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Exposure to extremely low-frequency electromagnetic fields (ELF-EMF) is inevitable in some industries. There are concerns about the possible effects of this exposure. The present study aimed to investigate the effect of chronic exposure to extremely low-frequency electromagnetic fields on sleep quality, stress, depression and anxiety among power plant workers. In this cross-sectional study, 132 power plant workers were included as the exposed group and 143 other workers were included as the unexposed group. The intensity of ELF-EMF at work stations was measured by using the IEEE Std C95.3.1 standard and then the time weighted average was calculated. Sleep quality, stress, depression and anxiety were measured by using the Pittsburgh Sleep Quality Index Questionnaire; and the Depression, Anxiety and Stress Scale. The workers in the exposed group experienced significantly poorer sleep quality than the unexposed group. Depression was also more severe in the exposed group than the unexposed group (P = 0.039). Increased exposure to ELF-EMF had a direct and significant relation with increased stress, depression, and anxiety. Sleep quality in technicians with the highest exposure was significantly lower than the other groups. This study suggests that long-term occupational exposure to ELF-EMF may lead to depression, stress, anxiety and poor sleep quality. [ABSTRACT FROM AUTHOR]