Due to demanding work schedules (e.g., shift work, long work hours, and overtime) and a variety of physical and psychosocial occupational stresses, nurses are at a high risk for work–family conflict and its negative consequences (e.g., workload and time pressure). Work–family conflict has been studied in the nursing staff and has been linked to mental disorders such as emotional tiredness and depressive symptoms [14]. Nurses with sleep difficulties due to excessive workload were at a higher risk of work stress and burnout as a result of their work and the patients [27].
The aim of this study was to examine the relationship between work–family conflict, sleep quality, and depressive symptoms among mental health nurses. The findings generally answered research questions.
The current study found that nurses had a mean age of 28.46 ± 6.28 with a range of 21 to 50 years that less than three-quarters of them were female, that the majority of them were married, and that their mean working experience score was 8.14 ± 5.14. Similarly, it was reported that the mean working experience in nursing was 15.73 years (SD = 5.64 years) in a study conducted in Greece, where the majority of those who took part were women (64.5%) and married (59.1%) [28].
Furthermore, Chueh, Chen, and Lin [29] found that the 119 participants’ mean age was 31.6 (SD = 7.6) years, with a range of 20 to 50 years, and that more than half of them were married. However, their result is lower than the mean working experience score reported in previous studies among nurses. In a similar study, Christina and Konjengbam [11] reported a greater mean score of 12.90 ± 8.057 among nursing staff at a tertiary hospital in Manipur, based on Cheng et al. [30], whose observations revealed that the mean job experience was 6.7 ± 6.4 years and more nurses who working in teaching medical center were female.
According to the current study findings, the nurses’ work interference with family mean score was 29 ± 7.49, family interference with work mean score was 26.295 ± 5.95, and work–family conflict mean score was 55.295 ± 12.62. As a result, WIF was found to be more significant than FIW. The first research question was answered by this result. In accordance with this study results, Sugawara et al. [4] found that, the WIF mean score was 23.4 ± 8.1 and the FIW mean score was 18.7 ± 6.2 among mental health nurses. As well, previous and recent researches conducted in China indicated that work–family conflict was more significant than family–work conflict [18, 31].
In the present study, nurses’ marital status was found to have statistically significant relations with WIF, FIW, and overall WFC. This could be explained by the fact that married nurses were more disturbed than unmarried ones due to that nurses with small children, those with employee husbands, nurses who work rotational shifts, and those who work in wards where patients are hurried leading to that those nurses are overworked much consequently experienced more role challenges. This finding is consistent with that of a study conducted in Iran, which showed that family influences include family members’ expectations of the nurse, as well as conflicts between family and professional roles [21].
The age of nurses under study was found to have highly statistically significant relations with work interference with family, family interference with work, and overall work–family conflict, with nurses aged 30 years or more being influenced more than nurses aged less than thirty. This could be due to that older nurses are given more duties and roles. However, this result contradicted with findings of a recent research carried out on Filipino nurses, which found that nurses’ age strongly predicted WFC, with newly qualified nurses showing higher levels of WFC than older nurses [32].
The current study result revealed that a statistically significant relation was detected between nurses’ educational level and family interference with work, with technical institute graduate nurses having the highest mean as experiencing the most family interference with work, followed by diploma nurses, and bachelor’s nurses were experiencing the least. This result is consistent with that of a study on Filipino nurses, with a B.Sc.N degree who reported a higher level of WFC when compared to nurses with higher education [32]. As previously clarified, higher education is required for the development of improved cognitive capacities, strong clinical judgment, and problem-solving ability, all of which are crucial when dealing with work–family conflict [33]. Furthermore, a much higher education can boost personal resources like self-efficacy or confidence, professional autonomy, and skill mastery [34].
According to this study results, more than three-quarters of studied nurses had poor sleep quality. The second research question was answered by this result. This could be due to that the current study is carried on mental nurses, who work in difficult working conditions and have long working hours with limited flexibility. In a related survey conducted in China, the sleep quality of medical nurses was poor [35]. As well, in Korea, 79.8% of clinical nurses reported having poor sleep quality [36] which is greater than the prevalence of 69.9% poor sleep quality among Saudi nursing students [37].
However, these findings are higher than the prevalence reported among nurses by previous studies. Using the Chinese version of the PSQI, the incidence of poor sleep quality among nurses in North China was 56.7% [38], an even higher prevalence of 65% among nursing professionals in Southeastern Brazil [39], and the prevalence of 46% among South Indian nurses [40].
