{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T01:54:51Z","timestamp":1781920491197,"version":"3.54.5"},"reference-count":105,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The nursing profession is recognized as a high-risk occupation, with the emotional toll on healthcare workers reaching a critical point. A complex interplay of anger and cynicism, often stemming from systemic pressures and chronic moral injury, seems to increasingly affect nurses\u2019 professional and personal lives. This psychological strain does not end when the shift ends; rather, it often manifests as insomnia and nightmare distress, creating a vicious cycle of exhaustion and emotional instability. This article explores how anger, cynical distrust, nightmare distress and insomnia are interrelated and jeopardize the well-being of nursing staff and what these \u201cinvisible\u201d symptoms reveal about the current state of healthcare by confirming their prevalence rates. Methods: This cross-sectional study was conducted online in October 2025 and included 441 hospital nurses who completed the Dimensions of Anger Reactions-5 (DAR-5), the 8-item Cynical Distrust scale (CDS-8), the Nightmare Distress Questionnaire (NDQ) and the Athens Insomnia Scale (AIS). Results: The prevalence rates of anger, nightmare distress and insomnia were 41.5%, 6.6%, and 62.1%, respectively. Based on the CDS-8 scores, a notable proportion (20.9%) of nurses fell within the highest quartile of CDS-8 scores (CDS-8 &gt; 29), indicating relatively elevated cynical distrust within this sample; this threshold is sample-derived and does not correspond to a validated clinical cut-off. Hierarchical multiple regression analysis indicated that the DAR-5 explained 22.1% of the variance in AIS, while an additional 10.2% was explained by NDQ and another 1.5% by the CDS-8. Both cynical distrust and nightmare distress displayed a chain mediation pattern in the association between anger and insomnia; however, given the cross-sectional design, the temporal order of these variables cannot be confirmed. Conclusions: Anger exhibited significant direct and indirect associations with insomnia, with cynical distrust and nightmare distress acting as serial mediators in this cross-sectional model. Findings from this cross-sectional study tentatively suggest that future intervention efforts targeting insomnia in nurses might benefit from addressing anger alongside nightmare distress and cynical attitudes; however, experimental studies are needed to confirm whether such interventions would be effective.<\/jats:p>","DOI":"10.3390\/jcm15103837","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T12:36:40Z","timestamp":1779107800000},"page":"3837","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Anger, Cynical Distrust, Nightmare Distress and Insomnia Among Nursing Personnel"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2591-965X","authenticated-orcid":false,"given":"Athanasios","family":"Tselebis","sequence":"first","affiliation":[{"name":"Psychiatric Department, Sotiria Thoracic Diseases Hospital of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9104-1099","authenticated-orcid":false,"given":"Argyro","family":"Pachi","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, Sotiria Thoracic Diseases Hospital of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Kasimis","sequence":"additional","affiliation":[{"name":"Psychiatric Department, Sotiria Thoracic Diseases Hospital of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evgenia","family":"Kavourgia","sequence":"additional","affiliation":[{"name":"Psychiatric Department, Sotiria Thoracic Diseases Hospital of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5718-7441","authenticated-orcid":false,"given":"Ioannis","family":"Ilias","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Hippokration General Hospital of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"S\u00f8vold, L.E., Naslund, J.A., Kousoulis, A.A., Saxena, S., Qoronfleh, M.W., Grobler, C., and M\u00fcnter, L. (2021). Prioritizing the Mental Health and Well-Being of Healthcare Workers: An Urgent Global Public Health Priority. Front. Public Health, 9.","DOI":"10.3389\/fpubh.2021.679397"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"100148","DOI":"10.1016\/j.ijnsa.2023.100148","article-title":"Perceptions of healthcare professionals\u2019 psychological wellbeing at work and the link to patients\u2019 experiences of care: A scoping review","volume":"5","author":"Bamforth","year":"2023","journal-title":"Int. J. Nurs. Stud. Adv."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"643","DOI":"10.3390\/epidemiologia5040045","article-title":"Resilience, Anger, and Insomnia in Nurses after the End of the Pandemic Crisis","volume":"5","author":"Pachi","year":"2024","journal-title":"Epidemiologia"},{"key":"ref_4","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":"2023","journal-title":"AIMS Public Health"},{"key":"ref_5","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_6","doi-asserted-by":"crossref","first-page":"e75432","DOI":"10.2196\/75432","article-title":"Work Experience and Anger Management in Nurses: Cross-Sectional Analysis Based on Benner\u2019s Novice to Expert Theory","volume":"9","author":"Rahmati","year":"2025","journal-title":"Asian Pac. Isl. Nurs. J."