Anxiety is a psychological and physiological state characterized by cognitive, somatic, emotional, and behavioral components which combine to create an unpleasant feeling that is typically associated with uneasiness, apprehension, fear, or worry [1
]. Anxiety can be a normal reaction to stress or threat, and it may help one to deal with stressful or threatening situations. However, when it becomes excessive and persistent, it becomes a disabling medical condition known as anxiety disorder, which, if let untreated, can get worse; frequently accompanied by physiological symptoms such as headache, sweating, muscle spasms, palpitations, fatigue or even exhaustion [1
Anxiety disorders are the most common class of psychiatric disorders in the U.S. [2
] and many other countries [3
]. In the U.S. alone, anxiety disorders affect about 40 million adults aged 18
years and older (about 18% of that population) annually and affect approximately 28.8% of the U.S. population in their life time [2
]. According to an ESEMeD study including six European countries, the 12-month prevalence of inappropriate anxiety was 6.4% [5
]. In a more recent systematic review of studies conducted in 16 European countries, however, this value was estimated to be 12% [6
]. In China, anxiety is also one of the most common mental disorders. A recent survey of mental disorders in Chinese population aged 18 and older showed that the current (1-month) prevalence of anxiety disorders was about 5.6% [7
]. It is estimated that one-eighth of the total population worldwide suffers from inappropriate anxiety [8
Anxiety disorders adversely affect a person’s quality of life, and can be debilitating in severe cases. They can be symptoms of an underlying health issue such as chronic obstructive pulmonary disease (COPD) and/or heart failure [9
]. Anxiety disorders are also highly comorbid with each other and other psychiatric disorders such as depression and substance abuse [4
]. Many epidemiologic studies have suggested that psychiatric and nonpsychiatric patients with chronic anxiety may be at risk for developing coronary heart disease [10
]. Anxiety disorders impose both an individual and a social burden that amounts to a total cost of $42.3 billion in the U.S. in 1990 [11
]. On the other hand, population-based studies have shown that anxiety disorders frequently go untreated [12
], and people with anxiety symptoms or disorders rarely seek help from mental or non-mental medical professionals [7
Prevalence of anxiety disorders varies among different populations. For example, women have been known to have higher prevalence than men; Older age (e.g. 40
years or older) has been associated with higher prevalence than the younger; People living in urban areas tend to have higher prevalence than people in the rural areas [7
]. In an UK obese population, as many as 56% of patients met the minimum criteria for an anxiety disorder [14
Nurses are an indispensable component of the work force in the health care system, and their work performance will undoubtedly affect the overall quality of patient care in the hospital. In this sense, the mental health of nurses deserves attention from nursing managers and hospital administrators. Studies have shown that, in general, the prevalence of anxiety in nurses is higher than that of the whole population, although it may vary greatly from country to country or between different nursing specialties. The lowest reported prevalence (7%) was seen in Japanese nurses who were working in the acute care hospitals (including departments of internal medicine, surgery, intensive care, operating room and outpatient clinic) [15
]. The highest reported prevalence of anxiety (43.2%) was found in Iranian hospital nurses who had to do shift work [16
]. In Singapore, 21% of nurses in a general hospital were found to suffering from anxiety disorders, but, interestingly, only a very small proportion actually sought help for their emotional problems (<4%) [17
]. In the U.S., about 20% of ICU and general care nurses from different hospitals had symptoms consistent with possible anxiety [18
]. Results of these studies indicated that hospital nursing is a profession that predisposes the workers to mental impairment such as anxiety.
Chinese nurses in the hospitals are known to work in stressful environment. This of course involves the characteristics of the profession such as the concerns with the occupational hazards (e.g. infections or injuries); worries over potential medical accidents and the associated consequences; physical and psychological exhaustion due to the intensive care of patients in emergency and seeing the death and suffering of patients. Social aspects of their work may also contribute to work stress. Generally, in Chinese society, the social status of nurses is relatively low and their work is often not highly valued. In some hospitals, they are not even well respected by their hospital administrators and doctors. In addition, the mode of nursing care in Chinese hospitals has changed rapidly in recent years. There is also dramatic reform in the medical care services in China which deviates from the previous market-oriented service system and emphasizes more the public welfare of the state owned hospitals. All the situations and changes make nursing practice even more demanding and challenging to nurses. As studies have pointed out the link between adverse psychosocial factors in the work environment and the psychological and physical health in nurses of other countries [19
], we hypothesize that Chinese nurses in public hospitals may find it difficult to adapt to the stress in their work and, as a result, may develop mental health problems such as anxiety. To test the hypothesis, we conducted a survey on the anxiety symptoms, one of the most common of mental problems in Chinese nurses.
In order to explore the associated factors for the anxiety symptoms of Chinese nurses, two theoretical models addressing work related stress have been included in the study. One is the JDC model proposed by Kaasek [21
]. The JDC model holds that psychological strains occur when the demand of the job is high, and the job control (decision latitude) and social interactions (social support) are low. Studies have shown that it is a useful model for explaining work stress and its adverse effect on health [23
]. The other model, known as the effort-reward imbalance (ERI) model, believes that psychological strains happen when people feel that their effort in work is not adequately appreciated. In addition, a personal characteristic i.e. excessive emotional and mental involvement with the work (overcommitment) may aggravate the strain [25
]. The two models complement each other in that the JDC model deals with the task characteristics and social aspect of the job, while the ERI model touches on the perceived effort-reward imbalance and personal cognitive style of coping with the work. Therefore, factors of both models were included together with demographic factors, factors of lifestyle behavior and additional work conditions.
In this study, we attempted to assess the prevalence of anxiety symptoms among Chinese nurses working in public city hospitals. In addition, we aimed to find out whether demographic factors, lifestyle, work conditions, job content and effort-reward imbalance were associated with the anxiety symptoms.