Gu XQ, Zhong NN, Zhang KX, Cheng Z, Xiang Y, Ding XM, Yang JY, Zhang YY, Zhang D. Depression and anxiety symptoms among operating room nurses: Prevalence and correlations with occupational environmental factors. World J Psychiatry 2026; 16(11): 122321 [DOI: 10.5498/wjp.122321]
Corresponding Author of This Article
Yi-Yun Zhang, MD, Doctor, Department of Surgery, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China. evianzhang0128@126.com
Research Domain of This Article
Psychiatry
Article-Type of This Article
research-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Xi-Qian Gu, Ni-Na Zhong, Kun-Xian Zhang, Zhi Cheng, Yang Xiang, Jing-Ying Yang, Yi-Yun Zhang, Di Zhang, Department of Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
Xiao-Min Ding, Department of Neuropsychology, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
Co-corresponding authors: Yi-Yun Zhang and Di Zhang.
Author contributions: Gu XQ and Zhong NN contributed to conceptualization, data curation, formal analysis, investigation, methodology, writing original draft; Zhang KX, Cheng Z, Xiang Y, Ding XM and Yang JY contributed to data curation, investigation, validation; Zhang YY and Zhang D contributed to conceptualization, project administration, resources, supervision, writing review and editing; Gu XQ and Zhong NN are co-first authors; Zhang YY and Zhang D are co-corresponding authors.
AI contribution statement: This article is independently written by the author without any assistance from artificial intelligence tools throughout the process.
Institutional review board statement: The study was reviewed and approved by Institutional Review Board of Zhongnan Hospital of Wuhan University (No. 2026100K).
Informed consent statement: All study participants provided written informed consent before study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: Owing to ethical constraints involving human participants, raw data cannot be shared publicly. De-identified datasets are available from the corresponding author (evianzhang0128@126.com) on request.
Corresponding author: Yi-Yun Zhang, MD, Doctor, Department of Surgery, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China. evianzhang0128@126.com
Received: May 15, 2026 Revised: June 23, 2026 Accepted: July 17, 2026 Published online: November 19, 2026 Processing time: 166 Days and 22.8 Hours
Abstract
BACKGROUND
Operating room nurses, working in a persistently high-pressure and demanding work environment, are at high risk of psychological distress. Their mental health status not only affects personal well-being but is also closely related to patient safety and medical quality.
AIM
To study depression and anxiety symptoms in operating room nurses and explored their association with multidimensional occupational environmental factors.
METHODS
This cross-sectional survey recruited operating room nurses between October 2024 and October 2025. Participants completed general information questionnaires and standardized scales to collect data on demographics, occupational characteristics, anxiety and depression symptoms, and work environments. Pearson correlation and linear regression analyses were used to explore the relationship between depression, anxiety symptoms, and occupational environmental factors.
RESULTS
We surveyed 151 nurses. The prevalence of anxiety symptoms was 56.95% (76.75% mild, 18.60% moderate, 4.65% severe). The prevalence of depressive symptoms was 62.91% (56.84% mild, 34.74% moderate, 8.42% severe). Anxiety and depression varied significantly according to demographic and occupational factors. Higher rates were found among nurses aged 26-36 years, those with 6-10 years of operating room tenure, Nurse-in-Charge, and scrub nurses. Depression scores and prevalence were significantly higher among female nurses (all P < 0.05). Correlation analysis indicated significant negative associations between occupational environment and both anxiety and depressive symptoms (P < 0.05). Occupational environmental factors independently explained an additional 28.6% of the variance in anxiety symptoms and 7.6% of the variance in depression symptoms.
CONCLUSION
Operating room nurses showed high rates of anxiety and depression, which were negatively correlated with the occupational environment. Therefore, targeted mental-health interventions are required in this population.
