Front. Public HealthFrontiers in Public HealthFront. Public Health2296-2565Frontiers Media S.A.10.3389/fpubh.2025.1617148Public HealthOriginal ResearchThe relationship of job and life satisfaction with symptoms of anxiety, depression, and irritability/anger in nursesSerzyskoBogusława1*†MroczkowskaRenata2†KamińskaJolanta3†PodsiadłoBeata4ŻarczyńskiGrzegorz5KrajzaAnna61Department of Healthcare, Higher School of Applied Sciences in Ruda Śląska, Ruda Śląska, Poland2Institute of Health Sciences, University of Opole, Opole, Poland3Faculty of Medicine and Health Sciences, Academy of Applied Sciences in Nowy Sącz, Nowy Sącz, Poland4Silesian Medical University in Katowice Faculty of Health Sciences in Katowice, Katowice, Poland5College of Health Sciences in Bydgoszcz, Bydgoszcz, Poland6Maria Sklodowska-Curie National Institute of Oncology, National Research Institute Gliwice, Gliwice, Poland
Edited by: Federica Vallone, University of Naples Federico II, Italy
Reviewed by: Lambert Zixin Li, National University of Singapore, Singapore
Maria Francesca Cattaneo Della Volta, University of Naples Federico II, Italy
Hadi Khoshab, Bam University of Medical Sciences and Health Services, Iran
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Introduction
The nursing profession involves substantial emotional and organizational demands, which may negatively affect nurses’ mental health and overall satisfaction with life and work.
Objective
To assess the levels of anxiety, depression, and irritability/anger symptoms in nurses and examine their associations with life and job satisfaction. In this study, the HADS-M subscale assessing irritability/anger was used. It captures symptoms of irritability and anger but does not measure aggression or anger expression as behavioral constructs.
Methods
A cross-sectional online survey was conducted among 538 registered nurses in Poland. Validated instruments were applied: HADS-M (for anxiety, depression, and irritability/anger symptoms), SWLS (life satisfaction), and SSP (job satisfaction). Statistical analyses included descriptive statistics, Spearman’s rank-order correlations, internal consistency (Cronbach’s alpha), and multiple linear regression (two-tailed, α = 0.05).
Results
A high prevalence of psychological symptoms was observed. All symptom domains were significantly and negatively correlated with life and job satisfaction (p < 0.001). Multiple regression analyses indicated that depressive symptoms were the strongest predictors of both life satisfaction (β = −0.429) and job satisfaction (β = −0.315), followed by irritability/anger symptoms. All models were statistically significant (p < 0.001).
Conclusion
Anxiety, depression, and irritability/irritability/anger symptoms significantly reduce nurses’ satisfaction with life and work. Depressive symptoms exerted the most profound impact. These findings emphasize the urgent need for targeted mental health support programs and preventive strategies to enhance nurses’ well-being and professional performance.
nursesjob satisfactionlife satisfactionanxiety symptomsdepression symptomsirritability/anger symptomsmental healthoccupational stresssection-at-acceptanceOccupational Health and SafetyIntroduction
Nurses play a pivotal role not only in providing direct patient care but also in shaping standards of care and advancing the professional development of nursing as a discipline (1, 2). They constitute the largest professional group in the Polish healthcare system. According to data from the Supreme Chamber of Nurses and Midwives, by 2022, 36% of actively employed nurses were aged 51–60, and nearly one-third were eligible for retirement. The average age of a nurse in Poland was 54 years and is projected to increase to 58 years by 2030 (3).
The majority of nurses work in rotating shifts, which disrupt circadian rhythms and adversely affect both mental and physical functioning (4). Nursing is considered a profession with a high risk of exposure to occupational stressors. In addition to shift work, the most frequently cited burdens include exposure to death and dying, emotional and physical overload, staff shortages, workplace bullying, and professional burnout (5, 6). The cumulative effect of these factors may result in decreased quality of life and reduced job satisfaction.
Subjective quality of life is a key component of psychological well-being (7, 8). Research indicates that chronic stress, emotional exhaustion, and negative affective states-frequently experienced by nurse-may diminish the quality of care, professional performance, and job satisfaction (9). Emotional responses such as anxiety, worry, and irritability are natural elements of daily functioning; however, prolonged stress exposure can result in psychophysiological dysfunctions, including sleep disturbances, somatic complaints, cardiovascular issues, or substance abuse (10–20). Shift work further impairs the gastrointestinal, hormonal, and cardiovascular systems (21–23). Accordingly, the World Health Organization recognizes nursing as one of the most demanding and stressful professions (24).
Studies conducted by researchers such as Zheng et al. (25), Desouky and Allama (26), Niedhammer et al. (27), and Nakada et al. (28) confirm high prevalence of depressive symptoms among nurses. Zheng et al. (25) additionally demonstrated that these symptoms are often intensified in this professional group. Studies conducted among nurses in Iran also confirm the frequent occurrence of anxiety and depressive disorders (29, 30). Abadi et al. (31) examined the influence of personality and occupational factors on the prevalence of anxiety and depression. Both physical and mental health in nurses are closely linked to the quality of their professional performance—particularly in relation to patient care, job satisfaction, and efficacy.
