{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T17:20:23Z","timestamp":1788628823870,"version":"build-2803163510"},"reference-count":127,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,10,10]],"date-time":"2024-10-10T00:00:00Z","timestamp":1728518400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Epidemiologia"],"abstract":"<jats:p>Introduction: Nurses seem to be persistently experiencing intense psychological repercussions, even after the official conclusion of the COVID-19 pandemic. In this cross-sectional study conducted after the end of the pandemic crisis, from 1 June 2023 to 30 June 2023, we evaluated the levels and explored the associations between anger, insomnia, and resilience among Greek nurses. Methods: A total of 441 nurses participated in an online survey and were invited to state their work experience, gender, and age and to complete the self-report measures of the Dimensions of Anger Reactions-5 (DAR-5), the Athens Insomnia Scale (AIS), and the Brief Resilience Scale (BRS). Results: Overall, 62.1% of the participants presented with positive scores on the AIS, and 41.5% displayed positive values on the DAR-5 scale, whereas 24.9% demonstrated scores indicative of low resilience on the BRS. A regression analysis revealed that 23.5% of the variance in the AIS scores can be attributed to the DAR-5 scores and 3% to the BRS scores. A mediation analysis confirmed the protective role of resilience, contributing as a negative mediator in the DAR-5 and AIS relationship. Conclusions: Screening for insomnia symptoms and anger issues among nurses after the end of the pandemic and implementing appropriate interventions is considered imperative to avoid long-term health consequences.<\/jats:p>","DOI":"10.3390\/epidemiologia5040045","type":"journal-article","created":{"date-parts":[[2024,10,10]],"date-time":"2024-10-10T07:53:05Z","timestamp":1728546785000},"page":"643-657","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Resilience, Anger, and Insomnia in Nurses after the End of the Pandemic Crisis"],"prefix":"10.3390","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9104-1099","authenticated-orcid":false,"given":"Argyro","family":"Pachi","sequence":"first","affiliation":[{"name":"Psychiatric Department, Sotiria Thoracic Diseases Hospital of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aspasia","family":"Panagiotou","sequence":"additional","affiliation":[{"name":"Department of Nursing, University of Peloponnese, 22100 Tripoli, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Soultanis","sequence":"additional","affiliation":[{"name":"Psychiatric Department, Sotiria Thoracic Diseases Hospital of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Ivanidou","sequence":"additional","affiliation":[{"name":"Psychiatric Department, Sotiria Thoracic Diseases Hospital of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Manta","sequence":"additional","affiliation":[{"name":"Psychiatric Department, Sotiria Thoracic Diseases Hospital of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8095-1479","authenticated-orcid":false,"given":"Christos","family":"Sikaras","sequence":"additional","affiliation":[{"name":"Nursing Department, \u201cSotiria\u201d General Hospital of Thoracic Diseases, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5718-7441","authenticated-orcid":false,"given":"Ioannis","family":"Ilias","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Hippocration General Hospital, Athens 11527, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2591-965X","authenticated-orcid":false,"given":"Athanasios","family":"Tselebis","sequence":"additional","affiliation":[{"name":"Psychiatric Department, Sotiria Thoracic Diseases Hospital of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1822064","DOI":"10.1080\/20008198.2020.1822064","article-title":"Psychological resilience: An update on definitions, a critical appraisal, and research recommendations","volume":"11","author":"Denckla","year":"2020","journal-title":"Eur. J. Psychotraumatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/S2215-0366(19)30434-1","article-title":"Resilience and mental health: How multisystemic processes contribute to positive outcomes","volume":"7","author":"Ungar","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Tselebis, A., and Pachi, A. (2022). Primary Mental Health Care in a New Era. Healthcare, 10.","DOI":"10.3390\/healthcare10102025"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1177\/26320770211050058","article-title":"COVID-19 pandemic and stress: Coping with the new normal","volume":"3","author":"Bhattacharjee","year":"2022","journal-title":"J. Prev. Health Promot."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"100127","DOI":"10.1016\/j.ijnsa.2023.100127","article-title":"Unbearable suffering while working as a nurse during the COVID-19 pandemic: A qualitative descriptive study","volume":"5","author":"Dolan","year":"2023","journal-title":"Int. J. Nurs. Stud. Adv."