Transition shock and depression-anxiety-stress symptoms among nursing interns in China: the indirect roles of self-efficacy and burnout in a cross-sectional mediation and network analysis study
5 affiliations
- 1Department of Nursing, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- 2Academic Affairs Office, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- 3The Nursing Department, Shaanxi Provincial People’s Hospital, Xi'an City, Shaanxi Province, China
- 4Department of Oncology and Hematology, The Ninth People’ s Hospital of Chongqing, Chongqing, China
- 5Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
Abstract
BackgroundClinical internship is a high-risk period for psychological distress among nursing interns. Grounded in Conservation of Resources theory's resource loss spiral proposition, this study examined serial associational pathways via self-efficacy and burnout linking transition shock to depression-anxiety-stress symptoms and explored their symptom-level network structure.Methods663 mid internship nursing interns from western China completed the Transition-Shock Scale, the General Self-Efficacy Scale, the Maslach Burnout Inventory and the Depression Anxiety Stress Scale 21 (DASS-21). Pearson correlation and multiple linear regression examined factors associated with DASS-21 scores. A serial mediation model (5,000 bootstraps) estimated direct and indirect statistical associations along the theorized sequence. A Gaussian graphical model estimated the DASS-21 symptom network, including node and bridge expected influence.ResultsAll main variables intercorrelated significantly (all p < 0.01); transition shock, self-efficacy and burnout were independently associated with DASS-21 scores. The mediation model fit acceptably; the direct association accounted for 44.53% of the total effect and three indirect pathways for 55.47%. In the DASS-21 symptom network, S6 (I was intolerant of anything that kept me from getting on with what I was doing), A6 (I was aware of the action of my heart in the absence of physical exertion) and S4 (I found myself getting agitated) had the highest expected influence, while A6, S2 (I tended to over-react to situations) and D2 (I found it difficult to work up the initiative to do things) showed the highest bridge expected influence. Both centrality indices demonstrated adequate stability (CS-coefficients = 0.750 for expected influence and 0.673 for bridge expected influence, respectively).ConclusionAmong nursing interns in western China, higher transition shock was associated with more severe depression-anxiety-stress symptoms both directly and indirectly, along sequential associational pathways involving self-efficacy and burnout. Several structurally central symptoms (S6, A6 and S4) and bridge symptoms (A6, S2 and D2) were identified as potentially important nodes for further clinical investigation, rather than confirmed intervention targets. These findings generate hypotheses for targeted mental health support in clinical nursing education. Given the cross-sectional design, causal or temporal ordering cannot be established; findings should be interpreted within this population and setting.
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BibTeX
@article{zheng2026transition,
title = {{Transition shock and depression-anxiety-stress symptoms among nursing interns in China: the indirect roles of self-efficacy and burnout in a cross-sectional mediation and network analysis study}},
author = {Qiulan Zheng and Juan Li and Xingfeng Yu and Yuying Chen and Jie Liu},
journal = {Frontiers in Medicine},
year = {2026},
month = nov,
doi = {10.3389/fmed.2026.1982612},
url = {https://doi.org/10.3389/fmed.2026.1982612},
note = {CC BY},
}
RIS
TY - JOUR
TI - Transition shock and depression-anxiety-stress symptoms among nursing interns in China: the indirect roles of self-efficacy and burnout in a cross-sectional mediation and network analysis study
AU - Qiulan Zheng
AU - Juan Li
AU - Xingfeng Yu
AU - Yuying Chen
AU - Jie Liu
PY - 2026
DA - 2026/11/04
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1982612
UR - https://doi.org/10.3389/fmed.2026.1982612
AB - BackgroundClinical internship is a high-risk period for psychological distress among nursing interns. Grounded in Conservation of Resources theory's resource loss spiral proposition, this study examined serial associational pathways via self-efficacy and burnout linking transition shock to depression-anxiety-stress symptoms and explored their symptom-level network structure.Methods663 mid internship nursing interns from western China completed the Transition-Shock Scale, the General Self-Efficacy Scale, the Maslach Burnout Inventory and the Depression Anxiety Stress Scale 21 (DASS-21). Pearson correlation and multiple linear regression examined factors associated with DASS-21 scores. A serial mediation model (5,000 bootstraps) estimated direct and indirect statistical associations along the theorized sequence. A Gaussian graphical model estimated the DASS-21 symptom network, including node and bridge expected influence.ResultsAll main variables intercorrelated significantly (all p < 0.01); transition shock, self-efficacy and burnout were independently associated with DASS-21 scores. The mediation model fit acceptably; the direct association accounted for 44.53% of the total effect and three indirect pathways for 55.47%. In the DASS-21 symptom network, S6 (I was intolerant of anything that kept me from getting on with what I was doing), A6 (I was aware of the action of my heart in the absence of physical exertion) and S4 (I found myself getting agitated) had the highest expected influence, while A6, S2 (I tended to over-react to situations) and D2 (I found it difficult to work up the initiative to do things) showed the highest bridge expected influence. Both centrality indices demonstrated adequate stability (CS-coefficients = 0.750 for expected influence and 0.673 for bridge expected influence, respectively).ConclusionAmong nursing interns in western China, higher transition shock was associated with more severe depression-anxiety-stress symptoms both directly and indirectly, along sequential associational pathways involving self-efficacy and burnout. Several structurally central symptoms (S6, A6 and S4) and bridge symptoms (A6, S2 and D2) were identified as potentially important nodes for further clinical investigation, rather than confirmed intervention targets. These findings generate hypotheses for targeted mental health support in clinical nursing education. Given the cross-sectional design, causal or temporal ordering cannot be established; findings should be interpreted within this population and setting.
SN - 2296-858X
ER -