Volume 22, Issue 5 (August 2024)                   Nursing and Midwifery Journal 2024, 22(5): 365-378 | Back to browse issues page


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Khorramnia S, Pakzad Moghadam S H, Sarkoohi A, Orandi A, Orandi A, Mohajeri Iravani M, et al . PREVALENCE OF DEPRESSION, STRESS AND ANXIETY IN NURSES OF INTENSIVE CARE UNITS IN IRANIAN HOSPITALS: A SYSTEMATIC REVIEW, META-ANALYSIS AND META-REGRESSION. Nursing and Midwifery Journal 2024; 22 (5) :365-378
URL: http://unmf.umsu.ac.ir/article-1-5196-en.html
1- Department of Anesthesiology, School of Medicine, Ali Ibn Abitaleb Educational and Treatment Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
2- Department of Anesthesiology, School of Medicine, Ali Ibn Abitaleb Educational and Tretment Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
3- School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
4- Department of Anesthesia and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
5- School of Allied Medical Sciences, 503 Hospital (Hajar), AJA University of Medical Sciences, Tehran, Iran
6- Department of Anesthesiology and Critical Care, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
7- Department of Orthopedics, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
8- School of Nursing, AJA University of Medical Sciences, Tehran, Iran
9- Department of Anesthesiology, School of Medicine, Ali Ibn Abitaleb Educational and Treatment Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran , drzianavidi49@gmail.com
Abstract:   (969 Views)
Background & Aim: Nurses in intensive care units face unique challenges that can have serious effects on their mental health and job performance, leading to depression, stress, and anxiety. This study was conducted to determine the prevalence of depression, stress, and anxiety among nurses in critical care units in Iranian hospitals through a systematic review and meta-analysis.
Materials & Methods: An electronic search was conducted in PubMed, Scopus, Web of Science, ScienceDirect, Scientific Information Database, and Magiran until June 2024. A manual search was also conducted in key review articles and primary sources. The studies were limited to Persian and English languages. Study bias was evaluated using the Newcastle-Ottawa Scale checklist, and data analysis was carried out using Comprehensive Meta-Analysis software version 3.
Results: A total of 18 observational studies involving 2,611 nurses were included in the study. The results of the meta-analysis indicated that the prevalence of depression, stress, and anxiety among ICU nurses was 28% (95% confidence interval [CI] 0.14-0.47, P=0.03), 68% (95% CI 0.53-0.80, P=0.01), and 53% (95% CI 0.29-0.76, P=0.76), respectively. There was no significant relationship between the prevalence of stress and the year of publication of the study (P>0.05). Publication bias was not observed in the study.
Conclusion: Intensive care unit nurses experience depression, stress, and anxiety. Therefore, implementing effective measures to identify and alleviate these issues among nurses can enhance their well-being and positively impact the quality of patient care.
 
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Type of Study: Review article | Subject: پرستاری

References
1. Al‐Ajarmeh DO, Rayan AH, Eshah NF, Al‐Hamdan ZM. Nurse-nurse collaboration and performance among nurses in intensive care units. Nurs Crit Care 2022;27(6):747-55. [PMID: 34962022] [DOI:10.1111/nicc.12745]