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.ejim.2022.07.009","article-title":"The COVID-19 pandemic\u2013How many times were we warned before?","volume":"105","author":"Mahroum","year":"2022","journal-title":"Eur. J. Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"106263","DOI":"10.1016\/j.ypmed.2020.106263","article-title":"Contributing factors to personal protective equipment shortages during the COVID-19 pandemic","volume":"141","author":"Cohen","year":"2020","journal-title":"Prev. Med."},{"key":"ref_8","unstructured":"World Health Organization (2020). Rational Use of Personal Protective Equipment for Coronavirus Disease (COVID-19) and Considerations during Severe Shortages: Interim Guidance, World Health Organization. No. WHO\/2019-nCov\/IPC_PPE_use\/2020.3."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.jss.2020.11.062","article-title":"A closer look into global hospital beds capacity and resource shortages during the COVID-19 pandemic","volume":"260","author":"Sutherland","year":"2021","journal-title":"J. Surg. Res."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"McCabe, R., Schmit, N., Christen, P., D\u2019aeth, J.C., L\u00f8chen, A., Rizmie, D., Nayagam, S., Miraldo, M., Aylin, P., and Bottle, A. (2020). Adapting hospital capacity to meet changing demands during the COVID-19 pandemic. BMC Med., 18.","DOI":"10.1186\/s12916-020-01781-w"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Khubchandani, J., Bustos, E., Chowdhury, S., Biswas, N., and Keller, T. (2022). COVID-19 Vaccine Refusal among Nurses Worldwide: Review of Trends and Predictors. Vaccines, 10.","DOI":"10.3390\/vaccines10020230"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.jhin.2021.10.015","article-title":"Risk of hospitalization and death for healthcare workers with COVID-19 in nine European countries, January 2020\u2013January 2021","volume":"119","author":"Ferland","year":"2022","journal-title":"J. Hosp. Infect."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"201199","DOI":"10.1098\/rsos.201199","article-title":"Susceptibility to misinformation about COVID-19 around the world","volume":"7","author":"Roozenbeek","year":"2020","journal-title":"R. Soc. Open Sci."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Milionis, C., Ilias, I., Tselebis, A., and Pachi, A. (2023). Psychological and Social Aspects of Vaccination Hesitancy\u2014Implications for Travel Medicine in the Aftermath of the COVID-19 Crisis: A Narrative Review. Medicina, 59.","DOI":"10.20944\/preprints202308.1596.v1"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Couarraze, S., Delamarre, L., Marhar, F., Quach, B., Jiao, J., Avil\u00e9s Dorlhiac, R., Saadaoui, F., Liu, A.S., Dubuis, B., and Antunes, S. (2021). The major worldwide stress of healthcare professionals during the first wave of the COVID-19 pandemic\u2014The international COVISTRESS survey. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0257840"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.1177\/0969733020934146","article-title":"Healthcare workers\u2019 stress when caring for COVID-19 patients: An altruistic perspective","volume":"27","author":"Wang","year":"2020","journal-title":"Nurs. Ethics"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"94","DOI":"10.3934\/publichealth.2022008","article-title":"Nursing staff fatigue and burnout during the COVID-19 pandemic in Greece","volume":"9","author":"Sikaras","year":"2021","journal-title":"AIMS Public Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"106219","DOI":"10.1016\/j.rmed.2020.106219","article-title":"Levels of resilience, anxiety and depression in nurses working in respiratory clinical areas during the COVID pandemic","volume":"176","author":"Roberts","year":"2021","journal-title":"Respir. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1016\/j.bbi.2020.05.026","article-title":"Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis","volume":"88","author":"Pappa","year":"2020","journal-title":"Brain Behav. Immun."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Tselebis, A., Lekka, D., Sikaras, C., Tsomaka, E., Tassopoulos, A., Ilias, I., Bratis, D., and Pachi, A. (2020). Insomnia, Perceived Stress, and Family Support among Nursing Staff during the Pandemic Crisis. Healthcare, 8.","DOI":"10.21203\/rs.3.rs-44847\/v1"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"36","DOI":"10.3934\/publichealth.2024003","article-title":"Nightmare distress, insomnia and resilience of nursing staff in the post-pandemic era","volume":"11","author":"Pachi","year":"2024","journal-title":"AIMS Public Health"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Tucker, M.A. (2020). The value of sleep for optimizing health. Nutrition, Fitness, and Mindfulness: An Evidence-Based Guide for Clinicians, Humana.","DOI":"10.1007\/978-3-030-30892-6_14"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Chaput, J.-P., McNeil, J., Despr\u00e9s, J.