Core Tip: We surveyed 151 operating room nurses. The prevalences of anxiety and depressive symptoms were 56.95% and 62.91%, respectively, with most cases being mild-to-moderate. Symptoms were more common among nurses aged 26-36 years, those with 6-10 years of experience, Nurse-in-Charge, and scrub nurses. Female nurses had significantly higher levels of depression than male nurses. The occupational environment was negatively correlated with anxiety and depression and was an independent influencing factor. Therefore, targeted mental-health interventions should be implemented.
Citation: Gu XQ, Zhong NN, Zhang KX, Cheng Z, Xiang Y, Ding XM, Yang JY, Zhang YY, Zhang D. Depression and anxiety symptoms among operating room nurses: Prevalence and correlations with occupational environmental factors. World J Psychiatry 2026; 16(11): 122321
The operating room is a critical environment in the diagnosis and treatment of acute and critical illnesses in hospitals and is characterized by complex medical tasks, precise operational techniques, and an intense work pace[1]. As important assistants to physicians and guardians of patient safety, operating room nurses endure considerably greater psychological pressure than staff members in general medical and nursing positions. Multiple surveys have indicated that operating room nurses work under conditions of prolonged high pressure and intense workloads and experience significantly higher levels of psychological stress and mental exhaustion than nurses in other departments[2,3]. Studies have indicated that frontline clinical nurses are a high-risk group for mental health problems such as depression and anxiety, with the incidence of depression in clinical nurses accounting for approximately 40% of the total incidence in medical staff[4]. Moreover, the proportion of operating room nurses experiencing mental health issues or negative emotions was found to be nearly 30% higher than in nurses in other departments[4,5]. These mental health problems not only affect nurses’ physical and mental health and quality of life but may also reduce nursing quality by affecting their work performance, thereby affecting patient safety and medical outcomes[6,7]. Thus, attending to the mental health problems and support needs of operating room nurses is of great importance. However, most existing studies have focused on nurses in general wards or medical staff groups as a whole, and in-depth research on the mental health status and influencing mechanisms in this group of nurses remains relatively scarce.
Research indicates that an individual’s psychological state does not exist in isolation but is profoundly influenced by their organizational environment[8]. The occupational environment is defined as a composite of organizational, supportive, and cultural working conditions that influence practices. It has been established as a key variable predicting nurses’ job satisfaction, retention intentions, and burnout[9,10]. Given that the operating room is a unique practice setting within nursing, its workflow is highly dependent on multidisciplinary teamwork. However, such collaborations present with numerous challenges during practical operations. For instance, insufficient knowledge sharing and inconsistent perceptions of collaboration and communication tend to exist in operating room teams[11]. In a team structure, operating room nurses may face hierarchical divisions in terms of roles and knowledge levels[12]; existing studies have confirmed that such hierarchical divisions may exert a negative effect on operating room nurses’ teamwork experience[13,14]. However, most existing studies on the mental health or negative emotions of operating room nurses have not systematically incorporated the perspective of the occupational environment[15,16]. Given the distinct contextual particularities of the occupational environment in the operating room, research on the correlation between this environment and nurses’ mental health has significant academic and practical value. Therefore, by systematically investigating the status of depressive and anxiety symptoms among operating room nurses, this study systematically analyzed the association between these symptoms and multidimensional nursing occupational environmental factors to identify the key environmental factors associated with mental health.
MATERIALS AND METHODS
Study participants
A cross-sectional survey was conducted among operating room nurses at the Zhongnan Hospital of Wuhan University from October 2024 to October 2025. This study used convenience sampling and conducted both online questionnaires and offline field investigations. The study was reviewed and approved by Institutional Review Board of Zhongnan Hospital of Wuhan University (No. 2026100K).
Inclusion and exclusion criteria
The inclusion criteria were: (1) Nurses who had obtained a nurse practicing certificate and were within the valid registration period; (2) Nurses who had worked in the operating room for 1 year or more; and (3) Nurses who provided informed consent and voluntarily participated in this survey. The exclusion criteria were: (1) Student nurses; (2) Nurses with advanced training, rotation, or standardized residency training; (3) Nurses who were absent from work during the survey period; and (4) Nurses who experienced major negative life events (e.g., bereavement of relatives, severe illness, or family changes) within 1 month prior to the survey.