In recent years, growing attention has been paid to anger symptoms and irritability as important indicators of psychological strain among nurses. Although not always manifesting as overt aggression, these symptoms are often referred to in the literature as irritability (internalized anger) and may reflect difficulties in emotional regulation. Studies indicate that trait anger and modes of anger expression—particularly emotional suppression—are associated with lower job satisfaction and greater risk of burnout. Additionally, nurses frequently experience aggression in the workplace, both from patients and colleagues, which significantly compromises their psychological well-being. Such experiences may lead to chronic overload, reduced engagement, and lower job satisfaction (32–38).
Today’s nursing work environment also involves a risk of direct emotional aggression from patients or their families. Such encounters may result in chronic stress, anxiety, emotional tension, and overall deterioration in well-being. In severe cases, they may lead to post-traumatic stress disorder (PTSD) (38). In the face of such threats, job motivation, satisfaction, and care quality may deteriorate, while the risk of medical errors and adverse events increases (20).
To better understand these associations, this study adopted the Job Demands-Resources (JD-R) model, which posits that occupational well-being depends on the balance between job demands (e.g., workload, emotional pressure) and resources (e.g., support, autonomy, recognition) (39, 40). When demands outweigh resources, the risk of burnout and emotional dysregulation increases. This approach is complemented by the Job Demand—Control model (41), which emphasizes that the greatest risk of occupational stress occurs when high workload is accompanied by low decision latitude (42). Siegrist’s effort–reward imbalance model (43) further suggests that insufficient rewards—both financial and emotional—in the context of high employee effort contribute to chronic stress and depressive symptoms (44). On the individual level, the theory of emotional self-regulation (Baumeister and Heatherton) (45) proposes that chronic stress weakens the ability to control emotions, which may lead to irritability and a decline in quality of life (46).
Recently, increased scholarly attention has been devoted to anger symptoms-often labeled “irritability” or “nervousness” in the literature. Although these symptoms are not unequivocally classified as clinical aggression, they constitute important indicators of emotional overload and affect regulation difficulties. Studies have shown that trait anger and its expression patterns, such as emotional suppression, are significantly associated with reduced job satisfaction and an increased risk of burnout among nurses (47–49). Furthermore, exposure to workplace violence—both verbal and physical—from patients, their families, or coworkers—can impair psychological well-being and lead to burnout symptoms, reduced engagement, and lower job satisfaction (33–35).
Despite numerous studies confirming the high level of emotional strain among nurses, there is still a lack of comprehensive analyses that simultaneously assess the relationship between the severity of negative emotions—such as anxiety, depression, and anger symptoms—and quality of life, both professionally and personally, in this occupational group. This is particularly true for studies that incorporate a broad range of psychosocial and organizational variables in the context of the Polish healthcare system.
International studies by Liu et al. (33) and Kim et al. (47) confirm the associations between symptoms of anxiety, depression, and anger symptoms and professional burnout and quality of life among nurses, but most often focus on a single variable or individual risk factor. Similarly, researchers such as Zheng et al. (48), Niedhammer et al. (49), and Nakada et al. (50) report a high prevalence of depressive and anxiety symptoms in this occupational group, highlighting the global nature of the problem. However, in Poland, there is still a lack of studies addressing the co-occurrence of multiple negative emotions and their cumulative impact on nurses’ well-being—both at work and beyond. Previous analyses, such as those by Uchmanowicz et al. (51) and Talarowska and Gałecki (52), have rarely explored the relationship between the full spectrum of negative emotional states and quality of life in the specific context of a healthcare system characterized by chronic staffing shortages, work overload, low salaries, and organizational changes.
To avoid conceptual ambiguity, it is necessary to clarify the main constructs examined in this study. Job satisfaction can be understood as the individual’s evaluation of their professional duties, reflecting the extent to which these activities are perceived as meaningful, rewarding, and consistent with personal values (53). Life satisfaction, in turn, represents a broader perspective, referring to the overall cognitive judgment of the quality of one’s life as a whole (54).
In contrast to these cognitive appraisals, the study focuses on emotional symptoms. Symptoms of anxiety are conceptualized as persistent tension, worry, or apprehension that interfere with daily functioning. Symptoms of depression do not necessarily indicate a clinical disorder but rather reflect mood-related difficulties, including sadness, loss of interest, or reduced motivation. Anger is conceptualized as a natural, immediate emotional reaction to frustration or provocation; in the present study we operationalize this affect as “anger symptoms” using the HADS-M irritability/anger subscale. Unlike aggression, which refers to behavioral manifestations, anger symptoms may serve an adaptive function if adequately regulated (10, 45).
It is also important to distinguish between mood-related phenomena (such as symptoms of anxiety and depression), which are generally more enduring and pervasive, and emotions like anger, which are typically shorter in duration and arise in response to specific stimuli (10). This distinction underscores the complex and multidimensional nature of psychological functioning considered in the present research. For clarity, in this manuscript we treat anxiety and depressive symptoms as mood phenomena (longer-lasting, pervasive), whereas anger is treated as an emotion (short-lived, stimulus-bound); we assess anger symptoms using the HADS-M anger subscale and do not assess aggressive behavior. Throughout this manuscript, the term “depression” refers exclusively to “symptoms of depression” as measured by the HADS-M; we do not infer clinical diagnoses.
The aim of this study was to evaluate the associations between the intensity of anxiety, depressive, and irritability/anger symptoms (operationalized via the HADS-M irritability/anger subscale) and levels of life and job satisfaction among nurses. The study also considered occupational factors such as years of experience, duration of employment at the current facility, shift work schedule, average monthly working hours, and number of jobs held. While stress and occupational burnout are addressed in the theoretical framework of this study, they were not directly measured and are discussed in the limitations section.