},{"key":"ref_7","unstructured":"Fink, G. (2016). Anger. Stress: Concepts, Cognition, Emotion, and Behavior, Elsevier Academic Press."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Quan, F., Wang, L., Gong, X., Lei, X., Liang, B., and Zhang, S. (2022). Hostile Attribution Bias and Anger Rumination Sequentially Mediate the Association Between Trait Anger and Reactive Aggression. Front. Psychol., 12.","DOI":"10.3389\/fpsyg.2021.778695"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Martin, C., Preedy, V.R., and Patel, V.B. (2023). Targeting Cognitive Bias to Reduce Anger and Aggression. Handbook of Anger, Aggression, and Violence, Springer.","DOI":"10.1007\/978-3-031-31547-3"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1984","DOI":"10.1057\/s41599-025-06227-3","article-title":"Effect of an anger management program on mental health of nurses working in an emergency department","volume":"12","author":"Nassehi","year":"2025","journal-title":"Humanit. Soc. Sci. Commun."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Tiryaki Sen, H., T\u00fcrkmen, E., Ku\u015fcu Karatepe, H., and Yurtsever, D. (2025). A pathway for nurses from work strain to anger: Mediation of social intelligence. BMC Health Serv. Res., 25.","DOI":"10.1186\/s12913-024-11845-9"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"23779608241251717","DOI":"10.1177\/23779608241251717","article-title":"Organizational Cynicism and Turnover Intention Among Nurses: Do Perceived Organizational Support Moderates the Relationship","volume":"10","author":"Ike","year":"2024","journal-title":"SAGE Open Nurs."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"215824402210933","DOI":"10.1177\/21582440221093343","article-title":"The Influence of Emotional Exhaustion on Organizational Cynicism: The Sequential Mediating Effect of Organizational Identification and Trust in Organization","volume":"12","author":"Atalay","year":"2022","journal-title":"SAGE Open"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1023\/A:1012268705059","article-title":"Cynicism as a fundamental dimension of moral decision-making: A scale development","volume":"34","author":"Turner","year":"2001","journal-title":"J. Bus. Ethics"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Padmanabhanunni, A., and Pretorius, T.B. (2024). Being Cynical Is Bad for Your Wellbeing: A Structural Equation Model of the Relationship Between Cynicism and Mental Health in First Responders in South Africa. Int. J. Environ. Res. Public Health, 21.","DOI":"10.3390\/ijerph21121684"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1007\/s10865-017-9834-2","article-title":"High levels of cynical distrust partly predict premature mortality in middle-aged to ageing men","volume":"40","author":"Julkunen","year":"2017","journal-title":"J. Behav. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1080\/00223980.2017.1408555","article-title":"Forgiveness and Suicidal Behavior: Cynicism and Psychache as Serial Mediators","volume":"152","author":"Dangel","year":"2018","journal-title":"J. Psychol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1037\/a0032225","article-title":"Does Cynicism Play a Role in Failure to Obtain Needed Care? Mental Health Service Utilization Among Returning, U.S. National Guard Soldiers","volume":"25","author":"Arbisi","year":"2013","journal-title":"Psychol. Assess"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1177\/0146167218783195","article-title":"The cynical genius illusion: Exploring and debunking lay beliefs about cynicism and competence","volume":"45","author":"Stavrova","year":"2019","journal-title":"Personal. Soc. Psychol. Bull."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Petitta, L., and Ghezzi, V. (2023). Remote, Disconnected, or Detached? Examining the Effects of Psychological Disconnectedness and Cynicism on Employee Performance, Wellbeing, and Work-Family Interface. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20136318"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.2466\/pr0.1991.68.3c.1059","article-title":"Cook-Medley hostility, anger, and the type A behavior in Finland","volume":"68","author":"Greenglass","year":"1991","journal-title":"Psychol. Rep."