ORIGINAL ARTICLE
RODRIGUES, Silvia Maria da Silva Sant’ana [1], ARAGÃO, Iapunira Catarina Sant’Anna [2], ARAGÃO, Felipe Matheus Sant’Anna [3], GUERRA, Danilo Ribeiro [4], MENDONÇA, Deise Maria Furtado de [5], FEITOSA, Vera Lúcia Correa [6], REIS, Francisco Prado [7], ARAGÃO, José Aderval [8]
RODRIGUES, Silvia Maria da Silva Sant’ana et al. Correlation between quality of life and depression during the work of nurses in public hospitals in the State of Sergipe. Revista Científica Multidisciplinar Núcleo do Conhecimento. Year 09, Ed. 01, Vol. 03, pp. 45-56. January 2024. ISSN: 2448-0959, Acess link: https://www.nucleodoconhecimento.com.br/health/nurses-in-public-hospitals, DOI: 10.32749/nucleodoconhecimento.com.br/health/nurses-in-public-hospitals
ABSTRACT
Depression can influence the Quality of Work Life (QWL) of nurses and the quality of care provided, in view of this, it is salutary to understand the situation of depression, the quality of work life of nurses. Objective: To verify the correlation between quality of work life and depressive symptoms, during the activities carried out by nurses in public hospitals in the State of Sergipe. Methods: A questionnaire was prepared by the researchers to obtain the sociodemographic characteristics of the nurses, as well as the Hospital Anxiety and Depression Scale (HADS) and the Quality of Work Life Assessment Instrument (QWL) were applied to a sample of 221 nurses. Results: Among those surveyed, 32.1% had symptoms of mild to moderate depression. The mean QWL was 8.70. The mean scores for the QWL dimensions were 8.92 for institutional appreciation and recognition, 6.14 for working conditions, safety and remuneration, 11.75 for identity and professional image, and 10.66 for integration with the team. A negative correlation was also observed between depression and global QWL and in its dimensions, through Spearman’s linear correlation test. Conclusion: Depression symptoms negatively interfere with nurses’ quality of work life in general and in all dimensions.
Keywords: Depression, Nurses, Quality of work life.
1. INTRODUCTION
Nursing is one of the vital work components of the health system, and for this reason, it constitutes, due to the characteristics inherent to its professional performance, one of the most demanded categories, physically and emotionally, making it, in this way, more conducive to the development of depression1.
For the existence of quality of work life and quality of services provided by nursing, it is important that the mental health of these professionals is not compromised2,3. Rios, Barbosa and Belasco4 stated that the higher the depression scores, the lower the quality of life indices.
The assessment of the Quality of Work Life (QWL) of nurses, as well as the causes that lead to the emotional exhaustion of these workers, can lead to the elaboration of actions and practices that lead to the improvement of their health situation and working conditions5. Zavala Klijin6, reported that knowing the QWL indices and the intervening factors, it will be possible to integrate the needs of the professional and the objectives of the health institutions, adapting them, so that there is no burden for any of the parties.
In this way, the quality of work life is essential in any work area, to attract and maintain an integrated team, as well as to reduce turnover, since it is perceived that QWL affects the worker in his social, executive, managerial and cultural context, and consequently the organization of which he is a part of7.
The present study aimed to verify the correlation between quality of work life and depressive symptoms, during the activities carried out by nurses, in public hospitals in the State of Sergipe.
2. MATERIAL AND METHODS
This is a descriptive, correlational, cross-sectional study with a quantitative approach and approved by the Research Ethics Committee (REC) of the Federal University of Sergipe (UFS) in accordance with the guidelines of Resolution 466/2012 of the National Health Council/Ministry of Health, with ZIP code number – 875.559.
