Anxiety, insomnia and family support in nurses, two years after the onset of the pandemic crisis

Christos Sikaras; Maria Tsironi; Sofia Zyga; Aspasia Panagiotou; Christos Sikaras; Maria Tsironi; Sofia Zyga; Aspasia Panagiotou

doi:10.3934/publichealth.2023019

AIMS Public Health

2023, Volume 10, Issue 2: 252-267. doi: 10.3934/publichealth.2023019

Previous Article Next Article

Research article

Anxiety, insomnia and family support in nurses, two years after the onset of the pandemic crisis

1.
University of the Peloponnese, Department of Nursing, 22100, Tripoli, Greece
2.
Sotiria Thoracic Diseases Hospital of Athens, Nursing Department, 11527, Athens, Greece

Received: 25 February 2023 Revised: 09 April 2023 Accepted: 12 April 2023 Published: 21 April 2023

Introduction
The Covid-19 pandemic continues to cause serious physical and mental problems for health professionals, particularly nurses.
Aim
To estimate the prevalence of anxiety and insomnia and to evaluate their possible association with family support received by nurses two years after the onset of the pandemic.
Materials and methods
In total, the study participants were 404 nurses (335 females and 69 males) with a mean age of 42.88 (SD = 10.9) years and a mean of 17.96 (SD = 12) years working as nurses. Nurses from five tertiary hospitals in Athens constituted the study population who completed the questionnaires State-Trait Anxiety Inventory (STAI), Athens Insomnia Scale (AIS) and Family Support Scale (FSS), in the months of November and December 2021. Regarding demographic and occupational characteristics, gender, age and years of experience as nurses were recorded.
Results
60.1% of the nurses showed abnormal scores in state anxiety, with 46.8% in trait anxiety, and 61.4% showed insomnia. Women showed higher scores on the two subscales of anxiety and the insomnia scale compared to men (p < 0.01 and p < 0.05 respectively), while they showed a lower score on the FSS without statistical significance (p > 0.05). Positive correlations (p < 0.01) were found between the State Anxiety Inventory, Trait Anxiety Inventory and AIS, while all of them showed a high negative correlation with FSS (p < 0.01). Age showed a negative correlation with Trait Anxiety Inventory (p < 0.05). As shown by the mediation analysis, the relationship between state anxiety and insomnia was mediated by trait anxiety, whereas state anxiety appeared to be dependent on family support.
Conclusions
Nurses continue to experience high levels of anxiety and insomnia and feel less supported by their families than in the first year of the pandemic. Insomnia appears to be dependent on state anxiety, with a significant indirect effect of trait anxiety, while family support seems to affect state anxiety.
- anxiety,
- insomnia,
- family support,
- nurses,
- COVID-19,
- mediation analysis
Citation: Christos Sikaras, Maria Tsironi, Sofia Zyga, Aspasia Panagiotou. Anxiety, insomnia and family support in nurses, two years after the onset of the pandemic crisis[J]. AIMS Public Health, 2023, 10(2): 252-267. doi: 10.3934/publichealth.2023019

Related Papers:

Abstract

Introduction

The Covid-19 pandemic continues to cause serious physical and mental problems for health professionals, particularly nurses.

Aim

To estimate the prevalence of anxiety and insomnia and to evaluate their possible association with family support received by nurses two years after the onset of the pandemic.

Materials and methods

In total, the study participants were 404 nurses (335 females and 69 males) with a mean age of 42.88 (SD = 10.9) years and a mean of 17.96 (SD = 12) years working as nurses. Nurses from five tertiary hospitals in Athens constituted the study population who completed the questionnaires State-Trait Anxiety Inventory (STAI), Athens Insomnia Scale (AIS) and Family Support Scale (FSS), in the months of November and December 2021. Regarding demographic and occupational characteristics, gender, age and years of experience as nurses were recorded.