The sample size was determined based on the rough estimation method for exploratory research proposed by Kendall, which stipulates that the sample size should be 5-10 times the number of research variables[17]. Fifteen variables were included in this study; a 10% rate of invalid questionnaires (due to incorrect or missing responses) was assumed, and the estimated final sample size ranged from 84 to 167.
Survey tools
We employed a general information questionnaire, the Self-Rating Anxiety Scale (SAS), the Self-Rating Depression Scale (SDS), and the Chinese version of the Practice Environment Scale of the Nursing Work Index (PES-NWI) to assess operating room nurses’ demographic and occupational profiles as well as their levels of anxiety and depression and the nursing occupational environment.
The general information questionnaire was designed by the research team and included items regarding nurses’ sex, age, marital status, educational background, professional title, operating room tenure, job position, and number of children. Based on the career development stage theory and relevant literature[18,19], the nurses’ age was classified into four categories: < 26 years, 26-36 years, 37-46 years, and > 46 years. The operating room tenure was categorized into five groups: 1-5 years, 6-10 years, 11-15 years, 16-20 years, and ≥ 21 years.
The SAS was compiled by Lindsay and Michie[20] in 1971, covering two aspects of psychological feelings and physical symptoms, with a total of 20 items, including 15 positive scoring items and 5 reverse scoring items. A 4-point Likert scale is used, ranging from 1 (no or little time) to 4 (most or all of the time). The scores all 20 items are added to obtain a rough score, which is then multiplied by 1.25 to convert into a standard score. In the Chinese version, a score ≥ 50 points indicates the presence of anxiety symptoms, with scores of 50-59 points indicating mild symptoms, 60-69 moderate symptoms, and ≥ 70 severe symptoms. The Cronbach’s α coefficient of the scale in this study was 0.779, and the reliability and validity were good.
The SDS scale was compiled by Zung[21] in 1965, with a total of 20 items rated on a 4-point Likert scale (1, no or little time; 4, most or all of the time). The scores of the 20 items are added to obtain a rough score, which is then multiplied by 1.25 to obtain a standard score. For the Chinese version[22], a standard score ≥ 53 is considered indicative of depressive symptoms, with 53-62 indicating mild symptoms, 63-72 moderate symptoms, and > 72 severe symptoms. In this study, the Cronbach’s α coefficient of the scale was 0.733, and the reliability was good.
The original PES-NWI was developed by Lake based on the “Magnet Hospital” model[23] and later translated and adapted into the Chinese version[24]. The five supporting dimensions and their items are: Nurse participation in hospital affairs (nine items), nursing administrators’ competence and leadership and support of nurses (five items), foundations for quality of care (10 items), staffing and resource adequacy (four items), and collegial nurse–physician relations (three items). All items are rated on a 4-point Likert scale (1, strongly disagree; 4, strongly agree). The score of each dimension is obtained by taking the average of the corresponding item scores, with higher scores indicating that nurses perceive the practice environment in that dimension to be more favorable. The range for total scores is 31-124, with higher total scores indicating that nurses feel positively about the overall practice environment. The Cronbach’s α coefficient of the scale in this study was 0.93.
Survey methods and quality control
With approval from the hospital ethics committee, the researchers contacted operating room supervisors to inform them of the research objectives, significance, and participant inclusion criteria. Data were collected via online and offline questionnaires. Online questionnaires were distributed to participants via WeChat using the Questionnaire Star platform. Prior to completion, standardized instructions were provided. The first page of the questionnaire was the informed consent form to ensure participants understood the procedures and took part voluntarily, and all personal information was kept anonymous. The platform was configured to make the completion of all items mandatory. To ensure complete and non-redundant data, each WeChat account was allowed to submit only one response. Questionnaires with a completion time of less than 1 minute, inconsistent personal information, or logically inconsistent answers were excluded. Offline paper questionnaires were distributed at a pre-arranged time and venue. Before distribution, trained researchers explained the principles of anonymity, confidentiality, and voluntary participation. We collected the questionnaires and checked for missing items and invalid responses, such as identical answers or patterned replies, and discarded all invalid questionnaires. Finally, two researchers entered and cross-checked the collected data.
