{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T01:10:25Z","timestamp":1792631425151,"version":"4.5.0"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Background<\/jats:title>\n This study aimed to investigate the prevalence of depression, anxiety, and perceived stress among nursing home caregivers in China and to examine the associated factors.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A multicenter cross-sectional study was conducted among 1,341 caregivers in nursing homes across Henan Province, China. Standardized instruments were applied, including the Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), and the 10-item Perceived Stress Scale (PSS-10). Descriptive statistics, univariate analysis, and multivariable logistic regression were performed to identify independent predictors of psychological distress.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The prevalence of depression and anxiety was 34.8 and 10.8%, respectively, while 49.6% of caregivers reported moderate-to-high levels of stress. Significant predictors included city region, type of nursing home, educational level, monthly income, working hours, night shifts, presence of chronic diseases, attention to mental health, and participation in psychological training. Higher education and moderate income were protective factors, whereas employment in rural private nursing homes, low engagement in mental health practices, and the presence of chronic diseases increased risks. Longer working hours and more frequent night shifts were unexpectedly associated with lower stress levels.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Depression and stress represent the major psychological concerns among nursing home caregivers in China. Targeted interventions should prioritize routine mental health screening, workplace-based psychological support, and policy measures aimed at improving working conditions and access to training, thereby safeguarding caregiver well-being and supporting the sustainability of long-term care services.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1690840","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T06:22:21Z","timestamp":1762150941000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Prevalence and factors associated with depression, anxiety and stress among nursing home caregivers in China: a multi-center cross-sectional study"],"prefix":"10.3389","volume":"13","author":[{"given":"Zhi-Ru","family":"Fan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei Chan","family":"Chong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng","family":"Xiaona","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ma","family":"Jing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan Li","family":"You","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chong Chin","family":"Che","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"890","DOI":"10.3390\/ijerph20010890","article-title":"Assessing spatial accessibility of community hospitals for the elderly in Beijing, China","volume":"20","author":"Luan","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1967","DOI":"10.1016\/S0140-6736(22)01546-X","article-title":"The path to healthy ageing in China: a Peking University\u2013lancet commission","volume":"400","author":"Chen","year":"2022","journal-title":"Lancet"},{"key":"ref3","year":"2024"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e13092","DOI":"10.1111\/ijn.13092","article-title":"Factors associated with eHealth use among community dwelling older adults","volume":"28","author":"Choi","year":"2022","journal-title":"Int J Nurs Pract"},{"key":"ref5","article-title":"Aging, dependence, and long-term care: a systematic review of employment creation","volume":"58","author":"Martinez L","year":"2021","journal-title":"J Health Care Organ Provision Financ"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"3225","DOI":"10.38124\/ijisrt\/IJISRT24JUN1000","article-title":"Occupational health and safety challenges faced by caregivers and the respective interventions to improve their wellbeing","volume":"9","author":"Omolara","year":"2024","journal-title":"Int J Innov Sci Res Technol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e029869","DOI":"10.1136\/bmjopen-2019-029869","article-title":"Knowledge, attitude and self-efficacy of elderly caregivers in Chinese nursing homes: a cross-sectional study in Liaoning Province","volume":"9","author":"Zhang","year":"2019","journal-title":"BMJ Open"},{"key":"ref8","volume-title":"The state of the health workforce in the WHO African region, 2021","year":"2021"},{"key":"ref9","first-page":"11","volume-title":"Aging in China: perspectives on public health","author":"Han","year":"2020"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1362","DOI":"10.1016\/S0140-6736(20)32136-X","article-title":"Long-term care system for older adults in China: policy landscape, challenges, and future prospects","volume":"396","author":"Feng","year":"2020","journal-title":"Lancet"},{"key":"ref11","first-page":"29","article-title":"Research on the current situation, problems, and countermeasures of employees in Chinese nursing institutions: data analysis based on the national nursing institution data reporting system of 239,312 employees","volume":"14","year":"2015","journal-title":"Chinese Civil Affairs"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1456","DOI":"10.1016\/j.jad.2021.09.026","article-title":"Prevalence and related factors of depression and anxiety in a cohort of Chinese elderly caregivers in the nursing home","volume":"295","author":"Yang","year":"2021","journal-title":"J Affect Disord"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1002\/wps.20996","article-title":"Mental health care for older adults: recent advances and new directions in clinical practice and research","volume":"21","author":"Reynolds","year":"2022","journal-title":"World