Influence of work conditions on nurses mental health disorders: a cross sectional study among 132 nurses


  • Kheder Asma University of Medicine of Monastir; University Hospital of Mahdia, Tunisia
  •  Rassas  Ines University of Medicine of Monastir; University Hospital of Mahdia, Tunisia
  •  Elgharbi Azza University of Medicine of Monastir; University Hospital of Mahdia, Tunisia
  •  Zaidi Manel University of Medicine of Monastir; University Hospital of Mahdia, Tunisia
  •  Khalfallah Taoufik University of Medicine of Monastir; University Hospital of Mahdia, Tunisia
  • Aouatef Mahfoudh University of Medicine of Monastir; University Hospital of Mahdia, Tunisia



nurses, mental health, work environment.


Background: Hospital caregivers are particularly exposed to several constraints related to work environment, which can affect them mental health and the quality of care delivered.

The aim of this study was to determine the degree of psychic suffering and evaluate its determinants among Tunisian nurses.

Materials and methods: A cross-sectional survey was conducted in seven district hospitals in Tunisia. The study was conducted over a period of three months. Data collection was assessed by a pre-established survey describing socio-professional characteristics of participants. The General Health Questionnaire (GHQ) was used to study participants' mental health.

Results: One hundred thirty two nurses have participated, of which 62.6% were women.  The study population was relatively young, with a mean age of 41 ± 11 years and average job tenure of 17 ± 11 years. In this study, 13.7% of participants worked on permanent night shift. The rate of psychic suffering among nurses is estimated at 73.3%. A mental health disorder was reported by 73.3% of health care workers, correlated after logistic regression to job tenure (p = 0.02, OR = 2.26, CI = [1.08-4.7]) and poor relationship within the health care and medical team (p = 0.05, OR = 1.2, CI [0.9-1.5]).

Conclusion: further studies are needed to better assess these risks and plan appropriate preventive actions.


Horellou-Lafarge CH., 2011. La santé des infirmières françaises. Revue multidisciplinaire sur l'emploi, le syndicalisme et le travail 6 (Supp.2): 73-102.

Delfrate, F., et al., 2018. Distress (MD) and burnout in mental health nurses: a multicenter survey. La Medicina del lavoro 109 (Supp.2): 97.

Sigman, A., 1992. The State of Corporate Health Care. Personnel Management: 24-9.

Work-related stress, anxiety or depression statistics in Great Britain, 2019. Health and Safety Executive. . Download from on 24 June 2019.

Langevin, V., François, M., Boinis Riou, A., 2014. Risques psychosociaux : outils d'évaluation – Questionnaire Contraintes Psychosociales et Organisationnelles (CPO) – FRPS37. . Download from: on 24 June 2019.

Goldberg, D. P., et Valerie, H. F., 1979. A scaled version of the General Health Questionnaire. Psychological medicine 9(Supp.1):139-45.

Goldberg, D.P., Gater, R., Sartorius, N., et al., 1997. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Medicine 27 (Supp.1): 191–7.

Fanello, S., et al., 2003. Souffrance psychique liée au travail: étude réalisée chez 456 soignants d'un centre hospitalier universitaire. Archives des Maladies Professionnelles et de l'Environnement 64(Supp.2): 70-6.

Fanello, S., et al., 2004. Étude des déterminants socioprofessionnels de la souffrance psychique au travail: Enquête auprès de 231 employés du tertiaire. Archives des Maladies Professionnelles et de l'Environnement 65(Supp.4):326-34.

Molarius, A., et al., 2009. Mental health symptoms in relation to socio-economic conditions and lifestyle factors – a population – based study in Sweden. BMC Public Health 9: 02.

Vézina, M., Bourbonnais, R., Marchand, A., et Arcand, R., 2008. Stress au travail et santé mentale chez les adultes québécois. Enquête sur la santé dans les collectivités canadiennes (cycle 1.2). Institut de la statistique du Québec, p 50. Downloaded from: on 24 June 2019.

