Nurses Experience Depression at Twice the Rate of General Public

Depression affects 9 percent of adults in the United States, with workplace stress playing a significant role and health care professionals ranking high for depressive episodes. The cost is staggering: an average of 4.8 sick days and 11.5 days of reduced productivity per depressed patient in a three-month period, adding up to tens of billions of dollars each year for absenteeism and lost productivity alone.

A recent study funded by the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI) looks at the nation’s largest group of health care professionals—nurses—to determine how musculoskeletal pain and depression impact productivity and quality of patient care. The study results were published in the February issue of the American Journal of Nursing. The researchers found that nurses experience depressive symptoms at a rate twice as high—18 percent—as the general public. The researchers specifically addressed the depression in nurses and focused on treatment options in their most recent publication, “Depression in Hospital-Employed Nurses,” in the May/June issue of the journal Clinical Nurse Specialist.

Depressed workers often exhibit low mood, have difficulty concentrating and are accident-prone; additionally, they have limited ability to perform mental or interpersonal tasks, struggle with time management and have lower total output than nondepressed workers. Hospital nurses with depression, therefore, are not only likely to suffer individually, their illness is likely to have an adverse impact on their coworkers and, potentially, the quality of patient care.

The research team behind the study consists of Susan Letvak, PhD, RN, associate professor of nursing, the University of North Carolina at Greensboro, School of Nursing; Christopher J. Ruhm, PhD, professor of public policy and economics, the University of Virginia, Department of Economics; Thomas McCoy, MS, and Sat Gupta, PhD, statisticians at the University of North Carolina at Greensboro.

The researchers analyzed surveys from 1,171 hospital nurses in North Carolina to determine the prevalence of depression and to determine individual and workplace characteristics that are associated with the illness. They also concluded that advanced practice nurses are uniquely positioned to recognize depression in staff nurses and offer them confidential and accessible treatment options.

Depression was measured by the PHQ-9, a nine-item self-reporting tool developed for use in primary care. Among individual variables, several emerged as having a significant relationship to a higher total depression score: body mass index (BMI), job satisfaction, number of health problems, mental well-being and health-related job productivity.

“As the country increases its focus on quality and error-free health care, we need to remember how much that depends on a healthy workforce,” said Letvak. “Depressive symptoms affect enough nurses to warrant concern and intervention, and high-stress environments are likely to contribute to more health problems for nurses, including mental health issues, which are less likely to be disclosed that physical problems.”

It is imperative to devote more attention to depression screening and early treatment, the research team points out. Advanced practice nurses can educate the staff nurses they work with about the high prevalence of depression in nurses, who, like the general population, may be reluctant to get screening and treatment, due to the social stigma attached to mental illness.

The researchers identify Web-based screening as a confidential and cost-effective means of reaching the nursing population, and they recommend that clinical nurse specialists inform nurses about options for computerized cognitive-based therapy (CCBT), which removes treatment barriers such as stigma, time constraints and cost. Other strategies for assisting nurses with depression include increasing staff nurses and managers’ awareness of and sensitivity to depression, advocating policies that support good mental health and treatment for those with problems, promoting supportive work environments and making reasonable accommodations for nurses whose depression is negatively affecting their work performance.