Prevalence and Factors Associated with Mental Health Disorders Among Nurses in Acute Care Settings in Riyadh: A Cross-Sectional Study
Downloads
Introduction: Nurses working in acute healthcare settings often experience mental health disorders while caring for palliative care and critically ill patients. As the backbone of the healthcare system, their mental well-being warrants greater attention. This study aims to assess the prevalence of mental health disorders and associated factors among nurses working in selected acute care settings in Riyadh, Saudi Arabia
Method: This cross-sectional study examined the mental health of nurses employed in acute healthcare settings in Riyadh, Saudi Arabia. A total of 485 participants were recruited using simple random sampling and proportionate allocation methods. Data were collected using an online questionnaire based on the Depression, Anxiety, and Stress Scale - 21 Items. Data were analyzed using descriptive statistics and inferential tests, including t-tests and a one-way analysis of variance, to determine associations between mental health outcomes and participant characteristics.
Results: The findings indicate that 59.8% of nurses reported normal depression levels, 28.2% experienced mild to moderate depression, and 12% suffered from severe or very severe depression. Regarding anxiety, 51.5% reported normal levels, 24.1% experienced mild to moderate anxiety, and 24.3% reported severe or extreme anxiety. Concerning stress, 73.4% of respondents indicated normal stress levels, 18.1% experienced mild to moderate stress, and 8.5% reported severe or extremely severe stress. Younger nurses and those with lower work experience exhibited significantly higher levels of stress, anxiety, and depression compared to their more experienced counterparts.
Conclusions: The study findings suggest that while most respondents experienced average levels of stress, anxiety, and depression, more than one-fourth of nurses reported severe to very severe levels of anxiety and depression, with 12% experiencing severe or very severe depression. These results highlight the urgent need for targeted mental health interventions, improved workplace policies, and supportive environments for nurses working in acute healthcare settings, which may enhance their mental well-being, job satisfaction, and quality of patient care.
Antony MM, Bieling PJ, Cox BJ, Enns MW, & Swinson RP (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychol. Assess, 10(2), 176. https://doi.org/10.1037/1040-3590.10.2.176.
Alharbi J, Jackson D, & Usher K (2019). Compassion fatigue in critical care nurses: An integrative review of the literature. Saudi Med. J, 40(11), 1087.doi: 10.15537/smj.2019.11.24569
Almeida D, Figueiredo AR., & Lucas P(2024, January). Nurses’ Well-Being at Work in a Hospital Setting: A Scoping Review. In Healthcare (Vol. 12, No. 2, p. 173). MDPI. https://doi.org/10.3390/healthcare12020173
Assis BBD, Azevedo, C, Moura CDC, Mendes PG, Rocha LL, Roncalli AA, ... & Chianca T C M (2022). Factors associated with stress, anxiety and depression in nursing professionals in the hospital context. Revista Brasileira de Enfermagem, 75(Suppl 3), e20210263.https://doi.org/10.1590/0034-7167-2021-0263
Babapour AR, Gahassab-Mozaffari N, & Fathnezhad-Kazemi A (2022). Nurses’ job stress and its impact on quality of life and caring behaviors: a cross-sectional study. BMC Nurs, 21(1), 75. https://doi.org/10.1186/s12912-022-00852-y
Betke K, Basińska MA, & Andruszkiewicz A (2021). Sense of coherence and strategies for coping with stress among nurses. BMC nursing, 20(1), 107.https://doi.org/10.1186/s12912-021-00631-1
Borhani F, Mohammadi S, & Roshanzadeh M (2015). Moral distress and perception of futile care in intensive care nurses. J Med Ethics Hist Med. 2015; 8:2.
.Brandford AA, & Reed DB (2016). Depression in registered nurses: a state of the science. Workplace Health Saf, 64(10), 488-511.https://doi.org/10.1177/2165079916653415
Brand SL, Thompson Coon J, Fleming LE, Carroll L, Bethel A, & Wyatt K (2017). Whole-system approaches to improving the health and wellbeing of healthcare workers: A systematic review. PLoS One, 12(12), e0188418. https://doi.org/10.1371/journal.pone.0188418
Brulin E, Lidwall U, Seing, I, Nyberg A, Landstad B, Sjöström M, ... & Nilsen P (2023). Healthcare in distress: A survey of mental health problems and the role of gender among nurses and physicians in Sweden. J. Affect. Disord, 339, 104-110.https://doi.org/10.1016/j.jad.2023.07.042
Cabarkapa S. King JA, & Ng CH(2020). The psychiatric impact of COVID-19 on healthcare workers. Aust J Gen Pract, 49(12), 791-795.doi: 10.31128/AJGP-07-20-5531
Chana N, Kennedy P, & Chessell ZJ (2015). Nursing staffs' emotional well‐being and caring behaviours. J. Clin. Nurs, 24(19-20), 2835-2848.doi:10.1111/jocn.12891.
