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Background: There has been growing concern about the negative mental health impact of long working hours and overwork. Our study examined how work-life imbalance (WLI) could be a mediator between working hours and poor mental well-being., Methods: We included 34,968 individuals from a nationwide cross-sectional survey in Korea. Self-reported working hours per week were collected, and mental health was assessed using the World Health Organization (WHO)-5 Well-Being Index. Counterfactual-based mediation models were employed to disentangle the total effects into a direct effect (work hour - poor mental health) and an indirect effect (work hour - WLI - poor mental health)., Results: Out of 34,968 participants, 52.6% worked 35-40 hours/week, 20.0% worked 41-48 hours/week, 11.7% worked 49-54 hours/week, and 15.6% worked ≥55 hours/week. The odds ratios (ORs) of the total impact of working hours on poor mental health were 1.08 (95% confidence interval [CI], 1.01-1.16) for 41-48 hours/week, 1.28 (95% CI, 1.17-1.39) for 49-54 hours/week, and 1.60 (95% CI, 1.48-1.74) for ≥55 hours/week in comparison to 35-40 hours/week. The ORs of the indirect effects were 1.04 (95% CI, 1.03-1.05) for 41-48 hours/week, 1.08 (95% CI, 1.07-1.09) for 49-54 hours/week, and 1.14 (95% CI, 1.12-1.16) for ≥55 hours/week, accounting for 51%, 31%, and 28% of the total effects, respectively., Conclusion: Our findings suggest that WLI can partially mediate the association of long working hours with mental health deterioration. Policy efforts are required to mitigate the adverse mental health effects of overwork.

Importance: Extended work hours and night shifts are essential in health care, but negatively affect physician sleep, well-being, and patient care. Alternative schedules with shorter work hours and/or reduced irregularity might mitigate these issues., Objective: To compare sleep, well-being, and cognition between interns working irregular, extended shifts (call schedule), and those working a more regular schedule with restricted hours (float schedule)., Design, Setting, and Participants: In this observational longitudinal cohort study, interns in a Singapore-based teaching hospital were studied for 8 weeks from January 2022 to July 2023. Data were analyzed from July 2023 to July 2024., Exposure: Participants worked either regular approximately 10-hour workdays, interspersed with 24 hour or more overnight calls 4 to 5 times a month, or a float schedule, which included regular approximately 10-hour workdays, and 5 to 7 consecutive approximately 12-hour night shifts every 2 months. Exposure was based on departmental training and operational needs., Main Outcomes and Measures: Sleep was measured with wearable sleep trackers and an electronic diary. Day-to-day well-being and cognitive assessments were collected through a smartphone application. Assessments included the Sleep Regularity Index (SRI; determines the probability of an individual being in the same state [sleep or wake] at any 2 time points 24 hours apart, with 0 indicating highly random sleep patterns and 100 denoting perfect regularity) and Pittsburgh Sleep Quality Inventory (PSQI; scores ranges from 0 to 21, with higher scores indicating poorer sleep; a score greater than 5 suggests significant sleep difficulties)., Results: Participants (mean [SD] age, 24.7 [1.1] years; 57 female participants [59.4%]; 41 on call schedule [42.7%]; 55 on float schedule [57.3%]) provided 4808 nights of sleep (84.2%) and 3390 days (59.3%) of well-being and cognition assessments. Participants on a float schedule had higher SRI scores (mean [SD] score, 69.4 [6.16]) and had better quality sleep (PSQI mean [SD] score, 5.4 [2.3]), than participants on call schedules (SRI mean [SD] score, 56.1 [11.3]; t91 = 6.81; mean difference, 13.3; 95% CI, 9.40 to 17.22; P < .001; PSQI mean [SD] score, 6.5 [2.3]; t79 = 2.16; 95% CI, 0.09 to 2.15; P = .03). Overnight call shifts, but not night float shifts, were associated with poorer mood (-13%; β = -6.79; 95% CI, -9.32 to -4.27; P < .001), motivation (-21%; β = -10.09; 95% CI, -12.55 to -7.63; P < .001), and sleepiness ratings (29%; β = 15.96; 95% CI, 13.01 to 18.90; P < .001) and impaired vigilance (21 ms slower; β = 20.68; 95% CI, 15.89 to 25.47; P < .001) compared with regular day shifts. Night shifts with naps were associated with better vigilance (16 ms faster; β = -15.72; 95% CI, -28.27 to -3.17; P = .01) than nights without naps., Conclusions and Relevance: In this cohort study, 24-hour call schedules were associated with poorer sleep, well-being, and cognition outcomes than float schedules. Naps during night shifts benefited vigilance in both schedules.

This study aimed to determine the relationship between melatonin hormone levels, sleep, and factors affecting sleep, psychological resilience, and depression in nurses working with a shift work system. Conducted between February 5-12, 2021, at the Training and Research Hospital in Ağrı province, the descriptive study included 41 night shift nurses and 35 day shift nurses, totaling 76 participants. Blood samples for melatonin analysis were collected and data were gathered using the Sociodemographic Information Form, Epworth Sleepiness Scale, Sleep Disorder Scale Short Form, Brief Psychological Resilience Scale, and Beck Depression Scale Short Form. Melatonin analysis was performed using the ELISA method. Statistical significance was set at p < 0.05. Results showed that sleep disorders were present in all nurses with <7 h of daily sleep. Factors such as the use of sleeping pills, marital status, age, and gender affected sleep disorders. Mean scores for melatonin levels were 67.82 ± 40.20 for night shift nurses and 68.08 ± 39.62 for day shift nurses, with no significant difference between shifts. Similarly, no significant differences were found in daytime sleepiness (7.49 ± 4.47 vs. 7.51 ± 4.65), sleep disturbance (24.71 ± 7.33 vs. 25.23 ± 6.64), psychological resilience (18.42 ± 4.19 vs. 17.89 ± 4.74), or depression (3.22 ± 2.60 vs. 3.49 ± 3.35). Nurses exhibited mild sleep disturbances, low depression tendencies, and moderate psychological resilience. Increased daytime sleepiness and sleep disorders correlated with higher depression tendencies and lower psychological resilience. Hospital management and education units are recommended to conduct interventions on sleep quality, depression, and psychological resilience to raise awareness among nurses., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: The association between occupational psychosocial factors and mental health has been studied in several systematic reviews. However, few systematic reviews exist that specifically address suicidal ideation. Therefore, this systematic review and meta-analysis aimed to examine the associations between long working hours, shift work, and suicidal ideation., Methods: We systematically screened and collected studies published between January 1970 and September 2022 from three electronic databases and Google Scholar. We conducted a meta-analysis using a random-effects model and assessed the risk of bias using a navigation guide. Additionally, the grading of recommendations assessment, development and evaluation (GRADE) approach was used to consider five items, including the risk of bias and publication bias., Results: Twenty-eight articles were included in this meta-analysis. After adjusting for covariates, the overall odds ratio (OR) for long working hours and shift work were 1.44 [95% confidence interval (CI) 1.26-1.63] and 1.34 (95% CI 1.22-1.47), respectively. Compared with those who worked <40 hours per week, those who worked >55 hours per week had a 1.65 (95% CI 1.37-1.98) higher risk of suicidal ideation, and fixed night shift workers had 1.37 (95% CI 1.03-1.83) higher risk than non-shift workers., Conclusions: Evidence has shown associations between long working hours, shift work, and suicidal ideation. Implementing evidence-based interventions to address these risk factors may help prevent the progression of suicidal ideation. However, further studies are critically needed, especially those using standardized exposure definitions and longitudinal data.

This cross-sectional study investigates the association between long working hours, short sleep duration, and mental health among Japanese physicians. We enrolled 232 Japanese physicians. We used the Brief Job Stress Questionnaire to assess high-stress status, and the Japanese version of the Center for Epidemiologic Studies Depression scale to assess depressive status. Daily sleep duration (DSD) and weekly working hours (WWHs) were collected using a self-administered questionnaire. Multivariable-adjusted logistic regression analysis was performed to examine the association of the combined categories of DSD and WWHs with high-stress and depressive status. Compared to physicians with WWHs <80 h and DSD ≥6 h, the multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of high-stress status for those with WWHs ≥80 and DSD ≥6, WWHs <80 and DSD <6, and WWHs ≥80 and DSD <6 were 2.76 (0.97-7.87), 3.36 (1.53-7.40), and 3.92 (1.52-10.14), respectively. The respective ORs (CIs) of depressive status were 1.82 (0.42-7.81), 4.03 (1.41-11.53), and 4.69 (1.33-16.62). The results showed that regardless of working long hours or not, physicians with DSD <6 h had significantly higher stress and depressive status, suggesting that not only regulating long working hours but also ensuring adequate sleep duration is important for preventing physicians' mental health.

