Fatigue, depression and anxiety among nurses working in shift in a tertiary care hospital in South India
DOI:
https://doi.org/10.18203/2320-6012.ijrms20192895Keywords:
Anxiety, Depression, Fatigue, Shift work, Sleep deprivationAbstract
Background: Shift work has become a social and economic necessity, as most sectors like the healthcare require round the clock operation. Extended and variable working hours leads to desynchronization of the body’s circadian rhythm. Thus, shift work is commonly associated with various physical and mental disorders like insomnia, fatigue, depression, anxiety, cognitive impairment, etc. The aim of the study was to assess the prevalence of sleep deprivation and hence, the levels of fatigue, depression and anxiety among shift working nurses.
Methods: This cross-sectional study was conducted among shift working nurses. Sleep deprivation among 97 female and 3 male healthy nurses of age 20-50 years was assessed by Epworth Sleepiness Scale (ESS). Fatigue Severity Scale, Patient Health Questionnaire (PHQ-9) and Hamilton Anxiety Rating Scale (HAM-A) were used for assessing fatigue, depression and anxiety respectively. Level of Sleep deprivation, Depression and Anxiety were expressed in Proportion. Difference in fatigue levels during day and night shift was analyzed using Wilcoxon Signed-Ranks Test.
Results: Analysis of ESS, showed, 69% of shift working nurses had poorer sleep quality. The level of fatigue experienced following a night shift work was significantly higher than that following day shift work (Z= 3.34, p = 0.0008). Moderate to severe depression and anxiety was observed in 15% and 16% of the nurses working in shift.
Conclusions: Thus, shift work is inevitably associated with sleep deprivation. There exists an increased prevalence of fatigue, depression and anxiety among shift working nurses.
References
Kushida C. Sleep Deprivation: Basic Science, Physiology, and Behavior. Marcel Dekker; 2005: 1-2.
Akerstedt T, Wright KP. Sleep loss and fatigue in shift work and shift work disorder. Sleep Med Clin. 2009;4(2):257-71.
Goel N, Rao H, Durmer JS, Dinges DF. Neurocognitive consequences of sleep deprivation. Seminars Neurol. 2009;29(4):320-339.
Harrington J. Health effects of shift work and extended hours of work. Occup Environ Med. 2001;58(1):68-72.
Stimpfel AW, Sloane DM, Aiken LH. The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Heal Aff. 2012;31(11):2501-9.
Kunert K, King ML, Kolkhorst FW. Fatigue and sleep quality in nurses. J Psychosoc Nurs Ment Heal Serv. 2007;45(8):30-7.
Ferri P, Guadi M, Marcheselli L, Balduzzi S, Magnani D, Di Lorenzo R. The impact of shift work on the psychological and physical health of nurses in a general hospital: a comparison between rotating night shifts and day shifts. Risk Manag Healthc Policy. 2016;9:203-211.
Driesen K, Jansen NW, Kant I, Mohren DC, Amelsvoort LG. Depressed mood in the working population: associations with work schedules and working hours. Chronobiol Int. 2010;27(5):1062-79.
Kleppa E, Sanne B, Tell GS. Working overtime is associated with anxiety and depression: the Hordaland Health Study. J Occup Environ Med. 2008;50(6):658-66.
Oyane NM, Pallesen S, Moen BE, Åkerstedt T, Bjorvatn B. Associations between night work and anxiety, depression, insomnia, sleepiness and fatigue in a sample of Norwegian nurses. PLoS One. 2013;8(8):e70228.
Kalmbach DA, Pillai V, Cheng P, Arnedt JT. Drake CL. Shift work disorder, depression, and anxiety in the transition to rotating shifts: the role of sleep reactivity. Sleep Med. 2015;16(12):1532-8.
McEwen BS, Karatsoreos IN. Sleep Deprivation and Circadian Disruption: Stress, Allostasis, and Allostatic Load. Sleep Med Clin. 2015;10(1):1-10.
Touitou Y, Reinberg A, Touitou D. Association between light at night, melatonin secretion, sleep deprivation, and the internal clock: Health impacts and mechanisms of circadian disruption. Life Sci. 2017;173:94-106.
Zhang L, Samet J, Caffo B, Punjab NM. Cigarette Smoking and Nocturnal Sleep Architecture. Am J Epidemiol. 2006;164(6):529-37.
Stein MD, Friedmann PD. Disturbed sleep and its relationship to alcohol use. Subst Abus. 2005;26(1):1-13.
Johns MW. Reliability and factor analysis of the epworth sleepiness scale. Sleep. 1992;15(4):376-81.
Valko PO, Bassetti CL, Bloch KE, Held U. Baumann CR. Validation of the fatigue severity scale in a Swiss cohort. Sleep. 2008;31(11):1601-7.
Burgess PA. Optimal shift duration and sequence: recommended approach for short-term emergency response activations for public health and emergency management. Am J Pub Heal. 2007;97(Suppl 1):S88-92.
Martin A, Rief W, Klaiberg A, Braehler E. Validity of the brief patient health questionnaire mood scale (PHQ-9) in the general population. Gen Hos Psychiatry. 2006;28(1):71-7.
Thompson E. Hamilton Rating Scale for Anxiety (HAM-A). Occup Med. 2015; 65(7):601.
Suzuki K, Ohida T, Kaneita Y, Yokoyama E, Miyake T, Harano S, et al. Mental health status, shift work, and occupational accidents among hospital nurses in Japan. J Occup Health. 2004;46(6):448-54.
Ardekani ZZ, Kakooei H, Ayattollahi SM, Choobineh A, Seraji GN. Prevalence of mental disorders among shift work hospital nurses in Shiraz, Iran. Pak J Biol Sci. 2008;11(12):1605-9.
Shen J, Botly LC, Chung SA, Gibbs AL, Sabanadzovic S, Shapiro CM. Fatigue Shift Work. J Sleep Res. 2006;15(1):1-5.
Bara AC, Arber S. Working shifts and mental health--findings from the British Household Panel Survey Scand J Work Env Heal. 2009;35(5):361-7.
Attarchi M, Darkhi H, Khodarahmian M, Dolati M, Kashanian M, Ghaffari M, et al. Characteristics of menstrual cycle in shift workers. Glob J Heal Sci. 2013;5(3):163-72.