Results

60.1% of the nurses showed abnormal scores in state anxiety, with 46.8% in trait anxiety, and 61.4% showed insomnia. Women showed higher scores on the two subscales of anxiety and the insomnia scale compared to men (p < 0.01 and p < 0.05 respectively), while they showed a lower score on the FSS without statistical significance (p > 0.05). Positive correlations (p < 0.01) were found between the State Anxiety Inventory, Trait Anxiety Inventory and AIS, while all of them showed a high negative correlation with FSS (p < 0.01). Age showed a negative correlation with Trait Anxiety Inventory (p < 0.05). As shown by the mediation analysis, the relationship between state anxiety and insomnia was mediated by trait anxiety, whereas state anxiety appeared to be dependent on family support.

Conclusions

Nurses continue to experience high levels of anxiety and insomnia and feel less supported by their families than in the first year of the pandemic. Insomnia appears to be dependent on state anxiety, with a significant indirect effect of trait anxiety, while family support seems to affect state anxiety.

Acknowledgments

We would like to thank all participants in our study.

Conflicts of interest

All authors declare no conflict of interest.

References

[1]	Yuan K, Zheng YB, Wang YJ, et al. (2022) A systematic review and meta-analysis on prevalence of and risk factors associated with depression, anxiety and insomnia in infectious diseases, including COVID-19: a call to action. Mol Psychiatry 27: 3214-3222. https://doi:10.1038/s41380-022-01638-z
[2]	Tselebis A, Pachi A (2022) Primary Mental Health Care in a New Era. Healthcare 10: 2025. https://doi.org/10.3390/healthcare10102025
[3]	Sikaras C, Ilias I, Tselebis A, et al. (2021) Nursing staff fatigue and burnout during the COVID-19 pandemic in Greece. AIMS Public Health 9: 94-105. https://doi:10.3934/publichealth.2022008
[4]	Schmuck J, Hiebel N, Rabe M, et al. (2021) Sense of coherence, social support and religiosity as resources for medical personnel during the COVID-19 pandemic: A web-based survey among 4324 health care workers within the German Network University Medicine. PLoS One 16: e0255211. https://doi:10.1371/journal.pone.0255211
[5]	Dong ZQ, Ma J, Hao YN, et al. (2020) The social psychological impact of the COVID-19 pandemic on medical staff in China: A cross-sectional study. Eur Psychiatry 63: e65. https://doi:10.1192/j.eurpsy.2020.59
[6]	Marvaldi M, Mallet J, Dubertret C, et al. (2021) Anxiety, depression, trauma-related, and sleep disorders among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Neurosci Biobehav Rev 126: 252-264. https://doi.org/10.1016/j.neubiorev.2021.03.024
[7]	Pappa S, Ntella V, Giannakas T, et al. (2020) Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun 88: 901-907. https://doi.org/10.1016/j.bbi.2020.05.026
[8]	Perego G, Cugnata F, Brombin C, et al. (2022) The “Healthcare Workers' Wellbeing [Benessere Operatori]” Project: A Longitudinal Evaluation of Psychological Responses of Italian Healthcare Workers during the COVID-19 Pandemic. J Clin Med 11: 2317. https://doi: 10.3390/jcm11092317
[9]	Varghese A, George G, Kondaguli SV, et al. (2021) Decline in the mental health of nurses across the globe during COVID-19: A systematic review and meta-analysis. J Glob Health 11: 05009. https://doi:10.7189/jogh.11.05009
[10]	Sarafis P, Rousaki E, Tsounis A, et al. (2016) The impact of occupational stress on nurses' caring behaviors and their health related quality of life. BMC Nurs 27: 56. https://doi.org/10.1186/s12912-016-0178-y
