Assessment of Night Shift Work on Depression and Sleep Disturbance among Nurses in Tertiary Care Hospital Lahore Pakistan

Naila Kiran; . Zarish; Nasim Kousar; Farzana Iqbal; Zunira Amir

doi:10.54112/bcsrj.v7i4.2329

Authors

Naila Kiran Jinnah Hospital, Lahore, Pakistan
. Zarish Jinnah Hospital, Lahore, Pakistan
Nasim Kousar Jinnah Hospital, Lahore, Pakistan
Farzana Iqbal College of Nursing Allama Iqbal Medical College, Lahore, Pakistan
Zunira Amir College of Nursing Allama Iqbal Medical College, Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v7i4.2329

Keywords:

Depression; Nurses; Shift Work Schedule; Sleep Quality; Sleep Wake Disorders

Abstract

Night-shift work may disturb circadian rhythm, impair sleep quality, and increase psychological stress among nurses. These effects may be more pronounced in nurses with frequent or permanent night-shift duties. Objective: To assess depression and sleep disturbance among nurses working in a tertiary care hospital in Lahore, Pakistan, and to determine their relationship with night-shift frequency. Methods: This descriptive cross-sectional study was conducted at Jinnah Hospital, Lahore, Pakistan, from September 2025 to February 2026. A total of 200 registered nurses working in medical, surgical, pulmonology, gynecology wards, and the Emergency Department were selected through simple random sampling. Data were collected using a structured self-administered questionnaire. Depression was assessed using the Beck Depression Inventory, while sleep disturbance was measured using the Sleep Quality Scale. Data were analyzed using IBM SPSS version 26.0. Categorical variables were expressed as frequencies and percentages, while continuous variables were presented as mean ± standard deviation. Independent-samples t-test was applied to compare day-shift and permanent night-shift nurses, and Pearson correlation was used to assess the relationship of night-shift frequency with depression and sleep disturbance. A p-value <0.05 was considered statistically significant. Results: Among 200 nurses, 145 (72.5%) were female. Overall, 82 (41.0%) nurses were working day shifts, 68 (34.0%) rotational shifts, and 50 (25.0%) permanent night shifts. The mean Beck Depression Inventory score was 21.84 ± 9.62, while the mean Sleep Quality Scale score was 52.71 ± 14.88. Permanent night-shift nurses had significantly higher depression scores than day-shift nurses (27.48 ± 9.10 vs. 17.36 ± 7.44; p<0.001). Sleep disturbance scores were also significantly higher among permanent night-shift nurses compared with day-shift nurses (63.54 ± 12.45 vs. 45.12 ± 11.32; p<0.001). Night-shift frequency showed a positive correlation with depression (r=0.52; p<0.01) and sleep disturbance (r=0.61; p<0.01). Depression and sleep disturbance were also strongly correlated (r=0.68; p<0.01). Conclusion: Permanent night-shift work was significantly associated with higher depressive symptoms and greater sleep disturbance among nurses. Increasing night-shift frequency was linked with worsening depression and poorer sleep quality, supporting the need for structured shift scheduling, adequate rest periods, sleep-health education, and regular psychological screening among nurses.

Downloads

Download data is not yet available.

0

References

1. Varghese A, George G, Kondaguli SV, Naser AY, Khakha DC, Chatterji R. Decline in the mental health of nurses across the globe during COVID-19: a systematic review and meta-analysis. J Glob Health. 2021;11:05009.

2. Boivin DB, Boudreau P, Kosmadopoulos A. Disturbance of the circadian system in shift work and its health impact. J Biol Rhythms. 2022;37(1):3-28.

3. Alfonsi V, Scarpelli S, Gorgoni M, Pazzaglia M, Giannini AM, De Gennaro L. Sleep-related problems in night shift nurses: towards an individualized interventional practice. Front Hum Neurosci. 2021;15:644570.

4. Okechukwu CE, Colaprico C, Di Mario S, Oko-Oboh AG, Shaholli D, Manai MV, et al. The relationship between working night shifts and depression among nurses: a systematic review and meta-analysis. Healthcare (Basel). 2023;11(7):937.

5. Jeon BM, Kim SH. Associations of extended work, higher workloads and emotional work demands with sleep disturbance among night-shift workers. BMC Public Health. 2022;22(1):2138.