Flexible working time arrangements (FWTA) have increased over the last decades, favored by labor market deregulation, the decentralization of collective bargaining and the development of new technologies. The negative impact of some non-standard working hours on health (like night work, shift work) is quite well-known but other forms of FWTA have been studied less so far. This article aims to investigate the relationship between FWTA and workers' health. It focuses on employer-oriented FWTA and uses a job demands-control framework to identify different types of working time demands and control. The study uses individual data from the French working conditions survey, including panel data from 2013 to 2019 (64,981 observations) and cross-sectional employer-employee linked data from 2019 (5687 employees from 4672 workplaces). We identify empirically two main dimensions of employer-oriented FWTA, based on 14 working time variables. The first type involves "atypical working hours", such as working weekends, nights, early mornings, evenings, or doing shift work. The second type - "work overflow" - is characterized by long working hours, overtime, taking work home, and having variable working hours. Using a fixed-effects model based on panel data, we show that both types of FWTA have a negative impact on workers' self-rated general health and mental health, as measured by the WHO-5 index. The study also finds that workers who have more control - both individual and collective - to face these demands demonstrate better health. Workers with control over their working hours report better health and are less negatively affected by FWTA. Moreover, workplace-level practices have ambiguous relationships with workers' health. However, those involving social dialogue and workers' participation have more favorable effects: the positive effect of health and safety committees is especially clear. To improve workers' health in the context of increased flexible working time arrangements, public policies should promote the development of control over working time and participation of workers to social dialogue on working time related issues., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This study characterizes, for the first time, the lives of U.S. Navy submariners engaged in normal, sea-based operations while following a circadian-aligned 24-h watchstanding schedule. Fifty-eight submarine crewmembers provided objective (actigraphy) and subjective (questionnaires) sleep data, and information about mood and lifestyle behaviors during 30 days underway. Projected performance scores and estimated circadian phase times were also calculated from actigraphy-based sleep/wake data. Submariners' objective (6.62 ± 0.94 h; mean ± SD) and subjective (5.90 ± 1.38 h) daily sleep quantities while underway were largely comparable to the sleep reportedly received by Sailors across other Navy platforms and watchstanding schedules. Additionally, submariners' actigraphy-predicted circadian phases shifted progressively toward better alignment with watchstanding schedules across time. Nevertheless, subjective sleep quality was low, submariners engaged in unfavorable lifestyle behaviors (lack of regular meals and exercise), and participants reported decreased mood at the completion of their underway time. Recommendations for countermeasure development are provided., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Burnout, stress and overwork are highly prevalent amongst junior training physicians worldwide, which explains the widespread phenomenon of physicians leaving the field and organised protests/strikes for better working conditions. Back in 2003, the mandatory duty hour restriction was a landmark intervention rolled out by the Accreditation Council for Graduate Medical Education that formally mandated limiting working hours of trainee residents to no more than 80 h per week, and not exceeding 24-h shifts with 6 added hours for education and handover. Nonetheless, 20 years later, this measure continues to be subject to multiple debates on its purported efficacy in achieving its intended objectives and fails to adequately prevent physician burnout and exodus. In our view, the current duty hour restriction model is, in and of itself, inadequate for combating burnout amongst medical residents for several reasons, including insignificant reduction in duty hours with suboptimal adherence/reporting, failure to account for off-site clinical and non-clinical duties, as well as nature of clinical work which typically involves high work intensity in less-than-optimal/unconducive work environments and significant psychoemotional stress. In this article, we offer our perspectives on pursuing a balanced approach towards both meaningful quantitative reduction in working hours as well as practical qualitative improvement in nature of clinical and non-clinical work that could collectively address resident burnout and improve work and training outcomes., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Working at night is associated with adverse cardiometabolic health outcomes. However, there are a lack of nutritional intervention studies conducted amongst night workers, subsequently contributing to a lack of evidence-based guidelines for night workers. The aim of The Eating on the Night Shift study was to understand how night shift workers view working at night in relation to nutritional health and wellbeing, the barriers and enablers to participate in research and what kind of guidance would be useful to them. Semi-structured qualitative interviews were conducted with a convenience sample (n = 18) of night workers based in England. The interview covered experiences of working night shifts, perceptions about night work and their health, and perceptions of and likely engagement with nutritional research. Interviews were audio recorded and transcribed verbatim. Transcripts were coded using an inductive thematic analysis approach. Of the final sample 13 were female (72%), 39% worked a rotating shift pattern and 78% had worked night shifts for 1 year or more. Four overarching themes were identified: (1) the consequences of night work on health and wellbeing, (2) eating at night means a less healthy diet, (3) working at night has wider knock-on effects on aspects of lifestyle and wellbeing and (4) nutritional research is perceived as important, but there are barriers to participation. Night workers are aware that working at night can negatively impact their diet as well as their health. Nutritional researchers need to engage with night workers when considering intervention design and implementation as well as in the development of any resultant evidence-based guidance to ensure its relevance., (© 2024 The Author(s). Nutrition Bulletin published by John Wiley & Sons Ltd on behalf of British Nutrition Foundation.)

Objectives: This study aimed to evaluate the independent and interactive effects of changes in overtime and night shifts on burnout among nurses during the COVID-19 pandemic., Methods: Nurses working in an Italian university hospital (N=317) completed the Maslach Burnout Inventory in September 2019 and again in December 2020. Based on hospital administrative data, changes in overtime and night shifts in the same years were categorized into three groups each. Linear regressions were used to estimate 2020 burnout differences between exposure groups, controlling for 2019 burnout levels, demographic and work-related characteristics, and to test the interaction between the two exposures., Results: Nurses in the onset of high overtime group had higher emotional exhaustion [4.33, 95% confidence interval (CI) 1.74-6.92], depersonalization (2.10, 95% CI 0.49-3.71), and poor personal accomplishment (2.64, 95% CI 0.55-4.74) compared to stable low overtime nurses. Nurses in the increase in night shifts group had lower emotional exhaustion (-4.49, 95% CI -7.46- -1.52) compared to no night shift nurses. Interaction analyses revealed that this apparently paradoxical effect was limited to stable low overtime nurses only. Moreover, increases in night shifts were associated with higher depersonalization and poor personal accomplishment in nurses in the stable high overtime group., Conclusions: Increase in overtime is an independent risk factor for burnout among nurses, highlighting the need for specific regulations and actions to address it. Long-standing guidelines for the assignment of night shifts might have contributed to attenuate the impact of their increase on nurses' mental health.

Introduction: Rotating shiftwork schedules are known to disrupt sleep in a manner that can negatively impact safety. Consumer sleep technologies (CSTs) may be a useful tool for sleep tracking, but the standard feedback provided by CSTs may not be salient to shift-working populations. SleepTank is an app that uses the total sleep time data scored by a CST to compute a percentage that equates hours of sleep to the fuel in a car and warns the user to sleep when the "tank" is low. Royal Australian Navy aircraft maintenance workers operating on a novel rotational shift schedule were given Fitbit Versa 2s to assess sleep timing, duration, and efficiency across a 10-week period. Half of the participants had access to just the Fitbit app while the other half had access to Fitbit and the SleepTank app. The goal of this study was to evaluate differences in sleep behavior between shifts using an off-the-shelf CST and to investigate the potential of the SleepTank app to increase sleep duration during the 10-week rotational shift work schedule., Materials and Methods: Royal Australian Navy volunteers agreed to wear a Fitbit Versa 2 with the SleepTank app (SleepTank condition), or without the SleepTank app (Controls), for up to 10 weeks from May to July 2023 during the trial of a novel shift rotation schedule. Participants from across 6 units worked a combination of early (6:00 AM to 2:00 PM), day (7:30 AM to 4:30 PM), late (4:00 PM to 12:00 AM), and night shifts (12:00 AM to 6:00 AM) or stable day shifts (6:00 AM to 4:00 PM). Differences in sleep behavior (time in bed, total sleep time, bedtime, wake time, sleep efficiency [SE]) between conditions and shift types were tested using Analysis of Variance. This study was approved by the Australian Departments of Defence and Veterans' Affairs Human Research Ethics Committee., Results: Thirty-four participants completed the full study (n = 17 Controls; n = 17 SleepTank). There was a significant effect of shift type on 24-hour time in bed (TIB24; F(4,9) = 8.15, P < .001, η2 = 0.15) and total sleep time (TST24; F(4,9) = 8.54, P < .001, η2 = 0.18); both were shorter in early shifts and night shifts compared to other shift types. TIB24 and TST24 were not significantly different between conditions, but there was a trend for greater SE in the SleepTank condition relative to Controls (F(1,9) = 2.99, P = .08, η2 = 0.11)., Conclusions: Sleep data collected by Fitbit Versa 2s indicated shorter sleep duration (TIB24, TST24) for Royal Australian Navy workers during early and late shifts relative to stable day shifts. Access to the SleepTank app did not greatly influence measures of sleep duration but may be protective against fatigue by affecting SE. Further research is needed to evaluate the utility of the SleepTank app as a means of improving sleep hygiene in real-world, shift-working environments., (© The Association of Military Surgeons of the United States 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

