How shift work influences anxiety, depression, stress and insomnia conditions in Italian nurses: an exploratory study Shift work in Italian nurses

Main Article Content

Elsa Vitale
Roberto Lupo
Giovanna Artioli
Rocco Mea
Pierluigi Lezzi
Luana Conte
Giorgio De Nunzio


Anxiety, Depression, Insomnia, Nurse, Shift, Stress, Work


Background and aim of the work. Evidence suggested that the nursing profession could be considered as a very complex profession also for nurses themselves. To investigate how shift work influence nurses’ health also considering anxiety, depression, stress and insomnia conditions. Methods. An on-line cohort observational study was conducted during May 2022 to 408 nurses. Results. 408 nurses were on-line recruited. Most of the nurses recruited worked also during the night shift (73.3%) and were very young (p<0.001), as aged less than 30 years (29.2%) and also aged between 31-40 years (29), too. Significant difference was reported in smoking habit, as nurses who worked also during the night reported higher smoking habit then the others (p=0.020). None further significant differences according to sex, age, work experience, nursing education, nursing activity, BMI and shift work was found. Finally, none differences were assessed between anxiety, depression, stress and insomnia conditions according to shift work typologies.

Conclusions. The present study discussed research results already highlighted in the current literature; however, it collected further information and assessed additional differences, so that a more complete picture of the nursing profession could be defined.