2. Kayambankadzanja RK, Schell CO, Wärnberg MG, Tamras T, Mollazadegan H, Holmberg M, et al. Towards definitions of critical illness and critical care using concept analysis. BMJ Open 2022;12(9):e060972. [PMID: 36606666] [DOI:10.1136/bmjopen-2022-060972] [PMCID: PMC9445819]
3. Khorramnia S, Souri Z, Bashari N, Farahbakhsh F, Khorramnia S, Koohestani S. Comparison of APACHE Scoring Systems in Predicting Mortality in ICU: a Systematic Review and Meta-Analysis. J Adv Biomed Sci 2020;10(4):2703-15. [URL:]
4. Keshvari M, Khansari Z, Rajabkhah K, Almasian A, Omidifar R, Mousavi SM. Challenges of clinical governance in risk management: A qualitative study of teaching hospitals. Manag Strat Health Syst 2017;1(2):93-102. [URL:] [DORL:]
5. Khorramnia S, Amini S, Aliniaghara E, Koohestani S, Khorramnia S. Estimating The Prevalence Of Nosocomial Bacterial Infections In Neonatal Intensive Care Units In Iranian Hospitals: A Systematic Review And Meta-Analysis. Stud Med Sci 2021;32(1):14-22. [URL:]
6. Khorramnia S, Jafari A, Farahbakhsh F, Aliniaghara E, Amani B, Amani B, et al. Estimation of mortality in the intensive care units in iran: A systematic review and meta-analysis. Nurs Midwifery J 2019;17(8):634-45. [URL:]
7. Mealer M, Burnham EL, Goode CJ, Rothbaum B, Moss M. The prevalence and impact of post traumatic stress disorder and burnout syndrome in nurses. Depress Anxiety 2009;26(12):1118-26. [PMID: 19918928] [DOI:10.1002/da.20631] [PMCID: PMC2919801]
8. Chuang C-H, Tseng P-C, Lin C-Y, Lin K-H, Chen Y-Y. Burnout in the intensive care unit professionals: A systematic review. Medicine 2016;95(50):e5629. [PMID: 27977605] [DOI:10.1097/MD.0000000000005629] [PMCID: PMC5268051]
9. Labrague LJ, McEnroe‐Petitte DM, Leocadio MC, Van Bogaert P, Cummings GG. Stress and ways of coping among nurse managers: An integrative review. J Clin Nurs 2018;27(7-8):1346-59. [PMID: 29148110] [DOI:10.1111/jocn.14165]
10. Adriaenssens J, De Gucht V, Maes S. Causes and consequences of occupational stress in emergency nurses, a longitudinal study. J Nurs Manag 2015;23(3):346-58. [PMID: 24330154] [DOI:10.1111/jonm.12138]
11. Naji T, Bekmaz K, Sadooghiasl A. Investigating the relationship between strategies for coping with nurses' stress and perceived organizational support in tehran university of medical sciences hospitals in 2021, TEHRAN, IRAN. Nurs Midwifery J 2022;20(4):302-11. [URL:] [DOI:10.52547/unmf.20.4.302]
12. Mealer M, Burnham EL, Goode CJ, Rothbaum B, Moss M. The prevalence and impact of post traumatic stress disorder and burnout syndrome in nurses. Depress Anxiety 2009;26(12):1118-26. [PMID: 19918928] [DOI:10.1002/da.20631] [PMCID: PMC2919801]
13. Labrague LJ, McEnroe-Petitte DM, Leocadio MC, Van Bogaert P, Cummings GG. Stress and ways of coping among nurse managers: An integrative review. J Clin Nurs 2018;27(7-8):1346-59. [PMID: 29148110] [DOI:10.1111/jocn.14165]
14. Colomer-Sánchez A, Ayuso-Murillo D, Lendínez-Mesa A, Ruiz-Nuñez C, Fontán-Vinagre G, Herrera-Peco I. Anxiety effect on communication skills in nursing supervisors: An observational study. Nurs Rep 2021;11(2):207-16. [PMID: 34968199] [DOI:10.3390/nursrep11020021] [PMCID: PMC8608119]
15. Cecere L, de Novellis S, Gravante A, Petrillo G, Pisani L, Terrenato I, et al. Quality of life of critical care nurses and impact on anxiety, depression, stress, burnout and sleep quality: A cross-sectional study. Intensive Crit Care Nurs 2023;79:103494. [PMID: 37556987] [DOI:10.1016/j.iccn.2023.103494]
16. Eghtedar S, Soheili A, Nemati S. The communication skills of nursing managers and their associations with nurses' job satisfaction and anxiety. Nurs Midwifery J 2023;21(9):708-17. [URL:] [DOI:10.61186/unmf.21.9.708]