[11]	Sikaras C, Zyga S, Tsironi M, et al. (2023) The Mediating Role of Depression and of State Anxiety οn the Relationship between Trait Anxiety and Fatigue in Nurses during the Pandemic Crisis. Healthcare 11: 367. https://doi.org/10.3390/healthcare11030367
[12]	Thorsteinsson EB, Brown RF, Owens MT (2019) Modeling the Effects of Stress, Anxiety, and Depression on Rumination, Sleep, and Fatigue in a Nonclinical Sample. J Nerv Ment Dis 207: 355-359. https://doi:10.1097/NMD.0000000000000973
[13]	Zhang C, Yang L, Liu S, et al. (2020) Survey of Insomnia and Related Social Psychological Factors Among Medical Staff Involved in the 2019 Novel Coronavirus Disease Outbreak. Front Psychiatry 11: 306. https://doi:10.3389/fpsyt.2020.00306
[14]	Morin CM, Rodrigue S, Ivers H (2003) Role of stress, arousal, and coping skills in primary insomnia. Psychosom Med 65: 259-267. https://doi:10.1097/01.psy.0000030391.09558.a3
[15]	Yazdi Z, Sadeghniiat-Haghighi K, Javadi AR, et al. (2014) Sleep quality and insomnia in nurses with different circadian chronotypes: morningness and eveningness orientation. Work 47: 561-567. https://doi:10.3233/WOR-131664
[16]	Knap M, Maciąg D, Trzeciak-Bereza E, et al. (2022) Sleep Disturbances and Health Consequences Induced by the Specificity of Nurses' Work. Int J Environ Res Public Health 19: 9802. https://doi:10.3390/ijerph19169802
[17]	Jahrami H, BaHammam AS, Bragazzi NL, et al. (2021) Sleep problems during the COVID-19 pandemic by population: a systematic review and meta-analysis. J Clin Sleep Med 17: 299-313. https://doi:10.5664/jcsm.8930
[18]	Watson NF, Badr MS, et al. (2015) Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion. Sleep 38: 1161-1183. https://doi.org/10.5665/sleep.4886
[19]	Hu J, Huang Y, Liu J, et al. (2022) COVID-19 Related Stress and Mental Health Outcomes 1 Year After the Peak of the Pandemic Outbreak in China: the Mediating Effect of Resilience and Social Support. Front Psychiatry 13: 828379. https://doi:10.3389/fpsyt.2022.828379
[20]	Zeng W, Fang Q, Wang C, et al. (2022) Perceived Family Function and Associated Predictors in Nurses: A Cross-Sectional Study. Front Psychiatry 13: 904581. https://doi:10.3389/fpsyt.2022.904581
[21]	Tselebis A, Lekka D, Sikaras C, et al. (2020) Insomnia, Perceived Stress, and Family Support among Nursing Staff during the Pandemic Crisis. Healthcare 8: 434. https://doi: 10.3390/healthcare8040434
[22]	Ilias I, Hatzimichelakis E, Souvatzoglou A, et al. (2001) Perception of family support is correlated with glycemic control in Greeks with diabetes mellitus. Psychol Rep 88: 929-930. https://doi:10.2466/pr0.2001.88.3.929
[23]	Sample size calculator & complete guide, 2020. Available from: https://www.qualtrics.com/blog/calculating-sample-size/.
[24]	Spielberger CD, Gorsuch RL, Lushene PR, et al. Manual for the State–Trait Spielberger Anxiety Inventory (Form Y). (1983).Consulting Psychologists Press.
[25]	Fountoulakis KN, Papadopoulou M, Kleanthous S, et al. (2006) Reliability and psychometric properties of the Greek translation of the State-Trait Anxiety Inventory form Y: preliminary data. Ann Gen Psychiatry 5: 2. https://doi.org/10.1186/1744-859X-5-2
[26]	Soldatos CR, Dikeos DG, Paparrigopoulos TJ (2003) The diagnostic validity of the Athens Insomnia Scale. J Psychosom Res 55: 263-267. https://doi.org/10.1016/s0022-3999(02)00604-9
[27]	Soldatos CR, Dikeos DG, Paparrigopoulos TJ (2000) Athens Insomnia Scale: Validation of an instrument based on ICD-10 criteria. J Psychosom Res 48: 555-560. https://doi.org/10.1016/s0022-3999(00)00095-7