Download data is not yet available.
Abstract 173 | PDF Downloads 132


1. Cook R I, Render M, Woods DD. Gaps in the continuity of care and progress on patient safety BMJ 2000; 320 :791.
2. Ebright P. The Complex Work of RNs: Implications for Healthy Work Environments OJIN: The Online Journal of Issues in Nursing 2010; 15(1): Manuscript 4.
3. Costa G. Shift work and health: current problems and preventive actions. Saf Health Work. 2010;1(2):112-23.
4. van Amelsvoort L, Schouten EG. Years of shiftwork experience in relation with body mass index and blood pressure. In The international conference on work environment and cardiovascuar diseases, Tel-Aviv, Israel. 1998; 10.
5. Kim MJ, Son KH, Park HY, et al. Association between shift work and obesity among female nurses: Korean Nurses' Survey. BMC Public Health. 2013; 13:1204.
6. Canuto R, Pattussi MP, Macagnan JBA, Henn RL, Olinto MTA. Sleep deprivation and obesity in shift workers in southern Brazil. Public Health Nutrition 2013; 29: 1–5.
7. Buijs R, Salgado R, Sabath E, Escobar C. Peripheral circadian oscillators: time and food. Progress in Molecular Biology and Translational Science 2013; 119: 83–103.
8. Cipolla-Neto J, Amaral FG, Afeche SC, Tan DX, Reiter RJ. Melatonin, energy metabolism, and obesity: a review. Journal of Pineal Research 2014; 56(4): 371–381.
9. Leproult R, Holmback U, van Cauter E. Circadian misa- lignment augments markers of insulin resistance and inflammation, independently of sleep loss. Diabetes 2014; 63(6): 1860–1869.
10. Esquirol Y, Bongard V, Ferrieres J, Verdier H, Perret B. Shiftwork and higher pancreatic secretion: early detection of an intermediate state of insulin resistance? Chronobiology International 2012; 29(9): 1258–1266.
11. Esquirol Y, Bongard V, Mabile L, Jonnier B, Soulat JM, Perret B. Shift work and metabolic syndrome: respective impacts of job strain, physical activity, and dietary rhythms,” Chronobiology International 2009; 26(3): 544–559.
12. Pan A, Schernhammer ES, Sun Q, Hu FB. Rotating night shift work and risk of type 2 diabetes: two prospective cohort studies in women. PLoS Medicine 2011; 8(12): e1001141.
13. Ika K, Suzuki E, Mitsuhashi T, Takao S, Doi H. Shift work and diabetes Mellitus among male workers in Japan: does the intensity of shift work matter? Acta Medica Okayama 2013; 67(1): 25–33.
14. Akbari H, Mirzaei R, Nasrabadi T, Gholami-Fesharaki M. Evaluation of the effect of shift work on serum cholesterol and triglyceride levels. Iranian Red Crescent Medical Journal. 2015;17(1): e18723.
15. Karlsson B, Knutsson A, Lindahl B. Is there an association between shift work and having a metabolic syndrome? Results from a population based study of 27,485 people. Occup Environ Med. 2001;58(11):747-52.
16. Knutsson A, Bøggild H. Shiftwork and cardiovascular disease: review of disease mechanisms. Reviews on Environmental Health 2000; 15(4): 359–372.
17. Karlsson B, Knutsson A, Lindahl B. Is there an association between shift work and having a metabolic syndrome? Results from a population based study of 27,485 people. Occup Environ Med. 2001; 58(11):747-52.
18. Dochi M, Suwazono Y, Sakata K, et al. Shift work is a risk factor for increased total cholesterol level: A 14-year prospective cohort study in 6886 male workers. Occupational and Environmental Medicine 2009; 66: 592-597.
19. Ulhôa MA, Marqueze EC, Burgos LG, Moreno CR. Shift work and endocrine disorders. Int J Endocrinol. 2015;2015: 826249.
20. Crispim CA, Padilha HG, Zimberg IZ, et al. Adipokine levels are altered by shiftwork: a preliminary study. Chronobiology International 2012; 29(5): 587–594.
21. Li Y, Sato,Y, Yamaguchi N. Shift work and the risk of metabolic syndrome: a nested case-control study. International Journal of Occupational and Environmental Health 2011; 17(2): 154–160.
22. Kawada T, Otsuka T. Effect of shift work on the development of metabolic syndrome after 3 years in japanese male workers. Archives of Environmental & Occupational Health 2014; 69(1): 55–61.
23. Kaliyaperumal D, Elango Y, Alagesan M, Santhanakrishanan I. Effects of Sleep Deprivation on the Cognitive Performance of Nurses Working in Shift. J Clin Diagn Res. 2017; 11(8): CC01-CC03.
24. Nishizawa Y, Shoji T, Emoto M, et al. Roles of metabolic and endocrinological alterations in atherosclerosis and cardiovascular disease in renal failure: another form of metabolic syndrome. Semin Nephrol. 2004; 24(5):423-5.
25. Vitale E, Mea R, Di Dio F, Canonico A, Galatola V. Anxiety, Insomnia and Body Mass Index Scores in Italian Nurses Engaged in the Care of COVID-19 Patients. Endocrine, Metabolic & Immune Disorders - Drug Targets 2021; 21(9).
26. Vitale E, Galatola V, Mea R, Di Dio F, Canonico A. The Linkage “Body Mass Index-Insomnia Levels-Eating Disorder Flexibility” in Italian Nurses During the Covid-19 Outbreak: A Psychoendocrinological Employment Disease. Endocrine, Metabolic & Immune Disorders - Drug Targets 2022; 22(5). doi:10.2174/1871530321666210715125939
27. Colleluori G, Goria I, Zillanti C, Marucci S, Dalla Ragione L. Eating disorders during COVID-19 pandemic: the experience of Italian healthcare providers. Eating and Weight Disorders 2021; 26: 2787 - 2793.
28. Phiri LP, Draper CE, Lambert EV, Kolbe-Alexander TL. Nurses' lifestyle behaviours, health priorities and barriers to living a healthy lifestyle: a qualitative descriptive study. BMC Nurs. 2014; 13(1):38.
29. Zanetti F, Gambi A, Bergamaschi A, Gentilini F, De Luca G, Monti C, Stampi S. Smoking habits, exposure to passive smoking and attitudes to a non-smoking policy among hospital staff. Public Health. 1998; 112(1): 57-62.
30. Buchvold HV, Pallesen S, Øyane NM, Bjorvatn B. Associations between night work and BMI, alcohol, smoking, caffeine and exercise--a cross-sectional study. BMC Public Health. 2015; 15:1112.
31. Samhat Z, Attieh R, Sacre Y. Relationship between night shift work, eating habits and BMI among nurses in Lebanon. BMC Nursing. 2020; 19:25.
32. Royal College of Physicians RCoP. Smoking and Mental Health. London: RCP; 2013.