Background: Unpaid overtime-describing a situation where extra hours are worked but not paid for-is a common feature of the labor market that, together with other forms of wage theft, costs workers billions of dollars annually. In this study, we examine the association between unpaid overtime and mental health in the Canadian working population. We also assess the relative strength of that association by comparing it against those of other broadly recognized work stressors., Methods: Data were drawn from a survey administered to a heterogeneous sample of workers in Canada (n = 3691). Generalized linear models quantified associations between unpaid overtime, stress, and burnout, distinguishing between moderate (1-5) and excessive (6 or more) hours of unpaid overtime., Results: Unpaid overtime was associated with higher levels of stress and burnout. Relative to those working no unpaid overtime, men working excessive unpaid overtime were 85% more likely to report stress (prevalence ratios [PR]: 1.85, 95% confidence interval [CI]: 1.26-2.72) and 84% more likely to report burnout (PR: 1.84, 95% CI: 1.34-2.54), while women working excessive unpaid overtime were 90% more likely to report stress (PR: 1.90, 95% CI: 1.32-2.75) and 52% more likely to report burnout (PR: 1.52; 95% CI: 1.12-2.06). The association of excessive unpaid overtime with mental health was comparable in magnitude to that of shift work and low job control., Conclusions: Unpaid overtime may present a significant challenge to the mental health of working people, highlighting the potential role of wage theft as a neglected occupational health hazard., (© 2024 The Authors. American Journal of Industrial Medicine published by Wiley Periodicals LLC.)

Background: Work-related fatigue, combined with shift work and prolonged work hours, has a significant effect, contributing to increasing accident rate by 50-100%., Aims: To assess the level of work-related fatigue over a 4-week work period among offshore rig oil and gas workers in Indonesia., Methods: This cohort study evaluated acute fatigue, chronic fatigue, and intershift recovery scores among offshore oil and gas rig workers using the Occupational Fatigue Exhaustion Recovery 15 (OFER15) questionnaire. Fatigue levels were assessed weekly throughout the study duration, which was 4-week work period. Additionally, at the fourth week, participants were asked about psychosocial factors that could be potentially related to fatigue., Results: Of 67 participants, the average scores of acute and chronic fatigue were 30.0 and 33.3, and the scores had significantly increased over 4 weeks (P < 0.001). The intershift recovery scores statistically significantly decreased over 4 weeks (P < 0.001), and the differences between weeks (Week 1 versus 2, Week 1 versus 3 and Week 1 versus 4) were also statistically significant (P < 0.001). Acute and chronic fatigue scores had a significant positive correlation with psychological job demands and negatively correlated with influence at work and job satisfaction. Over 4 weeks, acute fatigue augmented chronic fatigue, while acute and chronic fatigue demanded a longer recovery., Conclusions: Workers at the offshore rig experienced work fatigue during their on-duty periods, with the level of fatigue significantly increasing over the 4 weeks. Comprehensive fatigue management at offshore rigs is vital to mitigate work fatigue and minimize the risk of work-related accidents., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: The shift work schedule is a common work arrangement that can disrupt typical sleep-wake rhythms and lead to negative health consequences. The present study aims to examine the effect of shift work on health-related quality of life (QoL) and explore potential behaviorial mediators (i.e., sleep, eating, exercise, smoking, drinking)., Methods: A cross-sectional survey was conducted among 4,449 petroleum workers in southwest China. Data on shift work status, health behaviors, and physical and mental health QoL were collected. We tested our model using path analysis and the Monte Carlo approach among 2,129 included participants., Results: After adjusting for covariates, shift work did not exhibit a significant direct association with QoL. However, shift work indirectly related to poorer physical health quality of life via less frequent healthy food consumption; shift work also indirectly related to poorer mental health QoL via both less frequent healthy food consumption and physical exercise. No significant indirect effects were found via sleeping, smoking, or drinking., Conclusions: Results suggest that shift work presents a challenge for QoL among Chinese petroleum workers due to their lesser engagement in two specific health behaviors: healthy eating and physical exercise. Healthy eating and exercise may present an even more prominent threat to shift workers' QoL than sleep and substance use. Strategies targeting shift work schedule as well as eating and exercise behaviors may help protect against poor QoL and adverse physical and mental health outcomes in this vulnerable group., (© 2024. The Author(s).)

Importance: Misaligned dietary rhythmicity has been associated with metabolic diseases; however, its association with mental health remains largely unexplored., Objective: To examine the association between dietary rhythms and the mental health condition of shift workers, specifically airline crew members., Design, Setting, and Participants: This cross-sectional study analyzed data collected from the Civil Aviation Health Cohort of China, an ongoing large-scale health survey of pilots, flight attendants, and air security officers employed by major airline companies in China. Participants aged 18 to 60 years were invited through text messages to complete a web-based survey. The data collection period was December 2022 to March 2023. Statistical analysis was performed from July 24, 2023, to April 12, 2024., Exposure: Data on timing of breakfast and dinner on workdays and rest days, daily time windows for food intake, and meal and eating jet lags were collected and calculated., Main Outcomes and Measures: Anxiety and depressive symptoms were measured using the 7-item Generalized Anxiety Disorder Assessment and the 9-item Patient Health Questionnaire. Multivariate logistic regressions were performed to evaluate the associations of anxiety and depression with meal timing, eating window time, meal jet lag (ie, delayed meals), and eating jet lag (ie, delayed eating). All models were adjusted for individual socioeconomic, demographic, and lifestyle characteristics., Results: Of the 22 617 participants (median [IQR] age, 29.1 [26.3-33.7] years; 13 712 males [60.6%]), 1755 (7.8%) had anxiety and 2768 (12.2%) had depression. After controlling for confounding factors, having dinner after 8 pm on morning-shift days was associated with increased odds of anxiety (adjusted odds ratio [AOR], 1.78; 95% CI, 1.53-2.05) and depression (AOR, 2.01; 95% CI, 1.78-2.27), compared with consuming dinner before 8 pm. Similar results were observed on night-shift days and rest days. An eating window of less than 12 hours was associated with reduced odds of anxiety (AOR, 0.84; 95% CI, 0.75-0.93) and depression (AOR, 0.81; 95% CI, 0.75-0.89) on morning-shift days; the results remained significant on rest days. Delayed dinner on morning-shift days was associated with increased odds of anxiety (AOR, 1.32; 95% CI, 1.13-1.54) and depression (AOR, 1.39; 95% CI, 1.22-1.58). On night-shift days, delayed dinner was associated with higher odds of anxiety (AOR, 1.22; 95% CI, 1.06-1.39) and depression (AOR, 1.21; 95% CI, 1.08-1.36). On morning-shift days, delayed eating rhythms were associated with higher odds of depression (AOR, 1.35; 95% CI, 1.13-1.61), whereas advanced eating rhythms were associated with lower odds of anxiety (AOR, 0.78; 95% CI, 0.70-0.87)., Conclusions and Relevance: This cross-sectional study found that meal timing, long eating window, and meal jet lags were associated with increased odds of depression and anxiety. These findings underscore the need for interventions and supportive policies that help mitigate the adverse implications of shift work and irregular working hours for the mental health of shift workers.

Aims: The objective of this study is to explore the various latent categories within the sleep quality of night shift nurses and to investigate whether shift-related factors predispose nurses to higher levels of occupational stress and anxiety., Design: This is a cross-sectional study., Methods: From November to December 2020, registered nurses from 18 tertiary hospitals and 16 secondary hospitals in Chongqing were selected through convenience sampling for this study. Latent class analysis was used to investigate the sleep quality of nurses working night shifts. Furthermore, univariate analysis and logistic multivariate analysis were utilized to identify the contributing factors to occupational stress and anxiety., Results: The four latent categories of Pittsburgh Sleep Quality Index for night shift nurses were identified as 'Low Sleep Disorder Group' (56.34%), 'Moderate Sleep Disorder Group' (37.27%), 'High Sleep Disorder Non-Reliant on Sleeping medication Group' (4.89%) and 'High Sleep Disorder Reliant on Sleeping medication Group' (1.50%). The results showed that having a night-shift frequency of 3-4 times per month, night-shift durations of 9-12 h, sleep time delay after night shift (≥2 h), total sleep time after night shift less than 4 h were shift-related factors that increased the levels of occupational stress and anxiety., Conclusion: The sleep quality of night shift nurses demonstrates heterogeneity and can be classified into four latent categories. Higher frequency of night shifts, extended work hours and insufficient rest time are all associated with increased levels of occupational stress and anxiety., Impact: By identifying the four latent categories of sleep quality among night shift nurses, this study sheds light on the relationship between sleep patterns and levels of occupational stress and anxiety. These findings have important implications for healthcare institutions in the management of nurse well-being and work schedules., Patient or Public Contribution: No patient or public contribution., (© 2024 John Wiley & Sons Ltd.)

