The effect of sleep quality and depressive symptoms on the relationship between burnout and health-related productivity loss in nurses working in intensive care: a cross-sectional study from the Chinese nurses' health cohort study (TARGET).
6 affiliations
- 1Department of Nursing, Shandong Provincial Hospital, Jinan, Shandong, China.
- 2Department of Neurology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Lixia District, Jinan, Shandong, China.
- 3Department of Gastroenterology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Lixia District, Jinan, Shandong, China.
- 4University of New South Wales, Sydney, Australia.
- 5School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Lixia District, Jinan, Shandong Province, China. [email protected].
- 6Department of Nursing, Qilu Hospital, Shandong University, 107 Wenhuaxi Road, Lixia District, Jinan, Shandong Province, China. [email protected].
Abstract
Background
Burnout is highly prevalent among ICU nurses and compromises physical and psychological well-being, leading to productivity loss. However, limited evidence exists regarding the pathways through which burnout influences productivity, particularly the role of sleep disturbance and depression.Aim
Few studies have examined the mechanisms through which burnout affects health-related productivity in intensive care unit (ICU) nurses. This study addresses this gap by investigating the sequential mediating role of sleep quality and depressive symptoms in the relationship between burnout and health-related productivity loss.Design
A cross-sectional study.Methods
Baseline data from the Chinese Nurses' Health Cohort Study, collected between December 2020 and February 2024, included 3,491 ICU nurses. Burnout, health-related productivity loss, sleep quality and depressive symptoms were assessed using the Maslach Burnout Inventory-Human Services Survey, Stanford Presenteeism Scale, Pittsburgh Sleep Quality Index and Patient Health Questionnaire-9. Chain mediation analysis was conducted using the SPSS PROCESS macro, and subgroup analyses were performed.Results
Data from 3,491 ICU nurses were analyzed. Subgroup analyses showed female nurses aged 18-30 years, with a master's degree or above, senior titles, contract positions, clinical roles, and 6-10 years of experience reported higher productivity loss. Productivity loss correlated with burnout, poor sleep quality, and depressive symptoms. Mediation analysis using Bootstrap resampling (5,000 iterations) revealed that burnout had a significant total effect on productivity loss (β = 0.1019, 95% CI [0.0963, 0.1076]). The direct effect remained significant after accounting for mediators (β = 0.0587, 95% CI [0.0527, 0.0647]). The sequential indirect effect through sleep quality and depressive symptoms was significant (β = 0.0422, 95% CI [0.0395, 0.0469]), indicating that burnout impaired sleep quality, which increased depressive symptoms and ultimately contributed to greater productivity loss.Conclusion
The relationship between burnout and health-related productivity is mediated by sleep quality and depressive symptoms. Interventions reducing burnout, improving sleep quality, and preventing depression may help mitigate productivity loss.Registration
The study protocol for TARGET was registered with the China Clinical Trial Registry (registration number: ChiCTR2100043202, February 8, 2021, https://trialsearch.who.int/Default.aspx ).
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BibTeX
@article{liu2026effect,
title = {{The effect of sleep quality and depressive symptoms on the relationship between burnout and health-related productivity loss in nurses working in intensive care: a cross-sectional study from the Chinese nurses' health cohort study (TARGET).}},
author = {Xueyan Liu and Juan Kong and Xiaodong Yuan and Qian Ma and Zhen Zhang and Patricia M Davidson and Yingjuan Cao},
journal = {BMC nursing},
year = {2026},
month = jul,
doi = {10.1186/s12912-026-04744-3},
url = {https://europepmc.org/article/MED/42907890},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - The effect of sleep quality and depressive symptoms on the relationship between burnout and health-related productivity loss in nurses working in intensive care: a cross-sectional study from the Chinese nurses' health cohort study (TARGET).
AU - Xueyan Liu
AU - Juan Kong
AU - Xiaodong Yuan
AU - Qian Ma
AU - Zhen Zhang
AU - Patricia M Davidson
AU - Yingjuan Cao
PY - 2026
DA - 2026/07/01
JO - BMC nursing
DO - 10.1186/s12912-026-04744-3
UR - https://europepmc.org/article/MED/42907890
AB - Background Burnout is highly prevalent among ICU nurses and compromises physical and psychological well-being, leading to productivity loss. However, limited evidence exists regarding the pathways through which burnout influences productivity, particularly the role of sleep disturbance and depression.Aim Few studies have examined the mechanisms through which burnout affects health-related productivity in intensive care unit (ICU) nurses. This study addresses this gap by investigating the sequential mediating role of sleep quality and depressive symptoms in the relationship between burnout and health-related productivity loss.Design A cross-sectional study.Methods Baseline data from the Chinese Nurses' Health Cohort Study, collected between December 2020 and February 2024, included 3,491 ICU nurses. Burnout, health-related productivity loss, sleep quality and depressive symptoms were assessed using the Maslach Burnout Inventory-Human Services Survey, Stanford Presenteeism Scale, Pittsburgh Sleep Quality Index and Patient Health Questionnaire-9. Chain mediation analysis was conducted using the SPSS PROCESS macro, and subgroup analyses were performed.Results Data from 3,491 ICU nurses were analyzed. Subgroup analyses showed female nurses aged 18-30 years, with a master's degree or above, senior titles, contract positions, clinical roles, and 6-10 years of experience reported higher productivity loss. Productivity loss correlated with burnout, poor sleep quality, and depressive symptoms. Mediation analysis using Bootstrap resampling (5,000 iterations) revealed that burnout had a significant total effect on productivity loss (β = 0.1019, 95% CI [0.0963, 0.1076]). The direct effect remained significant after accounting for mediators (β = 0.0587, 95% CI [0.0527, 0.0647]). The sequential indirect effect through sleep quality and depressive symptoms was significant (β = 0.0422, 95% CI [0.0395, 0.0469]), indicating that burnout impaired sleep quality, which increased depressive symptoms and ultimately contributed to greater productivity loss.Conclusion The relationship between burnout and health-related productivity is mediated by sleep quality and depressive symptoms. Interventions reducing burnout, improving sleep quality, and preventing depression may help mitigate productivity loss.Registration The study protocol for TARGET was registered with the China Clinical Trial Registry (registration number: ChiCTR2100043202, February 8, 2021, https://trialsearch.who.int/Default.aspx ).
SN - 1472-6955
ER -