{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:56:14Z","timestamp":1790668574609,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Gen. Psychiatry"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Psychological distress among public health nurses (PHNs) during major public health emergencies may vary across response phases, from acute crisis to prolonged chronic strain. Although the mental health consequences of sustained emergency response are well documented, evidence on how symptom connectivity patterns differ across acute and chronic phases remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study aims to compare symptom centrality and connectivity patterns of job stress, anxiety and insomnia among PHNs during acute crisis and chronic strain and to identify phase\u2010specific associations that may inform tailored intervention strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a city\u2010wide, two\u2010wave census survey of PHNs across all 249 community health centres in Shanghai, China. Data were collected during the acute crisis phase (October\u2013November 2022;\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a01565) and the chronic strain phase (November 2023\u2013January 2024;\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a01718), with response rates exceeding 96% at both waves. Validated instruments were used to assess job stress, anxiety and insomnia. Undirected symptom networks were estimated using graphical least absolute shrinkage and selection operator models to characterise symptom connectivity patterns, whereas Bayesian network modelling was used to explore conditional probabilistic dependencies among symptoms. Exploratory subgroup analyses examined network heterogeneity by age and working hours.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall psychological distress was lower during the chronic strain phase than during the acute crisis phase; however, symptom\u2010level connectivity patterns differed between the two phases, with notable differences in centrality. Conflicting responsibilities and limited opportunity to draw on prior experience and training showed stable metric\u2010specific centrality across both phases. During the acute phase, network centrality was anchored by operational instability\u2014including unclear roles and high effort demands\u2014alongside anxiety\u2010related hyperarousal. During chronic strain, the most central nodes were characterised by sustained workload burden and impaired recovery, such as difficulty relaxing. Bayesian models consistently positioned work\u2010related stressors at upstream positions within the distress architecture. Subgroup analyses revealed that symptoms were more tightly interconnected among younger PHNs (&lt;\u00a036\u00a0years) during acute crisis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The psychological architecture of workforce distress is phase\u2010specific; therefore, \u2018one\u2010size\u2010fits\u2010all\u2019 interventions are inadequate. Interventions should prioritise operational clarity during acute crises and workload management and recovery support during prolonged strain. Integrating these phase\u2010adapted strategies into public health systems may help sustain a resilient frontline workforce.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/gps3.70064","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:15:01Z","timestamp":1790666101000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Phase\u2010specific networks of job stress, anxiety and insomnia during acute crisis and chronic strain: A citywide study of public health nurses in Shanghai"],"prefix":"10.1002","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4237-8482","authenticated-orcid":false,"given":"Quyige","family":"Gao","sequence":"first","affiliation":[{"name":"Institute of Clinical Research Tongren Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"},{"name":"School of Public Health Shanghai Jiao Tong University School of Medicine  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