Background: Work hours are an important aspect of one's job and these in turn have the potential to impact people's well-being. Much research investigating the link between working hours and well-being uses cross-sectional data. Longitudinal studies, especially those studying the same subjects changing their working time, can study the impact of work time more clearly. Using panel data, this study aims to explore the impact of a reduction in working time on three domains of well-being: general well-being, job-related well-being (positive work experience) and work-family well-being (work-family conflict). In addition, our study offers insights into the role of concomitant changes in work and private circumstances of employees as we investigate whether the impact of shorter working hours for well-being is mediated by changes in the participants' and circumstances related to paid and unpaid work resources., Method: An organization of about 60 (female) employees trialed a shorter workweek for one calendar year in 2019. All full-time employees reduced their hours. The part-time working employees can be used as a control group. Panel data (survey and time-use diary data) of a 30-h workweek trial in Belgium was collected in four waves over two years in a pre- and post-intervention design. Change over time (waves) was analyzed through multilevel growth models., Result: A decrease in work-family conflict was observed during the shorter workweek. Part of this decrease is explained by concomitant changes in work and private circumstances, such as sufficiency in free time, schedule control, and satisfaction with work pressure. Positive work experience and general well-being tend to have decreased during the shorter workweek, although this could partly be explained by other organizational changes and not by the reduction in working hours per se. Schedule control helped suppress these somewhat negative effects of organizational changes on positive work experience., Conclusion: Reduced working hours have the largest and most positive impact on work-family conflict. The feeling of having enough leisure time contributes to this increased well-being. Especially for women, who were the majority in this study, a reduction in working time might be beneficial as they often bear more responsibility for household work and care tasks. Next to the duration of working time, schedule control/autonomy has an important impact on well-being., (© 2024. The Author(s).)

Using the 2010-2019 Comprehensive Survey of Living Conditions (CSLC) conducted in Japan, we examined the impact of long working hours on mental health in Japan while addressing the endogeneity issue arising from non-random selection bias. We assessed the variations in the effects of long working hours on mental health across different groups. The results show that first, individuals working longer hours (55 h or more per week) exhibited a higher likelihood of developing mental illness than those working regular hours or fewer hours. Second, the negative effect of long working hours on mental health is more pronounced among non-regular workers than among regular workers. Third, the effect of long working hours on mental health varies among different demographic groups, with a greater impact observed among women, managers, non-regular workers, employees in small- or large-sized firms, and those in smaller cities compared to their counterparts. Thus, to enhance worker productivity, the Japanese government should address the issue of long working hours to improve employees' mental well-being. Initiatives aimed at promoting work-life balance, family-friendly policies, and measures to ameliorate working conditions are expected to help mitigate the challenges associated with long working hours and mental health issues, especially among non-regular workers., Competing Interests: The authors declare no competing interests.

Objective: to analyze sleep duration and sleep quality in nursing professionals who work in shifts., Method: this is a cross-sectional, analytical research, carried out between September 2017 and April 2018, at a public hospital in southern Brazil, with the nursing team. A socio-occupational and health symptoms questionnaire, the Epworth Sleepiness Scale, and the Pittsburgh Sleep Quality Index were used. Data are presented as descriptive and inferential statistics, bivariate analysis, and binary logistic regression., Results: participants were 308 nursing professionals with a predominance of long-term sleep, absence of drowsiness, and poor sleep quality. Short-term sleep (<6h) was associated with day shift and poor sleep quality. Sleep quality was associated with presence excessive daytime sleepiness and work day shift., Conclusion: work shift, insomnia and headache were the main factors related short-term sleep for nursing professionals. The results may justify the development of intervention research for workers' health.

Background: Presenteeism refers to being present at work but experiencing reduced productivity due to health problems, and has been known to be related to sleep loss. Workers commonly sleep longer on days off than on workdays, and presenteeism may be reduced with extended sleep on days off., Aims: This study aimed to determine the association between sleep duration both on workdays and days off and presenteeism., Methods: The participants were 1967 workers who engaged in work for 5 days and rested for 2 days weekly. Sleep duration was classified into less than 6 hours (short; S), 6-8 hours (medium; M), and 9 hours or longer (long; L), for workdays and days off, respectively. Presenteeism was assessed using the World Health Organization Health and Work Performance Questionnaire., Results: On both workdays and days off, compared to medium sleep duration, short sleep duration was significantly associated with increased odds of presenteeism. The odds of presenteeism were significantly increased for S-S (odds ratio [OR] 2.17, 95% confidence interval [CI]1.40-3.37), S-M (OR 1.59, 95% CI 1.14-2.22), S-L (OR 2.71, 95% CI 1.05-7.00), and M-S (OR 6.82, 95% CI 2.71-17.17) combined sleep duration for workdays and days off, respectively, compared to an M-M (reference)., Conclusions: Sleep loss on workdays cannot be compensated for with longer sleep on days off. This study suggests that sufficient sleep duration on both workdays and days off is important for reducing presenteeism., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Working from home has become standard for employees with a university degree. The most common scheme, which has been adopted by around 100 million employees in Europe and North America, is a hybrid schedule, in which individuals spend a mix of days at home and at work each week 1,2 . However, the effects of hybrid working on employees and firms have been debated, and some executives argue that it damages productivity, innovation and career development 3-5 . Here we ran a six-month randomized control trial investigating the effects of hybrid working from home on 1,612 employees in a Chinese technology company in 2021-2022. We found that hybrid working improved job satisfaction and reduced quit rates by one-third. The reduction in quit rates was significant for non-managers, female employees and those with long commutes. Null equivalence tests showed that hybrid working did not affect performance grades over the next two years of reviews. We found no evidence for a difference in promotions over the next two years overall, or for any major employee subgroup. Finally, null equivalence tests showed that hybrid working had no effect on the lines of code written by computer-engineer employees. We also found that the 395 managers in the experiment revised their surveyed views about the effect of hybrid working on productivity, from a perceived negative effect (-2.6% on average) before the experiment to a perceived positive one (+1.0%) after the experiment. These results indicate that a hybrid schedule with two days a week working from home does not damage performance., (© 2024. The Author(s).)

Introduction: The U.S. Air Force's Intercontinental Ballistic Missile (ICBM) force stands ready to launch weapons 365 days per year. Since its inception, missileers vigilantly operate launch consoles on a 3-day cycle: minimum 24-hour alert-shift/24-hour travel-admin/24-hour off, leading to concerns that health, morale, and alertness are chronically impacted. In 2020, a Missileer Occupational Health Assessment (OHA) revealed 76% of respondents struggle with being rested for duty and 29% of respondents never feel adequately rested for duty. Later that year, 20th Air Force initiated long-duration operations to safeguard from the SARS CoV-2 (COVID-19) Pandemic, resulting in increased operations tempo, and exacerbating crew fatigue.341st Operations Group and 341st Medical Group at Malmstrom Air Force Base enacted interventions to mitigate crew fatigue and support continued readiness during pandemic operations. They recorded, analyzed, and compiled findings in this report, including recommendations for long-term ICBM operations at Missile Wings., Materials and Methods: All participants were Nuclear and Missile Operations Officers, or missileers, were continuously evaluated with qualitative and quantitative measures to ensure safety of the force during a period of unprecedented change. Interventions implemented and evaluated during the 9-month period included: environmental modifications, scheduling changes, and crew education on fatigue management, nutrition, anticipatory sleep preparation, and fitness. Most notably, the 341st Operations Group examined various 3-person and 4-person shift-length and alert duration schedules. Psychomotor vigilance testing results validated safety of operators and delta between pre- and post-shift measurements. Crew force readiness trends were analyzed for force-health awareness. Pre- and post-OHA results were compared for subjective changes. Fatigue and health-related outcomes were collected from a safety monitoring effort during standard and COVID-19 operations at 341st Missile Wing., Results: Findings from qualitative and quantitative data indicate the optimal schedule is a 3-week cycle:7-day alert/7-day recovery/7-day training-administrative utilizing 4-member or 3-member crews for low tempo operations. Crews experimented with shift-lengths of 24hrs-on/24hrs-off, 16hrs-on/8hrs-off, and 12hrs-on/12hrs-off. Maximum safe alert duration is 7 days due to task fatigue onset between 8 and 10 days. Short and long duration Duties Not to Include Flight (DNIF) (also known as Duties Not to Include Alert (DNIA) among missileers) rates decreased from the first to last month of the period by 74.6% and 79.2%, respectively. The number of alerts missed per month decreased 86% from baseline. The 2021 OHA found a 7% decline in members seeking separation, and absence of sleep, fatigue, and physical or mental health as missileer concerns., Conclusions: This analysis has identified a sustainable alert rotation of 7/7/7 with emphasis on protected recovery and training time and has been continued after concluding pandemic operations, creating consistent schedule stability where there once was none. If executed properly, this alert rotation, regardless of shift-length selected, has potential to improve trust between crews and leadership, provides adequate recovery time between alerts to maintain health, and improves wellness, family stability, morale, unit cohesion, and crew force retention. Notably, all Air Force Global Strike Missile Operations Groups adjusted scheduling practices to align with these findings., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