In total, 155 questionnaires were distributed and recovered within the prescribed time. After verification, four invalid questionnaires with patterned answers (e.g., all identical answers or a zigzag pattern) were excluded. The remaining questionnaires had no missing items, yielding 151 valid responses with an effective response rate of 97.45%.
Statistical analysis
Data collation and analysis were performed using SPSS 26.0 (IBM Corp., Armonk, NY, United States) and R 4.2.3. Measurement data are presented as mean ± SD, and comparisons between groups were conducted using the Student’s t-test or one-way analysis of variance. Count data are presented as frequencies and constituent ratios. The χ2 test was used for intergroup comparisons of count data. Pearson’s correlation analysis was used to explore the correlations between anxiety, depression, and occupational environmental factors. Linear regression analysis was used to assess the independent explanatory power of occupational environmental factors on anxiety and depressive symptoms. P values < 0.05 were considered to indicate statistical significance.
RESULTS
Depression and anxiety symptoms among operating room nurses
The mean total anxiety score of the 151 included operating room nurses was 49.20 ± 10.74, indicating a mild anxiety level; 86 nurses (56.95%) exhibited anxiety symptoms. Among nurses with anxiety symptoms, mild anxiety was predominant, accounting for 76.75% of cases (66/86), and moderate and severe anxiety accounted for 18.60% (16/86) and 4.65% (4/86) of cases, respectively.
The mean total depression score was 54.93 ± 11.23, corresponding to a mild depression level, with 95 nurses (62.9%) indicating depressive symptoms. Among these nurses, 56.84 % (54/95) reported mild depression, and the proportions of those with moderate and severe depression were 34.74% (33/95) and 8.42% (8/95), respectively. See Figure 1 for details regarding symptom distributions.
Figure 1 Distribution of anxiety and depression symptoms among operating room nurses.
A: Distribution of anxiety symptoms; B: Distribution of depression symptoms.
Anxiety and depression symptoms according to participant characteristics
Statistically significant differences were observed in anxiety scores and the composition of symptom severity grades among operating room nurses with different ages, professional titles, operating room tenures, and job positions (P < 0.05). Among these groups, nurses aged 26-36 years, those with 6-10 years of operating room tenure, those holding the title of Nurse-in-Charge, and those working as scrub nurses had the highest anxiety scores and the largest proportion of individuals with anxiety symptoms (P < 0.05).
Regarding depression, statistically significant differences were also found in depression scores and the composition of symptom severity grades among operating room nurses stratified by sex, age, professional title, operating room tenure, and job position (P < 0.05). Specifically, female nurses aged 26-36 years, those with 6-10 years of operating room tenure, those holding the title of Nurse-in-Charge, and those working as scrub nurses presented the highest depression scores and the largest proportion of individuals with depressive symptoms (P < 0.05). Further details are provided in Tables 1 and 2.
Table 1 Anxiety and depression scores among operating room nurses with different characteristics, mean ± SD.
Occupational environment of operating room nurses and correlations with depression and anxiety
The mean total PES-NWI score was 94.21 ± 7.58, with an average item score of 3.04 ± 0.24. Among all dimensions, the nursing administrators’ competence and leadership and support of nurses dimension had the highest average item score (3.33 ± 0.47), while the nurse participation in hospital affairs dimension had the lowest (2.63 ± 0.55). Further details are presented in Table 3.
Table 3 Occupational environment scores of operating room nurses, mean ± SD.
Correlation analysis showed that anxiety scores were significantly negatively correlated with total PES-NWI scores and those of four sub-dimensions (nurse participation in hospital affairs, foundations for quality of care, staffing and resource adequacy, and collegial nurse-physician relations) (P < 0.05). Depression scores were also significantly negatively correlated with total PES-NWI scores and three subdimensions (nurse participation in hospital affairs, foundations for quality of care, and staffing and resource adequacy) (P < 0.05), as shown in Figure 2.