Nurses who were active in the institution, who worked in direct patient care, agreed to participate in the research voluntarily by signing the Free and Informed Consent Form were included and those nurses who were on vacation and away from work at the time of data collection were excluded. , those who reported a history of depression before entering the job market or were undergoing treatment for depression; held a management position or did not participate in direct patient care; or did not accept to participate in the research. The questionnaires were distributed at the end of each shift and collected on the following shift. There were five declared refusals, which were justified because the questions were considered quite personal, and, even though they were clarified and given guarantees of the confidentiality of the answers, they still maintained their refusals, in addition to these, 51 forms were not returned. It was also found that 16 of the total returned were incomplete to the point of being unfeasible to generate the scores necessary to obtain reliable results. Obtaining a total of 221 clinical nurses belonging to the four institutions that authorized data collection.
The study sample consisted of 221 nurses working in the morning, afternoon and night shifts who work in 4 public hospitals in the State of Sergipe. Data were collected from November 2015 to April 2016, through three self-administered questionnaires that addressed sociodemographic and professional data of nurses (age, gender, professional development, service time, number of employment relationships, shift, weekly workload, satisfaction with remuneration, length of service in the hospital area and in the institution where they work). The Hospital Anxiety and Depression Scale (HADS)8 was used, in its translated and validated version for Portuguese, by Botegal et al.,9. This scale has 14 items, of which seven are aimed at assessing anxiety (HADS-A) and seven for depression (HADS-D). Each of the items on the scale can be scored from zero to three, on a Likert-type scale, whose global score on each subscale ranges from 0 (zero) to 21 points, in which the higher the score, the greater the probability of developing a depression disorder. The score 8 is used as cutoff points for the interpretation and categorization of scores, where it is considered: 0-7 normal, 8-10 mild symptoms, 11-15 moderate symptoms and ≥ 16 severe symptoms of depression
The QWL Assessment was carried out using the instrument created and validated by Kimura, Carandina10, which consists of two parts, in which the first part evaluates the level of satisfaction and the second the level of importance, through 31 items, contained in each of the parts of the instrument, to which numerical values from 1 to 5 points are assigned, on a Likert-type scale, in which 1 corresponds to very dissatisfied and not at all important, and 5 corresponds to very satisfied and very important. By weighting the combined results (satisfaction x importance), the average QWL scores are obtained, globally and for the 4 dimensions that make up the quality of work life index (QWLI), which are: appreciation and institutional recognition; working conditions, security and remuneration; professional identity and image and integration with the team.
Data were analyzed descriptively and analytically. Numerical variables were observed for normality distribution using the Shapiro-Wilk test. In cases where the assumptions were met, the findings were presented using a mean ( ) and standard deviation, otherwise through median (Md) and its quartiles (1º-3º).
Categorical variables were presented using absolute and relative frequency. Correlation analyzes were performed using Spearman’s Linear Correlation test, where an r from 0 to 0.39 was considered weak, from 0.40 to 0.69 moderate and from 0.70 to 1.00 strong.
For unanswered items on the HADS scale, questionnaires with 1 or more unanswered items were excluded, as recommended by authors who claim that a single unanswered item interferes with the result found. Lost data were not accepted for the QWL instrument, since obtaining the final score and its domains were accounted for by crossing the responses of the two parts of the questionnaire (satisfaction x importance), and thus obtaining a reliable result.
3. RESULTS
320 questionnaires were distributed among a population of nurses from four public hospitals in the State of Sergipe. Of these nurses: five refused to answer; 16 questionnaires were incomplete; 51 were not returned; and 27 nurses carried out their activities in two of the researched hospitals. This resulted in a sample of 221 (69.06%) nurses, with an average age of 32 years (28-38), most of them female, with professional training of the lato sensu type, working the night shift, with more than 36 hours a week, having two or more employment relationships and being dissatisfied with the perceived remuneration (Table 1).
