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Common psychological repercussions of extended night
shifts among medical staff in Saudi Arabia
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Khawla
Mohammed Salih Elbasheri Jadkareem1,
Nazik Abdallah Ahmed Saad2, Aza Tarig Osman Ahmed3,
Yasir Dawelbeit Hamid Elbedri4, Mutaz Abbashar Mahdi Osman5, Inas Najeeb Mohammedsalih Ali6, Nagat
Abdelrhman Ahmed Mohamed7, Entisar Nageeb Mohamed salih Ali8,
Hussain Gadelkarim ahmed9,10
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1Obstetrics
and gynecology department, Al-Kharj Armed Forces
Hospital, Al-Kharj, Saudi Arabia.
2Department
of Microbiology. Faculty of medicine and health sciences, University of
Kordofan, El-Obeid, Sudan.3Clinical Chemistry and Histopathology
Department, Faculty of Medical Laboratory Sciences, National University,
Khartoum, Sudan.4Department of Medicine, Faculty of Medicine,
University of Kordofan, El-Obeid, Sudan.5Department of cardiology,
Somali Sudanese Specialized Hospital, Mogadishu, Somalia. 6Czech Saudi Medical Company (CSMC) Senior
specialist of internal medicine, Eastern province, Saihat,
Saudi Arabia.7Department
of Hematology and Immunohematology, Faculty of
Medical Laboratory Sciences, University of Kordofan, El-Obeid, NK, Sudan. 8Department
of Histopathology and Cytology, Faculty of Medical Laboratory Sciences,
University of Kordofan, El-Obeid, Sudan. 9Prof Medical research Consultancy Center, El-Obeid, Sudan.10Department of
Histopathology and Cytology, FMLS, University of Khartoum, Khartoum, Sudan.
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Edited By:
Ibrahim A. Ginawi
Ministry of Health, Saudi Arabia
Reviewed by:
-Hisham sherfi
Bon Secours Hospital, Irland
- Eldisugi HM Humida
Kordofan University, Sudan
Correspondence
to: Khawla
Mohammed Salih. Email: Khawlajad@hotmail.com
Received on:5/5/2025
Accepted on:
27/5/2025
Published on:
5-6-25
Citation: Jadkareem KMSE, Saad NAA, Ahmed ATO, Elbedri YDH, Osman MAM, Ali INM,
Mohamed NAA, Ali ENM, Ahmed HG. Common
psychological repercussions of extended night shifts among medical staff in
Saudi Arabia. Medical Research Updates Journal 2025;3(2): 12-20. DOI:10.70084/mruj.0000.P232
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ABSTRACT
Background: There are numerous health consequences associated with night
shift work, particularly for healthcare professionals. This study aims to
evaluate the prevalent psychological effects experienced by medical personnel
working extended night shifts in Saudi Arabia. Methodology: This was a
prospective descriptive study done in Al-Kharj, Saudi Arabia, from April 2025
to May 2025. Data for this study was collected through an online
questionnaire. Results: The highest
prevalence of depression was observed in score (5), followed by scores (3)
and (4), accounting for 30%, 26%, and 22%, respectively. Negative health
impacts were reported by 88% of the study participants, comprising 85.7% of
males and 88.9% of females. Concerning exhaustion, most participants achieved
a score of (5), followed by a score of (4) and a score of (3), corresponding
to 42%, 28%, and 18%, respectively. Conclusion: Depression, adverse
health effects, sleep problems, fatigue, and headaches are the predominant
psychiatric illnesses linked to prolonged night shift employment among the
entire medical workforce in Saudi Arabia.
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Keywords: Night shift, depression, anxiety, medical
personnel, Saudi Arabia
INTRODUCTION
Night shift work encompasses employment, including transmeridian
travel, conducted during the conventional sleeping hours of the general
population. This alters exposure to the natural light-dark cycle and disrupts
circadian rhythms. "Night" or "nighttime" is generally
defined as the period from sunset to sunrise within a 24-hour cycle. The human
biological night depends on individual circadian rhythms, typically spanning
from 23:00 to 07:00, a timeframe generally reserved for sleep; nonetheless,
variations may occur due to cultural and other influences [1].
The night shift is a prevalent work arrangement in medical hospitals,
necessitating continuous health monitoring and timely decision-making by
healthcare professionals. Night shifts can lead to notable health problems for
medical personnel, including cognitive impairments, insufficient sleep, and
inflammatory responses, potentially disrupting the gut-brain axis [2].
Night shift workers exhibited pooled relative risks of 1.02 (95% CI: 0.99,
1.06) for all-cause mortality, 1.18 (95% CI: 0.94, 1.47) for cardiovascular
mortality, and 1.05 (95% CI: 0.83, 1.34) for cancer mortality compared to
daytime workers [3].
Shift workers face various hazards that affect their health, quality of
life, and safety in the workplace. Individuals engaged in nocturnal labor exhibit heightened susceptibility. Healthcare
professionals must identify the risks associated with night shifts to develop
strategies that alleviate sleep and health problems. Shift and night workers
should have the opportunity to undergo screening for issues related to their
employment [4].