Psychiatry"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"2080","DOI":"10.1080\/13607863.2021.2013433","article-title":"The experiences of care home staff during the COVID-19 pandemic: a systematic review","volume":"26","author":"Gray","year":"2022","journal-title":"Aging Ment Health"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"61","DOI":"10.3390\/ijerph16010061","article-title":"Prevalence and risk factors of depression, anxiety, and stress in a cohort of Australian nurses","volume":"16","author":"Maharaj","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1186\/s12912-022-00807-3","article-title":"Psychosocial burden and associated factors among nurses in care homes during the COVID-19 pandemic: findings from a retrospective survey in Germany","volume":"21","author":"Hering","year":"2022","journal-title":"BMC Nurs"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"119961","DOI":"10.1016\/j.jns.2021.119961","article-title":"Anxiety and burnout in Alzheimer\u2019s caregivers in COVID-19 pandemic","volume":"429","author":"Franza","year":"2021","journal-title":"J Neurol Sci"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1159\/000524953","article-title":"Mental health of caregivers working in nursing homes during the COVID-19 pandemic","volume":"51","author":"Takahashi","year":"2022","journal-title":"Dementia Geriatr Cogn Disord"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1810","DOI":"10.1002\/gps.5602","article-title":"Evaluation of the mental health of care home staff in the Covid-19 era. What price did care home workers pay for standing by their patients?","volume":"36","author":"Mart\u00edn","year":"2021","journal-title":"Int J Geriatr Psychiatry"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"3587","DOI":"10.3390\/ijerph16193587","article-title":"Identifying individual stressors in geriatric nursing staff-a cross-sectional study","volume":"16","author":"Wollesen","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"5134","DOI":"10.3390\/jcm14145134","article-title":"Psychological mechanisms of caregiver involvement in caregiving for individuals with Alzheimer\u2019s disease: analysis of the moderated mediation model","volume":"14","author":"So\u0142tys","year":"2025","journal-title":"J Clin Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"593","DOI":"10.11622\/smedj.2021033","article-title":"Caregiver burden and its prevalence, measurement scales, predictive factors and impact: a review with an Asian perspective","volume":"63","author":"Loo","year":"2022","journal-title":"Singapore Med J"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e13","DOI":"10.2105\/AJPH.2019.305278","article-title":"Shift work and poor mental health: a Meta-analysis of longitudinal studies","volume":"109","author":"Torquati","year":"2019","journal-title":"Am J Public Health"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"368","DOI":"10.12688\/f1000research.110296.3","article-title":"Burnout and work satisfaction are differentially associated in gastroenterologists in Germany","volume":"11","author":"Adarkwah","year":"2022","journal-title":"F1000Res"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e0238906","DOI":"10.1371\/journal.pone.0238906","article-title":"Relationship quality and mental health during COVID-19 lockdown","volume":"15","author":"Pieh","year":"2020","journal-title":"PLoS One"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1016\/j.jad.2019.07.051","article-title":"A longitudinal exploration of the impact of social anxiety and individual attachment on depression severity","volume":"257","author":"Adams","year":"2019","journal-title":"J Affect Disord"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"590343","DOI":"10.3389\/fpsyt.2020.590343","article-title":"Prevalence and risk factors of anxiety, depression, and sleep problems among caregivers of people living with neurocognitive disorders during the COVID-19 pandemic","volume":"11","author":"Li","year":"2021","journal-title":"Front Psych"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1016\/j.jad.2020.08.041","article-title":"Prevalence of anxiety and depression symptoms, and association with epidemic-related factors during the epidemic period of COVID-19 among 123,768 workers in China: a large cross-sectional study","volume":"277","author":"Zhang","year":"2020","journal-title":"J Affect Disord"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1011775","DOI":"10.3389\/fpsyt.2022.1011775","article-title":"Factors associated with mental health outcomes among caregivers of older adults in long-term care facilities during COVID-19 post-epidemic era in Shandong, China","volume":"13","author":"Chen","year":"2022","journal-title":"Front Psych"},{"key":"ref30","doi-asserted-by":"crossref","DOI":"10.1201\/9781315183084","volume-title":"Sample size calculations in clinical research","author":"Chow","year":"2017"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1016\/j.csda.2013.07.037","article-title":"A GEE approach to determine sample size for pre-and post-intervention experiments with dropout","volume":"69","author":"Zhang","year":"2014","journal-title":"Comput Stat Data Anal"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1016\/S0033-3182(71)71479-0","article-title":"A rating instrument for anxiety disorders","volume":"12","author":"Zung","year":"1971","journal-title":"Psychosomatics"},{"key":"ref33","first-page":"73","article-title":"The self-rating anxiety scale (SAS)","volume":"2","author":"Wang","year":"1984","journal-title":"Shanghai Psychiatry"},{"key":"ref34","first-page":"71","article-title":"The self-rating depression scale (SDS)","volume":"2","author":"Wang","year":"1984","journal-title":"Shanghai Psychiatry"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"247-+","DOI":"10.1002\/1097-4679(197104)27:2<247::AID-JCLP2270270230>3.0.CO;2-6","article-title":"Personality dimension and self-rating depression scale","volume":"27","author":"Zung","year":"1971","journal-title":"J