IMPACT OF NIGHT SHIFT ON THE MENTAL HEALTH OF NURSES IN PUBLIC HOSPITALS

Introduction: Nurses are professionals who face great stress during their workday, making them more susceptible to developing mental disorders. This situation is further complicated for nurses who work night shifts in hospitals. Objective: This study aimed to evaluate the levels of anxiety and depression in nurses who work night shifts in public hospitals. Material and methods: For this, a sociodemographic information questionnaire and the Hospital Anxiety and Depression Scale (HADS) were used. Results: The sample consisted of 85 permanent nurses from four public hospitals, located in the city of Aracaju, Sergipe. Of the participating nurses, 83.5% were women. The average age was 35.7 years and the number of hours worked per week was 36.7. 69.4% had two or more jobs and 97.3% expressed unsatisfaction with their salary. Only 36.5% had a postgraduate degree. The average length of service in the hospitals surveyed was 90.5 months. It was found that 42.4% of nurses had anxiety, with the majority experiencing mild to moderate symptoms, and 34.1% had symptoms of depression. Most nurses with symptoms of anxiety and depression were between 25 and 39 years old, with anxiety being more prevalent between 25 and 29 years old (22.2%) and depression between 30 and 34 years old (24.1%). Nurses worked 20 to 44 hours a week, with the majority working 36 hours (57.6%), and this group had higher levels of anxiety (25.9%) and depression (21.2%). Nurses with two or more jobs had higher rates of anxiety (69.4%) and depression (30.5%). Conclusion: This study observed that most nurses were young females. The combination of age and low salary likely resulted in longer working hours and a reduced pursuit of specialization. The number of night shift workers who presented symptoms of anxiety and depression was high, indicating a need to improve working conditions and wages, as well as greater attention from the government to this part of society.


INTRODUÇÃO
Nurses play an exhausting and stressful role in the healthcare system and may experience symptoms of anxiety and depression (Preto et.al, 2009).These symptoms are even more common in nurses who work night shifts, as they are more likely to develop insomnia or excessive sleepiness (Hsu et al., 2009).Night work is directly linked to sleep disorders, leading to significant changes in physical, occupational, cognitive, and social aspects of individuals (da Rocha et al., 2010).
Nighttime hours are often associated with various health problems, particularly sleep-related disorders, which can lead to mental health issues such as severe depressive disorders (Scott, Monk, Brink, 1997;Parent-Thirion et al., 2007;Flo et al., 2012).
Combined with low pay, long working hours, and poor working conditions, night work has been identified as a trigger for psychological disorders and depression (Vargas, Dias, 2011).Nursing work, therefore, is combined with factors that can interfere with health of its workers, such as constant changes in sleep patterns, making them more susceptible to depression and tiredness (Costa, Morita, Martinez, 2000).
There are few studies that investigate the cumulative effects of night work and mental disorders (Øyane et al., 2013).Given these factors, it is important to conduct studies focused on the health of nurses who work at night to promote their well-being.
This study aimed to determine the prevalence of anxiety and depression symptoms in nurses working night shifts in public hospitals.

MATERIALS AND METHODS
This is an observational, descriptive, cross-sectional study with a quantitative approach.The study was carried out in four public hospitals in the city of Aracaju.The study included a sample of 85 nurses who worked night shifts.Nurses who were active in the institution and worked in direct patient care were included.Those who were on holydays, away from work at the time of data collection, and had a history of depression before working as a nurse were excluded.
This work met the ethical precepts in research with human beings.For that, the researchers asked for volunteers to participate in the study after explaining its purpose.
Participants were asked to sign a Free and Informed Consent Form, which outlined the risks, objectives, benefits, and research methods.To ensure that the form was easily understood, four nurses from the hospital were interviewed to verify its clarity, objectivity, readability and presentation.
Participants in the study were asked to complete a questionnaire that included sociodemographic information (age, sex, marital status), professional details (workplace, hours worked weekly, number of jobs, salary satisfaction, length of service, work unit, shift, qualifications), and history of depression diagnosis before work as a nurse.They also completed the Hospital Anxiety and Depression Scale (HADS) (Zigmond, Snaith, 1983), which assesses anxiety and depression.The scale was translated and validated in Brazil by Botega et al., (1998).
HADS has 14 items, seven of which are aimed at assessing anxiety (HADS-A) and seven for depression (HADS-D).Each of the items on the scale can be scored from zero to three, on a Likert-type scale, with an overall score for each subscale ranging from 0 (zero) to 21 points.
To assess the occurrence of anxiety and depression, the sum of the recommended responses for both subscales was obtained.In this way, HADS-anxiety: without anxiety from 0 to 7, with anxiety ≥ 8 and HADS-depression: without depression 0 to 7, with depression ≥8.Data from the HADS questionnaire were analyzed to identify any associations between anxiety and depression and variables such as weekly working hours, number of jobs, and salary satisfaction were evaluated.Participants with 20% or more unanswered items on the questionnaire were excluded from the sample.

RESULTS
Most nurses who participated in this study were female, with an average age of 35.7 years.They typically worked 36.7 hours per week, had multiple jobs, and expressed unsatisfaction with their salary (Table 1).showing symptoms of depression.Among this group, 15 anxious and 12 depressed individuals performed their professional activities in hospitals (Table 3).
The individuals in this study were divided into age groups based on the 2010 Census of the Brazilian Institute of Geography and Statistics (IBGE) to measure the prevalence of anxiety and depression.The highest number of nurses with anxiety and depression were aged 25-39.The majority of anxious individuals were 25-29 years old, representing 22.2% of the total sample, while the highest number of depressed individuals were 30-34 years old, totaling 24.1% of those with symptoms.The study also analyzed the nurses' working hours in relation to their anxiety and depression scores.Their weekly working hours ranged from 20 to 44, with 36 hours being the most common.The number of employment relationships was also observed, with 26 individuals with more than one job showing symptoms of anxiety and 23

Table 1 -
Sociodemographic characteristics of nurses who work at night in four public hospitals in the city of Aracaju, SE.

Table 2 -
The study aimed to assess the severity of anxiety and depression symptoms among nurses working night shifts in four public hospitals in the city of Aracaju, SE.

Table 3 -
Symptoms of anxiety and depression according to age, sex, working hours, and number of jobs of nurses who work night shifts in four public hospitals in Aracaju, SE.