The resilience-depression association shifted from negative to positive over the role transition, and the depression rebound at T2 marks a critical intervention window, while anxiety demonstrated chronic stability necessitating strategies distinct from depression-focused approaches.
Key Findings
Results
Resilience increased steadily across the three-year role transition period in novice nurses.
Resilience scores increased from 64.65 at baseline (T0) to 81.01 at T3 (P < 0.001).
Measured using the Connor-Davidson Resilience Scale (CD-RISC).
118 newly employed nurses were recruited at baseline; 102 (86.4%) completed all assessments at T0 and end of Years 1–3 (T1–T3).
Study conducted at a tertiary grade A hospital in Lanzhou, China, 2019–2021.
Results
Depression followed a U-shaped trajectory, reaching its lowest point at T2 before rebounding at T3.
Depression nadir occurred at T2 with a score of 50.49, measured by the Self-Rating Depression Scale (SDS).
Depression rebounded at T3 to 55.64 (P < 0.001).
The U-shaped trajectory indicates an initial improvement phase followed by a late-stage worsening.
Group-based trajectory modeling (GBTM) identified three latent trajectory classes for depression, including a low-fluctuating class (32.35%) exhibiting a U-shaped recovery then rebound.
Results
Anxiety exhibited chronic stability with only a late-stage increase from T2 to T3, contrasting with depression's U-shaped trajectory.
Anxiety was measured using the Self-Rating Anxiety Scale (SAS).
Anxiety remained relatively stable from T0 through T2, with a statistically significant increase only from T2 to T3 (P = 0.004).
The pattern of anxiety differed meaningfully from depression's trajectory, suggesting different underlying mechanisms.
Authors concluded that anxiety necessitates strategies distinct from depression-focused approaches.
Results
The resilience-depression association reversed direction over the course of the three-year role transition.
At T0 (baseline), the resilience-depression correlation was negative (r = -0.264, P = 0.007), indicating resilience was protective against depression.
At T1 and T2, the correlation was non-significant.
At T3, the correlation became positive (r = 0.377, P < 0.001), indicating that higher resilience was associated with more depression.
Steiger's Z-test confirmed this reversal was statistically significant (Z = -5.720, P < 0.001).
Hierarchical regression revealed that explanatory power of resilience for depression was highest at T0→T1 and became non-significant at T2→T3.
Results
Group-based trajectory modeling identified three distinct latent trajectory classes for depression among novice nurses.
One identified class was a low-fluctuating class comprising 32.35% of participants, which exhibited a U-shaped pattern of recovery followed by rebound.
GBTM was used to identify these latent classes from the longitudinal depression data.
The existence of distinct subgroups suggests that population-level averages may mask heterogeneous individual experiences.
Results
The depression rebound at T2 (end of Year 2) was identified as a critical intervention window.
Depression scores rose from their nadir of 50.49 at T2 to 55.64 at T3 (P < 0.001).
The rebound occurred despite continued increases in resilience, which aligns with the reversal of the resilience-depression relationship at T3.
Authors recommend a staged mental health monitoring system informed by this temporal pattern.
The late-stage increase in anxiety also coincided with this period (T2 to T3, P = 0.004).
Methods
The study used a prospective longitudinal cohort design with four assessment time points over three years.
118 newly employed nurses were recruited at baseline (T0) from a tertiary grade A hospital in Lanzhou, China.
Assessments were conducted at baseline and at the end of each of three years (T1, T2, T3), spanning 2019–2021.
102 participants (86.4%) completed all four assessments.
Data were analyzed using linear mixed-effects models, Pearson correlation with Steiger's Z-tests, GBTM, and hierarchical regression.
What This Means
This research suggests that the mental health experiences of new nurses change in complex and sometimes counterintuitive ways during their first three years on the job. While nurses generally became more resilient over time, their depression did not simply improve—it followed a U-shape, getting better in the second year but then getting worse again by the third year. Anxiety, unlike depression, stayed mostly stable but also worsened in the final year. These patterns suggest that the third year of nursing may be a particularly vulnerable period requiring targeted support.
One of the most striking findings is that the relationship between resilience and depression actually flipped over time. Early on, being more resilient was associated with less depression—as expected. But by the third year, higher resilience was paradoxically associated with more depression. This suggests that as nurses take on more responsibility and face greater workplace demands, even those who appear psychologically strong may be at risk, and that resilience alone may not be protective in the long run under sustained stress.
This research suggests that mental health support programs for new nurses should not be one-size-fits-all or delivered only at the start of employment. Instead, a staged monitoring approach is recommended, with particular attention to the end of the second and third years when both depression and anxiety worsen. Additionally, because anxiety and depression follow different patterns, interventions targeting one condition may not be effective for the other, highlighting the need for tailored strategies.
Hu Y, Wang R, Wei X, Wang X, Shao Q, Su Q. (2026). Mental health trajectories during new nurses' role transition: staged reversal of the resilience-depression and resilience-anxiety relationship.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1915462