High-frequency night shifts were significantly associated with higher odds of depressive, anxiety, and comorbid depressive-anxiety symptoms among Chinese nurses, with sleep quality serving as a statistical mediator accounting for 19–26% of these associations.
High-frequency night shifts were significantly associated with higher odds of depressive symptoms compared to low-frequency night shifts.
High-frequency night shifts were significantly associated with higher odds of anxiety symptoms compared to low-frequency night shifts.
High-frequency night shifts were significantly associated with higher odds of comorbid depressive-anxiety symptoms compared to low-frequency night shifts.
Sleep quality statistically mediated the association between high-frequency night shifts and all three mental health outcomes.
The indirect effect of night shift frequency on mental health outcomes through sleep duration was not statistically significant.
The study was conducted among nurses in seven hospitals in Zhejiang Province, China, using a cross-sectional design.
This research suggests that Chinese nurses who work night shifts frequently are more likely to experience depression, anxiety, and a combination of both conditions compared to nurses who work fewer night shifts. The study, which surveyed over 2,000 nurses across seven hospitals in Zhejiang Province in 2023, found that high-frequency night shift workers had roughly 29–46% higher odds of these mental health problems depending on the condition examined. Importantly, this research suggests that poorer sleep quality — not just shorter sleep duration — plays a meaningful role in explaining why night shifts are linked to worse mental health. Sleep quality accounted for roughly 19–26% of the connection between night shift frequency and mental health outcomes, acting as a pathway through which night shifts influence nurses' psychological well-being. Sleep duration, by contrast, did not show a statistically significant mediating role. The findings highlight a practical concern for hospital management and health workforce policy. This research suggests that simply adjusting how many hours nurses sleep may be less important than improving the quality of that sleep. Strategies such as optimizing shift scheduling, providing institutional support for sleep recovery after night shifts, and monitoring sleep quality as part of occupational health programs may help protect the mental health of nursing staff. Because this was a cross-sectional study — meaning it captured a snapshot in time — it cannot confirm that night shifts directly cause these mental health problems, but it does provide evidence of meaningful associations that warrant attention from healthcare administrators and policymakers.
Zhang C, Zhou J, Zhou Y, Zhu S, Sun W, Shan S, et al.. (2026). Associations Between Night Shifts and Comorbid Depressive-Anxiety Symptoms Among Chinese Nurses: Indirect Associations via Sleep Quality and Duration.. Journal of nursing management. https://doi.org/10.1155/jonm/9487063