Materials and methodsStudy design and setting
This was a cross-sectional study conducted using a diagnostic survey method. Data were collected via an anonymous online questionnaire distributed through the Google Forms platform between June 2023 and February 2024.
Given the specific characteristics of nursing work and the difficulty of conducting on-site research in clinical settings, a remote data-collection approach was adopted. Recruitment relied on purposive sampling via closed professional groups and thematic forums on social media, enabling access to nurses employed across multiple regions of Poland and in diverse healthcare facilities (hospitals, outpatient clinics, long-term care institutions, and other medical settings). Geographic quotas were not applied and province/voivodeship was not recorded; therefore, the study does not claim nationwide representativeness. This stance is consistent with the size and structure of the national nursing workforce reported by the Supreme Chamber of Nurses and Midwives (NIPiP) in 2022 (3), against which our convenience sample should not be viewed as representative.
Participation was entirely voluntary; no directly identifiable information was collected; and all data were stored securely with access limited to the research team. This strategy prioritized feasibility and confidentiality for a hard-to-reach workforce while acknowledging the non-probability nature of the sample.
Although not designed for population inference, the sample provided adequate statistical power for within-sample associations. A post-hoc power analysis in G*Power 3.1 for a two-tailed correlation test (Spearman), with α = 0.05, assumed medium effect (ρ = 0.30), and N = 538 yielded power 1–β ≈ 0.999, indicating very high sensitivity to detect the hypothesized relationships.
Participants
The study targeted actively employed registered nurses in Poland. Inclusion criteria were: current employment as a nurse in Poland, age ≥ 18 years, ability to complete an online Polish-language survey, and informed, voluntary consent with acknowledgment of the study’s purpose, anonymity, and data-processing procedures.
Exclusion criteria were: not currently employed as a nurse, nursing students/interns, midwives or other healthcare professionals working in non-nursing roles, lack of consent, and duplicate or incomplete questionnaires (removed prior to analysis).
Participants were recruited via purposive sampling through closed professional groups and thematic forums on social media. Respondents completed the questionnaire independently in a web browser. No geographic quotas were used and province/voivodeship was not recorded; therefore, we do not claim nationwide representativeness.
A total of 550 forms were submitted. After eligibility screening and data-quality checks, 538 fully completed questionnaires were retained for the final analysis. The sample encompassed nurses with diverse demographic and professional profiles, including variation in age, years of experience, employment setting (e.g., outpatient care, medical/surgical wards, ICU/ED, long-term care), work schedules, and educational levels.
Population characteristics
The final sample comprised 538 nurses. The majority were women (96.65%, n = 520), while men accounted for 3.35% (n = 18). The largest age group was 51–60 years (40.15%, n = 216), followed by 41–50 years (31.78%, n = 171). The youngest participants, aged 22–30, represented 9.29% (n = 50), and those over 60 years accounted for 6.32% (n = 34).
Most participants lived in urban areas (76.77%, n = 413), while 23.23% (n = 125) resided in rural areas. In terms of education, the most frequent qualification was a bachelor’s degree in nursing (39.41%, n = 212), followed by a master’s degree (33.83%, n = 182) and secondary medical education (26.77%, n = 144). Regarding marital status, most respondents were married (67.47%, n = 363). Others were single (10.22%), divorced (10.22%), widowed (5.02%), or in informal relationships (7.06%). In terms of work experience, the most common ranges were 31–40 years (33.64%, n = 181) and 21–30 years (29.37%, n = 158). A small proportion (3.16%) reported less than one year of total work experience. At their current workplace, most participants had worked for less than 5 years (25.46%), followed by 10–20 years (22.68%) and 5–9 years (12.45%). A minority (3.16%) had been employed at the same institution for over 40 years.
Participants were employed in a variety of healthcare settings. The most frequent workplaces were outpatient care facilities (38.29%), medical wards (36.25%), and surgical units (18.77%). A total of 10.59% were employed in intensive care units and emergency departments (ICU/ED), and 12.83% worked in long-term care.
Most respondents were employed on a permanent contract (94.98%). Approximately half (50.74%) worked 168–250 h per month, while 45.72% worked fewer than 168 h. A shift-work system reported by 72.49% of participants. The majority (63.38%) were employed in a single workplace, while 31.60% worked in two facilities simultaneously. Descriptive characteristics of the sample (sex, age, place of residence, education, marital status, job tenure, tenure at the current workplace, and place of work) are presented in Table 1.
Sociodemographic and professional characteristics of the respondents (n = 538).
Variable
Category
n
%
Sex
Female
520
96.65
Male
18
3.35
Age
22–30 years
50
9.29
31–40 years
67
12.45
41–50 years
171
31.78
51–60 years
216
40.15
>60 years
34
6.32
Place of residence
Rural area
125
23.23
Urban area
413
76.77
Education
Secondary medical education
144
26.77
Bachelor of science in nursing
212
39.41
Master of science in nursing
182
33.83
Marital status
Single
55
10.22
Married
363
67.47
Divorced
55
10.22
Widowed
27
5.02
Informal relationship
38
7.06
Job tenure
<1 year
17
3.16
1–10 years
81
15.06
11–20 years
67
12.45
21–30 years
158
29.37
31–40 years
181
33.64
>40 years
34
6.32
Seniority in current workplace
<5 years
137
25.46
5–9 years
67
12.45
10–20 years
122
22.68
21–30 years
98
18.22
31–40 years
97
18.03
>40 years
17
3.16
Place of work
Conservative wards
195
36.25
Surgical wards
101
18.77
ICU/emergency department
57
10.59
Long-term care
69
12.83
Outpatient care
206
38.29
Percentages may not total 100% due to rounding or multiple responses.