Table 1 – Sociodemographic characteristics of nurses working in four public hospitals in the State of Sergipe
| Variables | n (%) | Mean (sd*) | Variation |
| Sex | 26 (11.8) | ||
| Male | 195 (88.2) | ||
| Female | |||
| Age | 33.71±5.73 | 22-58 | |
| Professional development | |||
| Lato senso | 76 (34.4) | ||
| Stricto senso | 2 (0.9) | ||
| Graduation | 143 (64.7) | ||
| Work shift | |||
| Morning | 76 (34.4) | ||
| Afternoon | 60 (27.1) | ||
| Night | 85 (38.5) | ||
| Number of employment relationships | |||
| One | 99 (44.8) | ||
| Two or more | 122 (55.2) | ||
| Satisfaction with remuneration | |||
| Satisfied | 22 (9.9) | ||
| Unsatisfied | 199 (90.1) | ||
| Working hours (hours) | 37.33±4.74 | 20-60 | |
| Service time in the hospital area (years) | 7.93±4.8 | 0.08-35 | |
| Service time at the institution where you work (years) | 4.63±4.0 | 0.08-29 |
*sd = standard deviation
Source: Authors (2023).
It was found that among these nurses, 67.4% did not have symptoms of depression, while 32.6% showed symptoms of the disease. As for the degree of severity, of those who had signs of depression, after reclassification of points according to HADS, it was found that depression was mostly mild (Table 2).
Table 2 – Degree of severity of depression symptoms among nurses in four public hospitals in the State of Sergipe
| Degree of Severity | n (%) | Gap |
| Leve | 49 (22.5) | 8-10 |
| Moderada | 21 (9.6) | 11-15 |
| Severa | 1 (0.5) | ≥16 |
Source: Authors (2023).
Table 3 shows the values of the global QWL assessment scores and their dimensions. It can be observed that the lowest scores were found in the dimensions of appreciation and institutional recognition, working conditions, security and remuneration. The latter had the worst score.
Table 3 – QWL assessment scores and its dimensions in nurses
| QWL and its dimensions | Mean (dp*) | Variation |
|
Global QWL |
8.70±2.20 |
1.77-17.84 |
| Institutional Appreciation and Recognition | 8.92±2.63 | 0.5-18.00 |
| Working Conditions, Safety and Remuneration | 6.14±2.63 | 0-20 |
| Professional Identity and Image | 11.75±2.85 | 0-20 |
| Integration with the Team | 10.66±2.54 | 1.25-18.75 |
*sd = standard deviation
Source: Authors (2023).
The table 4 shows the correlation obtained through Spearman’s linear correlation test. It can be noted that there was a negative correlation between the depression score and the QWL dimensions.
Table 4. Correlation of depression measures with QWL and its dimensions among nurses in four public hospitals in the State of Sergipe
| QWL | D1 | D2 | D3 | D4 | |
| Depression | -0.341 | -0.355 | -0.219 | -0.277 | -0.364 |
Source: Authors (2023).
Spearman’s linear correlation test of the variables depression with quality of work life (QWL) and the dimensions: D1- Institutional appreciation and recognition, D2 – Working Conditions, security and remuneration, D3 – Identity and professional image, D4 – Integration with the team.
4. DISCUSSION
The working conditions of nursing professionals have been widely discussed for several years. According to Silva et al.11 and Miranda et al.12, excessive exposure to stress, work overload, unhealthy working conditions, absense of professional autonomy, requeriments from colleagues, intimate conflicts, insecurity in the elaboration of their tasks, institution requirements and wages incompatible with the demands exerted, has brought an increase in depression among these health professionals.
In our study, the frequency of depression symptoms among nurses was 32.6%. Similar findings were also found by Yoon, Kim13, Gong et al.14, who reported values of 37.7% and 38% respectively. Gao et al.15 and Li et al.16, found a frequency of 58.82% and 61.7%. To Schmidt, Dantas, Marziale17; Letvak, Ruhm, McCoy18; Haseli, Ghahramani, Nazari19; Eldevik et al.20; Mealer et al.21; Mejri et al.22; Ribeiro et al.23; Okechukwu et al.24 these depression frequencies ranged from 6.3% to 29.6%.
