The influence of workplace stress and coping on depressive symptoms among registered nurses in Bangladesh


occupational stress
mental health

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Mondal, R., Sitthimongkol, Y., Vongsirimas, N., Chansatitporn, N. ., & Hegadoren, K. (2022). The influence of workplace stress and coping on depressive symptoms among registered nurses in Bangladesh. Belitung Nursing Journal, 8(1), 11–19.
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Accepted for publication: 2021-12-19
Peer reviewed: Yes

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Background: Nurses report high levels of workplace stress, which has been linked to an increased risk for experiencing depressive symptoms.Nurses’ workplace stress is also linked to increased absenteeism and decreased job satisfaction.

Objectives: The objectives of this study were to examine: (1) the incidence of depressive symptoms among hospital-based registered nurses in Bangladesh; (2) common sources of workplace stress and their relationships to individual characteristics and depressive symptom scores; and (3) the potential mediating roles of coping strategies in the relationship between workplace stress and depressive symptoms.

Methods: A cross-sectional study design involved three hundred and fifty-two registered nurses. Data were collected using a demographic questionnaire and three standardized tools measuring sources of nurses’ workplace stress, coping strategies, and depressive symptoms.

Results: More than half of the participants scored ≥ 16 on the CES-D, which was associated with a major depression episode. Total NSS scores had a small but significant influence on scores on the depression scale. Coping strategies had no mediated effect on the relationship between workplace stress and scores on the depression scale. Low-reliability coefficients for subscales of two of the standardized tools highlight the challenge for researchers in developing countries to address contextual differences that may influence the meanings attached to individual items. 

Conclusion: Findings suggest that the mental health of registered nurses in Bangladesh requires immediate attention in part by attending to workplace stressors. Further research should focus on a deeper understanding of Bangladeshi registered nurses’ work experiences and the unique contribution that workplace stressors have on their physical and mental health.


Copyright (c) 2022 Reva Mondal, Yajai Sitthimongkol, Nopporn Vongsirimas, Natkamol Chansatitporn, Kathy Hegadoren

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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Declaration of Conflicting Interest

The authors have no conflict of interest to declare.


The authors would like to acknowledge and thank all RNs participating in this study.

Authors’ Contributions

RM: Conception and design of the study, acquisition, analysis, and interpretation of data, writing the article under supervision of all authors. YS: Consultant on the area of mental health and conceptual research framework, overall guidance, and supervision from the conception of the study to the final approval of the submitted version. NV: Supervision in methodology, data collection, analysis, and interpretation of results, facilitate in article revision for content accuracy. NC: Statistical analysis and interpretation of results KH: Consultant on the area of stress and coping, drafting the article and revising critically for important intellectual content, editing of article’s grammar, and overall content flow and consistency. All authors agreed with the final version of the article to be published.

Data Availability

Based on IRB-NS, raw data were not allowed to generate on request.


Al Gamal, E., Alhosain, A., & Alsunaye, K. (2018). Stress and coping strategies among Saudi nursing students during clinical education. Perspectives in Psychiatric Care, 54(2), 198-205.

Alenezi, A. M., Aboshaiqah, A., & Baker, O. (2018). Work‐related stress among nursing staff working in government hospitals and primary health care centres. International Journal of Nursing Practice, 24(5), e12676.

Alkrisat, M., & Alatrash, M. (2017). Psychometric properties of the extended nursing stress scale: Measuring stress in workplace. Journal of Nursing Measurement, 25(1), 31E-45E.

Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173-1182.

Bautista, J. R., Lauria, P. A. S., Contreras, M. C. S., Maranion, M. M. G., Villanueva, H. H., Sumaguingsing, R. C., & Abeleda, R. D. (2020). Specific stressors relate to nurses’ job satisfaction, perceived quality of care, and turnover intention. International Journal of Nursing Practice, 26(1), e12774.

Bianchi, R., Schonfeld, I. S., & Laurent, E. (2015). Burnout–depression overlap: A review. Clinical Psychology Review, 36, 28-41.

Chen, J., Li, J., Cao, B., Wang, F., Luo, L., & Xu, J. (2020). Mediating effects of self‐efficacy, coping, burnout, and social support between job stress and mental health among young Chinese nurses. Journal of Advanced Nursing, 76(1), 163-173.