Measures and instruments
The study used a self-developed questionnaire and three standardized tools: the Hospital Anxiety and Depression Scale—Modified (HADS-M) by Zigmond and Snaith (55), the Job Satisfaction Scale (SSP) by Zalewska (53), and the Satisfaction with Life Scale (SWLS) by Diener et al. (54).
The original questionnaire included 34 items. Section I (items 1–12) addressed sociodemographic and occupational variables. Section II (items 13–22) explored emotional responses related to professional duties. Section III (items 23–34) focused on perceived occupational stress and its effects on personal and professional life.
The HADS-M consists of 16 items that assess three emotional domains: anxiety, depression, and irritability/anger. It is a modified version of the original HADS by Zigmond and Snaith (55). The Polish adaptation was developed by Majkowicz (56). The irritability/anger subscale was added based on an unpublished version used in clinical research. Although HADS-M was originally designed for somatic patients, it has also been applied in population studies, including research among nurses, despite lacking formal validation in this professional group (57) and aggressive behaviors were not assessed. Each subscale uses a 4-point Likert scale (0–3). Scores range from 0–21 for anxiety and depression, and 0–6 for anger. Interpretation thresholds: 0–7 = normal, 8–10 = borderline, ≥11 = possible disorder (58). In this study, Cronbach’s alpha values were: anxiety −0.84, depression −0.863, anger −0.81, confirming good internal consistency.
Job Satisfaction Scale (SSP). This instrument evaluates the cognitive aspect of general job satisfaction and includes five items rated on a 7-point Likert scale (1 = strongly disagree to 7 = strongly agree). A higher score indicates greater job satisfaction. In this study, Cronbach’s alpha was 0.89, consistent with the original validation (53).
Satisfaction with Life Scale (SWLS). This tool assesses global life satisfaction using five items scored on a 7-point Likert scale. Total scores range from 5 to 35, with higher scores indicating greater life satisfaction. The Polish adaptation was developed by Juczyński (59). Reliability coefficients were: original version −0.87 (54), Polish adaptation −0.72 (59), current study −0.89.
Statistical analysis
Data collected from 538 nurses employed in various healthcare facilities were subjected to descriptive and inferential analyses using Statistica v.13.0 (TIBCO Software Inc., 2017) and Microsoft Excel. Categorical variables are presented as n (%) and scale scores as mean (SD) or median (IQR), as appropriate. Because summed scale scores can deviate from normality, associations were examined with Spearman’s rank-order correlation (ρ). To identify independent predictors of depressive symptoms, anxiety, and irritability/anger symptoms, separate multiple linear regression models were fitted for each dependent variable with SWLS and SSP total scores as predictors. Model assumptions (linearity, normality and homoscedasticity of residuals) were checked via residual diagnostics; multicollinearity was assessed with VIF; influential observations were screened using Cook’s distance. Where heteroscedasticity was detected, heteroscedasticity-robust standard errors (HC3) were used. Standardized coefficients (β) with 95% confidence intervals were reported. Internal consistency was evaluated with Cronbach’s alpha. All tests were two-tailed with α = 0.05. Post hoc power analysis (G*Power 3.1) for a two-tailed correlation (α = 0.05; n = 538) indicated power > 0.999 to detect a medium effect (ρ = 0.30); the minimum detectable correlation at 80% power was |ρ| ≈ 0.12 (≈0.14 for 90% and ≈0.155 for 95%).
Ethical considerations
The study was conducted in accordance with the Declaration of Helsinki (1975, revised in 2013) (60). All participants gave informed consent, and anonymity was maintained throughout the research. Participants were informed of the study’s purpose and their right to withdraw at any time without consequences. According to Polish regulations and institutional guidelines, anonymous non-interventional survey-based studies that do not involve sensitive personal data or direct health interventions do not require ethics committee approval. These studies are not classified as medical experiments under Article 21 of the Polish Act of December 5, 1996, on the professions of physician and dentist (Dz.U.2019.537 j.t.). Contact details were provided for participants in case of additional questions or concerns.
Results
A total of 538 nurses employed in various healthcare settings participated in the study. The results are presented in the following order: general psychological symptoms and work-related stress, scale assessments, correlation analyses, and regression modeling. All statistical analyses were performed using Statistica v.13.0 (77) and Microsoft Excel.
Psychological symptoms and emotional states related to work
A large proportion of respondents reported feeling emotionally exhausted due to work (86.25%) and physically fatigued (52.97%). Additionally, 36.80% of participants declared feeling tired upon waking, triggered by the mere thought of going to work.
Work-related anxiety was most frequently reported several times per month (39.96%), several times per week (28.07%), or daily (12.45%). A total of 19.52% of respondents reported no such emotions. Regarding irritability/anger symptoms, 44.61% experienced them several times per month, 31.23% several times per week, and 11.34% daily. No such experiences were reported by 12.83% of participants.
Work satisfaction was experienced several times a month by 41.45% of nurses, several times a week by 27.32%, and daily by 16.73%. A lack of job satisfaction was reported by 14.50% of respondents.
