Lifestyle Factors in the Association of Shift Work and Depression and Anxiety

Abstract

IMPORTANCEShift work may lead to adverse health outcomes. Whether shift work is associated with depression and anxiety, and to what extent lifestyle mediates the associations, remains unknown.OBJECTIVETo explore the associations of shift work, its type, frequency, and working years with anxiety and depression and to examine the potential mediating role of lifestyles.Design, Setting, and ParticipantsThis cohort study included 175 543 employed or self-employed workers who participated in the UK Biobank baseline survey (2006-2010). Data analysis was conducted from November 2022 to January 2023.EXPOSURESEmployment and shift work status information was obtained from baseline. Lifestyles included smoking, physical activity, alcohol consumption, dietary characteristics, sleep duration, sedentary time, and body mass index (BMI).MAIN OUTCOMES AND MEASURESDepression and anxiety were identified based on electronic health records. Cox proportional hazard regression models were used to calculate the association of shift work with anxiety and depression, and cause mediation analyses we used to test the mediating role of lifestyle factors in this association.RESULTSOf the 175 543 included participants (mean [SD] age, 52.6 [7.1] years; 88 290 men [50.3%]; 167 495 White participants [95.4%]), 27 637 participants (16.2%) reported shift work. During a median (IQR) follow-up of 9.06 (8.35-9.75) years, 3956 workers (2.3%) developed depression and 2838 (1.7%) developed anxiety. In the fully adjusted model, individuals who reported engaging in shift work, or shift workers, had a higher risk of depression (HR, 1.22; 95% CI, 1.12-1.33; P < .001) and anxiety (HR, 1.16; 95% CI, 1.04-1.28; P < .001), and the risk was positively associated with shift frequency. Among shift workers, there was no significant difference between night shifts and nonnight shifts. In the dose-association analyses, years of shift work were negatively associated with the risk of depression and anxiety. Smoking, sedentary time, BMI, and sleep duration were identified as the main potentially modifiable mediators. These mediators together explained 31.3% of the association between shift work and depression and 21.2% of the association between shift work and anxiety.CONCLUSIONS AND RELEVANCEIn this cohort study, shift work was significantly associated with a higher risk of depression and anxiety, and lifestyle factors partially mediated the associations. These findings not only support that shift work should be considered an occupational hazard, but also provide evidence for the urgent need for the development of public health interventions that promote healthy lifestyles aimed at improving the mental health of shift workers.

Association between Shift Work and Health Outcomes in the General Population in China: A Cross-Sectional Study

“…Our results suggested that shift work participation, even with low frequency, may be associated with higher ORs of poor health outcomes. Previous studies have also found that shift work increased the risk of anxiety, depression, and coronary heart disease, neglecting shift frequency [5,54]. However, some studies have found that poor health outcomes increased following more frequent shift work [53].…”

The effect of shift work on body mass index: A systematic review and meta‐analysis of observational studies

“…Twenty-four studies included participants of both sexes. The number of participants in each study ranged from 11 (Wehrens et al, 2012) to 27 637 (Xu et al, 2023) in the shift work groups and from 14 (Geliebter et al, 2000;Wehrens et al, 2012;Yoshizaki et al, 2013) to 197 597 (Ho et al, 2022) Female and man participants ranged from 24.4 ± 2.9 years (Morikawa et al, 2008) to 56.3 ± 8.5 years (Lavie & Lavie, 2007) in the shift group and from 25.2 ± 2.9 years to 55.5 ± 3.6 years (Kubo et al, 2011). The mean period of exposure to shift work ranged from 2.1 ± 2.2 (Morikawa et al, 2008) to 28.6 ± 4.2 years (Dong et al, 2022).…”

The Psychoneuroimmunological Model of Moral Distress and Health in Healthcare Workers: Toward Individual and System-Level Solutions

“…Despite substantial work examining the negative effects of stress on health, we currently lack an organized understanding of how stress leads to poor health and functioning in HCWs [ 31 ]. In this review, therefore, we apply the Job Demands-Resources (JD-R) health model [ 32 ], combining its core concept with a psychoneuroimmunological approach to elucidate neuroendocrine and neuroimmune mechanisms through which occupational stress may impact inflammation and immune dysregulation, resulting in long-lasting health consequences for HCWs.…”