Network analysis of burnout, depression, and anxiety with occupational and personal outcomes among clinical nurses in China

Chinese nurses face staff shortages and heavy workloads, leading to increased depression, anxiety, and burnout. This study aimed to examine the symptom network of burnout, depression, and anxiety and its associations with negative personal and occupational outcomes among Chinese nurses. A total of 2092 nurses were recruited through snowball sampling. Burnout, depression, and anxiety were assessed using the two single-item burnout measures, Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder Scale-7 (GAD-7), respectively. Adverse outcomes, including low quality of life (QOL), suicidal ideation (SI), turnover intention, and medical errors, were also assessed. The network was estimated via the EBICglasso model, and centrality indices and bridge centrality indices were calculated to identify central and bridge symptoms, respectively. The prevalence of depression, anxiety, burnout, low QOL, medical error, turnover intention, and SI was 30.1%, 16.5%, 26.4%, 34.4%, 16.1%, 26.0%, and 26.5%, respectively. Results showed that GAD2 (Uncontrollable worry) was the most central symptom, whereas emotional exhaustion (EX), PHQ8 (Motor), and PHQ4 (Fatigue) were bridge symptoms. Depersonalization (DP) was most strongly associated with adverse work outcomes, and EX was the strongest predictor of poor QOL. The findings highlight the need for early detection and intervention for burnout to mitigate negative impacts.