Nursing News

Why So Gloomy? Nurses Twice as Depressed as the General Public

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By Debra Wood, RN, contributor 

June 22, 2012 - Despite depression remedies seemingly everywhere in the media--from Dr. Drew to advertisements on the front page of daily papers about clinical trials--depression remains a significant problem in this country, and now a Robert Wood Johnson Foundation-funded study shows that hospital nurses report depressive symptoms at twice the rate of the general population.

Nurse Depression
Susan Letvak, PhD, RN, said nursing is all about caring and relationships with co-workers, patients and providers, and being depressed can affect those things.

“I am very concerned about these nurses, with the environment getting tougher and the health care system not looking at this concern,” said Susan Letvak, Ph.D., RN, associate professor of nursing at the University of North Carolina at Greensboro School of Nursing.

Letvak and colleagues found 18 percent of 1,171 hospital nurses surveyed reported depressive symptoms, twice as high as the general population. About 9 percent of U.S. adults are depressed, according to the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS). The research team, funded by the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative, published their findings in the journal Clinical Nurse Specialist.

Why are more nurses depressed?  

Why a greater number of nurses suffer from depression is hard to determine, Letvak said.

“Is it situational or the type of women who go into nursing? We cannot make that statement,” she said. “It’s hard to know, except we know the environment is getting more stressful.”

The study found increased body weight, pain and poor job satisfaction associated with higher depression scores. In a prior study, Letvak found that pain and depression are interlinked.

Marge Crotty, RN, MS, nursing coordinator at Timberline Knolls Residential Treatment Center in Lemont, Ill., expects much of the depression is associated with burnout and a feeling of a lack of accomplishment at the end of the shift.

“A lot of it has to do with multitasking,” Crotty said. Nursing also has become more difficult than it was 30 years ago and often leaves little time for developing relationships with patients.

A Swedish study supports the link with burnout. In 2008, researchers at the Karolinska Institute in Stockholm found greater depression among health care workers who reported high burnout than those who scored lower on burnout scores.

Nurse Depression
Marge Crotty, RN, MS, suggests burnout and the stressful nursing environment contributes to depression.

“Once there is burnout, you see a decline in the quality of work, more calling in, and it becomes a spiral [downward],” Crotty said.

Nurses who are depressed often have difficulty concentrating and are accident prone, Letvak said. They may struggle with interpersonal tasks and time management and be less productive than colleagues who are not depressed.

“If depression is impacting care and more medical errors are occurring, and it’s impacting relations, its troubling for the profession,” Letvak said.

How can we address this problem? 

“The most significant issue is understanding and recognition,” said Letvak, adding that several study participants told her that answering the questionnaire made them realize they may be depressed.

Free online screening tools can help a nurse self-identify depression and offer resources, including Web-based cognitive-behavioral therapy, Letvak reported. Several studies have found such online therapy effective.

“Nurses can do it in the privacy of their home,” Letvak said. “When time is a problem, or concern people might know, there are ways to confidentially get treatment.”

A stigma exists about depression and other mental health issues and may be stronger among health care professionals than other people, Letvak said. Even so, she suggests nurse managers discuss the study at a staff meeting and open up a discussion about depression.

Crotty suggested nurse managers watch for signs of depression in nurses and discuss it with them individually, before the nurse starts in a downward spiral. Sometimes, talking with a mental health counselor through an employee assistance program is beneficial.

Other strategies for assisting nurses with depression, suggested in the paper, include advocating policies that support good mental health and treatment for those with problems, promoting supportive work environments and making reasonable accommodations for nurses whose depression is negatively affecting their work performance.

“It’s looking at our workforce environments and being more proactive with occupational health and helping getting nurses healthier--maybe lose weight, to take better care of ourselves--so we can take better care of patients,” Letvak concluded.

Nurse Depression
Marge Crotty, RN, MS, suggests burnout and the stressful nursing environment contributes to depression.