-P., Bouchard, C., and Tremblay, A. (2013). Seven to Eight Hours of Sleep a Night Is Associated with a Lower Prevalence of the Metabolic Syndrome and Reduced Overall Cardiometabolic Risk in Adults. PLoS ONE, 8.","DOI":"10.1371\/annotation\/1bf80584-08ec-47c2-ba45-4e77554cd50a"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.puhe.2017.07.030","article-title":"Physical functioning and risk for sleep disorders in US adults: Results from the National Health and Nutrition Examination Survey 2005\u20132014","volume":"152","author":"Puri","year":"2017","journal-title":"Public Health"},{"key":"ref_25","first-page":"302","article-title":"Sleep and depression\u2014Theory and practice","volume":"38","author":"Berk","year":"2009","journal-title":"Aust. Fam. Physician"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Faulkner, S., and Bee, P. (2016). Perspectives on sleep, sleep problems, and their treatment, in people with serious mental illnesses: A systematic review. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0163486"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"524","DOI":"10.3934\/publichealth.2023037","article-title":"Family support, anger and aggression in health workers during the first wave of the pandemic","volume":"10","author":"Pachi","year":"2023","journal-title":"AIMS Public Health"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Williams, R. (2017). Anger as a Basic Emotion and Its Role in Personality Building and Pathological Growth: The Neuroscientific, Developmental and Clinical Perspectives. Front. Psychol., 8.","DOI":"10.3389\/fpsyg.2017.01950"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1080\/02699939208411068","article-title":"An argument for basic emotions","volume":"6","author":"Ekman","year":"1992","journal-title":"Cogn. Emot."},{"key":"ref_30","first-page":"16","article-title":"Basic emotions","volume":"Volume 98 (45\u201360)","author":"Ekman","year":"1999","journal-title":"Handbook of Cognition and Emotion"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1037\/1528-3542.4.2.107","article-title":"Toward an understanding of the determinants of anger","volume":"4","author":"Berkowitz","year":"2004","journal-title":"Emotion"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2090","DOI":"10.1037\/dev0000589","article-title":"Developmental patterns of anger from infancy to middle childhood predict problem behaviors at age 8","volume":"54","author":"Liu","year":"2018","journal-title":"Dev. Psychol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1037\/0012-1649.31.6.997","article-title":"The ontogeny and significance of infants\u2019 facial expressions in the first 9 months of life","volume":"31","author":"Izard","year":"1995","journal-title":"Dev. Psychol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1002\/dev.20151","article-title":"The relation of ANS and HPA activation to infant anger and sadness response to goal blockage","volume":"48","author":"Lewis","year":"2006","journal-title":"Dev. Psychobiol. J. Int. Soc. Dev. Psychobiol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Potegal, M., Stemmler, G., and Spielberger, C. (2010). The expression of anger across cultures. International Handbook of Anger: Constituent and Concomitant Biological, Psychological, and Social Processes, Springer Science + Business Media.","DOI":"10.1007\/978-0-387-89676-2"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"41","DOI":"10.16899\/jcm.804329","article-title":"Relationship of COVID-19 pandemic with anxiety, anger, sleep and emotion regulation in healthcare professionals","volume":"11","year":"2021","journal-title":"J. Contemp. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.jpsychores.2004.07.002","article-title":"Relationship between trait-anger and sleep disturbances in middle-aged men and women","volume":"58","author":"Shin","year":"2005","journal-title":"J. Psychosom. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1111\/jcap.12294","article-title":"The relationship between insomnia and trait anger and anger expression among adolescents","volume":"34","author":"Sisman","year":"2021","journal-title":"J. Child Adolesc. Psychiatr. Nurs."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.jradnu.2023.10.003","article-title":"The Relation between Sleep Quality and Anger Expression That Occur in Nurses: A Cross-Sectional Study","volume":"43","author":"Aldemir","year":"2024","journal-title":"J. Radiol. Nurs."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.ijpsycho.2013.05.010","article-title":"Sleep and emotions: Bidirectional links and underlying mechanisms","volume":"89","author":"Kahn","year":"2013","journal-title":"Int. J. Psychophysiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"101670","DOI":"10.1016\/j.smrv.2022.101670","article-title":"Sleep and affect: A conceptual review","volume":"65","author":"Dietch","year":"2022","journal-title":"Sleep Med. Rev."