33. Farrell M, Howes S, Taylor C, et al. Substance misuse and psychiatric comorbidity: An overview of the OPCS National Psychiatric Morbidity Survey. Addictive Behav. 1998; 23(6): 909–918. S0306-4603(98)00075-6.
34. Meltzer H, Gill B, Hinds K, Petticrew M. OPCS Surveys of Psychiatric Morbidity in Great Britain,Report 6: Economic Activity and Social Functioning of Residents With Psychiatric Disorders. London: HMSO; 1996.
35. Vitale E, Conte L, Dell'Aglio A, et al. Healthcare workers perceptions in the difficult moment of the end of life and coping strategies adopted during the COVID-19 pandemic: an Italian pilot study. Acta Biomed. 2021; 92(S2): e2021330.
36. Vitale E. Anxiety, depression and insomnia conditions in Italian nurses during the first and the second waves of the Covid-19 pandemic. Journal of Evidence-Based Psychotherapies 2021; 21(1): 69-82.
37. Vitale E, Casolaro S. Anxiety, Burnout and Depression levels according to sex and years of work experience in Italian nurses engaged in the care of Covid-19 patients. Journal of Evidence-Based Psychotherapies 2021; 21(1): 83-96.
38. Arnetz JE, Goetz CM, Arnetz BB, Arble E. Nurse Reports of Stressful Situations during the COVID-19 Pandemic: Qualitative Analysis of Survey Responses. Int J Environ Res Public Health. 2020; 17(21):8126.
39. Meehan CD, Schlamb CD, Nair JM. Strategies to improve nurses' stress response during the COVID-19 pandemic. Nursing. 2022; 52(1): 29-32.
40. Munarini E, Stival C, Boffi R, et al. Factors associated with a change in smoking habit during the first COVID-19 lockdown: an Italian cross-sectional study among ever-smokers. BMC public health 2022; 22(1): 1046.
41. Cochran, W.G. Sampling Techniques, 2nd Ed., New York: John Wiley and Sons, Inc, 1963.
42. Stubbs RJ, Brogelli DJ, Barber J, et al. Service evaluation of weight outcomes as a function of initial BMI in 34,271 adults referred to a primary care/commercial weight management partnership scheme. BMC Research Notes. 2013; 6. 161.
43. Dahlgren CL, Hage TW, Wonderlich JA, Stedal K. General and Eating Disorder Specific Flexibility: Development and Validation of the Eating Disorder Flexibility Index (EDFLIX) Questionnaire. Front Psychol. 2019; 10: 663
44. Szabó M. The short version of the Depression Anxiety Stress Scales (DASS-21): factor structure in a young adolescent sample. J Adolesc. 2010; 33(1): 1-8.
45. Lovibond SH, Lovibond PF. Manual for the Depression Anxiety Stress Scales. (2nd. Ed.) Sydney: Psychology Foundation; 1995.
46. Shahid A, Wilkinson K, Marcu S, Shapiro CM. Insomnia severity index (ISI). STOP, THAT and one hundred other sleep scales 2012; 191-193.
47. Bılgı B, Aksoy UM, Ö ŞO, Maner AF. Attention-deficit/hyperactivity disorder and nicotine dependence in adults. Noropsikiyatri Ars. 2017; 54(4):322–327.
48. Rissanen T, Viinamäki H, Honkalampi K, et al. Long term life dissatisfaction and subsequent major depressive disorder and poor mental health. BMC Psychiatry. 2011;11.
49. Talati A, Wickramaratne PJ, Keyes KM, Hasin DS, Levin FR, Weissman MM. Smoking and psychopathology increasingly associated in recent birth cohorts. Drug Alcohol Depend. 2013;133 (2):724–732.
50. Fluharty M, Taylor AE, Grabski M, Munafò MR. The association of cigarette smoking with depression and anxiety: a systematic review. Nicotine Tob Res. 2017;19(1):3–13. 65vecchio
51. World Health Organisation. Obesity and Overweight. WHO and European Office for Integrated Health Care Services, Geneva, Switzerland; 2015.
52. Kim MJ, Son KH, Park HY, et al. Association between shift work and obesity among female nurses: Korean Nurses’ Survey. BMC Public Health 2013; 13: 1204.
53. Bogossian F, Hepworth J, Leong G, et al. A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia, New Zealand and the United Kingdom. International Journal of Nursing Studies 2012; 49(6): 727–738.
54. Zhao I, Bogossian F, Turner C. Does maintaining or changing shift types affect BMI? a longitudinal study. Journal of Occupational and Environmental Medicine 2012(b); 54(5): 525–531.
55. Nahm E, Warren J, Zhu S, An M, Brown J. Nurses’ self-care behaviors related to weight and stress. Nursing Outlook 2012; 60(5): e23–e31.
56. Han K, Trinkoff A, Storr C, Geiger-Brown J. Job stress and work schedules in relation to nurse obesity. Journal of Nursing Administration 2011; 41(11): 488–495.
57. Waterhouse J, Buckley P, Edwards B, Reilly T. Measurement of and some reasons for, differences in eating habits between night and day workers. Chronobiology International 2003; 20(6): 1075–1092.
58. Han K, Choi-Kwon S, Kim KS. Poor dietary behaviors among hospital nurses in Seoul, South Korea. Applied Nursing Research: ANR 2016; 30: 38–44.
59. Yoshizaki T, Tada Y, Kodama T, et al. Influence of shiftwork on association between body mass index and lifestyle or dietary habits in female nurses and caregivers. Journal of Japanese Society of Nutrition and Food Science 2010; 63(4): 161– 167.
60. Zhao I, Turner C. The impact of shift work on people’s daily health habits and adverse health outcomes. Australian Journal of Advanced Nursing 2008; 25(3): 8–22.
61. Buss J. Associations between obesity and stress and shift work among nurses. Workplace Health & Safety 2012; 60(10): 453.
62. Øyane NMF, Pallesen S, Moen BE, A˚kerstedt 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.
63. Caruso CC. Negative impacts of shiftwork and long work hours. Rehabil Nurs. 2014; 39(1):16-25.
64. Bara AC, Arber S. Working shifts and mental health–findings from the British Household Panel Survey (1995-2005). Scand J Work Environ Health 2009; 35: 361–367.
65. Rutters F, Nieuwenhuizen AG, Lemmens SG, Born JM, Westerterp-Plantenga MS. Acute stressrelated changes in eating in the absence of hunger. Obesity. 2009; 17(1): 72–7.
66. Saville C, Dall'Ora C, Griffiths P. The association between 12-hour shifts and nurses-in- charge's perceptions of missed care and staffing adequacy: a retrospective cross-sectional observational study. Int J Nurs Stud. 2020; 112: 103721.

Most read articles by the same author(s)

1 2 3 4 5 6 7 8 9 10 11 12 13 > >>