Risk factors for anxiety, depression, stress, and their comorbidities among nurses: a prospective cohort from 2020 to 2022

Abstract

Background Nurses are at the forefront of healthcare delivery during the COVID-19, placing them at an increased risk for mental health issues. This study aimed to identify the risk factors for anxiety, depression, stress, and their comorbidities among nurses during the 2020–2022 period. Methods A prospective cohort of nurses in Zunyi City, China, was followed from 2020 to 2022. The Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Perceived Stress Scale (PSS) were used to assess anxiety, depression, and stress, respectively. A self-reported questionnaire was utilized to collect data on demographic characteristics, lifestyle habits, socioeconomic status, work-related factors, and medical history. The Healthy Eating Index (HEI) was calculated to evaluate diet quality. Univariate and multivariate logistic regression analyses were conducted to examine the associations between risk factors and mental health outcomes. Results Among the 516 participating nurses, the incidence rates of new-onset anxiety, depression, and stress were 27.1%, 33.9%, and 39.9%, respectively. Frontline experience with infected patients, night shift work, longer working hours, and higher body mass index were consistently associated with increased risks of anxiety, depression, and stress, whereas a higher healthy eating index score was linked to reduced odds of these mental health outcomes. Notably, higher BMI (≥ 28: OR = 1.67, 95% CI: 1.12–2.16, p = 0.011), night shifts (> 1/week: OR = 5.12, 95% CI: 3.64–5.99, p < 0.001), longer working hours (> 40/week: OR = 1.99, 95% CI: 1.66–2.89, p < 0.001), and frontline experience (OR = 6.11, 95% CI: 4.52–8.88, p < 0.001) significantly increased comorbidity risk, while higher HEI (> 3: OR = 0.51, 95% CI: 0.36–0.70, p < 0.001) reduced the risk. Conclusion Our study highlights the considerable mental health burden among nurses during the 2020–2022 period and identifies key risk factors associated with anxiety, depression, stress, and their comorbidities. These findings underscore the importance of providing targeted interventions and support for nurses, including workload management, work-life balance promotion, and healthy lifestyle encouragement, to mitigate the negative consequences of identified risk factors and improve mental health outcomes.