Figure 2 Correlation analysis of depression, anxiety, and occupational environment.1Indicates a significant correlation at the 0.05 level (two-tailed). 2Indicates a significant correlation at the 0.01 level (two-tailed). 3Indicates a significant correlation at the 0.001 level (two-tailed). PES-NWI: Practice Environment Scale of the Nursing Work Index; A1: Nurse participation in hospital affairs; A2: Nursing administrators’ competence and leadership; A3: Foundations for quality of care; A4: Staffing and resource adequacy; A5: Collegial nurse-physician relations.
Linear regression analysis of anxiety and depression symptoms
Hierarchical multiple linear regression was employed, with the standard scores of anxiety (SAS) and depression (SDS) as dependent variables, to examine the independent explanatory power of the occupational environment (PES-NWI scores). Variables with statistical significance in the analysis of demographic and occupational characteristics were included in the first layer, and the PES-NWI scores were entered into the second layer. The results showed that, after controlling for demographic variables, PES-NWI scores were significantly and independently negatively associated with both anxiety and depression scores (all P < 0.001).
For anxiety scores, the first-layer variables (age, operating room tenure, professional title, and job position) jointly explained 25.5% of the total variance (adjusted R2 = 0.255). After the inclusion of the PES-NWI scores, the overall explanatory power of the model increased significantly to 54.1% (adjusted R2 = 0.541) with a ΔR2 of 0.286 (P < 0.001). This indicated that occupational environmental factors independently explained 28.6% of the variance in anxiety symptoms among operating room nurses. Five occupational environmental factors nurse participation in hospital affairs, foundations for quality of care, and staffing and resource adequacy were all independently associated with anxiety. See Table 4 and Figure 3A for details.
Figure 3 Linear regression analysis of anxiety and depression in operating room nurses.
A: Results of linear regression analysis for anxiety; B: Results of linear regression analysis for depression. 1Indicates a significant correlation at the 0.05 level (two-tailed). 2Indicates a significant correlation at the 0.01 level (two-tailed). 3Indicates a significant correlation at the 0.001 level (two-tailed). PES-NWI: Practice Environment Scale of the Nursing Work Index; A1: Nurse participation in hospital affairs; A2: Nursing administrators’ competence and leadership; A3: Foundations for quality of care; A4: Staffing and resource adequacy; A5: Collegial nurse-physician relations.
Table 4 Hierarchical multiple linear regression analysis of anxiety in operating room nurses.
For depression scores, the first-layer variables (gender, age, operating-room tenure, professional title, and job position) jointly explained 17.4% of the total variance (adjusted R2 = 0.174). After the inclusion of PES-NWI scores, the overall explanatory power of the model increased significantly to 25.0% (adjusted R2 = 0.250), with a ΔR2 of 0.076 (P < 0.001). This indicated that occupational environmental factors independently explained an additional 7.6% of the variance in depressive symptoms among operating room nurses. Among them, nurse participation in hospital affairs, foundations for the quality of care, and staffing and resource adequacy were all independently associated with depressive symptoms. See Table 5 and Figure 3B for more information.
Table 5 Stratified multivariate linear regression analysis of depression among operating room nurses.
In recent years, with the rapid development of surgical techniques and quality control standards, the complexity, workload, and emergency requirements of operating room nursing have all risen considerably; as a result, physical and mental stress have also increased. This study found a high proportion of anxiety and depressive symptoms among operating room nurses, at 56.95% and 62.91%, respectively, both exceeding levels reported in most studies in general-ward nurses[25,26]. Thus, the specific conditions of work in the operating room are likely to cause high mental stress for nurses. Among the nurses with symptoms, both anxiety and depression were relatively mild (76.75% and 56.84%, respectively), which is in line with the findings of Aktas et al[27], Gül and Kılıç[28] showing that most operating room nurses experience mild psychological symptoms.