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"A105","DOI":"10.1093\/sleep\/zsaa056.274","article-title":"0276 Does Losing Sleep Unleash Anger?","volume":"43","author":"Krizan","year":"2020","journal-title":"Sleep"},{"key":"ref_43","first-page":"e2912","article-title":"The Amygdala, Sleep Debt, Sleep Deprivation, and the Emotion of Anger: A Possible Connection?","volume":"10","author":"Saghir","year":"2018","journal-title":"Cureus"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"163","DOI":"10.33069\/cim.2019.0023","article-title":"Anger Associated with Insomnia and Recent Stressful Life Events in Community-Dwelling Adults","volume":"1","author":"Kim","year":"2019","journal-title":"Chronobiol. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.5664\/jcsm.9926","article-title":"Sleep disorder symptoms are associated with greater posttraumatic stress and anger symptoms in US Army service members seeking treatment for posttraumatic stress disorder","volume":"18","author":"Miles","year":"2022","journal-title":"J. Clin. Sleep Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.jrp.2017.08.009","article-title":"Anger tendencies and sleep: Poor anger control is associated with objectively measured sleep disruption","volume":"71","author":"Hisler","year":"2017","journal-title":"J. Res. Personal."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1037\/xge0000522","article-title":"Sleepy anger: Restricted sleep amplifies angry feelings","volume":"148","author":"Krizan","year":"2019","journal-title":"J. Exp. Psychol. Gen."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1136\/bmj.p1041","article-title":"COVID-19: WHO declares end of global health emergency","volume":"381","author":"Wise","year":"2023","journal-title":"BMJ"},{"key":"ref_49","first-page":"1817","article-title":"WHO declares end of COVID-19 global health emergency","volume":"329","author":"Harris","year":"2023","journal-title":"JAMA"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/s11920-020-01166-z","article-title":"The Psychological Impact of Epidemic and Pandemic Outbreaks on Healthcare Workers: Rapid Review of the Evidence","volume":"22","author":"Preti","year":"2020","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_51","first-page":"2373","article-title":"A Moderated Mediation Model of the Influence of Cynical Distrust, Medical Distrust, and Anger on Vaccination Hesitancy in Nursing Staff","volume":"13","author":"Tselebis","year":"2023","journal-title":"Eur. J. Investig. Health Psychol. Educ."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/S0022-3999(00)00095-7","article-title":"Athens Insomnia Scale: Validation of an instrument based on ICD-10 criteria","volume":"48","author":"Soldatos","year":"2000","journal-title":"J. Psychosom. Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/S0022-3999(02)00604-9","article-title":"The diagnostic validity of the Athens Insomnia Scale","volume":"55","author":"Soldatos","year":"2002","journal-title":"J. Psychosom. Res."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Eleftheriou, A., Rokou, A., Arvaniti, A., Nena, E., and Steiropoulos, P. (2021). Sleep quality and mental health of medical students in Greece during the COVID-19 pandemic. Front. Public Health, 9.","DOI":"10.3389\/fpubh.2021.775374"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Kim, H.J., Lee, D.H., Kim, J.H., and Kang, S.-E. (2023). Validation of the Dimensions of Anger Reactions Scale (the DAR-5) in non-clinical South Korean adults. BMC Psychol., 11.","DOI":"10.1186\/s40359-023-01084-8"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1016\/j.janxdis.2014.09.015","article-title":"Evaluation of the Dimensions of Anger Reactions-5 (DAR-5) Scale in combat veterans with posttraumatic stress disorder","volume":"28","author":"Forbes","year":"2014","journal-title":"J. Anxiety Disord."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1080\/10705500802222972","article-title":"The brief resilience scale: Assessing the ability to bounce back","volume":"15","author":"Smith","year":"2008","journal-title":"Int. J. Behav. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1828","DOI":"10.4236\/psych.2018.97107","article-title":"Psychometric evidence of the Brief Resilience Scale (BRS) and modeling distinctiveness of resilience from depression and stress","volume":"9","author":"Kyriazos","year":"2018","journal-title":"Psychology"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Pachi, A., Kavourgia, E., Bratis, D., Fytsilis, K., Papageorgiou, S.M., Lekka, D., Sikaras, C., and Tselebis, A. (2023). Anger and Aggression in Relation to Psychological Resilience and Alcohol Abuse among Health Professionals during the First Pandemic Wave. Healthcare, 11.","DOI":"10.3390\/healthcare11142031"},{"key":"ref_60","first-page":"420","article-title":"Quantitative and qualitative assessment of nurse staffing indicators across NHS public hospitals in Greece","volume":"57","author":"Tziallas","year":"2018","journal-title":"Hell. J. Nurs."