Work errors caused by excessive workload occurred most frequently several times per year (55.58%), less often several times a month (9.85%), once a week (1.86%), or daily (0.74%). A total of 31.97% declared never making such errors. 15.43% reported having taken sick leave due to psychological overload, while 84.57% had not used this form of absence.
Work-related stress and its sources
Workplace stress was common among respondents. Daily stress was reported by 32.90% of participants, several times per week by 32.16%, and several times per month by 32.71%.
The most frequently reported sources of occupational stress included time pressure and work urgency (72.86%) and staff shortages (71.00%). Other reported causes included responsibility for patient health and life (51.86%), lack of supervisor support (44.98%), low pay (42.75%), and poor work organization (37.73%). Additional stressors were contact with patient death (29.74%), lack of breaks (28.25%), fear of infection (28.25%), shift work (26.39%), exposure to harmful factors (25.65%), and limited opportunities for professional development (10.04%). Detailed data are presented in Table 2.
Distribution of responses to the job satisfaction scale (SSP) (n = 538).
Item
1. Strongly disagree
2. Disagree
3. Slightly disagree
4. Neutral
5. Slightly agree
6. Agree
7. Strongly agree
n
%
n
%
n
%
n
%
n
%
n
%
n
%
1. In many ways, my work is close to ideal
76
14.13
125
23.23
112
20.82
123
22.86
71
13.20
25
4.65
6
1.12
2. I have great conditions at work
76
14.13
128
23.79
109
20.26
109
20.26
91
16.91
20
3.72
5
0.93
3. I am satisfied with the work
43
7.99
76
14.13
98
18.22
128
23.79
128
23.79
59
10.97
6
1.12
4. So far, I have achieved what I aimed for at work
33
6.13
72
13.38
81
15.06
125
23.23
162
30.11
57
10.59
8
1.49
5. If I had to decide again, I would choose the same job
74
13.75
55
10.22
53
9.85
130
24.16
99
18.40
87
16.17
40
7.43
Responses were recorded on a 7-point Likert scale ranging from “1 – strongly disagree” to “7 – strongly agree.” Percentages may not sum to 100% due to rounding.
HADS-M, SSP, and SWLS scale results
According to the HADS-M scale results, 46.65% of respondents occasionally experienced tension and irritability, while 49.07% reported symptoms of depression. Internal anxiety was declared by 44.80% of participants. Sad thoughts occurred in 39.22% of respondents, while 46.10% reported feeling cheerful and positive at times. Conversely, 42.57% stated they sometimes felt irritated and angry; anger symptoms were reported rarely (34.76%) or sometimes (32.53%). Detailed HADS-M results are presented in Tables 3, 4.
Distribution of responses to the HADS-M irritability/anger symptoms subscale (n = 538).
Item
Response
n
%
1. I felt tense or irritated
Most of the time
74
13.75
A lot of the time
187
34.76
Occasionally
251
46.65
Not at all
26
4.83
2. I still enjoy things that used to make me happy
Definitely the same
163
30.30
Not quite the same
250
46.47
Only a little
107
19.89
Not at all
18
3.35
3. I felt a frightening feeling, as if something terrible was about to happen
Very clearly
73
13.57
Clearly
158
29.37
Slightly
146
27.14
Not at all
161
29.93
4. I can laugh and see the funny side of events
Same as before
162
30.11
Now not so much as before
220
40.89
Much less than before
151
28.07
Not at all
5
0.93
5. I’m plagued by sad thoughts
Most of the time
38
7.06
A lot of the time
151
28.07
Occasionally but not very often
211
39.22
Rarely
138
25.65
6. I feel happy and cheerful
Not at all
17
3.16
Not often
129
23.98
Sometimes
248
46.10
Most of the time
144
26.77
7. I can sit still and feel relaxed
Definitely yes
0
0.00
Usually
0
0.00
Often
538
100.00
Not at all
0
0.00
8. I feel like I am in a ‘mental hole’
All the time
29
5.39
Very often
142
26.39
Occasionally
264
49.07
Not at all
103
19.14
9. I have an alarming feeling, as if something is shaking inside me
Not at all
185
34.39
From time to time
241
44.80
Quite often
94
17.47
Very often
18
3.35
10. I stopped taking interest in my external appearance
Completely stopped
10
1.86
Do not take care as I should
136
25.28
Not able as before
107
19.89
As always
285
52.97
11. I cannot sit still internally
To a very large extent
41
7.62
To a large extent
143
26.58
Rarely
205
38.10
I can sit
149
27.70
12. I look forward to various things
As much as before
135
25.09
Less than before
253
47.03
Definitely less than usual
139
25.84
Not at all
11
2.04
13. I have a sudden feeling of panic anxiety
Very often
23
4.28
Quite often
104
19.33
Not very often
192
35.69
Not at all
219
40.71
14. I can enjoy a good book, an TV program
Very often
123
22.86
Quite often
182
33.83
Not very often
207
38.48
Not at all
26
4.83
15. There have been times in the past week when I have exploded with anger
Often
70
13.01
Sometimes
175
32.53
Rarely
187
34.76
Not at all
106
19.70
16. There were times when I got upset and angry
Often
134
24.91
Sometimes
229
42.57
Rarely
154
28.62
Not at all
21
3.90
Responses are based on the modified hospital anxiety and depression scale (HADS-M), including anxiety, depression, and irritability/anger subscales. Percentages may not total 100% due to rounding.
