Depressive symptoms and occupational correlates among psychiatric nurses in northern Jiangsu: an explanatory sequential mixed-methods study

Psychiatric nurses manage aggression, interrupted recovery and emotionally demanding care. Surveys quantify distress but rarely show how these experiences accumulate during routine work.

We aimed to estimate the prevalence of a positive depressive-symptom screen among psychiatric nurses and to quantify its associations with four prespecified occupational exposures: workplace violence, night-shift burden, occupational strain and psychological resilience. A longitudinal qualitative phase then examined how nurses experienced these same exposures during routine work.

Four tertiary public psychiatric hospitals in northern Jiangsu participated from January 2025 to March 2026. A convenience sample of 357 nurses completed the survey. Workplace violence during the preceding 12 months was assessed with Wang's Workplace Violence Scale; at least one physical, verbal or psychological, or sexual incident perpetrated by a psychiatric inpatient or visiting family member defined exposure. Modified Poisson regression with hospital fixed effects estimated prevalence ratios (PRs) for an SDS-positive screen. A purposive subsample of 20 nurses completed interviews, diaries and observation over three months. Colaizzi's method and a joint display supported qualitative analysis and integration.

Of 357 nurses, 138 (38.7%) screened positive. Nurses reporting violence had a higher screening prevalence (PR 1.65, 95% CI 1.31-2.08). PRs per SD were 1.48 (95% CI 1.33-1.66) for night-shift burden and 1.45 (95% CI 1.28-1.65) for occupational strain. Resilience showed the opposite pattern (PR 0.79 per SD, 95% CI 0.70-0.88). Qualitative accounts centered on repeated strain, a value-recognition mismatch, unequal recovery resources and support considered generic or poorly timed.

Depressive symptoms were common. Nurses identified practical targets: safer work organization, rapid post-incident contact and support tailored to individual circumstances. Cross-sectional estimates do not establish diagnosis or causation.