Association between body mass index and mental health among nurses: a cross-sectional study in China

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Abstract

Purpose

To examine the correlation between body mass index (BMI) and mental well-being in Chinese nurses during the COVID-19 epidemic.

Method

This study was conducted in a tertiary hospital using a cross-sectional design. A total of 2,811 nurses were enlisted at Shengjing Hospital in China during the period from March to April, 2022. Information was gathered through a questionnaire that individuals completed themselves. The mental health of the participants was assessed using the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder Assessment-7. Binary logistic regression was used to calculate adjusted odds ratios (ORs) and their corresponding 95% confidence intervals.

Results

The prevalence of nurses experiencing depression and anxiety was 7.8% (219) and 6.7% (189), respectively. Regarding depression after adjustment, the odds ratios (ORs) for each quartile, compared to the lowest quartile, were as follows: 0.91 (95% confidence interval [CI]: 0.53, 1.56), 2.28 (95% CI: 0.98, 3.77), and 2.32 (95% CI: 1.41, 3.83). The p-value for trend was found to be 0.001. The odds ratios (ORs) for anxiety after adjustment were 2.39 (0.83, 4.36), 4.46 (0.51, 7.93), and 2.81 (1.56, 5.08) when comparing the highest quartiles to the lowest quartile. The p-value for trend was 0.009.

Conclusion

This study found a positive association between BMI and poor mental health among nurses during the COVID-19 pandemic, particularly in those who were overweight or obesity. The findings could assist in developing interventions and help policy-makers establish appropriate strategies to support the mental health of frontline nurses, especially those who are overweight or obesity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-024-11006-y.

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Most cited references 34

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Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.

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While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.

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The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research

Daniel J. Buysse, Charles Reynolds III, Timothy H Monk … (1989)

Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.

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Author and article information

Contributors

Dongmei Liu:

ORCID: http://orcid.org/0000-0003-1822-7580

liudongmeicmu@163.com

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 24 April 2024

Publication date PMC-release: 24 April 2024

Publication date Collection: 2024

Volume: 24

Electronic Location Identifier: 506

Affiliations

[1 ]GRID grid.412467.2, ISNI 0000 0004 1806 3501, Department of Operating Room, , Shengjing Hospital of China Medical University, ; Shenyang, P.R. China

[2 ]GRID grid.412467.2, ISNI 0000 0004 1806 3501, Department of Urology, , Shengjing Hospital of China Medical University, ; 36 Sanhao Street, Shenyang, Liaoning 110004 P.R. China

Author information

Bonan Luan http://orcid.org/0000-0003-2703-3390

Xueyan Tian http://orcid.org/0000-0002-7933-5844

Chao Wang http://orcid.org/0000-0001-6097-7719

Ming Cao http://orcid.org/0009-0001-4858-838X

Dongmei Liu http://orcid.org/0000-0003-1822-7580

Article

Publisher ID: 11006

DOI: 10.1186/s12913-024-11006-y

PMC ID: 11040996

PubMed ID: 38654347

SO-VID: 2aaed983-d93f-41ac-85bc-e244248e8cd9

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 31 January 2024

Date accepted : 18 April 2024

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: bmi,obesity,depression,anxiety,covid-19

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: bmi, obesity, depression, anxiety, covid-19

Association between body mass index and mental health among nurses: a cross-sectional study in China

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Novel Coronavirus Disease COVID-19

Most cited references 34

A brief measure for assessing generalized anxiety disorder: the GAD-7.

The PHQ-9: validity of a brief depression severity measure.

The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research

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