Distribution of responses to the satisfaction with life scale (SWLS) (n = 538).
Item
1. Strongly disagree
2. Disagree
3. Slightly disagree
4. Neutral
5. Slightly agree
6. Agree
7. Strongly agree
n
%
n
%
n
%
n
%
n
%
n
%
n
%
1. In many ways, my life is close to perfect.
43
7.99
106
19.70
119
22.12
171
31.78
94
17.47
5
0.93
0
0.00
2. The conditions of my life are excellent.
24
4.46
95
17.66
140
26.02
164
30.48
108
20.07
7
1.30
0
0.00
3. I am satisfied with my life.
10
1.86
44
8.18
114
21.19
137
25.46
189
35.13
40
7.43
4
0.74
4. In my life I have achieved the most important things I wanted
15
2.79
63
11.71
92
17.10
126
23.42
187
34.76
49
9.11
6
1.12
5. If I could live my life again, I would hardly want to change anything.
64
11.90
144
26.77
101
18.77
88
16.36
116
21.56
21
3.90
4
0.74
Data are based on the satisfaction with life scale (SWLS), which uses a 7-point Likert scale ranging from “1 – strongly disagree” to “7 – strongly agree.” Percentages may not total 100% due to rounding.
The Job Satisfaction Scale (SSP) results revealed notable variation. For example, the statement “In many ways my job is close to ideal” received disagreement from 23.23% of participants, a neutral response from 22.86%, and partial disagreement from 20.82%. The full distribution of responses is provided in Table 5.
Relationship between levels of depression, anxiety and irritability/anger symptoms and job satisfaction (n = 538).
Symptom category
Job satisfaction scale (SSP)
Spearman’s rank correlation
Mean ± SD
Median [Q25–Q75]
Min.–Max.
Confidence interval
Stand error.
−95.00%
+95.00%
Level of depressive symptoms
No symptoms (n = 216)
M = 21.55, SD = 5.6
Mdn = 21.5, IQR = 18–26
5–35
20.80
22.30
0.38
ρ = −0.48; p < 0.001
Subclinical (n = 135)
M = 17.6, SD = 5.7
Mdn = 18, IQR = 14–21
5–31
16.63
18.57
0.49
Clinical (n = 187)
M = 14.44, SD = 5.59
Mdn = 14, IQR = 10–19
5–28
13.64
15.25
0.41
Level of anxiety symptoms
No symptoms (n = 273)
M = 21.05, SD = 5.83
Mdn = 21, IQR = 18–25
5–35
20.35
21.74
0.35
ρ = −0.5; p < 0.001
Subclinical (n = 131)
M = 16.68, SD = 5.16
Mdn = 17, IQR = 13–21
5–26
15.79
17.57
0.45
Clinical (n = 134)
M = 13.43, SD = 5.31
Mdn = 14, IQR = 10–17
5–28
12.53
14.34
0.46
Level of irritability/anger symptoms
No symptoms (n = 279)
M = 20.59, SD = 6.01
Mdn = 21, IQR = 17–25
5–35
19.88
21.30
0.36
ρ = −0.4; p < 0.001
Subclinical (n = 194)
M = 15.77, SD = 5.53
Mdn = 16, IQR = 12–20
5–28
14.99
16.56
0.40
Clinical (n = 65)
M = 14.26, SD = 6.04
Mdn = 14, IQR = 10–19
5–27
12.76
15.76
0.75
Spearman’s correlation analysis. Differences in job satisfaction across groups are presented as mean ± SD, median [Q25–Q75], range, and 95% confidence intervals. All p-values < 0.001.
For the Satisfaction with Life Scale (SWLS), most respondents selected neutral answers to the statements “My life is close to ideal” (31.78%) and “The conditions of my life are excellent” (30.48%). Detailed results are presented in Table 6.
Relationship between frequency of experiencing work-related stress and levels of depression, anxiety and irritability/anger symptoms (n = 538).
Symptom category
Frequency of experiencing stressful situations at work
Spearman’s rank correlation
Never or a few times per month (n = 188)
Several times per week (n = 173)
Daily (n = 177)
n
%
n
%
n
%
Level of depressive symptoms
No symptoms
118
62.77
58
33.53
40
22.60
ρ = 0.4; p < 0.001
Subclinical
48
25.53
49
28.32
38
21.47
Clinical
22
11.70
66
38.15
99
55.93
Level of anxiety symptoms
No symptoms
132
70.21
74
42.77
67
37.85
ρ = 0.28; p < 0.001
Subclinical
35
18.62
46
26.59
50
28.25
Clinical
21
11.17
53
30.64
60
33.90
Level of irritability/anger symptoms
No symptoms
134
71.28
75
43.35
70
39.55
ρ = 0.28; p < 0.001
Subclinical
47
25.00
75
43.35
72
40.68
Clinical
7
3.72
23
13.29
35
19.77
Based on frequency distribution of work-related stress levels and symptom categories. Spearman’s correlation used; all p-values < 0.001.
Correlations between variables
Spearman’s rank-order correlation analyses showed statistically significant negative associations between life satisfaction and symptoms of depression (ρ = −0.56; p < 0.001), anxiety (ρ = −0.55; p < 0.001), and (ρ = −0.38; p < 0.001). Similar correlations were found between job satisfaction and these symptoms: depression (ρ = −0.48), anxiety (ρ = −0.50), and (ρ = −0.40), all significant at p < 0.001. Results are summarized in Table 7.