17. Sharifi A, Fallahi-Khoshknab M, Mohammadi S, Zeraati M, Jamshidi Z, Aghabeygi-Arani M, et al. Depression, anxiety, and stress among Iranian nurses in COVID-19 care wards. BMC Psychol 2022;10(1):205. [PMID: 35987839] [DOI:10.1186/s40359-022-00911-8] [PMCID: PMC9392054]
18. Turner K, McCarthy VL. Stress and anxiety among nursing students: A review of intervention strategies in literature between 2009 and 2015. Nurse Educ Pract 2017;22:21-9. [PMID: 27889624] [DOI:10.1016/j.nepr.2016.11.002]
19. Raeissi P, Rajabi MR, Ahmadizadeh E, Rajabkhah K, Kakemam E. Quality of work life and factors associated with it among nurses in public hospitals, Iran. J Egypt Public Health Assoc 2019;94:1-8. [PMID: 32813080] [DOI:10.1186/s42506-019-0029-2] [PMCID: PMC7364675]
20. Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Hosp Res Institute 2011;2(1):1-12. [URL:]
21. Alipoor M, Noori B, Khaloobagheri E, Bazmandegan G, Kamyab Z, Khodaee M. The Relationship between Palliative Care Knowledge, and Anxiety, Stress and Depression of Nurses in the Critical Care Department of Ali Ibn Abi Talib (AS) Rafsanjan Hospital in 2021: A Cross-Sectional Study. J Crit Care Nurs 2023;16(2):61-72. [URL:]
22. Ariapooran S, Ahadi B, Khezeli M. Depression, anxiety, and suicidal ideation in nurses with and without symptoms of secondary traumatic stress during the COVID-19 outbreak. Arch Psychiatr Nurs 2022;37:76-81. [PMID: 35337442] [DOI:10.1016/j.apnu.2021.05.005] [PMCID: PMC8938317]
23. Faraji A, Karimi M, Azizi SM, Janatolmakan M, Khatony A. Occupational stress and its related demographic factors among Iranian CCU nurses: a cross-sectional study. BMC Res Notes 2019;12:1-5. [PMID: 31558161] [DOI:10.1186/s13104-019-4674-5] [PMCID: PMC6764133]
24. Hajiseyedrezaei Sr, Alaee N, Zayeri F. Survey of status stress among nurses that working in critical care units at hospitals of tehran city, 2019. Nurs Midwifery J 2020;18(1):1-10. [URL:]
25. Keshavarzi N, Nourian M, Oujian P, Alaee Karahroudi F. Clinical competence and its relationship with job stress among neonatal intensive care unit nurses: a descriptive study. Nurs Midwifery J 2021;19(7):527-38. [URL:] [DOI:10.52547/unmf.19.7.2]
26. Khani H, Ghodsi H, Nezhadnik H, Teymori S, Ghodsi AR. Depression and its relationship with hypochondriasis in nurses in Neyshabur, Iran. Mil Caring Sci 2016;3(1):34-40. [URL:] [DOI:10.18869/acadpub.mcs.3.1.34]
27. M. Khodaveisi MS, N. Mohammadi MS, A.Omidi MS. Frequency of Job Stress in Clinical Nurses. Avicenna J Nurs Midwifery Care 2006;13(2):44-54. [URL:]
28. Moudi S, Bijani A, Tayebi M, Habibi S. Relationship between death anxiety and mental health status among nurses in hospitals affiliated to Babol University of Medical Sciences. J Babol Univ Med Sci 2017;19(2):47-53. [URL:] [DOI:10.22088/jbums.19.2.47]
29. Nouroozi Kushali a, Hajiamini z, Ebadi a, Khamseh f, Rafieyan z, Sadeghi a. Comparison of Intensive Care Unit and General Wards Nurses' Emotional Reactions and Health Status. Adv Nurs Midwifery 2013;23(80):15-23. [URL:]
30. Pourghane P, Jafakesh S, Shahbazi A. Survey the level of occupational stress in nurses working in CCU departments. Caring Today 2007;3(8):23-9. [URL:]
31. Salimi S, Pakpour V, Rahmani A, Wilson M, Feizollahzadeh H. Compassion satisfaction, burnout, and secondary traumatic stress among critical care nurses in Iran. J Transcult Nurs 2020;31(1):59-66. [PMID: 30957715] [DOI:10.1177/1043659619838876]