Santé mentale et activité professionnelle dans l’enquête décennale santé 2003 de l’Insee Octobre 2007. ISBN : 978-2-11-096998-9. Downloaded from: on 24 June 2019.

Rouillon Frédéric, 1997. Les troubles dépressifs: guide pratique. John Libbey Eurotext. ISBN 2-7420-0132-8

Stefansson Claes-Göran, 2006. Chapter 5.5: Major public health problems—Mental ill-health. Scandinavian journal of public health 34 (67): 87-103.

Malinauskienen, V., Leisyte, P., Malinauskas, R., 2009. Psychosocial job characteristics, social support, and sense of coherence as determinants of mental health among nurses. Medicina 45 (11): 910.

Silva, L.S., Barreto, S.M., 2010. Adverse psychosocial working conditions and minor psychiatric disorders among bank workers. BMC Public Health 10 (Supp.1): 686.

Gagnon, A., 1985. Burn-out institutionnel. Annales Médico Psychologiques 143 (Supp.7): 646-51.

Schütte, S., et al., 2015. Psychosocial work exposures among European employees: explanations for occupational inequalities in mental health. Journal Public Health 37 (Supp.3): 373-388.

Murcia Marie 2012. Rôle des facteurs psychosociaux au travail sur les troubles de la santé mentale et leur contribution dans les inégalités sociales de santé mentale. Thèse de doctorat. Université Paris Sud-Paris XI. Download from: on 25 juin 2019.

Chantal Horellou-Lafarge. La santé des infirmières françaises. Download from: on 25 juin 2019.

Donato Julie 2009. Une perception dégradée des conditions de travail. Santé & Travail 66: 31-3. Download from https :// on 3 July 2019.

Imprimerie Officielle de la République Tunisienne. Code du travail. Download from on 3 July 2019.

Aloulou, J., Damak, R., Masmoudi, F., et al., 2013. Burn out in health care providers: a Tunisian study about 142 nurses. Tunis Med. 91 (Supp.1): 44-9.

Cazabat, S., Barthe, B., Cascino, N., 2008. Charge de travail et stress professionnel : deux facettes d'une même réalité? Perspectives interdisciplinaires sur le travail et la santé: 10-1.

Estryn-Behar Madeleine 2011. Ergonomie hospitalière: Théorie et pratique. Octarès éd. ISBN 10 : 2915346917.

Nicolettin, C., Spengler, C.M., Laubli, T., 2014. Physical workload, trapezius muscle activity, and neck pain in nurses' night and day shifts: a physiological evaluation. Appl. Ergon. 45 (Supp.3): 741-6.

Bernal, D., et al., 2015. Work-related psychosocial risk factors and musculoskeletal disorders in hospital nurses and nursing aides: A systematic review and meta-analysis. International journal of nursing studies 52 (Supp.2): 635-48.

Zhang, Y., et al., 2014. Relationships among employees’ working Conditions, mental health, and intention to leave in nursing homes. Journal of Applied Gerontology 33 (Supp.1): 6–23.

Stansfeld, S.A., et al. 1999. Work characteristics predict psychiatric disorder: prospective results from the Whitehall II Study. Occup Environ Med.56 (Supp.5) : 302-7.

Lamy Sébastien 2013. Le rôle des contraintes psychosociales et organisationnelles sur l'état de santé des infirmières et des aides-soignantes: analyse longitudinale des données de 7 CHU en France. Diss. Toulouse 3. Download from on 3 July 2019

Chantal Horellou-Lafarge et Cresppa-GTM 2011. La santé des infirmières françaises. Revue multidisciplinaire sur l’emploi, le syndicalisme et le travail (REMEST) 6, Nº 2 : 73-101.

Wieclaw, J., et al. (2008). Psychosocial working conditions and the risk of depression and anxiety disorders in the Danish workforce. BMC Public Health 8:280.

Kovess Viviane et Facy Françoise (1996). Epidémiologie et santé mentale. Paris : Flammarion. ISBN: 2257155386.

Additional Files