As well, these previous results agreed with several scattered researches which found a relatively higher percentage more than 70% of nurses who work in general hospitals and emergency departments had poor sleep quality [41,42,43,44]. Similarly, 71.3% of nurses working in teaching medical centers in Taiwan reported poor sleep quality [30]. Poor sleep quality is a common health problem among staff nurses, according to the current study data. However, if nurses experience poor sleep quality on a regular basis, it may influence their professional and family life, as well as their health.
The current study results indicated that, the nurses’ sleep quality mean score was 8.14 ± 3.1, which agrees with those of a research conducted in a tertiary hospital in Manipur about sleep quality among nurses which found that the mean sleep quality score was 4.98 ± 3.123 [11]. Similar research in Istanbul indicated that the average age of the nurses on the PSQI scale was 6.65 ± 3.48, and 61.9% of the nurses reported poor sleep quality [45]. Furthermore, Dong et al. [46] detected that the average PSQI score among clinical nurses in general hospitals was 7.32 ± 3.24, with 3163 participants receiving a PSQI ≥ 5, while Chueh, et al. [29] revealed that sleep status had an average PSQI score of 7.2 (SD = 3.1) points.
The current study results revealed that, there was a statistically significant relation between nurses’ poor sleep quality and representing majority female sex, as well as a statistically significant relation between nurses’ sleep quality and their educational level, with the majority of technical institute graduates and bachelor degree nurses having poor sleep quality. As well, there was a statistically significant relation between sleep quality and their income level among nurses, with the majority of nurses with insufficient income having poor sleep quality.
As expected, working more night shifts a month is connected with an increase in sleep disturbances, as shown by several large studies on clinical nurses in general hospitals [43, 46, 47], while the current study result showed that, nurses’ sleep quality had no statistically significant relation with shift manner. This could be explained as most of them are taking daily naps during a night shift which may reduce sleep disturbances. Similarly, another research conducted in a tertiary hospital located in Imphal, Manipur, India, found no difference between nurses who performed only day shifts and those whose shifts included night, with regard to sleep quality [11].
According to the present study results, the nurses’ depressive symptoms mean score was 25.3 ± 9.73, with slightly less than two-thirds of them experiencing depressive symptoms. The third research question was answered by this result. This could be explained by the fact that nurses working in mental hospitals and clinics are more likely to suffer from depressive symptoms as a result of the stressful working conditions, job uncertainty, and life pressures they face. This finding is to some extent, similar to that of a previous study conducted in Japan in 2017, which reported that, the mean score of nurses’ depression was 16.7 ± 10.5 [4]. However, according to one other previous study conducted in the same year in Iran, the frequency of depression among Iranian nurses was only 22%. Furthermore, the average score of nurses’ depression was 10.5 (SD = 7.2) points among nurses working in general hospitals [48], which was greater than that of a very recent study research conducted in northern Taiwan [29].
The present study results revealed that, nurses’ depressive symptoms had highly statistically significant relations with their age. This means that all nurses aged 30 years or more suffered from depressive symptoms. This result is consistent with that of a research about sleep disturbance and depression in Iranian nurses, which revealed that age was positively associated with depression [27]. Additionally, a study conducted in China aimed to assess the association between work-family conflict and depressive symptoms among female nurses found that people under the age of 40 were more likely to have depressive symptoms [14]. Similarly, a study conducted in Malayer, Iran reported that work experience was positively associated with depression among nurses in general hospitals [27].
The current study findings confirmed that the majority of nurses having 10 years of experience or more suffered from depressive symptoms. This may be due to experiencing work stress, role overload, and a lack of compliment. Nurses’ depressive symptoms were found to have highly statistically significant positive relationships with their age, as well as with marital status, while with years of experience, it was only a statistically significant relation. This finding is consistent with that of Tsaras et al., who investigated “Predicting Factors of Depression and Anxiety in Mental Health Nurses,” in Greece, and found that age, marital status, educational level, and nursing experience were all associated with elevated depressive symptoms in mental health nurses [28].
In the same line, work–family conflict was positively associated with depressive symptoms among nurses in a previous study conducted in the northeastern United States [3], which is also consistent with other previous studies’ results in nursing populations [14, 49]. Moreover, an earlier study conducted in Malaysia found strong associations among work–family conflict, psychological strain, stress, anxiety, and depression [50].