[28]	Tselebis A, Anagnostopoulou T, Bratis D, et al. (2011) The 13 item Family Support Scale: Reliability and validity of the Greek translation in a sample of Greek health care professionals. Asia Pac Fam Med 10: 3. https://doi:10.1186/1447-056X-10-3
[29]	Tselebis A, Bratis D, Pachi A, et al. (2013) Chronic obstructive pulmonary disease: sense of coherence and family support versus anxiety and depression. Psychiatriki 24: 109-116.
[30]	Chang EC, Chang OD, Martos T, et al. (2017) Family Support as a Moderator of the Relationship Between Loneliness and Suicide Risk in College Students: Having a Supportive Family Matters!. Family J 25: 257-263. https://doi.org/10.1177/1066480717711102
[31]	Qi T, Hu T, Ge QQ, et al. (2021) COVID-19 pandemic related long-term chronic stress on the prevalence of depression and anxiety in the general population. BMC Psychiatry 21: 380. https://doi:10.1186/s12888-021-03385-x
[32]	Cyr S, Marcil MJ, Houchi C, et al. (2022) Evolution of burnout and psychological distress in healthcare workers during the COVID-19 pandemic: a 1-year observational study. BMC Psychiatry 22: 809. https://doi:10.1186/s12888-022-04457-2
[33]	Preti E, Di Mattei V, Perego G, et al. (2020) The Psychological Impact of Epidemic and Pandemic Outbreaks on Healthcare Workers: Rapid Review of the Evidence. Curr Psychiatry Rep 22: 43. https://doi:10.1007/s11920-020-01166-z
[34]	Dragioti E, Tsartsalis D, Mentis M, et al. (2022) Impact of the COVID-19 pandemic on the mental health of hospital staff: An umbrella review of 44 meta-analyses. Int J Nurs Stud 131: 104272. https://doi:10.1016/j.ijnurstu.2022.104272
[35]	Lai J, Ma S, Wang Y, et al. (2020) Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open 3: e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976
[36]	Morgan R, Tan HL, Oveisi N, et al. (2022) Women healthcare workers' experiences during COVID-19 and other crises: A scoping review. Int J Nurs Stud Adv 4: 100066. https://doi:10.1016/j.ijnsa.2022.100066
[37]	Li SH, Graham BM (2017) Why are women so vulnerable to anxiety, trauma-related and stress-related disorders? The potential role of sex hormones. Lancet Psychiatry 4: 73-82. https://doi:10.1016/S2215-0366(16)30358-3
[38]	Morin CM, Jarrin DC (2022) Epidemiology of Insomnia: Prevalence, Course, Risk Factors, and Public Health Burden. Sleep Med Clin 17: 173-191. https://doi:10.1016/j.jsmc.2022.03.003
[39]	Morin CM, Bjorvatn B, Chung F, et al. (2021) Insomnia, anxiety, and depression during the COVID-19 pandemic: an international collaborative study. Sleep Med 87: 38-45. https://doi:10.1016/j.sleep.2021.07.035
[40]	Alimoradi Z, Gozal D, Tsang HWH, et al. (2022) Gender-specific estimates of sleep problems during the COVID-19 pandemic: Systematic review and meta-analysis. J Sleep Res 31: e13432. https://doi:10.1111/jsr.13432
[41]	López-Soto PJ, Fabbian F, Cappadona R, et al. (2019) Chronotype, nursing activity, and gender: A systematic review. J Adv Nurs 75: 734-748. https://doi:10.1111/jan.13876
[42]	Xin J, Zhang Y, Tang Y, et al. (2019) Brain Differences Between Men and Women: Evidence From Deep Learning. Front Neurosci 13: 185. https://doi: 10.3389/fnins.2019.00185
[43]	AlRasheed MM, Fekih-Romdhane F, Jahrami H, et al. (2022) The prevalence and severity of insomnia symptoms during COVID-19: A global systematic review and individual participant data meta-analysis. Sleep Med 100: 7-23. https://doi:10.1016/j.sleep.2022.06.020
[44]	Carmel S, Anson O, Levenson A, et al. (1991) Life events, sense of coherence and health: gender differences on the kibbutz. Soc Sci Med 32: 1089-1096. https://doi.org/10.1016/0277-9536(91)90084-p