This study delved into the complex effects of work schedules on the well-being of healthcare professionals, spotlighting Nigeria's medical landscape. A diverse cohort of 387 participants, spanning doctors, nurses, pharmacists, and laboratory technicians or scientists, formed the research base, with the majority being women (67.7%), with a mean age of 34.67 years. Professionals self-reported their predominant schedules to gauge work patterns, classifying them as day or night shifts. The World Health Organization Quality of Life Brief Version (WHOQOL-BREF) tool assessed the quality of life across the physical, psychological, social relationship, and environmental domains. Psychological distress was measured using the Depression, Anxiety, and Stress Scales (DASS), and perceived social support was evaluated via the Multidimensional Scale of Perceived Social Support (MSPSS). A cross-sectional design was adopted, and the study employed moderated mediation analysis using SmartPLS 4.0. The results underscored the significant ramifications of night shifts on environmental and physical well-being. Psychological health and social relationships were better among day shift than night shift workers. There was a pronounced correlation between night shifts and heightened levels of anxiety, stress, and depression. The mediating role of psychological distress and the moderating influence of social support in these relationships were evident. This study offers invaluable insights into the role of work schedules in shaping the well-being of healthcare professionals, emphasising the protective role of social support and the unique challenges faced by migrant health workers., (© 2024. The Author(s).)

Object: We explored the circadian preferences of non-shift workers (non-SWs) and various types of shift workers (SWs), and the associations of these preferences with sleep and mood., Methods: In total, 4,561 SWs (2,419 women and 2,142 men aged 37.00 ± 9.80 years) and 2,093 non-SWs (1,094 women and 999 men aged 37.80 ± 9.73 years) completed an online survey. Of all SWs, 2,415 (1,079 women and 1,336 men aged 37.77 ± 9.96 years) reported regularly rotating or fixed schedules ("regular SWs"), and 2,146 (1,340 women and 806 men aged 36.12 ± 9.64 years) had irregular schedules ("irregular SWs"). Of the regular SWs, 2,040 had regularly rotating schedules, 212 had fixed evening schedules, and 163 had fixed night schedules. All participants completed the Morningness-Eveningness Questionnaire (MEQ) exploring circadian preferences, the short form of the Center for Epidemiological Studies-Depression Scale (CES-D) evaluating depression, the Insomnia Severity Index (ISI), and the Epworth Sleepiness Scale (ESS)., Results: Compared to non-SWs, SWs had lower MEQ scores, i.e., more eveningness, after controlling for age, gender, income, occupation, and weekly work hours ( F  = 87.97, p  < 0.001). Irregular SWs had lower MEQ scores than regular SWs ( F  = 50.89, p  < 0.001). Among regular SWs, the MEQ scores of fixed evening and fixed night SWs were lower than those of regularly rotating SWs ( F  = 22.42, p  < 0.001). An association between the MEQ and ESS scores was apparent in non-SWs (r = -0.85, p  < 0.001) but not in SWs (r = 0.001, p  = 0.92)., Conclusion: SWs exhibited more eveningness than non-SWs; eveningness was particularly prominent in SWs with irregular or fixed evening/night shifts. Eveningness was associated with sleepiness only in non-SWs, but not in SWs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ahn, Yeo, Lee, Hwang, Jeon and Kim.)

Background: While the link between non-standard work schedules and poor health outcomes is established, few studies have examined how resources both in and outside of work can support the well-being of workers with non-standard work schedules., Methods: Using a cross-sectional survey, we assessed the association between one facet of well-being, life satisfaction, and job and personal resources. In 2019, an electronic survey was administered to two unionized, public service populations who work non-standard work schedules: transportation maintainers and correctional supervisors. We assessed life satisfaction with a 10-item scale; a broad set of job resources (reward satisfaction, supervisor support, co-worker support, schedule satisfaction, and working hours fit); and a broad set of personal resources (health status, sleep, physical activity, and finances). We used log-binomial regression models to estimate prevalence ratios and 95% confidence intervals among statistically significant univariate predictors., Results: Of the 316 workers surveyed, the majority were male (86%), White (68%), and reported positive life satisfaction (56%). In multivariate models, the prevalence of positive life satisfaction was higher in workers reporting reward satisfaction (PR:1.35, 95% CI: 1.11, 1.65; p = 0.003), good work schedule fit (PR:1.43, 95% CI: 1.12, 1.83; p = 0.004), good health (PR:2.92, 95% CI: 1.70, 4.99; p < 0.0001), and good finances (PR:1.32, 95% CI: 1.01, 1.72; p = 0.04)., Conclusion: Employers should consider increasing work recognition, as well as improving schedule fit, financial well-being, and overall good health in support of worker life satisfaction and ultimately well-being., (© 2024. The Author(s).)

Background: Optimal cognitive functions, including working memory (WM), are crucial to enable trainee physicians to perform and excel in their clinical practice. Several risk factors, including on-call shifts, poor mental health, burnout, and sleep problems, can impair clinical practice in trainee physicians, potentially through cognitive impairment; however, these associations have not been fully explored., Objective: This study investigated the effect of on-call shifts on WM among trainee physicians and its association with burnout, depression, anxiety, affect, and sleep., Materials and Methods: This cross-sectional study involved 83 trainee physicians (45% male). We measured demographic and training-related factors including on-call shifts and working hours. We also assessed depressive symptoms (PHQ-9), both state and trait anxiety (STAI total score), burnout (OLBI total score), positive and negative affect scores (PANAS), and sleep disturbances (PSQI total score). WM was evaluated using spatial working memory (SWM) strategy scores that reflected performance and total error counts., Results: Trainee physicians with more on-calls per month had significantly worse depressive symptoms, burnout scores, and sleep, as well as more negative affect. While controlling for covariates, being on-call more times per month was significantly associated with worse WM. Worse depressive symptoms and burnout scores were also significantly associated with impaired WM., Conclusion: Working more on-call shifts is associated with compromised WM. Trainee physicians who experienced more depressive symptoms and burnout had worse WM.

Background: Atypical temporal work patterns such as working longer than the standard 35-40 h/ week, weekend working, and nonstandard work schedules (i.e. outside of the typical 9-5, including but not restricted to shiftwork) are increasingly prevalent in the UK. Aside from occupation-specific studies, little is known about the effects of these atypical temporal work patterns on sleep among workers in the UK, even though poor sleep has been linked to adverse health problems, lower workplace productivity, and economic costs., Method: We used regression models to investigate associations between three types of atypical temporal work patterns (long and short weekly work hours, weekend working, and nonstandard schedules) and sleep duration and disturbance using data from over 25,000 employed men and women from 2012-2014 and/or 2015-2017 in the UK Household Longitudinal Study, adjusting for potential confounders and psychosocial work factors., Results: We found that relative to a standard 35-40 h/week, working 55 h/week or more was related to short sleep (less than 7 h/night) and sleep disturbance. Working most/all weekends compared to non-weekends was associated with short sleep, long sleep (more than 8 h/night), and sleep disturbance, as was working nonstandard schedules relative to standard schedules (fixed day-time schedules). Further analyses suggested some gender differences., Conclusions: These results should prompt employers and policymakers to recognise the need for rest and recovery, consider how the timing and scheduling of work might be improved to better support workers' health and productivity, and consider appropriate compensation for anyone required to work atypical temporal work patterns., (© 2024. The Author(s).)

