Factors associated with depression, anxiety and stress among nurses in Ghana and the role of coping strategies

Workplace-related depression, anxiety, and stress significantly affect the wellbeing and job performance of nurses and may compromise the quality of healthcare delivery. The demanding nature of healthcare environments, particularly shift work and excessive workload, has been identified as a major contributor to mental health problems among nurses.To examine factors associated with workplace depression, anxiety, and stress among nurses in Ghana, and to assess the mediating and moderating role of coping strategies in the relationship between work schedule and mental health outcomes.The study employed a cross-sectional design with a quantitative approach using multistage sampling. Data were collected using a structured questionnaire and the DASS-21 scale via KoboCollect. Descriptive statistics and binary logistic regression analyses were conducted using Stata version 17.0, while mediation and moderation analyses were performed in RStudio using PROCESS Macro Models 4 and 1.The prevalence of depressive symptoms, anxiety symptoms, and stress symptoms among the respondents was 20.0%, 18.7%, and 74.2%, respectively. Nurses working in the Emergency/Medical Ward/ICU had higher odds of depressive symptoms (aOR = 7.1, 95% CI: 3.8–9.6, p = 0.006), stress symptoms (aOR = 1.7, 95% CI: 1.4–2.1, p < 0.001), and anxiety symptoms (aOR = 5.1, 95% CI: 2.7–7.1, p = 0.039). Similarly, respondents working fixed night shifts had higher odds of depressive symptoms (aOR = 10.0, 95% CI: 3.14–17.1, p < 0.001), stress symptoms (aOR = 2.0, 95% CI: 1.1–4.8, p = 0.004), and anxiety symptoms (aOR = 3.1, 95% CI: 2.2–7.0, p = 0.006) compared with those working rotating shifts. Mediation analysis showed that fixed night-shift work was associated with avoidance-based coping (a = 0.42, p < 0.001), with significant indirect effects for depressive symptoms (β = 0.23), stress symptoms (β = 0.19), and anxiety symptoms (β = 0.21). Moderation analysis revealed significant interaction effects between avoidance-based coping and work schedule for depressive symptoms (β = 0.34, p < 0.001), stress symptoms (β = 0.27, p = 0.003), and anxiety symptoms (β = 0.30, p < 0.001).This study found a high prevalence of depressive, anxiety, and stress symptoms among nurses in Greater Accra, with stress being the most common. Work schedule, department/unit, professional characteristics, and coping strategies were associated with mental health outcomes. Significant indirect and interaction effects involving coping strategies were also observed in the relationship between work schedule and mental health symptoms. Given the cross-sectional design, these findings should be interpreted as associations rather than causal effects.