32. Taghva A, Yazdani A, Ebrahimi M, Alizadeh K, Sakhabakhsh M. Prevalence of depression in psychiatric nurses and comparison with other parts of the AJA hospitals. J Nurse Physician War 2014(23):11-6. [URL:]
33. Tajvar A, Saraji GN, Ghanbarnejad A, Omidi L, Hosseini SSS, Abadi ASS. Occupational stress and mental health among nurses in a medical intensive care unit of a general hospital in Bandar Abbas in 2013. Electron Physician 2015;7(3):1108. [PMID: 26388976] [DOI:10.19082/1566] [PMCID: PMC4574696]
34. Talebian F, Goudarzi AH, Salehiniya H, Yaghoubi T. Relationship between Negative Affect and Mental Health of Nurses in Special Wards of Educational Hospitals Affiliated with Mazandaran University of Medical Sciences. Razi J Med Sci 2022;29(3):83-91. [PMID: 35693570] [DOI: 10.4314/ejhs.v32i2.21] [PMCID: PMC9175217]
35. Taleghani E, Noroozi M, Hadavi M. Prevalence of stress, anxiety and depression among nursing staff in intensive care units of Ali Ebn-e Abitaleb Hospital in Rafsanjan in 2017. Community Health J 2018;12(2):11-21. [URL:]
36. Tavakkoli S, Daman PV, Pourmosavi SM. Evaluation of death anxiety of nurses working in intensive care units (ICU) in Corona epidemic: Qom. J Iranian Soc Anaesthesiol Intensive Care 2021;43(4). [URL:]
37. Torkaman M, Heydari N, Kamali M. Occupational stress in intensive care units nurses: a cross-sectional study. Prev Care Nurs Midwifery J 2019;9(2):42-7. [URL:] [DOI:10.29252/pcnm.9.2.42]
38. Abdi H, Shahbazi L. Occupational stress in nurses working in the intensive care unit and its relationship with their job burnout. J Shahid Sadoughi Univ Med Sci 1999;9(3):58-63. [URL:]
39. Isfahani P, Bahador RC, Peirovy S, Afshari M, Samani S. Prevalence of depression among nurses of Iran: A meta-analysis. Evid Based Health Policy Manag Econ 2022;6(2):137-48. [URL:] [DOI:10.18502/jebhpme.v6i2.9945]
40. Shahri SSS, Ghashghaee A, Behzadifar M, Bragazzi NL, Behzadifar M, Mousavinejad N, et al. Depression among Iranian nurses: A systematic review and meta-analysis. Med J Islam Repub Iran 2017;31:130. [PMID: 29951430] [DOI:10.14196/mjiri.31.130] [PMCID: PMC601477]
41. Hemmati F, Sarokhani M, Abdan Z, Sarokhani D, Dehkordi AH, Fakhri M. The prevalence of depression, anxiety and stress in nurses working in Iranian hospitals: A systematic review and meta-analysis. Epidemiol Rev 2021;75(2):254-62. [PMID: 34696563] [DOI:10.32394/pe.75.24]
42. Mohammadi M, Vaisi-Raygani AA, Jalali R, Salari N, Sabbaghchi M. Prevalence of depression in nurses working in Iranian hospitals: a systematic review and Meta-analysis. Int J Med Rev 2020;7(1):32-8. [URL:] [DOI:10.30491/ijmr.2020.217384.1076]
43. Ameri M, Hosseini Nodoushan MR, Shahbazzadeh A, Arab Ahmadi M. Depression and its main determinants among Iranian operating room personnel: a systematic review and meta-analysis. Int Clin Neurosci J 2018;5(3):81-5. [URL:] [DOI:10.15171/icnj.2018.16]
44. Hachesu VR, Naderyan Fe'li S, Maajani K, Hokmabadi R, Golbabaei F. Prevalence of anxiety and depression in Iranian Health care workers during the COVID-19 pandemic: a systematic review and meta-analysis. J Health Saf Work 2022;12(1):123-40. [URL:] [DORL:]
45. Huang H, Xia Y, Zeng X, Lü A. Prevalence of depression and depressive symptoms among intensive care nurses: a meta‐analysis. Nurs Crit Care 2022;27(6):739-46. [PMID: 34989060] [DOI:10.1111/nicc.12734]
46. Xie N, Qin Y, Wang T, Zeng Y, Deng X, Guan L. Prevalence of depressive symptoms among nurses in China: a systematic review and meta-analysis. PloS One 2020;15(7):e0235448. [PMID: 32634150] [DOI:10.1371/journal.pone.0235448] [PMCID: PMC7340293]