Background: Shift work affects the mental and physical health of nurses, yet the effect of working irregular shifts on sleep and its association with the need for recovery is under-explored., Objective: The purpose of this study was to investigate the sleep quality of nurses working irregular shifts, including night shifts, and to determine whether sleep quality is associated with the need for recovery., Methods: This cross-sectional study included 405 nurses working irregular shifts. Data were collected using an online questionnaire that included sociodemographic characteristics, the Sleep-Wake Experience List, sleep problems, sleep duration, and the Need for Recovery scale. Data analyses included descriptive statistics, chi-square tests, t-tests, logistic and multiple linear regressions., Results: Nurses who worked irregular shifts had poor sleep quality. Those who also worked night shifts, had significantly poorer sleep quality and experienced more difficulties in daily functioning than those who did not work night shifts. Sleep quality was significantly associated with the need for recovery and this remained so after controlling for confounding variables (β= .554, p = .001)., Conclusion: The findings indicate that in nurses who work irregular shifts, the sleep quality is low. In this group, the sleep quality in nurses who work night shifts is lower than in nurses who do not work night shifts. Furthermore, better sleep quality was associated with lower need for recovery. These findings suggest that improving sleep quality in nurses working irregular shifts may lower their need for recovery, which may improve health, and reduce burnout and sickness absence.

This study examines the associations between working night shifts and various outcomes, including sleep patterns, healthcare workers' sleep quality, and physical, mental, and social well-being. A descriptive cross-sectional study was conducted, where the findings revealed that night shift healthcare workers experienced poor sleep quality and pattern. In addition, night shift healthcare workers were more likely to express their intent to leave, the impact of work on their social lives, and a low level of job satisfaction. Healthcare workers showed moderate anxiety and mild depression levels. Lower job satisfaction correlated with higher anxiety and depression levels among healthcare workers, while the negative impact of working hours on social life was associated with increased anxiety and depression. Organizations should consider establishing comprehensive wellness initiatives covering work-life balance, stress management strategies, and mental health resources.

Background: The main objective of this study was to describe the relationship between working conditions, sleep and psycho-affective variables and medical errors., Methods: This was an observational, analytical and cross-sectional study in which 661 medical residents answered questionnaires about working conditions, sleep and psycho-affective variables. Actigraphic sleep parameters and peripheral temperature circadian rhythm were measured in a subgroup of 38 subjects. Bivariate and multivariate predictors of medical errors were assessed., Results: Medical residents reported working 66.2 ± 21.9 weekly hours. The longest continuous shift was of 28.4 ± 10.9 h. They reported sleeping 6.1 ± 1.6 h per day, with a sleep debt of 94 ± 129 min in workdays. A high percentage of them reported symptoms related to psycho-affective disorders. The longest continuous shift duration (OR = 1.03 [95% CI, 1.00-1.05], p = 0.01), working more than six monthly on-call shifts (OR = 1.87 [95% CI, 1.16-3.02], p = 0.01) and sleeping less than six hours per working day (OR = 1.66 [95% CI, 1.10-2.51], p = 0.02) were independently associated with self-reported medical errors. The report of medical errors was associated with an increase in the percentage of diurnal sleep (2.2% [95% CI, 0.1-4.3] vs 14.5% [95% CI, 5.9-23.0]; p = 0.01) in the actigraphic recording., Conclusions: Medical residents have a high working hour load that affect their sleep opportunities, circadian rhythms and psycho-affective health, which are also related to the report of medical errors. These results highlight the importance of implementing multidimensional strategies to improve medical trainees' sleep and wellbeing, increasing in turn their own and patients' safety., (© 2023. The Author(s).)

Study Objectives: Shift work is associated with compromised cognitive function, and with chronic exposure, may place shift workers at elevated risk for dementia. However, evidence of cognitive impairment among former night shift workers is mixed, possibly due to inconsistencies regarding retirement status, work history classification, and cognitive assessments. To address these limitations, this study compared neurocognitive function between retired night shift workers and retired day workers using a well-characterized sample and a rigorous neurocognitive test battery., Methods: Participants (N = 61; mean age: 67.9 ± 4.7 years; 61% females; 13% non-white) were 31 retired day workers and 30 retired night shift workers equated on age, sex, race/ethnicity, premorbid IQ, years retired, and diary-assessed habitual sleep characteristics. Participants completed a neurocognitive battery assessing six cognitive domains (language, visuospatial ability, attention, immediate and delayed memory, executive function) and self-reported cognitive function. Linear regression models compared groups on individual cognitive domains, adjusting for age, sex, race/ethnicity, education level, and habitual sleep quality., Results: Retired night shift workers scored lower than retired day workers on attention (B = -0.38, 95% CI [-0.75, -0.02], p = .040) and executive function (B = -0.55, 95% CI [-0.92, -0.17], p = .005). In post hoc analyses, attention and executive function were unrelated to diary-assessed habitual sleep characteristics (disruption, timing, and irregularity) in retired night shift workers., Conclusions: The observed cognitive weaknesses in retired night shift workers may suggest increased risk for future dementia. Retired night shift workers should be followed to determine whether observed weaknesses progress., (© The Author(s) 2023. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Study Objectives: To identify sleep strategies of internal medicine residents transitioning to night shift and report their effect on performance., Methods: Residents logged hours of sleep and work starting 3 days prior to the first night shift and continuing through the next 8 days. Cohorts were defined by sleep logs and compared separately by transition strategy, total hours of sleep, amount of sleep occurring at work, weekend sleep schedule, and residency training year. Data from logs were entered into the Fatigue Avoidance Scheduling Tool to measure predicted Performance Effectiveness (PE) during each night shift., Results: Twenty-three residents were evaluated. The Sleep Banking transition strategy (n = 2) had higher PE (mean = 88.6%) than all other sleep strategies combined (n = 21, mean = 80.9%; P = .016). Additionally, residents who slept an average of 8-9 hours daily during their week of night shifts had a higher mean PE compared to those who slept < 6 hours (86.8% vs 78.6%; P = .014)., Conclusions: Residents who engaged in Sleep Banking prior to the first night shift had higher PE and spent less time above a 0.05% blood alcohol concentration equivalent compared to all other strategies. Similarly, PE and time spent above a 0.05% blood alcohol concentration equivalent improved with increased average hours slept per day during the week of night shifts. Optimizing performance on night shift through the adoption of efficacious sleep strategies is imperative to mitigate patient safety issues that may result from poor alertness and cognitive abilities., Citation: Cushman P, Scheuller HS, Cushman J, Markert RJ. Improving performance on night shift: a study of resident sleep strategies. J Clin Sleep Med . 2023;19(5):935-940., (© 2023 American Academy of Sleep Medicine.)

Aim: To investigate whether pain, sleep duration, insomnia, sleepiness, work-related factors, anxiety, and depression associate with excessive fatigue in nurses., Background: Fatigue among nurses is a problem in the context of ongoing nursing shortages. While myriad factors are associated with fatigue not all relationships are understood. Prior studies have not examined excessive fatigue in the context of pain, sleep, mental health, and work factors in a working population to determine if associations between excessive fatigue and each of these factors remain when adjusting for each other., Methods: A cross-sectional questionnaire study among 1,335 Norwegian nurses. The questionnaire included measures for fatigue (Chalder Fatigue Questionnaire, score ≥4 categorized as excessive fatigue), pain, sleep duration, insomnia (Bergen Insomnia Scale), daytime sleepiness (Epworth Sleepiness Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and work-related factors. Associations between the exposure variables and excessive fatigue were analyzed using chi-square tests and logistic regression analyses., Results: In the fully adjusted model, significant associations were found between excessive fatigue and pain severity scores for arms/wrists/hands (adjusted OR (aOR) = 1.09, CI = 1.02-1.17), hips/legs/knees/feet (aOR = 1.11, CI = 1.05-1.18), and headaches/migraines (aOR = 1.16, CI = 1.07-1.27), sleep duration of <6 hours (aOR = 2.02, CI = 1.08-3.77), and total symptom scores for insomnia (aOR = 1.05, CI = 1.03-1.08), sleepiness (aOR = 1.11, CI = 1.06-1.17), anxiety (aOR = 1.09, CI = 1.03-1.16), and depression (aOR = 1.24, CI = 1.16-1.33). The musculoskeletal complaint-severity index score (aOR = 1.27, CI = 1.13-1.42) was associated with excessive fatigue in a separate model adjusted for all variables and demographics. Excessive fatigue was also associated with shift work disorder (OR = 2.25, CI = 1.76-2.89) in a model adjusted for demographics. We found no associations with shift work, number of night shifts and number of quick returns (<11 hours between shifts) in the fully adjusted model., Conclusion: Excessive fatigue was associated with pain, sleep- and mental health-factors in a fully adjusted model., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Bjorvatn reports that he has served as consultant for F. Hoffmann-La Roche Ltd and Cura of Sweden, and received honoraria for lectures from Sanofi-Aventis and AGB-Pharma AB. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2023 Hiestand et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Night float call systems are becoming increasingly common at training programs with the goal of reducing fatigue related to sleep deprivation and sleep disturbance. Previous studies have shown that trainees obtain less sleep during the night float rotation and have decreased sleep efficiency for several days after the rotation. The impact on physical and emotional well-being has not been documented., Methods: Twenty-seven anesthesia residents were enrolled in a study using wearable sleep and activity trackers and National Institutes of Health Patient-Reported Outcome Measurement Information System (NIH PROMIS) surveys for sleep disturbance, fatigue, and positive affect to record data the week before ("baseline"), during ("night float"), and 1 week after ("recovery") their night float rotation. Each subject's data during the night float week and recovery week were compared to his or her own baseline week data using a paired, nonparametric analysis. The primary outcome variable was the change in average daily sleep hours during the night float week compared to the baseline week. Average daily rapid eye movement (REM) sleep, daily steps, and NIH PROMIS scores comparing night float and recovery weeks to baseline week were prespecified secondary outcomes. NIH PROMIS scores range from 0 to 100 with 50 as the national mean and more of the construct having a higher score., Results: There was no difference in average daily sleep hours between the night float and the baseline weeks (6.7 [5.9-7.8] vs 6.7 [5.5-7.7] hours, median [interquartile range]; P = .20). Residents had less REM sleep during the night float compared to the baseline weeks (1.1 [0.7-1.5] vs 1.4 [1.1-1.9] hours, P = .002). NIH PROMIS fatigue scores were higher during the night float than the baseline week (58.8 [54.6-65.1] vs 48.6 [46.0-55.1], P = .0004) and did not return to baseline during the recovery week (51.0 [48.6-58.8], P = .029 compared to baseline). Sleep disturbance was not different among the weeks. Positive affect was reduced after night float compared to baseline (39.6 [35.0-43.5] vs 44.8 [40.1-49.6], P = .0009), but returned to baseline during the recovery week (43.6 [39.6-48.2], P = .38)., Conclusions: The residents slept the same number of total hours during their night float week but had less REM sleep, were more fatigued, and had less positive affect. All of these resolved to baseline except fatigue, that was still greater than the baseline week. This methodology appears to robustly capture psychophysiological data that might be useful for quality initiatives., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 International Anesthesia Research Society.)