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1177\/0002764219859633","article-title":"Conditional process analysis: Concepts, computation, and advances in the modeling of the contingencies of mechanisms","volume":"64","author":"Hayes","year":"2020","journal-title":"Am. Behav. Sci."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/00273171.2014.962683","article-title":"An index and test of linear moderated mediation","volume":"50","author":"Hayes","year":"2015","journal-title":"Multivar. Behav. Res."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"252","DOI":"10.3934\/publichealth.2023019","article-title":"Anxiety, insomnia and family support in nurses, two years after the onset of the pandemic crisis","volume":"10","author":"Sikaras","year":"2023","journal-title":"AIMS Public Health"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"11072","DOI":"10.3390\/ijerph120911072","article-title":"Depression, anxiety and symptoms of stress among Hong Kong nurses: A cross-sectional study","volume":"12","author":"Cheung","year":"2015","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"93","DOI":"10.2466\/pr0.99.1.93-96","article-title":"Anxiety and depression in Greek nursing and medical personnel","volume":"99","author":"Tselebis","year":"2006","journal-title":"Psychol. Rep."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"2654","DOI":"10.1111\/jocn.15678","article-title":"Anxiety and its association with perceived stress and insomnia among nurses fighting against COVID-19 in Wuhan: A cross-sectional survey","volume":"30","author":"Shen","year":"2021","journal-title":"J. Clin. Nurs."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Lu, M.Y., Ahorsu, D.K., Kukreti, S., Strong, C., Lin, Y.H., Kuo, Y.J., Chen, Y.-P., Lin, C.-Y., Chen, P.-L., and Ko, N.-Y. (2021). The prevalence of post-traumatic stress disorder symptoms, sleep problems, and psychological distress among COVID-19 frontline healthcare workers in Taiwan. Front. Psychiatry, 12.","DOI":"10.3389\/fpsyt.2021.705657"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"759","DOI":"10.7205\/MILMED-D-10-00193","article-title":"Insomnia is the most commonly reported symptom and predicts other symptoms of post-traumatic stress disorder in U.S. service members returning from military deployments","volume":"175","author":"McLay","year":"2010","journal-title":"Mil. Med."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1136\/medethics-2020-106398","article-title":"\u2018Healthcare Heroes\u2019: Problems with media focus on heroism from healthcare workers during the COVID-19 pandemic","volume":"46","author":"Cox","year":"2020","journal-title":"J. Med. Ethics"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"e2036","DOI":"10.1002\/nop2.2036","article-title":"The relationships between nurses\u2019 resilience, burnout, perceived organisational support and social support during the second wave of the COVID-19 pandemic: A quantitative cross-sectional survey","volume":"11","author":"Abdulmohdi","year":"2024","journal-title":"Nurs. Open"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Moisoglou, I., Katsiroumpa, A., Malliarou, M., Papathanasiou, I.V., Gallos, P., and Galanis, P. (2024). Social Support and Resilience Are Protective Factors against COVID-19 Pandemic Burnout and Job Burnout among Nurses in the Post-COVID-19 Era. Healthcare, 12.","DOI":"10.20944\/preprints202402.0953.v1"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"614","DOI":"10.3934\/publichealth.2024031","article-title":"Impact of workplace bullying on job burnout and turnover intention among nursing staff in Greece: Evidence after the COVID-19 pandemic","volume":"11","author":"Galanis","year":"2024","journal-title":"AIMS Public Health"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.3390\/nursrep13030095","article-title":"Increased Job Burnout and Reduced Job Satisfaction for Nurses Compared to Other Healthcare Workers after the COVID-19 Pandemic","volume":"13","author":"Galanis","year":"2023","journal-title":"Nurs. Rep."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1037\/tra0001498","article-title":"Clinical correlates of irritability, anger, hostility, and aggression in posttraumatic stress disorder","volume":"16","author":"Zhan","year":"2024","journal-title":"Psychol. Trauma Theory Res. Pract. Policy"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/S0010-440X(99)90006-8","article-title":"Multidimensional assessment of anger in Vietnam veterans with posttraumatic stress disorder","volume":"40","author":"McFall","year":"1999","journal-title":"Compr. Psychiatry"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1007\/s11920-022-01380-x","article-title":"Problematic Anger in the Military: Focusing on the Forgotten Emotion","volume":"24","author":"Forbes","year":"2022","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"2031","DOI":"10.1017\/S0033291721003779","article-title":"Effects of prior deployments and perceived resilience on anger trajectories of combat-deployed soldiers","volume":"53","author":"Kautz","year":"2023","journal-title":"Psychol. Med."