Psychosocial working conditions and symptoms of depression, anxiety, and stress among nurses: A cross-sectional study

Adverse psychosocial working conditions are increasingly recognized as organizational factors associated with nurses' mental health. However, researchers conducting studies simultaneously evaluating multiple psychosocial work dimensions and symptoms of depression, anxiety, and stress using comprehensive, validated instruments remain limited, particularly in Spanish nursing populations.

To examine the association between psychosocial working conditions and depression, anxiety, and stress among registered nurses.

A cross-sectional analytical study was conducted among 336 registered nurses working in public and private healthcare settings in the province of Santa Cruz de Tenerife, Canary Islands, Spain. Psychosocial working conditions were assessed using the Copenhagen Psychosocial Questionnaire, and emotional health was evaluated with the Depression Anxiety Stress Scales-21. Descriptive statistics, internal consistency analyses, bivariate analyses, Pearson correlations, and multiple linear regression models were performed to examine the relationships between psychosocial work dimensions and emotional health, while adjusting for relevant sociodemographic and occupational variables.

High levels of adverse psychosocial exposure were identified, particularly for psychological demands (88.1%), work-family conflict (76.5%), organizational esteem (58.0%), and social support and leadership quality (48.8%). Symptoms of emotional distress were also highly prevalent, with severe or extremely severe symptoms reported by 40.5% of participants for stress, 42.6% for anxiety, and 30.7% for depression. All psychosocial dimensions were significantly associated with at least one emotional health outcome. Higher psychological demands, greater job insecurity, and increased work-family conflict were associated with higher levels of depression, anxiety, and stress, whereas greater organizational esteem, social support and leadership quality, and opportunities for professional development were associated with lower emotional distress. In the multivariable models, psychological demands and job insecurity showed consistent independent associations with all three emotional health outcomes, while work-family conflict remained independently associated with stress and organizational esteem with depression.

Adverse psychosocial working conditions were strongly associated with poorer emotional health among participants. Psychological demands and job insecurity showed the most consistent independent associations with symptoms of depression, anxiety, and stress, highlighting potentially modifiable organizational domains relevant to nurses' emotional health. Interventions aimed at improving the psychosocial work environment may contribute to supporting nurses' well-being, strengthening workforce retention, and promoting safer, higher-quality patient care.