Burden of poor sleep quality, stress, anxiety, and depression among staff nurses working in tertiary hospitals of Puducherry: a pilot study
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20252129Keywords:
Sleep quality, Nurses, Stress, Anxiety, Depression, Pittsburgh sleep quality indexAbstract
Background: Sleep deprivation and psychological distress have emerged as occupational health issues among staff nurses. Poor sleep quality is mostly combined with increased stress, anxiety, and depression, all of which can adversely affect personal well-being and professional performance in the health system. The aim of the pilot study assessed the prevalence of poor sleep quality, stress, anxiety, and depression among staff nurses working in tertiary hospitals of Puducherry.
Methods: A descriptive pilot study was conducted among 30 staff nurses aged 18 to 60 working in Puducherry tertiary care hospitals. One tertiary hospital was randomly selected, and participants were recruited through systematic random sampling. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), whereas psychological distress from common mental disorders was assessed using the depression, anxiety, and stress scale-21.
Results: The mean age of the participants was 47.13±7.47 years. About half of the participants (56.7%) have shown poor sleep quality (Global PSQI score>5). Among PSQI components, 16 (53.33%) participants had limited 5-6 hours of sleep, and 15 (50%) exhibited moderate to high sleep latency. 22 (73.33%) participants were found with good sleep efficiency. Regarding psychological distress, 20% of participants with stress, 36.7% revealed varying degrees of anxiety, and 16.7% showed symptoms of depression.
Conclusions: The study highlights a burden of poor sleep quality, stress, anxiety, and depression among staff nurses in tertiary care settings. These findings underscore the need for further large-scale studies, early identification and intervention strategies to support mental health and improve sleep hygiene among nursing professionals.
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References
Chattu VK, Manzar MD, Kumary S, Burman D, Spence DW, Pandi-Perumal SR. The Global Problem of Insufficient Sleep and Its Serious Public Health Implications. Healthcare (Basel). 2018;7(1):1. DOI: https://doi.org/10.3390/healthcare7010001
Magnavita N, Garbarino S. Sleep, health and wellness at work: a scoping review. Int J Environ Res Public Health. 2017;14(11):1347. DOI: https://doi.org/10.3390/ijerph14111347
Nelson KL, Davis JE, Corbett CF. Sleep quality: An evolutionary concept analysis. Nurs Forum. 2022;57(1):144-51. DOI: https://doi.org/10.1111/nuf.12659
Tsai K, Lee TY, Chung MH. Insomnia in female nurses: a nationwide retrospective study. Int J Occup Saf Ergon. 2017;23(1):127-32. DOI: https://doi.org/10.1080/10803548.2016.1248604
Rocha MC, De Martino MM. Stress and sleep quality of nurses working different hospital shifts. Rev Esc Enferm USP. 2010;44(2):280-6. DOI: https://doi.org/10.1590/S0080-62342010000200006
James SM, Honn KA, Gaddameedhi S, Van Dongen HPA. Shift Work: Disrupted Circadian Rhythms and Sleep-Implications for Health and Well-Being. Curr Sleep Med Rep. 2017;3(2):104-12. DOI: https://doi.org/10.1007/s40675-017-0071-6
Gaba DM, Howard SK. Patient safety: fatigue among clinicians and the safety of patients. N Engl J Med. 2002;347(16):1249-55. DOI: https://doi.org/10.1056/NEJMsa020846
Zeng LN, Yang Y, Wang C, Li XH, Xiang YF, Hall BJ, et al. Prevalence of Poor Sleep Quality in Nursing Staff: A Meta-Analysis of Observational Studies. Behav Sleep Med. 2020;18(6):746-59. DOI: https://doi.org/10.1080/15402002.2019.1677233
Christina S, Konjengbam S. Sleep quality among nurses in a tertiary hospital in Manipur. J Med Soc. 2019;33(3). DOI: https://doi.org/10.4103/jms.jms_80_20
Chueh KH, Chen KR, Lin YH. Psychological Distress and Sleep Disturbance Among Female Nurses: Anxiety or Depression? J Transcult Nurs. 2021;32(1):14-20. DOI: https://doi.org/10.1177/1043659619881491
Cappuccio FP, Cooper D, D'Elia L, Strazzullo P, Miller MA. Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J. 2011;32(12):1484-92. DOI: https://doi.org/10.1093/eurheartj/ehr007
Wang Y, Mei H, Jiang YR, Sun WQ, Song YJ, Liu SJ, et al. Relationship between Duration of Sleep and Hypertension in Adults: A Meta-Analysis. J Clin Sleep Med. 2015;11(9):1047-56. DOI: https://doi.org/10.5664/jcsm.5024
Anothaisintawee T, Reutrakul S, Van Cauter E, Thakkinstian A. Sleep disturbances compared to traditional risk factors for diabetes development: Systematic review and meta-analysis. Sleep Med Rev. 2016;30:11-24. DOI: https://doi.org/10.1016/j.smrv.2015.10.002
WHO. Stress, 2024. Available at: https://www.who.int/newsroom/questionsandanswers/item/stress. Accessed on 23 May 2025.
