Article Data

  • Views 3846
  • Dowloads 303

Original Research

Open Access

Relationship among anxiety, depression, social and self-efficacy in night-shift nurses

  • Hui-Xiu Liao1
  • Hai Zou2
  • Jie Pang3,*,
  • Hua-Hua Liu4,*,

1Department of Neurology, Xinyu People's Hospital, 338025 Xinyu, Jiangxi, China

2Department of Anaesthesia, Critical Care and Pain Medicine, Fudan University Shanghai Cancer Center, 200032 Shanghai, China

3Department of Cardiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, 310014 Hangzhou, Zhejiang, China

4Department of Respiratory, Huashan Hospital, Fudan University, 200032 Shanghai, China

DOI: 10.22514/sv.2021.135 Vol.19,Issue 1,January 2023 pp.117-122

Submitted: 06 June 2021 Accepted: 16 July 2021

Published: 08 January 2023

*Corresponding Author(s): Jie Pang E-mail:
*Corresponding Author(s): Hua-Hua Liu E-mail:


Night shift disturbs normal circadian rhythm, thus leads to several psychological problems. We aim to investigate the anxiety, depression, social support and self-efficacy of night-shift nurses compared with day-shift nurses and explore the association between emotional status and social support as well as the combined influence of social support and self-efficacy on emotional status. We conducted this quantitative comparative study in a hospital from January 1, 2019 to August 31, 2020, using the Hospital Anxiety and Depression Scale (HADS), Perceived Social Support Scale (PSSS), and General Self-Efficacy Scale (GSES). The HADS-A and HADS-D scores were higher for the night-shift nurses than for the day-shift nurses (7.38 ± 3.228 vs. 5.81 ± 3.180 and 6.79 ± 3.444 vs. 5.43 ± 3.155, respectively, P < 0.01). The family support, friend support, other support and total social support scores were lower for the night-shift nurses than for the day-shift nurses. In both groups, these scores were lower for nurses with suspected anxiety than for those without anxiety (61.16 ± 12.208 vs. 66.35 ± 9.976, P < 0.01) and were lower for nurses with suspected depression than for those without depression (59.91± 11.606 vs. 66.77 ± 10.320, P < 0.01). The item scores, total scores and total mean score for the night-shift nurses were significantly lower than those for the day-shift nurses (P < 0.01). Social support and self-efficacy had noticeable regression effects on nurses’ anxiety and depression, and both variables had significant negative effects on anxiety and depression. This study suggests that night-shift nurses may have higher anxiety and depression than day-shift nurses. Nurses with suspected anxiety and depression nurses may have lower social support than those without anxiety and depression.


Nurses; Anxiety; Depression; Social support; Self-efficacy

Cite and Share

Hui-Xiu Liao,Hai Zou,Jie Pang,Hua-Hua Liu. Relationship among anxiety, depression, social and self-efficacy in night-shift nurses. Signa Vitae. 2023. 19(1);117-122.


[1] Adeniran R, Healy D, Sharp H, Williams JMG, Minors D, Waterhouse JM. Interpersonal sensitivity predicts depressive symptom response to the circadian rhythm disruption of nightwork. Psychological Medicine. 1996; 26: 1211–1221.

[2] Sircar BK, Saha MR, Deb BC, Singh PK, Pal SC. Effectiveness of oral rehydration salt solution (ORS) in reduction of death during cholera epidemic. Indian Journal of Public Health. 1990; 34: 68–70.

[3] Letvak S, Ruhm CJ, McCoy T. Depression in hospital-employed nurses. Clinical Nurse Specialist CNS. 2012; 26: 177–182.

[4] Jiao M, Ning N, Li Y, Gao L, Cui Y, Sun H, et al. Workplace violence against nurses in Chinese hospitals: a cross-sectional survey. BMJ Open. 2015; 5: e006719.