Chuah PF, Lim ML, Choo SL, Woo GY, To HK, Lau KY, ... & Lian SB (2017). A qualitative study on oncology nurses’ experiences of providing palliative care in the acute care setting. Proceedings of Singapore healthcare, 26(1), 17-25. https://doi.org/10.1177/2010105816660322
Chen C, & Meier ST (2021). Burnout and depression in nurses: A systematic review and meta-analysis. Int. J. Nurs. Stud, 124, 104099.https://doi.org/10.1016/j.ijnurstu.2021.104099
Derblom K, Molin J, Gabrielsson S, & Lindgren BM (2022). Nursing staff’s experiences of caring for people with mental ill-health in general emergency departments: A qualitative descriptive study. Issues Ment. Health Nurs, 43(12), 1145-1154.https://doi.org/10.1080/01612840.2022.2138653
Faraji A, Karimi M, Azizi SM., Janatolmakan M, & Khatony A (2019). Occupational stress and its related demographic factors among Iranian CCU nurses: a cross-sectional study. BMC Res. Notes, 12, 1-5. https://doi.org/10.1186/s13104-019-4674-5
Ghods AA, Sotodehasl N, Khalaf ME, & Mirmohamadkhani M(2017). Situational anxiety among nurses. Middle East j. rehabil. health stud, 4(4). doi: 10.5812/mejrh.57560.
Halms T, Strasser, M, Papazova I, Reicherts P, Zerbini G, Grunde, S, ... & Hasan A (2023). What do healthcare workers need? A qualitative study on support strategies to protect mental health of healthcare workers during the SARS-CoV-2 pandemic. BMC psychiatry, 23(1), 195. https://doi.org/10.1186/s12888-023-04686-z
Hao Q, Wang D, Xie M, Tang Y, Dou Y, Zhu L, ... & Wang Q (2021). Prevalence and risk factors of mental health problems among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Front. Psychiatry, 12, 567381.https://doi.org/10.3389/fpsyt.2021.567381
Hall LH, Johnson J, Watt I, Tsipa A, & O’Connor DB (2016). Healthcare staff wellbeing, burnout, and patient safety: a systematic review. PLoS One, 11(7), e0159015. doi: 10.1371/journal.pone.0159015
Hall AL, Franche RL, & Koehoorn M (2018). Examining exposure assessment in shift work research: a study on depression among nurses. Ann. Work Expo. Health, 62(2), 182-194.https://doi.org/10.1093/annweh/wxx103
Hill JE, Harris C, Danielle LC, Boland P, Doherty AJ, Benedetto V, ... & Clegg AJ (2022). The prevalence of mental health conditions in healthcare workers during and after a pandemic: Systematic review and meta‐analysis. J. Adv. Nurs, 78(6), 1551-1573.https://doi.org/10.1111/jan.15175
Holmberg M, Hammarbäck S, & Andersson H (2020). Registered nurses’ experiences of assessing patients with mental illness in emergency care: A qualitative descriptive study. Nord. J. Nurs. Res, 40(3), 151-161.https://doi.org/10.1177/2057158520941753
Huang CLC, Wu MP, Ho, CH, & Wang JJ (2018). Risks of treated anxiety, depression, and insomnia among nurses: A nationwide longitudinal cohort study. PLoS One, 13(9), e0204224.doi.org/10.1371/journal.pone.0204224
Karagozoglu S, Yildirim G, Ozden D, & Çına, Z (2017). Moral distress in Turkish intensive care nurses. Nursing Ethics, 24(2), 209-224. https://doi.org/10.1177/0969733015593408
La Torre G, Sestili C, Mannocci A, Sinopoli A, De Paolis M, De Francesco S, ... & De Giusti M (2018). Association between work related stress and health related quality of life: the impact of socio-demographic variables. A cross sectional study in a region of central Italy. Int. J. Environ. Res. Public Health, 15(1), 159. https://doi.org/10.3390/ijerph15010159
Lagunes Cordoba E (2021). Well-being and mental health of healthcare workers before, during, and after COVID-19. Salud mental, 44(5), 211-214.https://doi.org/10.17711/sm.0185-3325.2021.027
Lovibond SH, & Lovibond, PF (1996). Depression anxiety stress scales. Psychol. Assess. https://doi.org/10.1037/t01004-000
Mahran GS, Taher AA, & Saleh NM (2017). Challenges and work crisis facing critical care nurses. Egypt. Nurs. J, 14(3), 235-241. DOI: 10.4103/ENJ.ENJ_27_17