6. Zhao H, Li Q, Huang H, Lan F, Yang H, He Y, et al. Circadian rhythm types and shift work demands shape sleep quality and depressive symptoms in shift-working nurses. Front Public Health. 2025;13:1667778.

7. Al Maqbali M, Alsayed A, Hughes C, Hacker E, Dickens GL. Stress, anxiety, depression and sleep disturbance among healthcare professionals during the COVID-19 pandemic: an umbrella review of 72 meta-analyses. PLoS One. 2024;19(5).

8. Jatt KA, Froelicher ES, Pienaar AJ, Dhamani KA. Prevalence of anxiety and depression among nurses during the early phase of COVID-19: a meta-analysis. Pak J Med Sci. 2025;41(2):622-629.

9. Fatima A, Ali S, Ghani N, Shah BA. Psychological distress among nurses working at Hayatabad Medical Complex Peshawar, Pakistan. Khyber Med Univ J. 2020;12(4):321-325.

10. Chen C, Meier ST. Burnout and depression in nurses: a systematic review and meta-analysis. Int J Nurs Stud. 2021;124:104099.

11. Alreshidi SM, Rayani AM. The correlation between night shift work schedules, sleep quality, and depression symptoms. Neuropsychiatr Dis Treat. 2023;19:1565-1571.

12. Jiang M, Yang W, Ji Y, Cai X, Li Y, Guan A, et al. The impact of night shift workload on nurses’ depressive symptoms: a chain mediation analysis of sleep disturbances, social avoidance and fear of missing out. Front Public Health. 2025;13:1723567.

13. Al-Hrinat J, Al-Ansi AM, Hendi A, Adwan G, Hazaimeh M. The impact of night shift stress and sleep disturbance on nurses’ quality of life: case in Palestine Red Crescent and Al-Ahli Hospital. BMC Nurs. 2024;23(1):24.

14. Wang H, Dai X, Yao Z, Zhu X, Jiang Y, Li J, et al. The prevalence and risk factors for depressive symptoms in frontline nurses under COVID-19 pandemic based on a large cross-sectional study using the propensity score-matched method. BMC Psychiatry. 2021;21(1):152.

15. Tosun A, Tosun H, Ozkaya BO, Erdogan Z, Gul A. Sleep quality and depression level in nurses in COVID-19 pandemic. Omega (Westport). 2025;90(4):1473-1490.

16. Huang Q, Tian C, Zeng XT. Poor sleep quality in nurses working or having worked night shifts: a cross-sectional study. Front Neurosci. 2021;15:638973.

17. Liu BP, Jia CX. Shift work schedule and sleep patterns in relation to incident depression: evidence from a prospective cohort study. Psychiatry Res. 2023;321:115076.

18. Al Maqbali M, Al Sinani M, Al-Lenjawi B. Prevalence of stress, depression, anxiety and sleep disturbance among nurses during the COVID-19 pandemic: a systematic review and meta-analysis. J Psychosom Res. 2021;141:110343.

19. Slusarska B, Nowicki GJ, Niedorys-Karczmarczyk B, Chrzan-Rodak A. Prevalence of depression and anxiety in nurses during the first eleven months of the COVID-19 pandemic: a systematic review and meta-analysis. Int J Environ Res Public Health. 2022;19(3):1154.

20. Simonetti V, Durante A, Ambrosca R, Arcadi P, Graziano G, Pucciarelli G, et al. Anxiety, sleep disorders and self-efficacy among nurses during COVID-19 pandemic: a large cross-sectional study. J Clin Nurs. 2021;30(9-10):1360-1371.

21. Luo Y, Fei S, Gong B, Sun T, Meng R. Understanding the mediating role of anxiety and depression on the relationship between perceived stress and sleep quality among health care workers in the COVID-19 response. Nat Sci Sleep. 2021;13:1747-1758.

22. Tamrakar P, Pant SB, Acharya SP. Anxiety and depression among nurses in COVID and non-COVID intensive care units. Nurs Crit Care. 2023;28(2):272-280.

23. Baraka AAE, Ramadan FH, Hassan EA. Predictors of critical care nurses’ stress, anxiety, and depression in response to COVID-19 pandemic. Nurs Crit Care. 2023;28(2):177-183.