[45]	Sriharan A, West KJ, Almost J, et al. (2021) COVID-19-related occupational burnout and moral distress among nurses: a rapid scoping review. Nurs Leadersh 34: 7-19. https://doi:10.12927/cjnl.2021.26459
[46]	Galanis P, Vraka I, Fragkou D, et al. (2021) Nurses' burnout and associated risk factors during the COVID-19 pandemic: a systematic review and meta-analysis. J Adv Nurs 77: 3286-3302. https://doi:10.1111/jan.14839
[47]	Italia S, Costa C, Briguglio G, et al. (2021) Quality of Life, Insomnia and Coping Strategies during COVID-19 Pandemic in Hospital Workers. A Cross-Sectional Study. Int J Environ Res Public Health 18: 12466. https://doi:10.3390/ijerph182312466
[48]	Sahebi A, Abdi K, Moayedi S, et al. (2021) The prevalence of insomnia among health care workers amid the COVID-19 pandemic: An umbrella review of meta-analyses. J Psychosom Res 149: 110597. https://doi:10.1016/j.jpsychores.2021.110597
[49]	Jahrami H, Haji EA, Saif ZQ, et al. (2022) Sleep Quality Worsens While Perceived Stress Improves in Healthcare Workers over Two Years during the COVID-19 Pandemic: Results of a Longitudinal Study. Healthcare 10: 1588. https://doi:10.3390/healthcare10081588
[50]	Trakada A, Nikolaidis PT, Economou NT, et al. (2022) Comparison of sleep characteristics during the first and second period of restrictive measures due to COVID-19 pandemic in Greece. Eur Rev Med Pharmacol Sci 26: 1382-1387. https://doi:10.26355/eurrev_202202_28131
[51]	COVID-19 CORONAVIRUS PANDEMIC, 2023. Available from: https://www.worldometers.info/coronavirus/country/greece/.
[52]	Health at a Glance: Europe 2020 STATE OF HEALTH IN THE EU CYCLE, 2020. Available from: https://ec.europa.eu/health/system/files/2020-12/2020_healthatglance_rep_en_0.pdf.
[53]	Zhao Y, Hu B, Liu Q, et al. (2022) Social support and sleep quality in patients with stroke: The mediating roles of depression and anxiety symptoms. Int J Nurs Pract 28: e12939. https://doi:10.1111/ijn.12939
[54]	Ye B, Hu J, Im H, et al. (2022) Family Cohesion and Sleep Disturbances During COVID-19: the Mediating Roles of Security and Stress. Int J Ment Health Addict : 1-14. https://doi:10.1007/s11469-022-00753-w
[55]	Xiao H, Zhang Y, Kong D, et al. (2020) The effects of social support on sleep quality of medical staff treating patients with Coronavirus Disease 2019 (COVID-19) in January and February 2020 in China. Med Sci Monit 26: e923549. https://doi.org/10.12659/MSM.923549
[56]	Bilgiç Ş, Çelikkalp Ü, Mısırlı C (2021) Stress level and sleep quality of nurses during the COVID-19 pandemic. Work 70: 1021-1029. https://doi:10.3233/WOR-210538
[57]	Bruce HA, Kochunov P, Kvarta MD, et al. (2023) Frontal white matter association with sleep quality and the role of stress. J Sleep Res 32: e13669. https://doi:10.1111/jsr.13669
[58]	Chan NY, Chan JWY, Li SX, et al. (2021) Non-pharmacological Approaches for Management of Insomnia. Neurotherapeutics 18: 32-43. https://doi:10.1007/s13311-021-01029-2
[59]	Hertenstein E, Feige B, Gmeiner T, et al. (2019) Insomnia as a predictor of mental disorders: A systematic review and meta-analysis. Sleep Med Rev 43: 96-105. https://doi:10.1016/j.smrv.2018.10.006
[60]	Meaklim H, Saunders WJ, Byrne ML, et al. (2023) Insomnia is a key risk factor for persistent anxiety and depressive symptoms: A 12-month longitudinal cohort study during the COVID-19 pandemic. J Affect Disord 322: 52-62. https://doi:10.1016/j.jad.2022.11.021
[61]	Acar Sevinc S, Metin S, Balta Basi N, et al. (2022) Anxiety and burnout in anesthetists and intensive care unit nurses during the COVID-19 pandemic: a cross-sectional study. Braz J Anesthesiol 72: 169-175. https://doi:10.1016/j.bjane.2021.07.011