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"e12472","DOI":"10.1111\/nin.12472","article-title":"\u201cIt\u2019s like we\u2019re at war\u201d: Nurses\u2019 resilience and coping strategies during the COVID-19 pandemic","volume":"29","author":"Asadi","year":"2022","journal-title":"Nurs. Inq."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.euroneuro.2021.10.864","article-title":"The impact of the prolonged COVID-19 pandemic on stress resilience and mental health: A critical review across waves","volume":"55","author":"Manchia","year":"2022","journal-title":"Eur. Neuropsychopharmacol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.mnl.2022.04.009","article-title":"Trauma, Compassion Fatigue, and Burnout in Nurses: The Nurse Leader\u2019s Response","volume":"21","author":"Wolotira","year":"2023","journal-title":"Nurse Lead."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1007\/s00127-013-0709-8","article-title":"The role of stress sensitization in progression of posttraumatic distress following deployment","volume":"48","author":"Smid","year":"2013","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"100379","DOI":"10.1016\/j.jadr.2022.100379","article-title":"Coping with COVID-19: Testing the stress sensitization hypothesis among adults with and without a history of adverse childhood experiences","volume":"10","author":"Russo","year":"2022","journal-title":"J. Affect. Disord. Rep."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1097\/NMD.0000000000000712","article-title":"Can anger be helpful?: Soldier perceptions of the utility of anger","volume":"205","author":"Adler","year":"2017","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1111\/jnu.12627","article-title":"Mediating Effects of Anger Expression in the Relationship of Work Stress with Burnout among Hospital Nurses Depending on Career Experience","volume":"53","author":"Lee","year":"2021","journal-title":"J. Nurs. Scholarsh."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.anr.2019.09.002","article-title":"Effects of Trait Anger and Anger Expression on Job Satisfaction and Burnout in Preceptor Nurses and Newly Graduated Nurses: A Dyadic Analysis","volume":"13","author":"La","year":"2019","journal-title":"Asian Nurs. Res."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1111\/j.1467-6494.2009.00607.x","article-title":"The anatomy of anger: An integrative cognitive model of trait anger and reactive aggression","volume":"78","author":"Wilkowski","year":"2010","journal-title":"J. Pers."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.sleep.2016.11.004","article-title":"Sleep-related cognitive processes, arousal, and emotion dysregulation in insomnia disorder: The role of insomnia-specific rumination","volume":"30","author":"Palagini","year":"2017","journal-title":"Sleep Med."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.sleep.2019.11.1184","article-title":"Nocturnal cognitive arousal is associated with objective sleep disturbance and indicators of physiologic hyperarousal in good sleepers and individuals with insomnia disorder","volume":"71","author":"Kalmbach","year":"2020","journal-title":"Sleep Med."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1738","DOI":"10.1111\/j.1469-8986.2011.01281.x","article-title":"The role of presleep negative emotion in sleep physiology","volume":"48","author":"Vandekerckhove","year":"2011","journal-title":"Psychophysiology"},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Norell-Clarke, A., Hagstr\u00f6m, M., and Jansson-Fr\u00f6jmark, M. (2021). Sleep-Related Cognitive Processes and the Incidence of Insomnia Over Time: Does Anxiety and Depression Impact the Relationship?. Front. Psychol., 12.","DOI":"10.3389\/fpsyg.2021.677538"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1177\/2165079917737090","article-title":"Role of Irrational Beliefs and Anger Rumination on Nurses\u2019 Anger Expression Styles","volume":"66","author":"Ham","year":"2018","journal-title":"Workplace Health Saf."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"110615","DOI":"10.1016\/j.jpsychores.2021.110615","article-title":"Modelling the relationship between poor sleep and problem anger in veterans: A dynamic structural equation modelling approach","volume":"150","author":"Metcalf","year":"2021","journal-title":"J. Psychosom. Res."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.sleh.2022.02.005","article-title":"Multilevel analysis of sleep quality and anger in emergency medical service workers","volume":"8","author":"Hruska","year":"2022","journal-title":"Sleep Health"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1037\/vio0000018","article-title":"Sleep disruption and aggression: Implications for violence and its prevention","volume":"6","author":"Krizan","year":"2016","journal-title":"Psychol. Violence"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.sleep.2011.12.006","article-title":"Poor sleep as a potential causal factor in aggression and violence","volume":"13","author":"Kamphuis","year":"2012","journal-title":"Sleep Med."