Background: Rotating shift work is common in high-hazard industries, despite documented associations with sleep disturbance and impairment. In the oil industry, where rotating and extended shift schedules are used to staff safety-sensitive positions, work intensification and increasing overtime rates have been broadly documented over the last few decades. Research on the impacts of these work schedules on sleep and health has been limited for this workforce., Methods: We examined sleep duration and quality among rotating shift workers in the oil industry and explored associations between schedule characteristics, sleep, and health outcomes. We recruited hourly refinery workers from the West and Gulf Coast oil sector members of the United Steelworkers union., Findings: Impaired sleep quality and short sleep durations were common and associated with health and mental health outcomes common among shift workers. Shortest sleep durations followed shift rotations. Early rise and start times were associated with shorter sleep duration and poorer sleep quality. Drowsiness and fatigue-related incidents were common., Conclusion/application to Practice: We observed lower sleep duration and quality and increased overtime in 12-hour rotating shift schedules. These long workdays with early start times may reduce available hours for quality sleep; here they were associated with reduced exercise and leisure activity which correlated with good sleep. This safety-sensitive population appears severely impacted by poor sleep quality, which has broader implications for process safety management. Later start times, slower rotation, and a reconsideration of two-shift schedules are interventions to consider for improving sleep quality among rotating shift workers.

Objectives: Depression and anxiety are prominent in paramedics, as is the prevalence of shift work disorder (SWD), a circadian sleep condition comorbid with mental health disorders. However, the role of mental health risk factors for SWD is largely unknown. This study investigated whether mental health levels in recruit paramedics before shift work predicted greater risk of SWD at 6-months into their career and explored whether shift and sleep factors mediated this relationship., Design: A longitudinal study., Setting: Victoria, Australia., Participants: Recruit paramedics were assessed at baseline (n = 101; ie, pre-shift work) and after 6-months (n = 93) of shift and emergency work., Measurements: At both time points, participants completed self-reported measures of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder Questionnaire-7), and SWD (SWD-Screening Questionnaire). Participants also filled a sleep and work diary for 14-days at each timepoint., Results: After 6-months of emergency work 21.5% of paramedics had a high SWD risk. Logistic regression models showed baseline depression predicted 1.24-times greater odds for SWD at 6-months. Through Lavaan path analysis we found shift and sleep variables did not mediate the relationship between baseline mental health and SWD risk. Baseline depression was associated with increased sleepiness levels following paramedics' major sleep periods at 6-months. Pre-existing depression levels also predicted greater perceived nightshift workload., Conclusions: Our results highlight depression symptoms before emergency work are a risk factor for SWD within 6-months of work. Depression represents a modifiable risk factor amenable to early interventions to reduce paramedics' risk of SWD., (Copyright © 2022 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Sleep deprivation is a significant risk to the health and judgment of physicians. We wanted to investigate whether anesthesiology residents (ARs) who work only one night shift per week have different physical and mental health from occupational medicine residents (OMRs) who do not work at night. A total of 21 ARs and 16 OMRs attending a university general hospital were asked to wear an actigraph to record sleep duration, heart rate and step count and to complete a questionnaire for the assessment of sleep quality, sleepiness, fatigue, occupational stress, anxiety, depression and happiness. ARs had shorter sleep duration than OMRs; on average, they slept 1 h and 20 min less ( p < 0.001). ARs also had greater daytime sleepiness, a higher heart rate and lower happiness than OMRs. These results should be interpreted with caution given the cross-sectional nature of the study and the small sample size, but they are an incentive to promote sleep hygiene among residents.

Background: Nurses work in a shift system that determines the provision of round-the-clock care of a patient in hospital conditions; however, it entails health consequences., Objective: The aim of the study was the evaluation of work conditions of nurses engaged in shift work in hospital wards during the COVID-19 pandemic., Methods: The study was conducted in 2020, and included 108 nurses working in a shift system in hospital wards. The research method was a diagnostic survey, using an author-constructed questionnaire., Results: 88.9% nurses reported a negative effect of shift work on their physical health: 'musculoskeletal pain', 'elevated arterial blood pressure', and 'hormonal disorders' - 54.5% of respondents used pharmacological treatment. The causes of physical disorders were: 'microclimate', 'physical effort', 'noise', and 'forced body position'. Shift work exerted a negative effect on psychological health of the majority of respondents (75.0%): 'deconcentration', 'sleep disorders', 'feeling of occupational burnout' - treatment in 38.9% of respondents. Psychological health disorders were caused by: 'circadian rhythms disturbance by shift work', 'chronic stresses', and 'conflicts at work'. 69.7% of respondents reported that their shift work was disturbed by organizational factors, including: a 'badly planned work schedule', 'enhanced pace of work due to staff shortage', 'ambiguous division of duties, rights, responsibilities', 'shortages of equipment at the workplace'., Conclusion: The examined nurses experienced a negative effect of shift work on their physical and psychological health which, for some of them, was the cause of pharmacological treatment. Many organizational factors hindered the work of nurses in a shift system in hospital wards.

Objective: Acute sleep deprivation can induce antidepressant effects. We hypothesized that overnight calls can trigger symptoms of hypomania during the post-on-call period., Methods: Online anonymous cross-sectional survey among Spanish-speaking healthcare professionals, including the Hypomania Symptom Checklist-32 (HCL-32)., Results: 2099 respondents. Most of them reported that they usually feel worse on their post-on-call period (91,3%), but the 51,6% acknowledged having felt better at least once and 33,4% reported it happened in at least at 50% of their calls. Up to 4,9% reached the cut-off at HCL-32. Males, younger professionals, those with less years of practice and residents were more likely to full fit hypomania criteria. Participants and their environment correctly identified the symptoms and their negative consequences., Conclusions: On-calls with sleep deprivation may trigger hypomanic symptoms with reported negative consequences among healthcare professionals, showing how working conditions' impact in professionals' wellbeing and raising concerns about decision-making performance after long-lasting working shifts., Competing Interests: Declaration of competing interest All filiations have been reported, no conflict of interest to declare., (Copyright © 2022. Published by Elsevier B.V.)

Study Objectives: Shift work is common yet does not always result in Diagnostic and Statistical Manual of Mental Disorders , fifth edition (DSM-5)-defined shift work sleep disorder (SWD). This study reports on the reliability and validity of the DSM-5 informed Shift Work Disorder Index (SWDI), the presence of probable SWD in nurses, and demographic, sleep, and psychosocial correlates., Methods: Nurses (n = 454) completed the SWDI, psychosocial, and demographic questionnaires. Of the sample, n = 400 completed 14 days of sleep diaries, actigraphy, and additional questionnaires., Results: The global SWDI demonstrated excellent internal consistency (α = .94), as well as good convergent and divergent validity in the nurse sample. Thirty-one percent of nurses were past-month shift workers, with 14% (ie, 44% of shift workers) having probable SWD based on SWDI. Nurses who worked shift work and/or met SWD criteria were more likely to be younger and unmarried and less likely to have children than day workers and reported greater evening chronotype, insomnia, nightmares, and sleep-related impairment, greater depression, anxiety, posttraumatic stress, and perceived stress symptoms, as well as later and more variable sleep midpoint (actigraphy), shorter sleep duration (actigraphy, diaries), and lower sleep efficiency (diaries)., Conclusions: The SWDI is an efficient and valid self-report assessment of DSM-5-defined SWD. Shift work and/or SWD were prevalent and associated with worse sleep and psychosocial health, particularly among nurses with probable SWD., Citation: Taylor DJ, Dietch JR, Wardle-Pinkston S, et al. Shift Work Disorder Index: initial validation and psychosocial associations in a sample of nurses. J Clin Sleep Med . 2022;18(10):2339-2351., (© 2022 American Academy of Sleep Medicine.)