The psychological well-being of mental health care workers has become a
significant area of research, driven by increasing expectations and stressors
in their work environment. The findings suggest that interventions to reduce
the negative impacts of night shifts are necessary, including improvements in
shift systems, increased organizational support, and the implementation of
targeted mental health programs. The implementation of these measures would
enhance the health and job satisfaction of night shift workers, thereby
improving the overall quality of healthcare services [5].
Several studies conducted in Saudi Arabia have reported the negative
health and social impacts of night shift work on medical personnel [6-9]. This
study aimed to estimate the psychological consequences associated with
prolonged night shift work among medical personnel.
MATERIALS AND METHODS
This
was a prospective descriptive research study conducted in Al-Kharj, Saudi
Arabia, from April 2025 to May 2025. Data for this study was collected through
an online questionnaire. The questionnaire was disseminated to healthcare
providers, including physicians and nurses. In addition to the demographic
information of the study participants, the questionnaire incorporated inquiries
regarding stress, anxiety, and depression.
Data analysis
The
data pertinent to this study was first organized in a data sheet and
subsequently input into a statistical software package for Social Sciences
(SPSS). Frequencies, percentages, means, and cross-tabulations were collected.
The chi-square test was calculated with a 95% confidence interval in mind. A
p-value of less than 0.05 was deemed statistically significant.
RESULTS
The
study included 100 medical staff between the ages of 20 and 61, with a mean age
of 37.4 ± 7.7 years.
Regarding tiredness, the majority of participants
scored (5), followed by Score (4) and Score (3), comprising 42/100 (42%), 28%,
and 18%, respectively. The majority of subjects
reported a headache (72%). Males had 17/28 (60.7%) headaches, while females had
54/72 (75%). The incidence of headache linked with an extended night shift
among females, the relative risk (RR), and the 95% confidence interval (95%CI):
RR (95%CI) = 0.816 (0.597-1.116), P value = 0.122.
Approximately 63% of subjects reported difficulties sleeping, with 17/28
(60.7%) males and 46/72 (63.9%) females.
About 88% of the study subjects reported a negative health impact, including
24/28 (85.7%) males and 64/72 (88.9%) females, as shown in Table 1 and Figure
1.
Table
1. Distribution of the study subjects according to sex and psychological
influences
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Variable
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Males
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Females
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Total
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Exhaustion Score
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1
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1
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1
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2
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2
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4
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6
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10
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3
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7
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11
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18
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4
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7
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21
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28
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5
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9
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33
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42
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Total
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28
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72
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100
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Headache
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No
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11
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18
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29
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Yes
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17
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54
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71
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Total
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28
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72
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100
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Sleeping difficulty
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No
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11
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26
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37
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Yes
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17
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46
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63
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Total
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28
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72
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100
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Negative health impact
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No
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1
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2
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3
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Not Sure
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3
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6
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9
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Yes
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24
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64
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88
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Total
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28
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72
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100
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Figure 1.
Description of the study subjects by sex and psychological influences
Table
2 and Figure 2 show the distribution of stress, anxiety, and depression scores
by gender. Most participants reported the highest stress score (5), followed by
(4) and (3), which accounted for 33%, 28%, and 23%, respectively. The majority
of males indicated a stress score of 4, followed by scores of 2 and 3,
comprising 9/28 (32%), 8 (28.5%), and 6 (21.4%), in that order; thus, females
were more frequent with a score of 5, followed by 4 and 3, representing 28/72
(38.9%), 19 (26.4%), and 17 (23.6%), respectively. 22% of the contributors
reported anxiety, with 5/28 (17.8%) males and 17/72 (23.6%) females. The risk
of anxiety in women: RR (95% CI) = 0.913 (0.698-1.193), P-value = 0.369.
The highest depression frequency was detected in score (5), followed by scores
(3) and (4), which were 30%, 26%, and 22%, respectively. Most males reported a
score of 3, followed by scores of 4 and 5, accounting for 8/28 (28.6%) and 6/28
(21.4%), respectively, per capita. The majority of
females reported a score of 5, followed by 3 and 4, representing2 (33.3%), 18
(25%), and 16 (22.2%), respectively, as shown in Table 2 and Figure 2.
Table
2. Distribution of stress, anxiety, and depression scores by sex
|
Variable
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Males
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Females
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Total
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Stress Score
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1
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0
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0
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0
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2
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8
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8
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16
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3
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6
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17
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23
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4
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9
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19
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28
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5
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5
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28
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33
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Total
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28
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72
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100
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Anxiety
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No
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23
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55
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78
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Yes
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5
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17
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22
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Total
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28
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72
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100
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Depression score
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|
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1
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3
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5
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8
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2
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5
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9
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14
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|
3
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8
|
18
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26
|
|
4
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6
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16
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22
|
|
5
|
6
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24
|
30
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Total
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28
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72
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100
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Figure 2.