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"e13928","DOI":"10.1111\/jsr.13928","article-title":"Hyperarousal in insomnia disorder: Current evidence and potential mechanisms","volume":"32","author":"Dressle","year":"2023","journal-title":"J. Sleep Res."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"403","DOI":"10.3390\/clockssleep3030027","article-title":"Dream Recall\/Affect and the Hypothalamic\u2013Pituitary\u2013Adrenal Axis","volume":"3","author":"Tselebis","year":"2021","journal-title":"Clocks Sleep"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"193","DOI":"10.2147\/NSS.S138823","article-title":"Hyperarousal and sleep reactivity in insomnia: Current insights","volume":"10","author":"Kalmbach","year":"2018","journal-title":"Nat. Sci. Sleep"},{"key":"ref_99","doi-asserted-by":"crossref","unstructured":"Altena, E., Chen, I.Y., Daviaux, Y., Ivers, H., Philip, P., and Morin, C.M. (2017). How Hyperarousal and Sleep Reactivity Are Represented in Different Adult Age Groups: Results from a Large Cohort Study on Insomnia. Brain Sci., 7.","DOI":"10.3390\/brainsci7040041"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"zsae028","DOI":"10.1093\/sleep\/zsae028","article-title":"Insomnia is more likely to persist than remit after a time of stress and uncertainty: A longitudinal cohort study examining trajectories and predictors of insomnia symptoms","volume":"47","author":"Meaklim","year":"2024","journal-title":"Sleep"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"e13787","DOI":"10.1111\/jsr.13787","article-title":"Emotion regulation mediates the effects of sleep on stress and aggression","volume":"32","author":"Demichelis","year":"2023","journal-title":"J. Sleep Res."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1002\/jclp.23622","article-title":"The inner workings of anger: A network analysis of anger and emotion regulation","volume":"80","author":"Larsson","year":"2024","journal-title":"J. Clin. Psychol."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"e13892","DOI":"10.1111\/jsr.13892","article-title":"The sleep response to stress: How sleep reactivity can help us prevent insomnia and promote resilience to trauma","volume":"32","author":"Reffi","year":"2023","journal-title":"J. Sleep Res."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"2538","DOI":"10.1073\/pnas.1522520113","article-title":"Slow dissolving of emotional distress contributes to hyperarousal","volume":"113","author":"Wassing","year":"2016","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_105","doi-asserted-by":"crossref","unstructured":"Li, Y., Gu, S., Wang, Z., Li, H., Xu, X., Zhu, H., Deng, S., Ma, X., Feng, G., and Wang, F. (2019). Relationship between Stressful Life Events and Sleep Quality: Rumination as a Mediator and Resilience as a Moderator. Front. Psychiatry, 10.","DOI":"10.3389\/fpsyt.2019.00348"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1007\/s40675-024-00274-z","article-title":"Improving Sleep to Improve Stress Resilience","volume":"10","author":"Berteotti","year":"2024","journal-title":"Curr. Sleep Med. Rep."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"A108","DOI":"10.1093\/sleepj\/zsx050.293","article-title":"0294 Resilience, Emotion and Arousal Regulation in Insomnia Disorder","volume":"40","author":"Palagini","year":"2017","journal-title":"Sleep"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"759","DOI":"10.5664\/jcsm.7100","article-title":"Lack of resilience is related to stress-related sleep reactivity, hyperarousal, and emotion dysregulation in insomnia disorder","volume":"14","author":"Palagini","year":"2018","journal-title":"J. Clin. Sleep Med."},{"key":"ref_109","doi-asserted-by":"crossref","unstructured":"Zhan, N., Xu, Y., Pu, J., Wang, W., and Xie Zand Huang, H. (2024). The interaction between mental resilience and insomnia disorder on negative emotions in nurses in Guangdong Province, China. Front. Psychiatry, 15.","DOI":"10.3389\/fpsyt.2024.1396417"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.jsmc.2007.04.002","article-title":"Chronic Insomnia and Stress System","volume":"2","author":"Basta","year":"2007","journal-title":"Sleep Med. Clin."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1080\/13548506.2020.1734637","article-title":"Relationship between resilience and insomnia among the middleaged and elderly: Mediating role of maladaptive emotion regulation strategies","volume":"25","author":"MenCheng","year":"2020","journal-title":"Psychol. Health Med."},{"key":"ref_112","doi-asserted-by":"crossref","unstructured":"de Almondes, K.M., Mar\u00edn Agudelo, H.A., and Jim\u00e9nez-Correa, U. (2021). Impact of Sleep Deprivation on Emotional Regulation and the Immune System of Healthcare Workers as a Risk Factor for COVID 19: Practical Recommendations from a Task Force of the Latin American Association of Sleep Psychology. Front. Psychol., 12.","DOI":"10.3389\/fpsyg.2021.564227"},{"key":"ref_113","first-page":"e7","article-title":"The Relationship between Nurses\u2019 Sleep Quality and Their Tendency to Commit Medical Errors","volume":"17","author":"Demir","year":"2023","journal-title":"Sleep Sci."