The prevalence of anxiety and depression symptoms among operating room nurses was affected by age, operating room tenure, and professional titles and positions. Participants with a higher prevalence of symptoms were mainly 26-36 years old, had 6-10 years of operating room tenure, held the title of Nurse-in-Charge, and worked as a scrub nurse. Studies have demonstrated that the type and nature of work in occupational populations directly affect psychological load. Long-term work under high workload and high responsibility can exacerbate stress and substantially increase the risk of anxiety and depressive symptoms[29]. Operating room nurses aged 26-36 years are in a critical stage of family and career development. They endure intense occupational stress with high risk, high standards, and heavy workloads in the operating room. At the same time, they must also manage social and familial responsibilities and balance career development demands, including professional advancement and skill development. Distraction and sustained strain from multiple roles are associated with elevated risks of anxiety and depressive symptoms[30,31]. Operating room nurses with 6-10 years of operating room tenure are often in stages with high rates of job burnout[32]. During this phase, nurses clinical competence matures and experience and increasing load of medical, teaching, and management responsibilities; yet their professional cognition and capacity to handle complex clinical scenarios still have room for improvement[32]. At the same time, nurses in this career stage often have social and familial responsibilities. Under the combined action of a high standard of work requirements, family affairs, and limited psychological resources, this group is more prone to emotional exhaustion, and anxiety and depression symptoms are relatively common[33-35].
Scrub nurses directly participate in core surgery tasks and must strictly abide by principles of sterility and accurate cooperation with surgeons. The nature of their work determines that they often face persistent, immediate high pressure and high mental tension. The frequent overtime work and disrupted routines caused by the uncertainty of operation times can further aggravate the physical and mental burden. The long-term accumulation of physical and mental exhaustion makes this a high-risk group for psychological symptoms. The roles of nurse-in-charge (intermediate-level nurses) have partially shifted from mere technical execution to dimensions such as clinical guidance, quality supervision, and team coordination[36]. The generalization of responsibilities and role overload expose them to more complex and diverse occupational stressors[37]. However, such role transition and associated occupational stress patterns may not be consistent across all societies, given the distinct nursing management models and cultural norms in different regions. In addition, female nurses have higher levels of depression, which may be related to factors such as gender role stress and differences in emotional expression[38].
In the present study, nurses who were older, had longer operating room tenure, held higher professional titles, and had administrative/managerial responsibilities showed the lowest SAS and SDS scores and the lowest prevalence of anxiety and depressive symptoms. These nurses often have rich clinical experience, strong psychological resilience, and high professional identity and can better cope with work pressure[39,40]. In addition, higher salaries, as a metric for social support, can provide better psychological backing for nurses[41], enabling them to maintain a positive views of their work environment and actively mobilize resources to address any negative emotions.
The occupational environment refers to all circumstances that directly or indirectly affect a work system, such as the surroundings, staff, and on-site supplies. Lucas et al[42] showed that a good occupational environment is associated with higher job satisfaction and work engagement among nurses. According to triadic reciprocal determinism theory, an individual’s environment and psychological state interact and determine one another, and the environment can greatly affect emotions[43]. Consistent with the above findings, this study found that the anxiety and depression scores of operating room nurses were significantly negatively correlated with the total PES-NWI scores; that is, better perception of the occupational environment among operating room nurses was associated with lower anxiety and depression levels. The occupational environmental features of operating room nurses (e.g., high-intensity workload, complex multidisciplinary collaboration) can be chronic external stressors, and extended exposure to such stress is a key contributor to many mental health problems[44]. Previous studies have found that both individual and occupational environmental factors can lead to burnout in nurses, and the latter have been found to have a relatively larger impact on emotional exhaustion and depersonalization[45]. Combined with the theoretical model of job burnout proposed by Maslach and Leiter[46], job burnout with emotional exhaustion at the core often serves as an intermediary path for chronic work stress to lead to emotional disorders[46]. This study speculates that a negative perceptions of the occupational environment among operating room nurses may correlate with emotional exhaustion and depersonalization, which are accompanied by anxiety and depression symptoms measurable via scales.