The assessment of global QWL, in the present study, had a score of 8.70. Kimura, Carandina10, using the same research instrument to assess QWL, found an average QWL score of 15.81. We believe that this difference in the mean scores may have occurred due to the fact that these authors carried out their work in private institutions. Bragard et al.25, reported that the QWL score obtained by the Quality of Work Life Systemic Inventory (QWLSI) among nurses and physicians working in rural areas was 19.6 on average. We assume that this finding differs from those found in this current study, either due to the type of instrument used in the evaluation and/or because it was applied in a work environment different from the environment experienced by our nurses.
In the present study, the dimensions: appreciation and institutional recognition; working conditions, safety and remuneration, the average scores of quality of life were 8.92 and 6.14 respectively, that is, much lower when compared to the studies by Kimura, Carandina10, which found scores of 15.2 and 14.2. However, in the image and professional identity domain, both authors reported the highest QWL averages. This conclusion leads us to assume that the nurses in the present investigation would be aware of the role they play in society and the importance and contribution of their work to the population. Lee et al.26 evaluating Chinese nurses with a QWL scale, similar to the one used in the present study, found low average scores for QWL in 3 out of 6 dimensions, of which two were related to working conditions, security and remuneration, and integration with the team. Dissatisfaction with important areas of work, the low prospect of improvement in these areas, which often do not depend only on the nurse to be achieved, such as recognition and appreciation of their actions, improvement in remuneration and the conditions in which they carry out their activities, seem to reflect dissatisfaction with QWL.
In the correlation between depression and QWL in nurses, a negative correlation was found. This finding was noticed when the correlation between depression and the dimensions of appreciation and institutional recognition was particularly analyzed; working conditions, safety and remuneration; integration with the team and professional identity and image. These findings were similar to those reported by Jho27; Rusli, Edimamsyah, Naing28; Rios, Barbosa, Belasco4 and Schmidt et al.29, when assessing depression and quality of life in nursing technicians and assistants, also found a negative correlation between depression and QWL, which allowed deducing that the lower the depression scores, the better the quality of life. Mohammadi et al.7, while studying nurses in an intensive care unit, found no correlation between depression and quality of life.
5. CONCLUSION
There is a negative correlation between symptoms of depression and quality of life at work for nurses in general and in all its dimensions. Symptoms of anxiety and depression contribute to a decrease in quality of life at work, as the presence of symptoms in nurses negatively reflects on their performance at work and perception of the aspects that involve it. Furthermore, we understand that some sociodemographic and professional characteristics, such as age, number of employment relationships, satisfaction with remuneration and work shift are factors that influence quality of life at work for better or worse. The results presented here are very relevant for the development of preventive measures, especially within the hospital environment, which is a stressful place full of factors that predispose to depression and anxiety. The recognition of the agents involved in QWL, associated with resources and actions appropriate to the needs of each hospital, can develop quality of life at work and reduce the emergence of illnesses or their worsening in workers. It is hoped that this study can contribute to the development of actions that prioritize measures to promote quality of life at work and prevent the emergence of depression symptoms.
REFERENCES
1. Perry L, Lamont S, Brunero S, Gallagher R, Duffield C. The mental health of nurses in acute teaching hospital settings: a cross-sectional survey. BMC Nurs. 2015 Mar 27;14:15.
2. Kawano Y. Association of job-related stress factors with psychological and somatic symptoms among Japanese hospital nurses: effect of departmental environment in acute care hospitals. J Occup Health. 2008;50(1):79-85.
3. Watanabe N, Furukawa TA, Horikoshi M, Katsuki F, Narisawa T, Kumachi M, Oe Y, Shinmei I, Noguchi H, Hamazaki K, Matsuoka Y. A mindfulness-based stress management program and treatment with omega-3 fatty acids to maintain a healthy mental state in hospital nurses (Happy Nurse Project): study protocol for a randomized controlled trial. Trials. 2015 Jan 31;16:36.
4. Rios KA, Barbosa DA, Belasco AG. Evaluation of quality of life and depression in nursing technicians and nursing assistants. Rev Lat Am Enfermagem. 2010 May-Jun;18(3):413-20.