Nurses’ family interference with work was shown to be highly statistically significantly positively correlated with sleep quality and their age in the current study. This highlighted that nurses beyond the age of 30 had a greater impact than nurses under the age of thirty. This study result is congruent with that of Aazami et al., who in their study on Malaysian working women found that high levels of strain-based FIW impact the sleep quality of women in their 30s. They explained that women in their 30s have often established their jobs and are well-versed in their fields. As a result, stress from home responsibilities interferes with job performance, and the magnitude of this type of conflict is strong enough to disrupt sleep among women working as civil servants [13].
The current study result showed that highly statistically significantly positive correlation between overall WFC and Pittsburgh Sleep Quality Index, which means that work–family conflict leads to poor sleep quality. The fourth research question was answered by this result. The preceding finding is consistent with that of Zhang, et al. [3], who found that sleep disturbances are related to both work–family conflict and depressive symptoms in nurses, verifying justifying their hypothesis. Sleep quantity and quality have previously been linked to work–family conflict among nurses [51].
Work–family conflict was found to be positively related to the Pittsburgh Sleep Quality Index in a study of Chinese nurses working in comprehensive tertiary hospital [18], and a previous study found a link between work–family conflicts and sleep issues [52]. However, a study of 744 nursing assistants in 15 non-unionized facilities in Maryland and New England found that the relationship between work–family conflict and sleep quantity or quality was not statistically significant (p > .05). The difference could be attributed to various settings. Generally, WFCs of hospital nurses working in nursing homes must be reduced, according to hospital management [8].
In this study, highly statistically significant correlation was found between depressive symptoms and overall work family conflict. This study result answered the fourth research question. This result agrees with that of a study on Chinese female nurses which showed that high levels of WFCs can affect work performance, and as a result, lead to psychological depression among female Chinese nurses [14]. In addition, Zhang et al. reported that there was a significant a correlation between work–family conflict and depressive symptoms in nurses (β = 2.22, p < .001) [3].
The current study findings demonstrated that depressive symptoms and Work Interference with Family are highly statistically significantly positively correlated. This finding was comparable to that of Zhang et al., who found that more work–family interference was linked to higher physical and psychological demands at work [8].
Concerning the nurses’ depressive symptoms, the current study found that depression symptoms among nurses were very statistically significantly positively correlated with sleep quality. This finding is consistent with the findings of a study conducted among Saudi nursing students, which found a weak positive correlation between sleep quality and depression (r = 0.274, p < 0.001) [37]. Similarly, a very recent study conducted in northern Taiwan that tried to examine which psychological distress variables are associated with sleep difficulties among female nurses, found that depression (β = 0.15, p = .007) was significantly associated with sleep disturbance [29].
According to the findings of this study, family interference with work was extremely statistically significantly positively correlated with work interference with family. This result could be seen as a conflict between work and family responsibilities, as high work demands deplete time and energy that could otherwise be employed for family responsibilities. As a result, the family’s role will be threatened. This result differed from that found in Jakarta, which indicated a negative and substantial link between both directions of work–family conflict (WIF & FIW) among working mother [5].
Finally, a multi variate linears regression was used to predict nurses’ depressive symptoms score from Family interference with work score, sleep quality score, and Work interference with family score in the current study. These variables predicted depressive symptoms score as statistically significantly (f = 43.5, p = .0001, R2 = 0.492). In comparing this result with that of a study done in Maryland and New England, showed that Sleep quality was introduced into the multivariate linear regression model for work–family conflict and mental health. Poor sleep quality was linked to lower mental health scores (model 2, R2 = 16.1%, β = − 5.22, p < .01), and it reduced the link between work–family conflict and mental health by 5.5% [8].
Similarly, Christina and Konjengbam [11], found in their study that, Poor sleep quality, can lead to depression in their study. Moreover, depression is exacerbated by poor sleep quality [45]. Additionally, a significant relationship was found between work–family conflict and sleep disruptions (model 2, R2 = .15, F [11, 346] = 5.71, β = 3.67, p < .001) [3], as well as between sleep disturbances and depressed symptoms (model 3, R2 = .32, F[11, 341] = 14.33, β = .27, p < .001) and nurses are more likely to suffer from depression and lack of concentration in their everyday work if their sleep quality is poor [18].