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"3826","DOI":"10.1017\/S0033291722000472","article-title":"Improved resilience following digital cognitive behavioral therapy for insomnia protects against insomnia and depression one year later","volume":"53","author":"Cheng","year":"2023","journal-title":"Psychol. Med."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"zsaa258","DOI":"10.1093\/sleep\/zsaa258","article-title":"Digital cognitive behavioral therapy for insomnia promotes later health resilience during the coronavirus disease 19 (COVID-19) pandemic","volume":"44","author":"Cheng","year":"2021","journal-title":"Sleep"},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"e54132","DOI":"10.2196\/54132","article-title":"Web-Based Mindfulness Meditation as an Adjunct to Internet-Delivered Cognitive Behavioral Therapy for Public Safety Personnel: Mixed Methods Feasibility Evaluation Study","volume":"8","author":"Landry","year":"2024","journal-title":"JMIR Form. Res."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.genhosppsych.2022.02.003","article-title":"Resilience coaching for healthcare workers: Experiences of receiving collegial support during the COVID-19 pandemic","volume":"75","author":"Rosen","year":"2022","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_118","doi-asserted-by":"crossref","unstructured":"Martoni, M., Fabbri, M., Grandi, A., Sist, L., and Colombo, L. (2023). Self-Care Practices as a Mediator between Workaholism and Sleep\u2013Wake Problems during COVID-19. Sustainability, 15.","DOI":"10.3390\/su151612603"},{"key":"ref_119","doi-asserted-by":"crossref","unstructured":"Sist, L., Savadori, S., Grandi, A., Martoni, M., Baiocchi, E., Lombardo, C., and Colombo, L. (2022). Self-Care for Nurses and Midwives: Findings from a Scoping Review. Healthcare, 10.","DOI":"10.3390\/healthcare10122473"},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"104503","DOI":"10.1016\/j.nedt.2020.104503","article-title":"Knowledge for nurses to better care for themselves so they can better care for others during the COVID-19 pandemic and beyond","volume":"94","author":"Hofmeyer","year":"2020","journal-title":"Nurse Educ. Today"},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1097\/jnr.0000000000000095","article-title":"The relationships among sleep quality and chronotype, emotional disturbance, and insomnia vulnerability in shift nurses","volume":"23","author":"Lee","year":"2015","journal-title":"J. Nurs. Res."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1111\/j.1365-2702.2008.02583.x","article-title":"Factors associated with perceived sleep quality of nurses working on rotating shifts","volume":"18","author":"Chan","year":"2009","journal-title":"J. Clin. Nurs."},{"key":"ref_123","doi-asserted-by":"crossref","unstructured":"Pachi, A., Tselebis, A., Ilias, I., Tsomaka, E., Papageorgiou, S.M., Baras, S., Kavouria, E., and Giotakis, K. (2022). Aggression, Alexithymia and Sense of Coherence in a Sample of Schizophrenic Outpatients. Healthcare, 10.","DOI":"10.3390\/healthcare10061078"},{"key":"ref_124","first-page":"109","article-title":"Chronic Obstructive Pulmonary Disease: Sense of Coherence and Family Support versus Anxiety and Depression","volume":"24","author":"Tselebis","year":"2013","journal-title":"Psychiatriki"},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1111\/jsr.12172","article-title":"The role of vulnerability in stress-related insomnia, social support and coping styles on incidence and persistence of insomnia","volume":"23","author":"Jarrin","year":"2014","journal-title":"J. Sleep Res."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/1447-056X-10-3","article-title":"The 13 item Family Support Scale: Reliability and validity of the Greek translation in a sample of Greek health care professionals","volume":"10","author":"Tselebis","year":"2011","journal-title":"Asia Pac. Fam. Med."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1111\/jssr.12581","article-title":"Sleep quality and the stress-buffering role of religious involvement: A mediated moderation analysis","volume":"58","author":"Ellison","year":"2019","journal-title":"J. Sci. Study Relig."}],"container-title":["Epidemiologia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2673-3986\/5\/4\/45\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:10:33Z","timestamp":1760112633000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2673-3986\/5\/4\/45"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,10]]},"references-count":127,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["epidemiologia5040045"],"URL":"https:\/\/doi.org\/10.3390\/epidemiologia5040045","relation":{},"ISSN":["2673-3986"],"issn-type":[{"value":"2673-3986","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,10]]}}}