5. Vitale E, Lupo R, Artioli G, Mea R, Lezzi P, Conte L, De Nunzio G. How shift work influences anxiety, depression, stress and insomnia conditions in Italian nurses: an exploratory study. Acta Biomed. 2023 Apr 24;94(2):e2023102.
6. Zavala MO, Klijn TM. Calidad de vida en el trabajo del equipo de enfermería. Rev Bras Enferm. 2014 Mar-Apr;67(2):302-5.
7. Mohammadi A, Sarhanggi F, Ebadi A, Daneshmandi M, Reiisifar A, Amiri F. Relationship between psychological problems and quality of work life of Intensive Care Units Nurses. IJCCN. 2011;4(3):135–40.
8. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361-70.
9. Botega NJ, Pondé MP, Medeiros P, Lima MG, Guerreiro CAM. Validação da escala hospitalar de ansiedade e depressão (HAD) em pacientes epiléticos ambulatoriais. J Bras Psiquiatr.1998;47(6):285–9.
10. Kimura M, Carandina DM. Desenvolvimento e validação de uma versão reduzida do instrumento para avaliação da qualidade de vida no trabalho de enfermeiros em hospitais. Rev Esc Enferm USP. 2009;43(spe):1044-1054.
11. Silva DSD, Tavares NVS, Alexandre ARG, Freitas DA, Brêda MZ, Albuquerque MCS, Neto VLM. Depressão e risco de suicídio entre profissionais de Enfermagem: revisão integrativa. Rev Esc Enferm USP. 2015;49(6):1027-36.
12. Miranda FMD, Santana LL, Pizzolato AC, Saquis LMM. Condições de trabalho e o impacto na saúde dos profissionais de enfermagem frente à Covid-19. Cogitare enferm. 2020;25:e72702.
13. Yoon SL, Kim JH. Job-related stress, emotional labor, and depressive symptoms among Korean nurses. J Nurs Scholarsh. 2013 Jun;45(2):169-76.
14. Gong Y, Han T, Yin X, Yang G, Zhuang R, Chen Y, Lu Z. Prevalence of depressive symptoms and work-related risk factors among nurses in public hospitals in southern China: a cross-sectional study. Sci Rep. 2014 Nov 27;4:7109.
15. Gao YQ, Pan BC, Sun W, Wu H, Wang JN, Wang L. Depressive symptoms among Chinese nurses: prevalence and the associated factors. J Adv Nurs. 2012 May;68(5):1166-75.
16. Li Y, Wang Y, Lv X, Li R, Guan X, Li L, Li J, Cao Y. Effects of Factors Related to Shift Work on Depression and Anxiety in Nurses. Front Public Health. 2022 Jul 11;10:926988.
17. Schmidt DR, Dantas RA, Marziale MH. Ansiedade e depressão entre profissionais de enfermagem que atuam em blocos cirúrgicos. Rev Esc Enferm USP. 2011 Apr;45(2):487-93.
18. Letvak SA, Ruhm CJ, Gupta SN. Nurses’ presenteeism and its effects on self-reported quality of care and costs. Am J Nurs. 2012 Feb;112(2):30-8; quiz 48, 39.
19. Haseli N, Ghahramani L, Nazari M. General Health Status and Its Related Factors in the Nurses Working in the Educational Hospitals of Shiraz University of Medical Sciences, Shiraz, Iran, 2011. Nurs Midwifery Stud.2013;2(1):146–51.
20. Eldevik MF, Flo E, Moen BE, Pallesen S, Bjorvatn B. Insomnia, excessive sleepiness, excessive fatigue, anxiety, depression and shift work disorder in nurses having less than 11 hours in-between shifts. PLoS One. 2013 Aug 15;8(8):e70882.
21. Mealer M, Jones J, Newman J, McFann KK, Rothbaum B, Moss M. The presence of resilience is associated with a healthier psychological profile in intensive care unit (ICU) nurses: results of a national survey. Int J Nurs Stud. 2012 Mar;49(3):292-9.