Relationship between frequency of experiencing work-related stress and levels of life and job satisfaction (n = 538).
Scale
Frequency of experiencing stressful situations at work
Descriptive statistics
Spearman’s rank correlation
Mean ± SD
Median [Q25–Q75]
Min.–Max.
Confidence interval
Stand error.
−95.00%
+95.00%
Satisfaction with life scale (SWLS)
Never or a few times per month (n = 188)
M = 19.97, SD = 4.69
Mdn = 20, IQR = 17–23
6–29
19.30
20.65
0.34
ρ = −0.26; p < 0.001
Several times per week (n = 173)
M = 17.62, SD = 4.85
Mdn = 18, IQR = 14–21
7–29
16.90
18.35
0.37
Daily (n = 177)
M = 16.86, SD = 5.16
Mdn = 17, IQR = 13–21
5–28
16.09
17.62
0.39
Job satisfaction scale (SSP)
Never or a few times per month (n = 188)
M = 20.86, SD = 6.02
21 [17–25.5]
5–34
20.00
21.73
0.44
ρ = −0.32; p < 0.001
Several times per week (n = 173)
M = 17.13, SD = 6.14
Mdn = 17, IQR = 14–21
5–35
16.21
18.05
0.47
Daily (n = 177)
M = 16.07, SD = 6.05
Mdn = 16, IQR = 12–20
5–33
15.18
16.97
0.45
The table presents descriptive statistics and Spearman’s rank correlation coefficients for the relationship between the frequency of experiencing stressful situations at work and levels of life satisfaction (SWLS) and job satisfaction (SSP). A significant negative correlation was found in both cases (p < 0.001), indicating that more frequent work-related stress is associated with lower satisfaction levels.
Predictors of psychological functioning—regression analysis
Multiple linear regression models were constructed to identify predictors of depression, anxiety, and symptoms. Total scores from the SWLS and SSP were included as independent variables in each model. All three models reached statistical significance (p < 0.001). The highest explanatory power was observed in the depression model (R2 = 0.452), followed by anxiety (R2 = 0.324) and (R2 = 0.237). Regression results are summarized in Table 8.
All regression models were statistically significant (p < 0.001). SWLS – Satisfaction With Life Scale; SSP – Job Satisfaction Scale.
Reliability of measurement instruments
Internal consistency of the applied scales was assessed using Cronbach’s alpha. The HADS subscales yielded the following values: HADS-Anxiety (α = 0.868; after removing item 7), HADS-Depression (α = 0.863), and HADS-Anger subscale (α = 0.813). The Satisfaction with Life Scale (SWLS) reached α = 0.86, and the Job Satisfaction Scale (SSP) α = 0.89. These values indicate high psychometric reliability. Reliability coefficients are presented in Table 9.
Internal consistency (Cronbach’s alpha) of the applied scales.
Scale
Cronbach’s alpha (α)
HADS-anxiety (after removing item 7)
0.868
HADS-depression
0.863
HADS-irritability/anger
0.813
Satisfaction with life scale (SWLS)
0.860
Job satisfaction scale (SSP)
0.890
Cronbach’s alpha values above 0.80 indicate good internal consistency of the applied instruments, supporting their psychometric reliability.
Ethical considerations
All participants provided informed consent. According to national regulations and institutional policies, ethical approval was not required for this type of non-interventional, anonymous online survey.
Discussion
The findings of this study allow for a multidimensional analysis of the severity of depression, anxiety, and irritability/anger symptoms among nurses, as well as their relationship with job and life satisfaction. The nursing profession is associated with substantial physical and mental burdens. Occupational stress—resulting from interactions with patients and their families, staffing shortages, shift work, and interpersonal dynamics—is a constant element of nurses’ professional reality. These factors promote the development of intensified anxiety and depressive symptoms, driven by prolonged emotional strain, a sense of helplessness, and exposure to death and suffering.
A high prevalence of anxiety among nurses has been confirmed in previous studies. For instance, Sharif et al. (61) reported that 89.7% of respondents experienced anxiety, with 73% describing it as moderate or severe. These data are consistent with the current findings, where 12.45% of nurses experienced anxiety daily, 28.07% several times per week, and 39.96% several times per month. Similarly, Huang et al. (11) indicated that longer work experience may increase the risk of anxiety disorders, while Maharaj et al. (62) reported symptoms in 41.2% of nurses.
Depression, one of the most common mental disorders, also affects nursing personnel. Constant exposure to illness, death, and clinical responsibility may lead to chronic mood deterioration. In this study, 6% of participants reported experiencing depressive symptoms daily, 26.39% very frequently, and nearly half (49.07%) declared sporadic symptoms. Anxiety and depression are currently among the most frequently diagnosed mental health conditions (63). According to the World Health Organization, nurses are particularly vulnerable to the negative effects of occupational stress (24). This is supported by Angermeyer et al. (64), who found a high prevalence of anxiety, depression, and fatigue among nurses. Wang et al. (65) also emphasized that workplace-related factors significantly influence the development of psychopathological symptoms.
International studies have reported that the prevalence of anxiety and depressive symptoms among nurses ranges from 11 to 80%, depending on the country and methodology (62). In our study, 34.76% met the HADS-M clinical cut-off for depressive symptoms and 24.91% met the clinical cut-off for anxiety symptoms, which is consistent with the mid-to-upper range of prior estimates.