Description of stress, anxiety, and depression scores by sex
DISCUSSION
Long-term
night shift work has various health and social consequences. Healthcare
personnel are at an increased risk for various health disorders linked to night
shift work globally. However, the aim of the present study was to investigate
the psychiatric issues related to night shift work among medical staff in Saudi
Arabia.
Many organisms possess circadian rhythms that enable them to anticipate changes
in their environment. The circadian clock regulates food intake, sleep
patterns, physical activity, and cortisol levels. The circadian clock is
regulated by environmental light signals and can be disturbed by factors such
as shift work, jet lag, stress, aging, and exposure to artificial light at
night. Mood exhibits a daily cycle. Patients with depression exhibit irregular
biological rhythms in sleep, appetite, activity, and cortisol levels,
indicating that circadian rhythmicity plays a significant role in the etiology
and pathophysiology of the disorder.
The findings of this study indicate elevated depression scores. The cumulative
percentage of individuals with a score of 3 or higher exceeded 78%.
Additionally, over 20% of the study participants reported experiencing anxiety
and stress. Nonetheless, a comparable study has presented differing results.
The study evaluated 9,181 nurses working night shifts. Depression was reported
in 58.82% of participants, while anxiety was reported in 62.08%. The
discrepancies may be attributed to the limited sample size and the inclusion of
all medical staff rather than focusing solely on nurses. The study's extensive
sample size and evaluated parameters encompass fatigue during shift work,
psychological stress before, during, and after night shifts, feelings of
refreshment following rest before and after night shifts, use of sleep
medication prior to and following night shifts, physical discomfort experienced
during night shifts, busyness during night shifts, food intake during shift
work, working over 40 hours per week during shift work, and sleep quality
before and after night shifts [10]. As a result, their findings may exhibit
greater reliability than ours. Depression constitutes 4.3% of the global
disease burden and incidence, with projections indicating that mental disorders
will incur costs of US $16.3 million by 2030. Approximately 20% of individuals
in the United States and Europe engage in shift work, which correlates with a
heightened risk of adverse mental health outcomes. Consequently, industries
that rely on shift work represent a critical area for intervention aimed at
alleviating this issue. Health promotion programs in the workplace are
essential to reduce the risk of poor mental health among shift workers [11].
In the current study, over 70% of participants reported experiencing headaches.
Shift work correlates with musculoskeletal pain and headaches [12]. A
significant trend suggested that the risk of headaches was elevated on workday
3 compared to workday 2 for night shifts (OR 1.13, 95% CI 0.99 to 1.28). The
risk decreased when sleep duration was considered (OR 0.37, 95% CI 0.17 to
0.81) [13].
A significant number of participants experienced sleep disturbances,
exhaustion, and negative impacts. Working more than eight-night shifts per
month is associated with a higher risk of insomnia, fatigue, and depression.
The risk of these conditions was significantly and directly proportional to the
number of night shifts conducted per month [14]. Shift work is associated with
reduced sleep and shift work disorder, as well as various sleep disorders,
including insomnia, sleep-related breathing disorders, and sleep-related
movement disorders. Our findings suggest that education on coping strategies is
particularly crucial for young and lower-educated shift workers [15].
Countermeasures for wakefulness and sleep promotion may mitigate sleepiness and
enhance sleep quality; however, currently, there are no effective treatments
capable of fully counteracting the adverse effects of shift work schedules on
human physiology and behaviour. Further research is required to elucidate the
reasons behind certain individuals' susceptibility to nighttime sleepiness and
daytime insomnia [16].
Shift work elevated the overall risk of adverse mental health outcomes,
including depression and anxiety, by 28% [11]. Occupational physicians have
long debated the association between night shift work and depression, as well
as other concurrent mental health issues, focusing on work-related, biological,
individual, and environmental factors. A recent meta-analysis demonstrated a
significant correlation between night shift work, the resultant circadian and
sleep disruption, and the increased risk of depression among nurses. This
indicates that nurses employed in night shifts are susceptible to the
development of depression [17].
The literature on night shift work is limited; however, the study revealed a
significant psychosocial impact on nurses engaged in night shifts. It is
recommended to develop incentives and support structures for nurses engaged in
night shift work [18].
This study encourages authorities to provide support for psychiatric disorders
related to night shift work among medical teams; however, it has limitations,
such as a small sample size and the use of an online cross-sectional survey
design.
In conclusion, depression, negative health impacts, sleep disturbances,
exhaustion, and headaches are the most prevalent psychiatric disorders linked
to prolonged night shift work among medical staff in Saudi Arabia. Support
initiatives are considered essential for medical staff to mitigate the adverse
effects of night shifts.
Acknowledgement
The
authors express their sincere appreciation to the participants for dedicating
their time to complete the questionnaire.
Funding
Self-funded
Conflict
of interest
The
authors declare no conflict of interest.
Ethical
consent
Before completing out the
questionnaire, each participant gave permission to participate.
Ethical
approval
The
Human Research Ethics Committee at MRCC has approved the study's proposal.
Approval Number: HREC0015/PMRCC.4/25.
Data
availability
Data
regarding this study is available from the corresponding author.
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