Further analysis showed that, after controlling for the effects of demographic and occupational characteristic variables on anxiety and depression, the occupational environment independently explained 28.6% and 7.6% of the variances in anxiety and depression symptoms, respectively, among operating room nurses, suggesting that the occupational environment is highly correlated with anxiety and depression in this group, but the strength of the association differs markedly, with greater explanatory power for anxiety symptoms than for depressive symptoms. This difference can be understood from the perspective of the distinct stress response mechanisms of anxiety and depression. Anxiety is described as a response to threatening experiences and tends to develop quickly in response to acute, immediate environmental stressors, such as the collaboration climate, resource shortages, and time pressure[47], and is therefore more susceptible to current occupational environment perceptions. Depression, in contrast, is described as a response to loss, and its formation requires the longer-term accumulation of negative events and solidification of cognitive patterns. A study by McGonagle and Kessler[48] confirmed that the relationship between depressive symptoms and chronic stress was significantly stronger than that with acute stress. Although operating room nurses are chronically exposed to a high-load acute stress environment, the occurrence of depression still requires cumulative conditions such as sustained depletion of physical and mental resources and insufficient recovery. Therefore, the association between the occupational environment and depression mostly arises through intermediary variables such as emotional exhaustion and job burnout. The direct correlation between the two is relatively limited.
Among the relevant occupational environmental factors, the three dimensions of nurse participation in hospital affairs, foundations for quality of care, and staffing and resource adequacy had low scores and were particularly strongly associated with anxiety and depressive symptoms. This indicates that operating room nurses lack a certain degree of autonomy in key matters affecting their work, have overall low satisfaction with staffing, material supplies, and equipment support required for surgical cooperation, and perceive weak support for the foundation of high-quality nursing services. These factors tend to be associated with higher rates of anxiety and depression symptoms. Wang et al[49] found that work empowerment negatively correlated with emotional exhaustion and significantly positively correlated with the achievement of personal values. When managers grant nurses more autonomy through empowerment, they can effectively enhance their sense of work control and self-efficacy, improve their occupational satisfaction, and reduce the accumulation of negative emotions[50]. Thus, nurse participation in hospital affairs may reflect work autonomy. Lower scores on this dimension are related to lower work control, self-efficacy, and job satisfaction, which are further associated with higher detection rates of anxiety and depression symptoms. For operating room nurses, the adequacy of human and material resources directly correlates with their daily workload. The characteristics of their work, such as frequent back-to-back surgeries and complex intraoperative demands for instruments and supplies, determine their reliance on resource availability. Insufficient resource allocation forces nurses to overload their work. While coping with the physical and mental exhaustion caused by excessive tasks, they are more likely to have professional frustration because they cannot provide ideal care and it is difficult to guarantee the quality of surgical cooperation. This persistent resource-demand imbalance is a factor associated with anxiety and depression[51]. The core of a high-quality nursing service foundation is to build an environment that supports professional practice. This includes not only the team culture and institutional support needed to ensure quality of care but also investments in nurses’ professional development, such as providing on-the-job education, learning resources, and career planning guidance[52].
Operating room nursing is demanding and carries many responsibilities, placing high standards on nurses’ professional competence. When operating room nurses lack adequate support for career development and promotion amid mounting work pressure, they tend to report lower professional identity and emotional exhaustion. Such conditions show a significant correlation with anxiety and depression[53]. Notably, the collegial nurse physician relations dimension was only significantly correlated with anxiety symptoms in operating room nurses. This reflects the characteristics of operating room work that rely heavily on immediate team collaboration. Issues such as communication barriers and collaborative disconnections in nurse physician relations are typical acute stressors. Based on the different stress mechanisms of anxiety and depression, these stressors show a significantly stronger correlation with anxiety symptoms than with depressive symptoms[47,48].