Shift work, performed by 72.49% of participants, has been identified as a factor that disrupts circadian rhythms and burdens mental health. Several studies [e.g., Maharaj et al. (62), Cheung et al. (66), Sharif et al. (61), and Motta de Vasconcelos et al. (67)] have demonstrated a relationship between shift work and depression. Additionally, a lack of social support and emotional connections can increase the risk of mood disorders (65, 67).
In light of the above findings, implementing preventive programs and psychological interventions in the workplace appears justified. Literature suggests that mindfulness-based interventions may help enhance psychological resilience and reduce stress (68).
Irritability/anger symptoms, frustration, and emotional aggression—both internalized and externally expressed—also warrant attention. Only 12.83% of respondents in this study reported an absence of such emotions. The most commonly reported frequency of anger was several times per month (44.61%).
These findings are consistent with those of Wyderka and Niedzielska (69), who found that 40% of nurses had difficulties with emotional regulation. Cheung et al. (66) noted that nurses are more likely to experience emotional aggression than other professional groups. Mosiołek et al. (70) reported that 66.7% of respondents had experienced verbal aggression and 50% had experienced physical aggression from patients.
The impact of emotional overload on nurses’ mental health is therefore significant. In terms of occupational satisfaction, only 5.57% of participants described their job as fully satisfying, while more than half (58.18%) reported varying degrees of dissatisfaction.
Nonetheless, 44.61% of respondents indicated they would choose the nursing profession again. In a study by Ostrowicka et al. (71), only 5% of participants reported a complete lack of job satisfaction. Factors influencing satisfaction included workplace relationships, employment stability, and working conditions.
Kunecka (72) and Gawęda et al. (73) have emphasized that a positive team atmosphere and a sense of meaning in work enhance job satisfaction. Lubrańska (74) found a strong correlation between job satisfaction and life satisfaction. Siemiginowska et al. (75) and Mroczkowska et al. (76) highlighted that shift work intensifies work–life conflict, although it does not always directly reduce overall satisfaction.
In summary, our findings confirm that nurses’ psychological well-being is strongly influenced by working conditions, interpersonal relationships, and workplace organization. Therefore, healthcare facility administrators should implement comprehensive strategies to promote the mental health of nursing personnel. Particular emphasis should be placed on improving the work environment, reducing occupational stressors, and preventing workplace phenomena such as bullying. Proper interventions may help reduce symptoms of anxiety and depression, and anger symptoms, thereby enhancing occupational well-being.
Limitations of the study
Despite the statistically significant findings, this study has several limitations that must be considered when interpreting and generalizing the results.
First, the use of purposive sampling and an online survey format may have influenced the sample structure. The study primarily included individuals active on social media, potentially excluding participants less familiar with digital technologies. It is also possible that the sample was overrepresented by individuals more motivated to share emotional experiences, as evidenced by a higher proportion of older respondents with longer work experience.
Second, the cross-sectional design of the study does not allow for causal inferences. The results reflect co-occurring variables at a single point in time, without the possibility of assessing their temporal dynamics. Moreover, although standardized and validated self-report tools were used, there remains a risk of subjectivity, anchoring bias, or socially desirable responses.
It is also important to note that the study focused exclusively on nurses working in Poland. Thus, caution should be exercised when attempting to generalize these findings to other professional or international populations that may operate under different systemic conditions. We did not collect province/voivodeship, formal specialty status, or job grade (e.g., ward/charge vs. staff), which limits geographic and professional subgroup analyses.
Nevertheless, this study provides a valuable contribution to understanding the mental health, well-being, and working conditions of nurses, and underscores the need for further research in this field.
Conclusion
Nurses experience considerable psychological burden, which contributes to the intensification of depressive, anxiety, and irritability/anger symptoms, as well as a reduction in life and job satisfaction. The most significant factors negatively affecting their well-being include shift work, excessive workload, lack of organizational support, and frequent exposure to stressful situations.
The results revealed statistically significant associations: the more intense the emotional symptoms, the lower the levels of life and job satisfaction. This highlights the critical role of working conditions and interpersonal relationships in maintaining the mental health of this professional group.
The findings emphasize the need to implement strategies that support the mental health of nursing personnel. These include emotional aggression prevention, the development of psychoeducational programs, and organizational changes aimed at reducing occupational stress. Ensuring the psychological well-being of nursing teams may not only improve the quality of patient care but also enhance the overall functioning of the healthcare system.
Data availability statement
The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.
Ethics statement
The study was conducted strictly in accordance with the 1975 Declaration of Helsinki (revised in 2013) (33). Informed consent was obtained from all participants, and their anonymity was assured throughout the study. Participants were informed about the purpose of the study and were assured that they could withdraw from participation at any stage, without any consequences. It is worth noting that according to local regulations and institutional guidelines, non-interventional survey-based research that does not involve sensitive personal data or direct health interventions usually does not require approval from a bioethics committee. This type of research does not meet the definition of a medical experiment under Article 21 of the Law on the Profession of Physician and Dentist of December 5, 1996 (Journal of Laws 2019.537) and does not require the opinion of the Bioethics Committee. Nevertheless, in case of any doubts or the need for additional information, participants have been provided with contact information for further inquiries. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.
The author(s) declare that no financial support was received for the research and/or publication of this article.
We thank the nurses who participated in the survey and the moderators of professional social-media groups who assisted with study dissemination.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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