In our previous article, ‘Can nurses have depression?’ we explored recent research outlining the rates of depression in nursing. Another logical question that follows is to ask, why are these nurses depressed? And, which nurses are more at risk of depression?

In this article we will highlight some recent findings that explain causes for depression in nurses, and identify which characteristics make certain nurses more at-risk of developing this condition. 

Encouragingly, research also provides information about what factors help to protect nurses against depression. We’ll be covering that too as we like to provide solutions and not just problems here at Nurse Wellbeing Mission.

Why are some nurses depressed? Risk factors from the literature

Brandford and Reed (2016) identified some specific factors that lead to depression in nursing. This was achieved through a systematic review of the literature on depression in nurses. If a nurse had one or more of the following features, they were at higher risk of developing depression:

Demographic factors

• Female gender (consistent with other research on depression in the general population)
• Younger age
• Single and/or divorced

Occupational factors

• Fewer years of work experience
• Working in psychiatric, community settings and midwife settings.
• Working in more acute settings (e.g. ICU, psychiatric unit)
• Shift work
• Workplace violence or trauma
• Job strain
• Role overload (too much work for your pay grade)
• Role insufficiency (not getting enough out of your role)
• Diminished role boundaries (lack of clarity about yours and others’ responsibilities)
• Lack of supervisor support
• Job insecurity
• Lack of reward 
• Lower job satisfaction 

Whilst many of these are not specific to nursing, there are a few key ones that are more common to the profession, which make nurses more likely to experience depression. 

For example, working in hostile environments with harassment, bullying and incivility is common for nurses and not found in many other environments.

As is witnessing traumatic events. Moreover, shift work is uncommon in many other professions, yet this is known to be detrimental to physical and mental health.

So, the answer to the question, why are nurses depressed? Can be answered with relevance to some of the specific occupational factors that affect nurses. 

This has important implications for the prevention of depression because interventions delivered within an organisation can target specific occupational factors.

COVID related stressors and depression in nurses

In our previous article [link to ‘Can nurses have depression?’] we reported how one study showed 43% of frontline health workers were experiencing depression during the pandemic.

In addition to those described above, a number of new occupational risk factors emerged during COVID that made depression more likely in nurses. For example,

• Uncertainty and fear around exposure of self and to others of COVID.
• Increased exposure to stressful and traumatic events.
• Increased stressogenic working environments (long working hours, restricted breathing from PPE).
• An interruption to some of the usual positive and protective factors of the nursing role such as physical touch with patients, having no time for breaks, not being able to bond with colleagues as easily.
• Consequential impact on positive lifestyle factors such as reduced sleep and impact on diet, social relationships, time for self-care at home.
• Social stigma (e.g. being labelled “COVID nurses”).

What factors protect against depression?

The good news is that current research has identified several factors which seem to be protective against depression. That is, if these are present, nurses are less likely to become depressed, and experience positive wellbeing:

Demographic/social protective factors

• Older age
• Married
• High level of perceived social support outside work.

Occupational protective factors

• Higher job satisfaction
• More years of experience
• Resourcefulness

Psychological/lifetsyle related protective factors

• Positive evaluations and expectations toward self and others
• Self-efficacy (the belief that you are in control of your life and confidence in skills and abilities)
• High degree of optimism 
• Engagement in regular exercise.

To read further about these, check out papers by Luo et al (2021) and Schug et al (2021).

This list is encouraging as it points towards potential targets for intervention at the individual and organisational level. Naturally, some of these are easier to increase or promote, than others. 

For example, social support can be encouraged through workplace initiatives, positive psychological coping can be trained, and interventions can promote lifestyle changes such as increased exercise. 

It might be unethical for organisations to encourage marriage, though….

Given the huge role that organisations have in shaping some of these risk/protective factors, there is a responsibility here to make changes and implement programs and training to benefit the mental health of nursing staff.

Conclusion 

Nurses, like the world at large, have suffered psychologically throughout the pandemic. If you are a nurse who worked in a frontline role or had any exposure to COVID, there is an alarmingly high chance you may have developed depression in the past couple of years.

Pandemic aside, several nursing working environments make it more likely you are going to develop depression than someone else who is not a nurse. This route is far from set in stone, however, as there are many nurses who stay well and are not depressed. 

Nurse Wellbeing Mission are committed to supporting nurses’ mental health and helping provide tools to prevent and manage common mental health problems.