Exploring the bidirectional relationships and mediating pathways between burnout and depression, anxiety, and sleep among cancer nursing staff: A multicenter study in China

Backgrounds: Burnout is related to nursing turnover, especially among cancer nursing staff. Evidence shows that depression, anxiety, and sleep are all associated with burnout. However, no studies have explored the potential bidirectional and mediating effects among them. Methods: A total of 1023 cancer nursing staff from 20 hospitals from January 2021 to January 2023 in the economically developed, central, and western regions of China were selected for this study. The Self-Rating Depression Scale, Self-Rating Anxiety Scale, Pittsburgh Sleep Quality Index, and Maslach Burnout Inventory General Survey were used to assess their depression, anxiety, sleep, and burnout. An online questionnaire was used for the assessment. Cross-lagged panel modeling (CLPM) was applied to reveal the associations between depression, anxiety, sleep, and burnout after adjusting for demographic variables. Results: Age group differences in PSQI, SDS, SAS, and burnout at baseline were statistically significant, and the older the age, the higher the score (p < 0.001). The difference in SDS between gender groups was statistically significant (54.969.65 vs. 53.629.14, p = 0.030). The difference in PSQI between marital status groups was statistically significant, with the divorce group scoring the highest (P = 0.049). Models for this analysis showed significant net predictive effects of baseline depression, anxiety, and sleep on follow-up burnout, and a significant net predictive effect of baseline burnout on follow-up sleep. The mediating effects of depression (indirect effect: 0.011, 95% CI: 0.007, 0.016) and anxiety (indirect effect: 0.012, 95% CI: 0.007, 0.017) held true when sleep was the independent variable and burnout was the dependent variable. Conclusions: Both the bidirectional cross-causal effects and potential mediating effects can contribute to the understanding of the factors influencing burnout among cancer nursing staff. Early intervention targeting relevant factors may be beneficial in alleviating burnout among cancer nursing staff.