Associations Between Fatigue and Sleep Among Night-Shift Nurses: Mediating Role of Depressive Symptoms and Social...

This study examined the association between fatigue and sleep disturbance among night-shift nurses during the COVID-19 pandemic and the mediating roles of depressive symptoms and social support.

A cross-sectional survey was conducted involving 1667 night-shift nurses from multiple hospitals. The Pittsburgh Sleep Quality Index (PSQI), Fatigue Scale-14, Hospital Anxiety and Depression Scale, and Social Support Rating Scale were used for assessment. Correlation analysis and mediation effect analysis were performed using SPSS 26.0 and PROCESS macro.

Poor sleep (PSQI ≥ 6) was reported by 70.7% of nurses. Increased workload (89.7%) and fear of infection (58.1%) were significantly associated with worse sleep (both p < 0.05). Fatigue correlated positively with depression (r = 0.607, p < 0.001) and sleep disturbance (r = 0.550, p < 0.001) and negatively with social support (r = -0.242, p < 0.001). Mediation analysis identified three pathways: depressive symptoms alone (30.25% of the total effect), social support alone (0.80%), and the sequential depression ⟶ social support path (2.23%).

Among night-shift nurses, fatigue is directly and indirectly associated with poorer sleep quality via three mediating pathways: depressive symptoms alone, social support alone, and the sequential effect of depressive symptoms on social support. Interventions should address these pathways to improve sleep in night-shift nurses under high-load public health emergency contexts.

For night-shift nurses facing excess workload during public health emergencies, managers could adopt a tiered strategy: (1) optimize shift schedules to reduce fatigue and (2) strengthen peer and family support systems. Regular monitoring of sleep and fatigue indicators is recommended to evaluate intervention effectiveness under such high-stress contexts.