Misganaw A, Hailu M, Bayleyegn G, Aderaw M, Yigzaw ZA, Alemu T, & Asmare L (2024). Exploring factors affecting nurse anxiety in Northwest Ethiopia: a multicenter study. Front. Psychiatry, 15, 1434701.https://doi.org/10.3389/fpsyt.2024.1434701
Noben C, Evers S, Nieuwenhuijsen K, Ketelaar S, Gärtner F, Sluiter J, & Smit F(2015). Protecting and promoting mental health of nurses in the hospital setting: is it cost-effective from an employer’s perspective? Int. J. Occup. Med. Environ. Health, 28(5), 891-900.http://dx.doi.org/10.13075/ijomeh.1896.00465
Oates J (2018). What keeps nurses happy? Implications for workforce well-being strategies. Nurs. Manag, 25(1). doi: 10.7748/nm. 2018.e1643
Okechukwu CE, Colaprico C, Di Mario S, Oko-Oboh AG, Shaholli D, Manai MV, & La Torre G (2023). The relationship between working night shifts and depression among nurses: a systematic review and meta-analysis. In Healthcare (Vol. 11, No. 7, p. 937). MDPI. https://doi.org/10.3390/healthcare11070937
Perry A, Lawrence V, & Henderson C (2020). Stigmatisation of those with mental health conditions in the acute general hospital setting. A qualitative framework synthesis. Soc. Sci. Med, 255, 112974.https://doi.org/10.1016/j.socscimed.2020.112974
Perry L, Lamont S, Brunero S, Gallagher R, & Duffield C (2015). The mental health of nurses in acute teaching hospital settings: a cross-sectional survey. BMC Nurs, 14, 1-8.DOI 10.1186/s12912-015-0068-8
Santos A, Chambel MJ, & Castanheira F (2020). Wellbeing among hospital nurses: A cross-sectional study of the contributions of relational job characteristics. Int. J. Nurs. Stud, 105, 103438. https://doi.org/10.1016/j.ijnurstu.2019.103438
Saragih ID, Tonapa SI, Saragih IS, Advani S, Batubara SO, Suarilah I, & Lin CJ (2021). Global prevalence of mental health problems among healthcare workers during the Covid-19 pandemic: a systematic review and meta-analysis. Int. J. Nurs. Stud, 121, 104002.https://doi.org/10.1016/j.ijnurstu.2021.104002
Shajan A, & Nisha C (2019). Anxiety and Depression among nurses working in a tertiary care hospital in South India. International Journal of Advances in Medicine, 6(5), 1611.DOI: http://dx.doi.org/10.18203/2349-3933.ijam20194228
Søvold LE, Naslund JA, Kousoulis AA, Saxena S, Qoronfleh MW, Grobler C, & Münter L (2021). Prioritizing the mental health and well-being of healthcare workers: an urgent global public health priority. Front Public Health, 9, 679397.https://doi.org/10.3389/fpubh.2021.679397
Uphoff E P, Lombardo C, Johnston G, Weeks L, Rodgers M, Dawson S, ... & Churchill R (2021). Mental health among healthcare workers and other vulnerable groups during the COVID-19 pandemic and other coronavirus outbreaks: A rapid systematic review. PLoS One, 16(8), e0254821.https://doi.org/10.1371/journal.pone.0254821
Vernekar SP, & Shah H (2018). A study of work-related stress among nurses in a tertiary care hospital in Goa. Int. j. community med. public health, 5(2), 657-661.DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20180246
Xiao Q, Cooke FL, & Chen L (2022). Nurses’ well‐being and implications for human resource management: A systematic literature review. Int. J. Manag. Rev, 24(4), 599-624.https://doi.org/10.1111/ijmr.12295
Zhang H (2023). Valuing nurses’ mental health and enhancing their psychological resilience. Lancet Reg Health West Pac, 30.https://doi.org/10.1016/j.lanwpc.2022.100643
Copyright (c) 2025 Khalid S AlGhamdi, Diana S Lalithabai, Buhaiseh Owaishiz

This work is licensed under a Creative Commons Attribution 4.0 International License.
1. The journal allows the author to hold the copyright of the article without restrictions.
2. The journal allows the author(s) to retain publishing rights without restrictions
3. The legal formal aspect of journal publication accessibility refers to Creative Commons Attribution (CC BY).