Association of Anxiety and Depression with Work Engagement among Hospital Nurses in an Ethnically Diverse Region of Iran: A cross-sectional study

Abstract Background Work engagement is a positive, work-related state of mind characterized by vigor, dedication, and absorption, and a key determinant of the quality and safety of nursing care. Nurses experience disproportionately high rates of anxiety and depressive symptoms. However, the relationship between these symptoms and engagement, and the role of sociodemographic and ethnolinguistic factors, remains poorly understood outside high-income settings. This study examined whether anxiety and depressive symptoms were associated with work engagement among hospital nurses, and whether sociodemographic characteristics, including ethnolinguistic background (mother tongue), were associated with engagement or modified this relationship. Methods We performed a cross-sectional study in 2025 on all 300 nurses employed at Panj-e-Azar Hospital, Gorgan, Iran. Anxiety and depressive symptoms were measured with the Hospital Anxiety and Depression Scale (HADS), and work engagement with the 17-item Utrecht Work Engagement Scale (UWES). Spearman correlations and univariate and multivariable linear regression models were fitted to examine associations of anxiety, depression, and demographic variables (sex, age, marital status, education, income, and mother tongue) with engagement. Statistical significance was set at p < 0.05. Results Clinically relevant anxiety (borderline or probable) was present in 43.3% of nurses, and depressive symptomatology in 55.4%. Higher anxiety and depressive symptoms were negatively correlated with vigor, dedication, and total work engagement (all p < 0.001), whereas absorption was correlated only with depression. In multivariable analysis, depressive symptoms were the strongest independent negative correlate of total work engagement and higher education the only positive independent correlate; anxiety, age, sex, marital status, income and mother tongue were not independently associated. Although the sample was drawn from an ethnically diverse region, self-reported mother tongue (Farsi, Turkmen, other) was unrelated to engagement in unadjusted and adjusted analyses. Conclusions Depressive symptoms are an important and independent negative correlate of work engagement among nurses, and their effect exceeded that of anxiety. Higher education was associated with greater engagement. In this predominantly Farsi-speaking sample, ethnolinguistic background was not associated with work engagement, suggesting that ethnicity-related influences, if present, operate through workplace climate rather than background alone. Screening for symptoms of depression and increasing education and training can protect nurse engagement and, in turn, quality of care.