[5] de Leo D, Magni G, Vallerini A. Anxiety and depression in general and psychiatric nurses: a comparison. International Journal of Nursing Studies. 1982; 19: 173–175.

[6] Sawatzky JV. Stress in critical care nurses: Actual and perceived. Heart & Lung. 1996; 25: 409–417.

[7] Baba VV, Galperin BL, Lituchy TR. Occupational mental health: a study of work-related depression among nurses in the Caribbean. International Journal of Nursing Studies. 1999; 36: 163–169.

[8] Gao Y, Pan B, Sun W, Wu H, Wang J, Wang L. Anxiety symptoms among Chinese nurses and the associated factors: a cross sectional study. BMC Psychiatry. 2012; 12: 141.

[9] Dai C, Qiu H, Huang Q, Hu P, Hong X, Tu J, et al. The effect of night shift on sleep quality and depressive symptoms among Chinese nurses. Neuropsychiatric Disease and Treatment. 2019; 15: 435–440.

[10] Kuhn G. Circadian rhythm, shift work, and emergency medicine. Annals of Emergency Medicine. 2001; 37: 88–98.

[11] Ulas T, Buyukhatipoglu H, Kirhan I, Dal MS, Eren MA, Hazar A, et al. The effect of day and night shifts on oxidative stress and anxiety symptoms of the nurses. European Review for Medical and Pharmacological Sciences. 2012; 16: 594–599.

[12] Øyane NMF, Pallesen S, Moen BE, Akerstedt T, Bjorvatn B. Associations between night work and anxiety, depression, insomnia, sleepiness and fatigue in a sample of Norwegian nurses. PLoS ONE. 2013; 8: e70228.

[13] Kroenke CH, Kubzansky LD, Schernhammer ES, Holmes MD, Kawachi I. Social networks, social support, and survival after breast cancer diagnosis. Journal of Clinical Oncology. 2006; 24: 1105–1111.

[14] Hill J, Holcombe C, Clark L, Boothby MRK, Hincks A, Fisher J, et al. Predictors of onset of depression and anxiety in the year after diagnosis of breast cancer. Psychological Medicine. 2011; 41: 1429–1436.

[15] Agard AS, Maindal HT. Interacting with relatives in intensive care unit. Nurses’ perceptions of a challenging task. Nursing in Critical Care. 2009; 14: 264–272.

[16] Paukert AL, Pettit JW, Kunik ME, Wilson N, Novy DM, Rhoades HM, et al. The roles of social support and self-efficacy in physical health’s impact on depressive and anxiety symptoms in older adults. Journal of Clinical Psychology in Medical Settings. 2010; 17: 387–400.

[17] Muris P. Relationships between self-efficacy and symptoms of anxiety disorders and depression in a normal adolescent sample. Personality and Individual Differences. 2002; 32: 337–348.

[18] Zheng R, Bloomer MJ, Guo Q, Lee SF. New graduate nurses’ coping with death and the relationship with death self‐efficacy and death anxiety: a multicentre cross‐sectional study. Journal of Advanced Nursing. 2021; 77: 795–804.

[19] Ding Y, Huang L, Feng C, Yang M, Zhang Y. Depression and self-efficacy in medical residents. Journal of Central South University. Medical Sciences. 2017; 42: 83–87. (In Chinese)

[20] Lev EL. Bandura’s theory of self-efficacy: applications to oncology. Scholarly Inquiry for Nursing Practice. 1997; 11: 21–43.

[21] Bandura A, Adams NE, Beyer J. Cognitive processes mediating behavioral change. Journal of Personality and Social Psychology. 1977; 35: 125–139.

[22] van der Heijden BIJM, Kümmerling A, van Dam K, van der Schoot E, Estryn-Béhar M, Hasselhorn HM. The impact of social support upon intention to leave among female nurses in Europe: Secondary analysis of data from the next survey. International Journal of Nursing Studies. 2010; 47: 434–445.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time