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World J Psychiatry. Oct 19, 2026; 16(10): 122230
Published online Oct 19, 2026. doi: 10.5498/wjp.122230
Published online Oct 19, 2026. doi: 10.5498/wjp.122230
Association between job burnout and depressive symptoms in rural primary healthcare workers: The indirect role of sleep quality
Lian Nan, Muhammad Sanan, Xiao-Feng Zhao, Lei Yang, Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
Ye Wang, Department of Psychiatry, Shenyang Mental Health Center, Shenyang 110000, Liaoning Province, China
Nicha Wareesawetsuwan, Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02108, United States
Wen-Li Zhu, Department of Psychiatry, The Fourth People’s Hospital of Wuhu, Wuhu 241002, Anhui Province, China
Co-corresponding authors: Lei Yang and Wen-Li Zhu.
Author contributions: Nan L contributed to conceptualization, study design, project coordination, data interpretation, supervision, and drafting of the original manuscript; Wang Y contributed to data collection, data curation, preliminary analysis, and manuscript revision; Wareesawetsuwan N contributed to manuscript review, editing, and critical revision for important intellectual content; Sanan M contributed to data analysis, data interpretation, and manuscript revision; Zhao XF contributed to data acquisition, investigation, and data verification; Yang L contributed to data acquisition, statistical support, and data interpretation; Zhu WL contributed to study supervision, project administration, data interpretation, and critical revision of the manuscript. All authors read and approved the final manuscript. Yang L and Zhu WL were designated as co-corresponding authors because they made complementary and substantial contributions to the study and share responsibility for its integrity and communication. Yang L contributed significantly to data acquisition, statistical support, interpretation of the results, and coordination of issues related to the dataset and analytical methods. Zhu WL provided overall study supervision, project administration, interpretation of the findings, and critical revision of the manuscript for important intellectual content. Their respective expertise enables them to respond appropriately to questions concerning both the methodological and administrative aspects of the study. In addition, they represent the principal institutions involved in conducting and supervising the research. Both authors approved the final version of the manuscript and agreed to share responsibility for correspondence with the journal, responses to reviewers, provision of study materials, and any questions arising after publication. Therefore, co-corresponding authorship accurately reflects their shared leadership, accountability, and continuing responsibility for this work.
AI contribution statement: During the preparation of this manuscript, artificial intelligence assisted tool (Chatgpt) was used only for language polishing and grammar improvement. The authors reviewed, edited, and approved all AI assisted content and take full responsibility for the accuracy, integrity, and originality of the manuscript.
Supported by Anhui Province Clinical Medical Research Transformation Special Project, No. 2022-04295107020065, No. 2022-04295107020006, and No. 2022-04295107020028; and Henan Province Science and Technology Research and Development Program, No. 242102311050.
Institutional review board statement: This study was approved by the Institutional Review Board of the Ethical Committee of the Fourth People's Hospital of Wuhu, No.[2023]-KY-18.
Informed consent statement: The requirement for written informed consent was waived by the Institutional Review Board of the Ethical Committee of the Fourth People's Hospital of Wuhu because this was an anonymous questionnaire based observational study involving minimal risk. Participation was voluntary, and completion of the questionnaire was considered implied informed consent.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.
Corresponding author: Lei Yang, MD, PhD, Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou 450000, Henan Province, China. 355280249@qq.com
Received: April 16, 2026
Revised: May 28, 2026
Accepted: August 25, 2026
Published online: October 19, 2026
Processing time: 180 Days and 7.2 Hours
Revised: May 28, 2026
Accepted: August 25, 2026
Published online: October 19, 2026
Processing time: 180 Days and 7.2 Hours
Core Tip
Core Tip: This cross-sectional study among rural primary healthcare workers demonstrates that sleep quality partially mediates the relationship between job burnout and depressive symptoms, accounting for 25.6% of the total effect. These findings highlight sleep disturbance as a modifiable pathway linking occupational stress to depression. Targeting sleep quality may offer a practical and scalable strategy to reduce depressive symptoms and improve workforce retention in resource-limited primary care settings.