Shift workers have a 25 to 40% higher risk of depression and anxiety partly due to a misalignment between the central circadian clock and daily environmental/behavioral cycles that may negatively affect mood and emotional well-being. Hence, evidence-based circadian interventions are required to prevent mood vulnerability in shift work settings. We used a stringently controlled 14-d circadian paradigm to assess mood vulnerability during simulated night work with either daytime and nighttime or daytime-only eating as compared with simulated day work (baseline). Simulated night work with daytime and nighttime eating increased depression-like mood levels by 26.2% ( p -value adjusted using False Discovery Rates, p FDR = 0.001; effect-size r = 0.78) and anxiety-like mood levels by 16.1% ( p FDR = 0.001; effect-size r = 0.47) compared to baseline, whereas this did not occur with simulated night work in the daytime-only eating group. Importantly, a larger degree of internal circadian misalignment was robustly associated with more depression-like ( r = 0.77; P = 0.001) and anxiety-like ( r = 0.67; P = 0.002) mood levels during simulated night work. These findings offer a proof-of-concept demonstration of an evidence-based meal timing intervention that may prevent mood vulnerability in shift work settings. Future studies are required to establish if changes in meal timing can prevent mood vulnerability in night workers.

The objective of this study is a comparative analysis of the psychological adaptability of shift staff in oil and gas and diamond production in the Far North. In total, 227 shift workers took part in the study. Using the methods of psychophysiological and psychological testing, we studied the following parameters of the psychological adaptation of shift personnel: regulatory processes, subjective control, socio-psychological adaptation and personality characteristics. As a result of the study, some differences were found in the parameters of the psychological adaptation of shift workers of various industries. In conclusion, the parameters of socio-psychological adaptation as a criterion of psychological adaptation for the workers of the southern shift are much higher than for the shift workers in the Far North. The shift workers with a favorable functional status have a higher dominance rate. The workers in the Far North also have a higher level of self-regulation.

Rotating shift work places a serious burden on nurses' physical and psychological health. Gastrointestinal (GI) symptoms are a common complaint among shift workers. This study assessed GI symptoms and identified the associations between dietary habits, psychological status, and sleep quality among rotating shift nurses. Data from 125 female nurses in rotating shifts who worked at two tertiary hospitals in South Korea were collected using a questionnaire that included the Gastrointestinal Symptoms Questionnaire; the Dietary Habit Questionnaire; the Depression, Anxiety, Stress Scale (DASS)-21; and the Pittsburgh Sleep Quality Index (PSQI). All participants experienced various GI symptoms, and 47% of them complained of at least one severe GI symptom. There were significant differences in GI symptom scores according to the status of depression, anxiety, stress, and sleep quality. In multiple linear regression analysis, the factors associated with an increase in the occurrence and severity of GI symptoms were poor sleep quality and morbid anxiety and stress. The model explained power at 43.2%. As most nurses in rotating shifts experience GI symptoms, they should receive counseling and training programs at work to alleviate psychological symptoms, improve sleep quality, and pay more attention to their health status as well as GI symptom management.

Background: Although shift work is the foundation of the provision of 24-h continuous care in hospitals, it can negatively impact mental health in hospital workers such as nurses. Despite the connection between mental health and overall health, little is known about the effect of shift work-related factors on mental health in this population., Objectives: We investigated the effect of scheduling practices, physical and psychological characteristics related to shift work, and personal habits during shift work on depression and anxiety among nurses., Methods: In this multi-center cross-sectional study, 11,061 nurses from 20 hospitals in the Shandong Province of China completed an online survey between December 2020 and February 2022. Multivariate ordered logistic regression analysis was performed to examine shift-related factors associated with depression and anxiety in the study population., Results: The completion rate of all nurses' questionnaires was 83.00% ( n = 9,181). Among the 9,181 respondents, 66.20% ( n = 6,078) were shift nurses. Depression and anxiety were found in 58.82 and 62.08% of shift nurses, respectively, and these rates were influenced by fatigue during shift work, psychological stress before/during/after night shifts, feeling of being refreshed after resting before/after night shifts, using sleep medication before/after night shifts, physical discomfort during night shifts, busyness during night shifts, food intake during shift work, working > 40 h/week during shift work, and sleep quality before/after night shifts., Conclusions: Depression and anxiety in shift nurses may be addressed by reducing their workload, sources of stress during night shifts, and facilitating rest and relaxation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Li, Wang, Lv, Li, Guan, Li, Li and Cao.)

Night work leads to sleepiness and reduced vigilant attention during work hours, and bright light interventions may reduce such effects. It is also known that total sleep deprivation impairs cognitive flexibility as measured by reversal learning tasks. Whether night work impairs reversal learning task performance or if bright light can mitigate reversal learning deficits during night work is unclear. In this counterbalanced crossover study (ClinicaTrials.gov Identifier NCT03203538), young healthy individuals completed a reversal learning task twice during each of three consecutive simulated night shifts (23:00-07:00 h). The night shifts were performed in a laboratory under a full-spectrum (4000 K) bright light (~900 lx) and a standard light (~90 lx) condition. Reversal learning task performance was reduced towards the end of the night shifts (04:50 h), compared to the first part of the night shifts (00:20 h) in both light conditions. However, with bright light, the reversal learning task performance improved towards the end of the night shifts, compared to standard light. The study shows that bright light may mitigate performance deficits on a reversal learning task during night work and implies that bright light interventions during night work may be beneficial not only for vigilant attention but also for cognitive flexibility.

Background: Long working hours are detrimental to physical and mental health. However, the association between long working hours and psychosomatic symptoms have remained controversial, possibly because of the existence of mediators between working hours and psychosomatic stress responses. We hypothesized that lifestyle habits, regarding sleep and mealtimes, act as mediators, and analyzed the associations between long working hours, sleep duration, mealtime regularity, and psychosomatic stress responses in office workers., Methods: From April 2017 to March 2018, an online cross-sectional survey regarding overtime work hours, work-related stress, sleep, and eating habits was conducted with employees of 17 companies located in Tokyo, Japan. Answers were obtained from 3559 employees, and 3100 provided written consent for the academic use of their answers, and were included in the analysis. A path analysis was conducted to assess the effect of overtime work on psychosomatic stress via shortened sleep or irregular mealtimes., Results: Overtime work hours had no direct effect on psychosomatic stress responses and depressive symptoms. However, overtime work hours affected sleep duration and the regularity of mealtimes. The effects of overtime work hours on psychosomatic stress responses and depressive symptoms were completely mediated by sleep duration and the regularity of mealtimes., Conclusion: Long working hours do not affect mental health directly; however, shortened sleep duration and irregular mealtimes mediate the effect of long working hours on psychosomatic stress responses and depressive symptoms.

Background: Although various work-related adverse events affect workers' mental health, the association between long working hours and mental disorders remains unclear. We investigated the characteristics of overtime work and work-related adverse events among all cases of compensated work-related suicide in Japan to empirically reveal the context of the serious consequences., Methods: We analysed all 167 cases of mental disorders resulting in suicide that were compensated in fiscal year 2015-2016. Hierarchical clustering was applied to the overtime working history. Work-related adverse events were also evaluated as the qualitative aspects of their jobs., Results: More than half of the cases committed suicide within a month of developing a mental disorder. The Administrative and professional or engineering workers had a higher suicide rate. The clustering analysis revealed chronic long working hours (19%), gradual increase (27%), or rapid increase (25%) in working hours before the onset of a mental disorder. A group of cases with less overwork experienced more interpersonal conflicts., Conclusion: This is the first study to employ a clustering technique to objectively reveal the actual working patterns behind suicide. The patterns of working overtime before the onset of mental disorders varied considerably among the cases. Taking the transition of working overtime into account may provide clearer insight into the relationship between long working hours and workers' mental health. These results highlight the need for countermeasures especially for causes of chronic overworking, drastic increases in working hours, and interpersonal conflicts to prevent work-related suicide., (© 2021. The Author(s).)