Dynamic networks of anxiety and depressive symptoms in female intern nurses with shift work: a three-wave longitudinal study

Although anxiety and depressive symptoms were prevalent mental health outcomes among shift nurses, a mechanistic understanding of their psychopathological interplay remains underexplored. Hence, this study employed network analysis to characterize symptom interactions of anxiety and depression among female intern nurses during initial shift work transitions and compare the differences in the network properties. Using a three-wave longitudinal design at a Guangzhou nursing school, we assessed anxiety and depressive symptoms using the 7-item Generalized Anxiety Disorder and 9-item Patient Health Questionnaire, respectively. All networks were estimated using the Extended Bayesian Information Criterion graphical Least Absolute Shrinkage and Selection Operator. The Network Comparison Test was used to compare differences in the network properties pre/post-transition. The comorbidity rate of anxiety-depressive symptoms among female intern nurses showed a progressive increase (6.2% to 7.7%) following shift work initiation. Symptoms of "Trouble relaxing" and "Restlessness" had higher EI values in anxiety-depressive networks post-transition. Significant differences existed in network global strength and network structure during initial shift work transitions. These results establish key central symptoms as critical intervention targets. Integrated interventions, including mindfulness, yoga, increased exposure to natural sunlight, and engaging in structured leisure activities, should be provided for nurses following the transition to shift work.