[62]	Roberts NJ, McAloney-Kocaman K, Lippiett K, et al. (2021) Levels of resilience, anxiety and depression in nurses working in respiratory clinical areas during the COVID pandemic. Respir Med 176: 106219. https://doi:10.1016/j.rmed.2020.106219
[63]	Varma P, Junge M, Meaklim H, et al. (2021) Younger people are more vulnerable to stress, anxiety and depression during COVID-19 pandemic: A global cross-sectional survey. Prog Neuropsychopharmacol Biol Psychiatry 109: 110236. https://doi:10.1016/j.pnpbp.2020.110236
[64]	Pachi A, Sikaras C, Ilias I, et al. (2022) Burnout, Depression and Sense of Coherence in Nurses during the Pandemic Crisis. Healthcare 10: 134. https://doi:10.3390/healthcare10010134
[65]	Bratis D, Tselebis A, Sikaras C, et al. (2009) Alexithymia and its association with burnout, depression and family support among Greek nursing staff. Hum Resour Health 7: 72. https://doi:10.1186/1478-4491-7-72
[66]	Tselebis A, Bratis D, Karkanias A, et al. (2008) Associations on dimensions of burnout and family support for a sample of Greek nurses. Psychol Rep 103: 63-66. https://doi:10.2466/pr0.103.1.63-66
[67]	Lekka D, Pachi A, Tselebis A, et al. (2014) Pain and Anxiety versus Sense of Family Support in Lung Cancer Patients. Pain Res Treat 2014: 312941. https://doi:10.1155/2014/312941
[68]	Noh D, Park S (2022) Mediating Effects of Social Support and Resilience on the Association between COVID-19-Related Stress and Mental Health in Korean Young Adults. Int J Environ Res Public Health 19: 6935. https://doi:10.3390/ijerph19116935
[69]	Shi LS, Xu RH, Xia Y, et al. (2022) The Impact of COVID-19-Related Work Stress on the Mental Health of Primary Healthcare Workers: The Mediating Effects of Social Support and Resilience. Front Psychol 12: 800183. https://doi:10.3389/fpsyg.2021.800183
[70]	Mohammed S, Peter E, Killackey T, et al. (2021) The “nurse as hero” discourse in the COVID-19 pandemic: A poststructural discourse analysis. Int J Nurs Stud 117: 103887. https://doi: 10.1016/j.ijnurstu.2021.103887
[71]	Boulton M, Garnett A, Webster F (2022) A Foucauldian discourse analysis of media reporting on the nurse-as-hero during COVID-19. Nurs Inq 29: e12471. https://doi.org/10.1111/nin.12471
[72]	Elsayed MEG, El-Abasiri RA, Marzo RR, et al. (2023) Mental health, risk perception, and coping strategies among healthcare workers in Egypt during the COVID-19 pandemic. PLoS One 18: e0282264. https://doi:10.1371/journal.pone.0282264
[73]	Htay MNN, Marzo RR, Bahari R, et al. (2021) How healthcare workers are coping with mental health challenges during COVID-19 pandemic? - A cross-sectional multi-countries study. Clin Epidemiol Glob Health 11: 100759. https://doi:10.1016/j.cegh.2021.100759
[74]	Htay MNN, Marzo RR, AlRifai A, et al. (2020) Immediate impact of COVID-19 on mental health and its associated factors among healthcare workers: A global perspective across 31 countries. J Glob Health 10: 020381. https://doi:10.7189/jogh.10.020381
[75]	Marzo RR, ElSherif M, Abdullah MSAMB, et al. (2022) Demographic and work-related factors associated with burnout, resilience, and quality of life among healthcare workers during the COVID-19 pandemic: A cross sectional study from Malaysia. Front Public Health 10: 1021495. https://doi:10.3389/fpubh.2022.1021495
[76]	Kamberi F, Sinaj E, Jaho J, et al. (2021) Impact of COVID-19 pandemic on mental health, risk perception and coping strategies among health care workers in Albania - evidence that needs attention. Clin Epidemiol Glob Health 12: 100824. https://doi:10.1016/j.cegh.2021.100824

Reader Comments

Your name:*

Email:*
© 2023 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)