Clin Psychol"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"385","DOI":"10.2307\/2136404","article-title":"A global measure of perceived stress","volume":"24","author":"Cohen","year":"1983","journal-title":"J Health Soc Behav"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/2050-7283-1-9","article-title":"Validation of the 10-item Chinese perceived stress scale in elderly service workers: one-factor versus two-factor structure","volume":"1","author":"Ng","year":"2013","journal-title":"BMC Psychol"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1037\/0012-1649.37.4.491","article-title":"Getting older, getting better? Personal strivings and psychological maturity across the life span","volume":"37","author":"Sheldon","year":"2001","journal-title":"Dev Psychol"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"e2345073","DOI":"10.1001\/jamanetworkopen.2023.45073","article-title":"Age disparities in prevalence of anxiety and depression among US adults during the COVID-19 pandemic","volume":"6","author":"Villaume","year":"2023","journal-title":"JAMA Netw Open"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1080\/13607860500409898","article-title":"Age differences in the presentation of anxiety","volume":"10","author":"Brenes","year":"2006","journal-title":"Aging Ment Health"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1016\/j.jamda.2022.04.001","article-title":"Nursing home workers\u2019 mental health during the COVID-19 pandemic in France","volume":"23","author":"Husky","year":"2022","journal-title":"J Am Med Dir Assoc"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1590\/0034-7167-2018-0137","article-title":"Elderly caregivers of the elderly: frailty, loneliness and depressive symptoms","volume":"72","author":"Santos-Orlandi","year":"2019","journal-title":"Rev Bras Enferm"},{"key":"ref43","first-page":"242","article-title":"The evaluation of rural territorial functions: a case study of Henan, China","volume":"8","author":"Chao","year":"2017","journal-title":"J Resour Ecol"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1177\/0164027520949117","article-title":"Current status of the long-term care security system for older adults in China","volume":"43","author":"Du","year":"2021","journal-title":"Res Aging"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1139","DOI":"10.1186\/s12909-024-06075-w","article-title":"Digital health literacy among undergraduate nursing students in China: associations with health lifestyles and psychological resilience","volume":"24","author":"Liu","year":"2024","journal-title":"BMC Med Educ"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"62","DOI":"10.5455\/medarh.2017.72.62-67","article-title":"Predicting factors of depression and anxiety in mental health nurses: a quantitative cross-sectional study","volume":"72","author":"Tsaras","year":"2018","journal-title":"Med Arch"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1016\/S0140-6736(13)61489-0","article-title":"Subjective wellbeing, health, and ageing","volume":"385","author":"Steptoe","year":"2015","journal-title":"Lancet"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"1016286","DOI":"10.3389\/fpsyg.2022.1016286","article-title":"More income, less depression? Revisiting the nonlinear and heterogeneous relationship between income and mental health","volume":"13","author":"Li","year":"2022","journal-title":"Front Psychol"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1177\/0022146511419206","article-title":"Marriage and mental health among young adults","volume":"53","author":"Uecker","year":"2012","journal-title":"J Health Soc Behav"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"6130","DOI":"10.3390\/ijerph19106130","article-title":"Sustainable working life in intensive care: a qualitative study of older nurses","volume":"19","author":"Sousa-Ribeiro","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1016\/j.apergo.2011.08.009","article-title":"Understanding the link between psychosocial work stressors and work-related musculoskeletal complaints","volume":"43","author":"Eatough","year":"2012","journal-title":"Appl Ergon"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1177\/01640275211043486","article-title":"Effects of mindfulness-based interventions on depressive symptoms, anxiety, stress, and quality of life in family caregivers of persons living with dementia: a systematic review and meta-analysis","volume":"44","author":"Han","year":"2022","journal-title":"Res Aging"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1111\/ppc.12828","article-title":"Effects of group psychoeducation on depression, anxiety, stress and coping with stress of nursing students. A randomized controlled study","volume":"58","author":"G\u00fcnaydin","year":"2021","journal-title":"Perspect Psychiatr Care"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1111\/bjc.12288","article-title":"Effectiveness of stress control large group psychoeducation for anxiety and depression: systematic review and meta-analysis","volume":"60","author":"Dolan","year":"2021","journal-title":"Br J Clin Psychol"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1007\/BF01061227","article-title":"The revised ABC\u2019S of rational-emotive therapy (RET)","volume":"9","author":"Ellis","year":"1991","journal-title":"J Ration Emot Cogn Behav Ther"},{"key":"ref56","first-page":"34","volume-title":"Stress and coping","author":"Lazarus","year":"1985"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1690840\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T06:22:23Z","timestamp":1762150943000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1690840\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,3]]},"references-count":56,"alternative-id":["10.3389\/fpubh.2025.1690840"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1690840","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,3]]},"article-number":"1690840"}}