Cheung, T., & Yip, P. S. F. (2015). Depression, anxiety and symptoms of stress among Hong Kong nurses: A cross-sectional study. International Journal of Environmental Research and Public Health, 12(9), 11072-11100.

Crocker, L., & Algina, J. (1986). Introduction to classical and modern test theory. Orlando, FL: ERIC.

Deng, X., Liu, X., & Fang, R. (2020). Evaluation of the correlation between job stress and sleep quality in community nurses. Medicine, 99(4).

Dewe, P. J., O’Driscoll, M. P., & Cooper, C. (2010). Coping with work stress: A review and critique. Oxford: John Wiley & Sons.

Eid, R. S., Gobinath, A. R., & Galea, L. A. M. (2019). Sex differences in depression: Insights from clinical and preclinical studies. Progress in Neurobiology, 176, 86-102.

Enns, V., Currie, S., & Wang, J. (2015). Professional autonomy and work setting as contributing factors to depression and absenteeism in Canadian nurses. Nursing Outlook, 63(3), 269-277.

Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175-191.

Folkman, S., & Lazarus, R. S. (1980). An analysis of coping in a middle-aged community sample. Journal of Health and Social Behavior, 21(3), 219-239.

Folkman, S., & Lazarus, R. S. (1985). If it changes it must be a process: Study of emotion and coping during three stages of a college examination. Journal of Personality and Social Psychology, 48(1), 150-170.

Folkman, S., & Lazarus, R. S. (1988a). Ways of coping questionnaire. Palo Alto, CA: Consulting, Psychological Press.

Folkman, S., & Lazarus, R. S. (1988b). Coping as a mediator of emotion. Journal of Personality and Social Psychology, 54(3), 466-475.

Gray-Toft, P., & Anderson, J. G. (1981). The nursing stress scale: Development of an instrument. Journal of Behavioral Assessment, 3(1), 11-23.

Hall, A. L., Franche, R.-L., & Koehoorn, M. (2018). Examining exposure assessment in shift work research: A study on depression among nurses. Annals of Work Exposures and Health, 62(2), 182-194.

Jang, M. H., Gu, S. Y., & Jeong, Y. M. (2019). Role of coping styles in the relationship between nurses’ work stress and well‐being across career. Journal of Nursing Scholarship, 51(6), 699-707.

Joarder, T., Parvage, M. A., Rawal, L. B., & Ahmed, S. M. (2021). A policy analysis regarding education, career, and governance of the nurses in Bangladesh: A qualitative exploration. Policy, Politics, & Nursing Practice, 22(2), 114-125.

Kaddourah, B., Abu-Shaheen, A. K., & Al-Tannir, M. (2018). Quality of nursing work life and turnover intention among nurses of tertiary care hospitals in Riyadh: A cross-sectional survey. BMC Nursing, 17(1), 1-7.

Karadzinska Bislimovska, J., Basarovska, V., Mijakoski, D., Minov, J., Stoleski, S., Angeleska, N., & Atanasovska, A. (2014). Linkages between workplace stressors and quality of care from health professionals’ perspective–Macedonian experience. British Journal of Health Psychology, 19(2), 425-441.

Kato, T. (2015). Frequently used coping scales: A meta‐analysis. Stress and Health, 31(4), 315-323.

Khodadadi, E., Hosseinzadeh, M., Azimzadeh, R., & Fooladi, M. (2016). The relation of depression, anxiety and stress with personal characteristics of nurses in hospitals of Tabriz, Iran. International Journal of Medical Research & Health Sciences, 5(5), 140-148.

Kieffer, K. M., & MacDonald, G. (2011). Exploring factors that affect score reliability and variability. Journal of Individual Differences, 31(1), 26-38.

Kim, K. M., Nam, K. A., Lee, E., & Jeong, G. H. (2015). Validity and reliability of the Korean version of the expanded nursing stress scale. Journal of Korean Academy of Nursing Administration, 21(5), 542-551.

Labrague, L. J., McEnroe‐Petitte, D. M., Leocadio, M. C., Van Bogaert, P., & Cummings, G. G. (2018). Stress and ways of coping among nurse managers: An integrative review. Journal of Clinical Nursing, 27(7-8), 1346-1359.

Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.

