Nurses suffer high rate of depression

Work stress, pain are factors

Nurses suffer from depression at twice the rate as the general population, a problem that contributes to nurse burnout, low productivity and staff turnover, nursing researchers say.

Long work hours, high stress, pain and sleep deprivation are factors in the high rates of depression among nurses, says Susan Letvak, PhD, RN, FAAN, associate professor and chair of Adult Health Nursing at the University of North Carolina Greensboro.

Pain and depression also are costly for hospitals and the nation’s health care system, she says. Letvak calculated that pain and depression result in reduced productivity of $14,339 per nurse. On a national basis, that would amount to a loss of about $22.7 billion.1

In her survey of 1,171 registered nurses in North Carolina, which included a depression questionnaire, Letvak found that 18% of the nurses had symptoms of at least mild to moderate depression. One-third of those nurses (6% of the total) had moderately severe or severe depression.2 Depression affects 9% of the general population, with a rate of major depression of 4%, according to the Centers for Disease Control and Prevention.3

A burden of that magnitude should get the attention of hospital leadership, says Letvak. But there’s still a fear of stigma around depression, even among nurses, so the problem is often under-reported and unrecognized, she says.

“They’re afraid to come forward,” Letvak says. Nurses may be reluctant to go to an employee assistance program, which means that wellness and employee health programs should provide awareness and counseling, she says.

Help nurses cope with stress

Why do nurses have a high rate of depression? Work factors play a role, says Naomi Swanson, PhD, chief of the Organizational Science and Human Factors Branch at the National Institute for Occupational Safety and Health (NIOSH) in Cincinnati.

Long shifts (12 hours or more) and heavy workload among nurses are associated with depression, she says. “Those are known correlates of sleep problems, and sleep problems are highly correlated with depression,” she says.

Nurses also cope with stress, particularly if they deal with trauma and death in the emergency department or intensive care unit, Swanson says. Yet they have to hide their emotions to project calmness and competence, she says. “What they’re showing on the outside may not necessarily match what they’re feeling on the inside,” she says.

Letvak did not find a difference in depression rates among units, but she concurs that the chronic exposure to grief has an impact. “The emotional burden is just tremendous. I think that leads to higher rates of depression,” she says.

Pain and other physical problems contribute to the problem of depression. Letvak found that more than two-thirds (71%) of the nurses work with musculoskeletal pain — and 18% of them had pain that was moderate to severe (5 or higher on an 11-point pain scale).

Nurses with pain and other health problems, such as allergies, headaches, high blood pressure and joint pain, were more likely to be depressed, as were obese nurses. Low job satisfaction also was associated with depression.

Raise awareness, lower stigma

In her survey, Letvak says some of the nurses commented that they didn’t realize they were depressed. That finding points to the need for greater awareness, she says.

“How sad it is that these nurses who are under tremendous stress have the pain of depression but aren’t aware of it,” she says.

Wellness programs should incorporate mental health screening with other health risk assessments, she says. Awareness programs also can seek to remove the stigma of mental illness, she says.

While it’s important to help individuals receive the care and support they need to cope with depression, employers also should seek ways to improve the work environment through better staffing levels and scheduling, Swanson says.

Focus groups can help identify the stresses and work problems affecting nurses, she says. “A good place to start is by asking the nurses themselves where the problems lie,” she says.


  1. Letvak SA, Ruhm CJ, Gupta SN. Nurses’ presenteeism and its effects on self-reported quality of care and costs. Amer Jrl Nurs 2012;112:30-38.
  2. Letvak S, Ruhm CJ, McCoy T. Depression in hospital-employed nurses. Clin Nurse Special 2012;26:177-182
  3. Centers for Disease Control and Prevention. Current depression among adults – United States, 2006 and 2008. MMWR 2010;59:1229-1259.