Dong H, Zhang Q, Sun Z, Sang F, Xu Y. Sleep disturbances among Chinese clinical nurses in general hospitals and its influencing factors. BMC Psych. 2017;17:1-9. DOI: https://doi.org/10.1186/s12888-017-1402-3
Kunzweiler K, Voigt K, Kugler J, Hirsch K, Bergmann A, Riemenschneider H. Factors influencing sleep quality among nursing staff: Results of a cross sectional study. Appl Nurs Res. 2016;32:241-4. DOI: https://doi.org/10.1016/j.apnr.2016.08.007
Cheung T, Yip PS. Depression, Anxiety and Symptoms of Stress among Hong Kong Nurses: A Cross-sectional Study. Int J Environ Res Public Health. 2015;12(9):11072-100. DOI: https://doi.org/10.3390/ijerph120911072
Saleh AM, Awadalla NJ, El-masri YM, Sleem WF. Impacts of nurses’ circadian rhythm sleep disorders, fatigue, and depression on medication administration errors. Egyptian J Chest Dis Tubercul. 2014;63(1):145-53. DOI: https://doi.org/10.1016/j.ejcdt.2013.10.001
APA. Anxiety, 2024. Available at: https://www.apa.org/topics/anxiety. Accessed on 23 May 2025.
WHO. Anxiety disorders, 2024. Available at https://www.who.int/newsroom/factsheets/detail/anxiety-disorders. Accessed on 23 May 2025.
WHO. Depressive disorder (depression), 2024. Available at: https://www.who.int/newsroom/factsheets/detail/anxiety-disorders. Accessed on 23 May 2025.
Kaushik A, Ravikiran SR, Suprasanna K, Nayak MG, Baliga K, Acharya SD. Depression, Anxiety, Stress and Workplace Stressors among Nurses in Tertiary Health Care Settings. Indian J Occup Environ Med. 2021;25(1):27-32. DOI: https://doi.org/10.4103/ijoem.IJOEM_123_20
Sen A, Tai XY. Sleep Duration and Executive Function in Adults. Curr Neurol Neurosci Rep. 2023;23(11):801-3. DOI: https://doi.org/10.1007/s11910-023-01309-8
Segon T, Kerebih H, Gashawu F, Tesfaye B, Nakie G, Anbesaw T. Sleep quality and associated factors among nurses working at comprehensive specialized hospitals in Northwest, Ethiopia. Front Psychiatry. 2022;13:931588. DOI: https://doi.org/10.3389/fpsyt.2022.931588
Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213. DOI: https://doi.org/10.1016/0165-1781(89)90047-4
Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33(3):335-43. DOI: https://doi.org/10.1016/0005-7967(94)00075-U
SCIRP. Released, 2007. Available at: https://www.who.int/newsroom/factsheets/detail/anxiety-disorders. Accessed on 23 May 2025.
Zhou Y, Wang S, Liu M, Gan G, Qin N, Luo X, et al. The role of sleep quality and perceived stress on depressive symptoms among tertiary hospital nurses: a cross-sectional study. BMC Psych. 2023;23(1):416. DOI: https://doi.org/10.1186/s12888-023-04936-0
An M, Kim J, Heo S, Kim SH, Hwang YY. Factors Affecting Sleep Quality of Clinical Nurses Working in a Hospital. Korean J Adult Nurs. 2018;30(2):126. DOI: https://doi.org/10.7475/kjan.2018.30.2.126
Kayaroganam R, Sarkar S, Satheesh S, Tamilmani S, Sivanantham P, Kar SS. Sleep Quality and its Associated Factors among Nurses in a Tertiary Care Public Hospital in Puducherry District: A Cross-sectional Study. Iran J Nurs Midwifery Res. 2024;29(5):617-22. DOI: https://doi.org/10.4103/ijnmr.ijnmr_482_21
Tarhan M, Aydin A, Ersoy E, Dalar L. The sleep quality of nurses and its influencing factors. Eurasian J Pulmonol. 2018;20(2):78.
Tosun A, Tosun H, Ödül Özkaya B, Erdoğan Z, Gül A. "Sleep Quality and Depression Level in Nurses in COVID-19 Pandemic". Omega (Westport). 2025;90(4):1473-90. DOI: https://doi.org/10.1177/00302228221123159
Kaur J, Upendra S, Barde S. Prevalence and factors associated with the poor quality of sleep among Indian nurses. J Educ Health Promot. 2024;13:288. DOI: https://doi.org/10.4103/jehp.jehp_1557_23
Luo Y, Fei S, Gong B, Sun T, Meng R. Understanding the Mediating Role of Anxiety and Depression on the Relationship Between Perceived Stress and Sleep Quality Among Health Care Workers in the COVID-19 Response. Nat Sci Sleep. 2021;13:1747-58. DOI: https://doi.org/10.2147/NSS.S313258
Hu X, Mu W, Zhou J, Zhou H, Yan X, Yue K, et al. Risk factors for anxiety, depression, stress, and their comorbidities among nurses: a prospective cohort from 2020 to 2022. BMC Nurs. 2024;23(1):916. DOI: https://doi.org/10.1186/s12912-024-02577-6
Al Maqbali M. Sleep disturbance among frontline nurses during the COVID-19 pandemic. Sleep Biol Rhy. 202;19(4):467-73. DOI: https://doi.org/10.1007/s41105-021-00337-6
Shahadan SZ, Mohamad Ismail MF, Kamaruzaman KN. Sleep Quality and Stress Levels Among Nurses: A Single Center Study. J Keperawatan Indonesia. 2023;26(3):142-52. DOI: https://doi.org/10.7454/jki.v26i3.1077
Manzar MD, Moiz JA, Zannat W, Spence DW, Pandi-Perumal SR, Ahmed S. BaHammam; Hussain ME. Validity of the Pittsburgh Sleep Quality Index in Indian University Students. Oman Med J. 2015;30(3):193-202. DOI: https://doi.org/10.5001/omj.2015.41
Nada Q, Herdiana I, Andriani F. Testing the validity and reliability of the Depression Anxiety Stress Scale (DASS)-21 instrument for individuals with psychodermatology. Psikohumaniora J Penelitian Psikologi. 2022;7(2):153-68. DOI: https://doi.org/10.21580/pjpp.v7i2.11802
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