Li, L., Ai, H., Gao, L., Zhou, H., Liu, X., Zhang, Z., . . . Fan, L. (2017). Moderating effects of coping on work stress and job performance for nurses in tertiary hospitals: A cross-sectional survey in China. BMC Health Services Research, 17(1), 1-8.

Lin, H. S., Probst, J. C., & Hsu, Y. C. (2010). Depression among female psychiatric nurses in southern Taiwan: main and moderating effects of job stress, coping behaviour and social support. Journal of Clinical Nursing, 19(15‐16), 2342-2354.

Maharaj, S., Lees, T., & Lal, S. (2019). Prevalence and risk factors of depression, anxiety, and stress in a cohort of Australian nurses. International Journal of Environmental Research and Public Health, 16(1), 61.

Martin, C. J. (2015). The effects of nurse staffing on quality of care. MedSurg Nursing, 24(2), S4-S4.

Mert, S., Aydin Sayilan, A., & Baydemir, C. (2021). Nurse Stress Scale (NSS): Reliability and validity of the Turkish version. Perspectives in Psychiatric Care, 57(2), 443-454.

Newman, C., Jackson, J., Macleod, S., & Eason, M. (2020). A survey of stress and burnout in forensic mental health nursing. Journal of Forensic Nursing, 16(3), 161-168.

Pathak, V., Chakraborty, T., & Mukhopadhyay, S. (2013). Reliability and validity analysis of modified Nursing Stress Scale for Indian population. Journal of Nursing Measurement, 21(2), 224-245.

Peter, K. A., Hahn, S., Schols, J. M. G. A., & Halfens, R. J. G. (2020). Work‐related stress among health professionals in Swiss acute care and rehabilitation hospitals—A cross‐sectional study. Journal of Clinical Nursing, 29(15-16), 3064-3081.

Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385-401.

Ramezanli, S., Koshkaki, A. R., Talebizadeh, M., Jahromi, Z. B., & Jahromi, M. K. (2015). A study of the coping strategies used by nurses working in the intensive care units of hospitals affiliated to Jahrom University of Medical Sciences. International Journal of Current Microbiology and Applied Sciences, 4(4), 157-163.

Rexrode, K. R., Petersen, S., & O'Toole, S. (2008). The Ways of Coping Scale: A reliability generalization study. Educational and Psychological Measurement, 68(2), 262-280.

Rony, M. K. K. (2021). Diploma in Nursing or Bachelor of Science in Nursing: Contradictory issues among nurses in Bangladesh. Belitung Nursing Journal, 7(1), 57-58.

Salk, R. H., Hyde, J. S., & Abramson, L. Y. (2017). Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychological Bulletin, 143(8), 783-822.

Salma, U., & Hasan, M. M. (2020). Relationship between job satisfaction and depression, anxiety and stress among the female nurses of Dhaka Medical College and Hospital, Bangladesh. Patient Care, 10(3), 94-102.

Tsaras, K., Papathanasiou, I. V., Vus, V., Panagiotopoulou, A., Katsou, M. A., Kelesi, M., & Fradelos, E. C. (2018). Predicting factors of depression and anxiety in mental health nurses: A quantitative cross-sectional study. Medical Archives, 72(1), 62-67.

Vakili, M. M., & Jahangiri, N. (2018). Content validity and reliability of the measurement tools in educational, behavioral, and health sciences research. Journal of Medical Education Development, 10(28), 106-118.

Walker, J. L., Slavish, D. C., Dolan, M., Dietch, J. R., Wardle-Pinkston, S., Messman, B., . . . Kelly, K. (2021). Age-dependent associations among insomnia, depression, and inflammation in nurses. Psychology & Health, 36(8), 967-984.

Wang, W., Kong, A. W. M., & Chair, S. Y. (2011). Relationship between job stress level and coping strategies used by Hong Kong nurses working in an acute surgical unit. Applied Nursing Research, 24(4), 238-243.

World Health Organization. (2017). Number of people with depression increases. Retrieved from

World Health Organization. (2020). The Global health observatory: Bangladesh national health accounts, an overview on the public and private expenditures in health sectors. Retrieved from

Yuwanich, N., Akhavan, S., Nantsupawat, W., Martin, L., Elfström, M. L., & Sandborgh, M. (2018). Development and psychometric properties of the stressor scale for emergency nurses. International Emergency Nursing, 39, 77-88.

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