Based on the present findings, we put forward the following recommendations. First, regular psychological monitoring and support systems should be established, integrating anxiety and depression screening into routine occupational health management and focusing on high-risk groups, including operating room nurses aged 26-36 years, those with 6-10 years of operating room work experience, those holding the title of Nurse-in-Charge, and those working as scrub nurses. Second, nursing staff allocation should be reasonably increased and flexible scheduling and job rotation should be adopted to reduce physical and mental exhaustion caused by high workload and long-term fixed positions, thereby minimizing stressors. Third, management approaches should be shifted from unilateral directives to shared participation, creating channels for nurses to engage in decision-making regarding departmental policies, procedures, and quality improvement, thereby enhancing their clinical autonomy and problem-solving skills and improving their sense of control over the work environment and professional identity. Fourth, a harmonious and fair departmental climate should be fostered, improving multidisciplinary collaboration and communication mechanisms, and providing clear career advancement and training pathways, thereby reducing occupational burnout through multidimensional support and maintaining nurses’ long-term mental health.
This study had certain limitations. First, as a single-center cross-sectional survey, it had a limited sample size with insufficient representativeness; therefore, extrapolation of these conclusions should be treated with caution. Second, considering that the SAS and SDS are widely used in the nursing field in China with complete norm data, facilitating horizontal comparisons with previous similar studies, this study selected these two scales to assess anxiety and depression symptoms. However, the SAS and SDS are highly sensitive to somatic symptoms[54,55], and physiological fatigue commonly experienced by operating room nurses may have affected the accuracy of the assessment of their emotional symptoms[56]. Future research should consider the use of mental health screening tools with symptom items that are more focused on the core characteristics of emotions, such as the Patient Health Questionnaire Depression Symptom Cluster Scale and the Generalized Anxiety Disorder Scale; compared with SAS and SDS, the item design of these scales focuses more on cognitive and emotional dimensions and is less affected by somatic symptoms[57,58]. Third, owing to data limitations, this study did not incorporate workload indicators such as night shift frequency, weekly working hours, average monthly surgical volume, and emergency surgery involvement. The above factors are closely related to nurses’ anxiety and depression, which may have potential confounding effects. The higher anxiety and depression levels among scrub nurses may be attributed to their prolonged standing, sustained high concentration demands, and greater intraoperative responsibility pressure; however, data constraints prevented this study from validating this inference using workload measures. Fourth, we used convenience sampling, combining online WeChat-based questionnaires and offline centralized distribution of paper questionnaires. This method may introduce selection bias. In online surveys, nurses with high work pressure or time constraints may have lower response rates, resulting in the underestimation of mental health problems. At the same time, the difference in the response environment of the two survey models may also affect the consistency of the results.
CONCLUSION
Anxiety and depressive symptoms were prevalent among operating room nurses, with those aged 26-36 years, those with 6-10 years of working experience in the operating room, those holding the title of Nurse-in-Charge, and those working as scrub nurses identified as high-risk groups. Female nurses had a higher risk of depression than male nurses. Operating room nurses’ evaluations of the occupational environment were moderately positive, and occupational environmental factors were significantly correlated with anxiety and depressive symptoms. Among these factors, nurses’ participation in hospital affairs, foundations for quality of care, and staffing and resource adequacy were the core correlates of anxiety and depressive symptoms.
Aktas FO, Turhan Damar H, Ozkul B, Voight P, Guckian Fisher M, Elin M, Sharma SK, Bird S. Predictors of anxiety and depression in operating room nurses during the COVID-19 pandemic: A multi-center cross-sectional study.Work. 2024;78:279-293.
[RCA] [PubMed] [DOI] [Full Text][Cited by in RCA: 2][Reference Citation Analysis (1)]
Yu DSF, Chen F, Li AR, Wong CWY, Chen J, Zhan S, Chan SWC, Holroyd E, Chair SY, Sim CY, Wong WCW. The global landscape of the evolving nurses' roles and core competency in primary healthcare: An expanding umbrella review.Int J Nurs Stud. 2025;171:105177.
[RCA] [PubMed] [DOI] [Full Text][Cited by in RCA: 5][Reference Citation Analysis (0)]
