1), 123–129 doi: 10.7334/psicothema2011.239
Sairanen, E., Lappalainen, P., & Hiltunen, A. (2018). Psychological inflexibility explains distress in parents whose children have chronic conditions. PLoS ONE 13(7): e0201155 https://doi.org/10.1371/journal.pone.0201155
Samaei, S. E., Taban, E., Soleimanian, S. S., Beheshti, M. H., Ahmadi, O., Kalantari, M., Akbarian, N., Sadeghi, M., & Galeshi, M. (2018). Evaluating the status of occupational stress and identifying its related risk factors among nurses in Babol City, Northern Iran: A cross-sectional study. International Journal of Occupational Hygiene, 10(2), 60–66.
Santos, R., Campos, P., Da Silva, F. J., & Andrés, V. E. (2017). Mental health problems among nurses in paediatric cardiac intensive care. British Journal of Nursing, 26(15)
Vasconcelos, E., Martino, M., & França, S. (2018). Burnout and depressive symptoms in intensive care nurses: relationship analysis. Revista brasileira de enfermagem,71(1), 135–141. doi: 10.1590/0034-7167-2016-0019
Wahlberg, L., Nirenberg, A., & Capezuti, E. (2016). Distress and coping self-efficacy in inpatient oncology nurses. Oncology Nursing Forum, 43(6),738–746. doi: 10.1188/16.ONF.738-746
Wang, S. M., Lai, C. Y., Chang, Y. Y., Huang, C. Y., Zauszniewski, J. A., & Yu, C. Y. (2015). The relationships among work stress, resourcefulness, and depression level in psychiatric nurses. Archives of Psychiatric Nursing, 29(1), 64–70. doi: 10.1016/j.apnu.2014.10.002. Epub 2014 Nov 6.
Waters, C. S., Frude, N., Flaxman, P. E., & Boyd, J. (2018). Acceptance and commitment therapy (ACT) for clinically distressed health care workers: Waitlist-controlled evaluation of an ACT workshop in a routine practice setting. The British journal of clinical psychology, 57(1), 82–98. https://doi.org/10.1111/bjc.12155
White, R., Gumley, A., McTaggart, J., Rattrie, L., McConville, D., Cleare, S., & Mitchell, G. (2013). Depression and anxiety following psychosis: Associations with mindfulness and psychological flexibility. Behavioral and Cognitive Psychotherapy, 41(1), 34–51. doi: 10.1017/S1352465812000239
World Health Organization (2017). Depression and Other Common Mental Disorders: Global Health Estimates. Geneva. License: CC BY-NC-SA 3.0 IGO