Job Stressors Linked With Mental Health Issues, Sleep Difficulty in Nurses Amid Pandemic

Occupational stressors in nurses working amid the peak of the coronavirus disease 2019 (COVID-19) pandemic in China were found to be significantly correlated with mental health and sleep difficulty, according to study findings published in Journal of Contextual Behavioral Science.

The impact of the COVID-19 pandemic on front-line workers has become a notable concern, as researchers have highlighted that nurses have faced several occupational stressors, such as heavy workload and shift work, that contribute to the risk of mental health and sleep problems. A prior study indicated that these populations are at risk for psychiatric illnesses at severity levels higher than other national disasters, including 9/11 and Hurricane Katrina.

Seeking to further examine the associations between occupational stressors, mental health problems, and sleep difficulty, the study authors sought to investigate whether cognitive fusion and cognitive reappraisal may play a mediating role in the relationships.

“For nurses, occupation stressors might lead to mental health problems via cognitive fusion, in which nurses construct their thoughts towards the stressors and cannot distinguish between thoughts and facts,” explain the study authors. “On the other hand, cognitive reappraisal….can also help nurses to manage their occupational stressors and regulate emotions and thoughts to reduce mental health problems.”

They recruited 323 nurses (mean [SD] age, 32.11 [6.75] years; 92.6% female) from 25 hospitals in China who completed a cross-sectional online survey on psychological and behavioral variables from May 25-31, 2020. Participants were asked to base their responses on their experiences amid the most severe period of the pandemic in China, noted as January to March 2020.

At the height of the pandemic in China, the nurse cohort worked an average 8.48 hours per day and got an average 6.60 hours of actual sleep per night, with 40.2% saying they had contact with and taking care of patients with COVID-19.

Analyses unveiled that sleep difficulty was significantly and positively correlated (r) with occupational stressors (r, .449; P < .001), cognitive fusion (r, 0.448; P < .001), and mental health problems (r, 0.492; P < .001). Moreover, mental health problems were found to be significantly and positively correlated with occupational stressors (r, 0.388; P < .001) and cognitive fusion (r, 0.592; P < .001).

Notably, mental health problems were also indicated to be significantly and negatively correlated with cognitive reappraisal (r, −0.156; P = .005).

“Findings from the current study indicate that intervention strategies focusing on the reduction of cognitive fusion and improvement of cognitive reappraisal could help better prepare nurses to alleviate mental health problems and sleep difficulties that are related to COVID-19 and potentially similar pandemics in the future,” concluded the study authors.

Reference

Zhang CQ, Zhang R, Lu Y, et al. Occupational stressors, mental health, and sleep difficulty among nurses during the COVID-19 pandemic: the mediating roles of cognitive fusion and cognitive reappraisal. J Contextual Behav Sci. Published online December 17, 2020. doi:10.1016/j.jcbs.2020.12.004