22. Mejri I, Youssfi I, Znegui T, Mechergui N, El Kefi H, Hammami R, Chenik S, Ben Mansour A, Ben Saad S, Moatemri Z. Mental health status of healthcare workers at a third line Tunisian hospital during COVID-19 pandemic. Tunis Med. 2022 Octobre;100(10):670-675.
23. Ribeiro CL, Maia ICVL, Pereira LP, Santos VF, Brasil RFG, Santos JS, Cunha MB, Vieira LJES. Ansiedade e depressão em profissionais de enfermagem de uma maternidade durante a pandemia de COVID-19. Esc Anna Nery. 2022;26(spe): e20220041.
24. Okechukwu CE, Colaprico C, Di Mario S, Oko-Oboh AG, Shaholli D, Manai MV, La Torre G. The Relationship between Working Night Shifts and Depression among Nurses: A Systematic Review and Meta-Analysis. Healthcare (Basel). 2023 Mar 24;11(7):937.
25. Bragard I, Fleet R, Etienne AM, Archambault P, Légaré F, Chauny JM, Lévesque JF, Ouimet M, Poitras J, Dupuis G. Quality of work life of rural emergency department nurses and physicians: a pilot study. BMC Res Notes. 2015 Apr 1;8:116.
26. Lee YW, Dai YT, Park CG, McCreary LL. Predicting quality of work life on nurses’ intention to leave. J Nurs Scholarsh. 2013 Jun;45(2):160-8.
27. Jho MY. Study on the correlation between depression and quality of life for Korean women. Nurs Health Sci. 2001 Sep;3(3):131-7.
28. Rusli BN, Edimansyah BA, Naing L. Working conditions, self-perceived stress, anxiety, depression and quality of life: a structural equation modelling approach. BMC Public Health. 2008 Feb 6;8:48.
29. Schmidt DR, Paladini M, Biato C, Pais JD, Oliveira AR. Qualidade de vida no trabalho e burnout em trabalhadores de enfermagem de Unidade de Terapia Intensiva. Rev Bras Enferm. 2013 Jan-Feb;66(1):13-7
NOTE
This article was translated by Iapunira Catarina under the responsibility of the author José Aderval Aragão.
[1] Doctoral student of the Postgraduate Program in Health Sciences at the Federal University of Sergipe. ORCID: https://orcid.org/0000-0003-2421-8701. Currículo Lattes: http://lattes.cnpq.br/4983328198656611.
[2] Medical Clinic Resident. ORCID: https://orcid.org/0000-0002-5298-537X. Currículo Lattes: http://lattes.cnpq.br/6291628187714859.
[3] Medical Clinic Resident. ORCID: https://orcid.org/0000-0001-9211-7000. Currículo Lattes: http://lattes.cnpq.br/4619345212343744.
[4] Adjunct Professor of Clinical Anatomy. ORCID: https://orcid.org/0000-0002-2146-3499. Currículo Lattes: http://lattes.cnpq.br/3543011108453552.
[5] Associate Professor of Anatomy. ORCID: https://orcid.org/0000-0001-9166-1995. Currículo Lattes: http://lattes.cnpq.br/7452033697540038.
[6] Titular Professor of Molecular Biology. ORCID: https://orcid.org/0000-0001-5705-6433. Currículo Lattes: http://lattes.cnpq.br/3337321488338686.
[7] Titular Professor of the Medical School. ORCID: https://orcid.org/0000-0002-7776-1831. Currículo Lattes: http://lattes.cnpq.br/6858508576490184.
[8] Advisor. Titular Professor of Clinical Anatomy. ORCID: https://orcid.org/0000-0002-2300-3330. Currículo Lattes: http://lattes.cnpq.br/6911783083973582.
Material received: November 22, 2023.
Peer-Approved Material: December 26, 2023.
Edited material approved by the authors: January 25, 2024.