47. Ślusarska B, Nowicki GJ, Niedorys-Karczmarczyk B, Chrzan-Rodak A. Prevalence of depression and anxiety in nurses during the first eleven months of the COVID-19 pandemic: a systematic review and meta-analysis. Int J Environ Res Public Health 2022;19(3):1154. [PMID: 35162183] [DOI:10.3390/ijerph19031154]
48. Al Maqbali M, Al Sinani M, Al-Lenjawi B. Prevalence of stress, depression, anxiety and sleep disturbance among nurses during the COVID-19 pandemic: A systematic review and meta-analysis. J Psychosom Res 2021;141:110343. [PMID: 33360329] [DOI:10.1016/j.jpsychores.2020.110343] [PMCID: PMC7831768]
49. Tung Y-J, Lo KK, Ho RC, Tam WSW. Prevalence of depression among nursing students: A systematic review and meta-analysis. Nurse Educ Today 2018;63:119-29. [PMID: 29432998] [DOI:10.1016/j.nedt.2018.01.009]
50. Vargas Dd, Dias APV. Depression prevalence in Intensive Care Unit nursing workers: a study at hospitals in a northwestern city of São Paulo State. Rev Lat Am Enfermagem 2011;19:1114-21. [PMID: 22030575] [DOI:10.1590/S0104-11692011000500008]
51. McVicar A. Workplace stress in nursing: a literature review. J Adv Nurs 2003;44(6):633-42. [PMID: 14651686] [DOI:10.1046/j.0309-2402.2003.02853.x]
52. Jiaru J, Yanxue Z, Wennv H. Incidence of stress among emergency nurses: A systematic review and meta-analysis. Medicine 2023;102(4):e31963. [PMID: 36705357] [DOI:10.1097/MD.0000000000031963] [PMCID: PMC9875949]
53. Gheshlagh RG, Parizad N, Dalvand S, Zarei M, Farajzadeh M, Karami M, et al. The prevalence of job stress among nurses in Iran: A meta-analysis study. Nurs Midwifery Stud 2017;6(4):143-8. [URL:] [DOI:10.4103/nms.nms_33_17]
54. Isfahani P, Shamsaie M, Peirovy S, Bahador RC, Afshari M. Job stress among Iranian nurses: A meta-analysis. Nurs Midwifery Stud 2021;10(1):57-64. [URL:] [DOI:10.4103/nms.nms_28_20]
55. Mohammadi M, Vaisi-Raygani A, Jalali R, Salari N. Prevalence of job stress in nurses working in Iranian hospitals: a systematic review, meta-analysis and meta-regression study. J Health Safety Work 2020;10(2):119-28. [URL:]
56. Aberhe W, Mariye T, Bahrey D, Hailay A, Mebrahtom G, Zereabruk K, et al. Job stress among nurses in Ethiopia: A Systematic Review and Meta-analysis. Int J Afr Nurs Sci 2024:100661. [URL:] [DOI:10.1016/j.ijans.2024.100661]
57. Poncet MC, Toullic P, Papazian L, Kentish-Barnes N, Timsit J-F, Pochard F, et al. Burnout syndrome in critical care nursing staff. Am J Respir Crit Care Med 2007;175(7):698-704. [PMID: 17110646] [DOI:10.1164/rccm.200606-806OC]
58. Johan S, Sarwar H, Majeed I. To identify the causes of stress among nurses working in intensive care unit of Ittefaq Hospital Lahore. Int J Soc Sci Manag 2017;4(2):96-109. [URL:] [DOI:10.3126/ijssm.v4i2.17159]
59. Isfahani P, Arefi M, Borang MS, Mirboluki E, Rasoulkhani F, Alirezaei S, et al. Anxiety in Iranian Nurses during the COVID-19 Pandemic: A Meta-Analysis. J Iranian Inst Health Sci Res 2023;22(6):749-59. [URL:] [DOI:10.61186/payesh.22.6.749]
60. Raoofi S, Kan FP, Rafiei S, Khani S, Hosseinifard H, Tajik F, et al. Anxiety during the COVID-19 pandemic in hospital staff: systematic review plus meta-analysis. BMJ Support Palliat Care 2023;13(2):127-35. [PMID: 34312187] [DOI:10.1136/bmjspcare-2021-003125]
61. Rezaei-Hachesu V, Naderyan Fe'li S, Maajani K, Golbabaei F. The global prevalence of anxiety, depression, and insomnia among healthcare workers during the Covid-19 pandemic: a systematic review and meta-analysis. J Occup Health Epidemiol 2022;11(1):48-66. [URL:] [DOI:10.52547/johe.11.1.48]

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