Nurses, Overtime and Depression: Is There a Link?


By Melissa Hagstrom, contributor

It’s no secret that nurses have demanding jobs: they are responsible for the most fragile human lives on a daily basis, and busy schedules and long shifts can certainly wear on them physically. But can the combination of long work hours and high demands of their job also contribute to the chances that they might develop depression? New research out of Japan suggests that it can.

In a study published in the August 2013 issue of the Journal of Occupational and Environmental Medicine (JOEM), researchers Takashi Amagasa, MD, MPH, and Takeo Nakayama, MD, PhD, sought to clarify how long working hours affect the likelihood of current and future depression. 

Although the study did not focus on nurses or healthcare professionals in particular, the authors see the findings as relevant across all industries, especially in jobs that are highly demanding. Their findings also add to the results of earlier studies on nurses and depression. 

After analyzing a combination of job and workplace factors affecting the depression risk of workers, the authors found that employees who were long-hours overworked (LHO)--defined as working 60+ hours per week in addition to “usually” having too much work--were at higher risk of depression. 

“We have shown that working hours can affect the long-term risk of depression and that being LHO is a risk factor for future de novo depression,” the study authors said. 

They concluded that reducing LHO status could ultimately lower employee depression.

So what does this mean for nurses?

Susan Letvak, PhD, RN, associate professor of nursing at the University of North Carolina at Greensboro School of Nursing, said it is important for nurses to take care of themselves when working extra shifts and overtime.

Last year, Letvak and some research colleagues published a widely publicized study on nurses and depression in Clinical Nurse Specialist, funded by the Robert Wood Johnson Foundation (RWJF) Interdisciplinary Nursing Quality Research Initiative.

The research team found some startling results: 18 percent of 1,171 hospital nurses surveyed reported depressive symptoms, equaling twice the rate of the general population.

Letvak explained that the basis of the study came out of her past research on the aging of the nursing workforce and hearing stories on how nurses' health issues--including back pain, arthritis and the difficulty of taking a break when you were in an operating room for hours at a time--was impacted by their job. 

“It made me wonder if the health of nurses also impacted their work productivity and quality, and we were lucky that Robert Wood Johnson Foundation provided the funding.  Two conditions known to lead to decreased productivity and quality concerns are pain and depression, and it was never looked at in nurses,” Letvak said. “We were not surprised at the high levels of pain, but we were very surprised at the high levels of depression. The depression was on a depression scale, so those with depression had active symptoms vs. just having a diagnosis [and being treated/not symptomatic].”

Although Letvak’s research did not look at overtime's influence on depression in the study, she believes that it must weigh in.

“Minimum staffing is now the rule vs. the exception,” she said. “Nurses work 12-hour shifts, which really are 13-14 hour shifts. Where is there time to take care of self?”

The JOEM study identified high job demands as a factor that contributed to depression in employees, and Letvak agreed that the evolution of nursing is facilitating some particularly stressful and demanding conditions.

“One could ask, ‘Does nursing cause depression, or do depressed people go into nursing?’ Personally I believe hospital nursing is dramatically changing: high levels of stress, high patient volumes and high acuity levels. Add that to the pressures of a down economy--many nurses who want to be home with their kids are now forced to work full-time just to support their families--and I think it is just too much,” she explained. 

“There is also more awareness of ‘chronic grief,’” said Letvak. “Nurses get very little support or resources for dealing with all they do on a daily basis...humans in pain and crisis. This has to eventually weigh on nurses--especially those who do not have adequate rest and support at home.”

Combating depression can be a long battle, and it all starts with awareness and removing the stigma from mental health issues. 

“Nurses can freely talk about a diagnosis of osteoarthritis or hypertension but would never openly feel comfortable talking about being ‘depressed,’” Letvak said. “I think, too, that managers must be provided training on how to help nurses. Often they know a nurse is struggling--more errors, distracted, mood is different--yet they may ignore it for fear of getting into the ‘personal life’ of their nurses vs. offering support and assistance.”

Both Letvak and the JOEM study authors agree that more research in the area of depression and overtime needs to be completed before we can have a full understanding of the link. 

“Few studies have investigated the relationship between changes in work stress factors and depression by repeatedly measuring work stress factors as predictive factors for depression,” Amagasa and Nakayama noted.

Letvak urges nurses who are working a lot of shifts to take extra care of themselves and pay attention to warning signs of depression or other mental health issues. 

“Sometimes we can't control our circumstances. In a perfect world, no nurse would have to work extra shifts/over time, but that is not the case.  It is critical that nurses try to space their work days, have a fitness routine, eat healthy, get adequate sleep, etc. We also must advocate for better working conditions: better staffing, less lifting, more occupational health and wellness programs,” Letvak concluded. “As the profession that cares for others, we do a very poor job of caring for ourselves and each other.”

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