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Friedman, H.S. (1992). Hostility, health, and social contexts. Hostility, Coping, & Health, American Psychological Association.","DOI":"10.1037\/10105-000"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e000052","DOI":"10.1161\/JAHA.113.000052","article-title":"Hostility, health behaviors, and risk of recurrent events in patients with stable coronary heart disease: Findings from the Heart and Soul Study","volume":"2","author":"Wong","year":"2013","journal-title":"J. Am. Heart Assoc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1002\/wps.20311","article-title":"Understanding the burnout experience: Recent research and its implications for psychiatry","volume":"15","author":"Maslach","year":"2016","journal-title":"World Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"7","DOI":"10.5334\/irsp.1009","article-title":"\u2018Do Good, Expect the Worst\u2019: The Indirect Effect of Social Cynicism on Prosocial Behavior via Empathy and Trust","volume":"38","author":"Coca","year":"2025","journal-title":"Int. Rev. Soc. Psychol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"341","DOI":"10.2307\/259378","article-title":"Organizational Cynicism","volume":"23","author":"Dean","year":"1998","journal-title":"Acad. Manag. Rev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1108\/LODJ-02-2021-0069","article-title":"Exploitative leadership and organizational cynicism: The mediating role of emotional exhaustion","volume":"43","author":"Elsaied","year":"2022","journal-title":"Leadersh. Organ. Dev. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.5664\/jcsm.7904","article-title":"Nightmares and Stress: A Longitudinal Study","volume":"15","author":"Schredl","year":"2019","journal-title":"J. Clin. Sleep Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1111\/j.1479-8425.2012.00586.x","article-title":"The association between nightmares and daily distress","volume":"11","author":"Lancee","year":"2013","journal-title":"Sleep Biol. Rhythms"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1037\/drm0000214","article-title":"Nightmare frequency and nightmare distress: Relationship to the big five personality factors and sensory-processing sensitivity","volume":"32","author":"Carr","year":"2022","journal-title":"Dreaming"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1037\/0033-2909.133.3.482","article-title":"Disturbed dreaming, posttraumatic stress disorder, and affect distress: A review and neurocognitive model","volume":"133","author":"Levin","year":"2007","journal-title":"Psychol. Bull."},{"key":"ref_32","first-page":"11","article-title":"Pre- and post-sleep stress levels and negative emotions in a sample dream among frequent and non-frequent nightmare sufferers","volume":"14","year":"2012","journal-title":"Arch. Psychiatry Psychother."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.smrv.2007.03.004","article-title":"Nightmares: A new neurocognitive model","volume":"11","author":"Nielsen","year":"2007","journal-title":"Sleep Med. Rev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1111\/j.1467-8721.2009.01614.x","article-title":"Nightmares, bad dreams, and emotion dysregulation: A review and new neurocognitive model of dreaming","volume":"18","author":"Levin","year":"2009","journal-title":"Curr. Dir. Psychol. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Schmidt, R.E., Harvey, A.G., and Van der Linden, M. (2011). Cognitive and affective control in insomnia. Front. Psychol., 2.","DOI":"10.3389\/fpsyg.2011.00349"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1016\/S0005-7967(01)00061-4","article-title":"A cognitive model of insomnnia","volume":"40","author":"Harvey","year":"2002","journal-title":"Behav. Res. Ther."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"101931","DOI":"10.1016\/j.smrv.2024.101931","article-title":"The relationships between insomnia, nightmares, and dreams: A systematic review","volume":"75","author":"Delage","year":"2024","journal-title":"Sleep Med. Rev."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1037\/drm0000203","article-title":"Bad dreams and bad sleep: Relationships between nightmare frequency, insomnia, and nightmare proneness","volume":"32","author":"Kelly","year":"2022","journal-title":"Dreaming"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"zsaa254","DOI":"10.1093\/sleep\/zsaa254","article-title":"The nightmare disorder index: Development and initial validation in a sample of nurses","volume":"44","author":"Dietch","year":"2021","journal-title":"Sleep"},{"key":"ref_40","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_41","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_42","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.ijpsycho.2008.02.001","article-title":"Cynicism, anger and cardiovascular reactivity during anger recall and human-computer interaction","volume":"68","author":"Why","year":"2008","journal-title":"Int. J. Psychophysiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1007\/s10865-013-9501-1","article-title":"Longitudinal measurement invariance, stability and change of anger and cynicism","volume":"37","author":"Hakulinen","year":"2014","journal-title":"J. Behav. Med."},{"key":"ref_44","first-page":"499","article-title":"Cynicism as subscale of burnout","volume":"56","author":"Viljoen","year":"2017","journal-title":"WORK"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1007\/s12529-010-9107-8","article-title":"Is There a Bidirectional Link Between Insomnia and Burnout? A Prospective Study in the Swedish Workforce","volume":"17","author":"Lindblom","year":"2010","journal-title":"Int. J. Behav. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1016\/j.sleh.2021.03.007","article-title":"A longitudinal investigation of the bidirectional relationship of sleep quality with emotional stability and social cynicism in a large community sample","volume":"7","author":"Lau","year":"2021","journal-title":"Sleep Health"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Frey, E., Chong, Y.Y., Chien, W.T., and Gloster, A.T. (2025). Cross-Cultural Comparison of Burnout, Insomnia and Turnover Intention Among Nurses in Eastern and Western Cultures During the COVID-19 Pandemic: Protective and Risk Factors. Nurs. Rep., 15.","DOI":"10.3390\/nursrep15020052"},{"key":"ref_48","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_49","unstructured":"Cochran, W.G. (1963). Sampling Techniques, John Wiley and Sons Inc.. [2nd ed.]."},{"key":"ref_50","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_51","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_52","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_53","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_54","unstructured":"Stalikas, A., Triliva, S., and Roussi, P. (2000). Cynical distrust scale. Psychometric Tools in Greece, Ellinika Grammata. (In Modern Greek)."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1037\/h0094355","article-title":"The relationship of nightmare frequency to nightmare suffering with implications for treatment and research","volume":"2","author":"Belicki","year":"1992","journal-title":"Dreaming"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1037\/0021-843X.101.3.592","article-title":"Nightmare frequency versus nightmare distress: Relations to psychopathology and cognitive style","volume":"101","author":"Belicki","year":"1992","journal-title":"J. Abnorm. Psychol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1037\/a0037749","article-title":"What does nightmare distress mean? Factorial structure and psychometric properties of the Nightmare Distress Questionnaire (NDQ)","volume":"24","author":"Gieselmann","year":"2014","journal-title":"Dreaming"},{"key":"ref_58","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":"2003","journal-title":"J. Psychosom. Res."},{"key":"ref_59","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_60","unstructured":"Hayes, A.F. (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach, The Guilford Press. Available online: http:\/\/www.afhayes.com."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"975","DOI":"10.2147\/RMHP.S511543","article-title":"Prevalence and Associated Factors of Poor Sleep Quality Among Nurses in a Tertiary Care Hospital: A Cross-Sectional Study","volume":"24","author":"Mohamed","year":"2025","journal-title":"Risk Manag. Healthc. Policy"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Sanaie, N., Sarmadi, S., and Zare-Kaseb, A. (2025). Prevalence of poor sleep quality among critical care unit nurses: A systematic review and meta-analysis. BMC Nurs., 24.","DOI":"10.1186\/s12912-025-04094-6"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Pachi, A., Sikaras, C., Melas, D., Alikanioti, S., Soultanis, N., Ivanidou, M., Ilias, I., and Tselebis, A. (2025). Stress, Anxiety and Depressive Symptoms, Burnout and Insomnia Among Greek Nurses One Year After the End of the Pandemic: A Moderated Chain Mediation Model. J. Clin. Med., 14.","DOI":"10.3390\/jcm14041145"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3934\/Neuroscience.2018.5.1","article-title":"Emotion, emotion regulation and sleep: An intimate relationship","volume":"5","author":"Vandekerckhove","year":"2017","journal-title":"AIMS Neurosci."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"zsac256","DOI":"10.1093\/sleep\/zsac256","article-title":"Daily reactivity to stress and sleep disturbances: Unique risk factors for insomnia","volume":"46","author":"Yoo","year":"2023","journal-title":"Sleep"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.ddmod.2011.07.002","article-title":"A Neurobiological Model of Insomnia","volume":"8","author":"Buysse","year":"2011","journal-title":"Drug Discov. Today Dis. Models"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Vaziri, Z., Nami, M., Leite, J.P., Delbem, A.C.B., Hyppolito, M.A., and Ghodratitoostani, I. (2021). Conceptual Framework for Insomnia: A Cognitive Model in Practice. Front. Neurosci., 15.","DOI":"10.3389\/fnins.2021.628836"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"e13923","DOI":"10.1111\/jsr.13923","article-title":"Cognitive factors and processes in models of insomnia: A systematic review","volume":"32","author":"Tang","year":"2023","journal-title":"J. Sleep Res."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/S0191-8869(02)00054-5","article-title":"Trait hostility: The breadth and specificity of schema effects","volume":"34","author":"Guyll","year":"2003","journal-title":"Personal. Individ. Differ."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"\u00d6zmen, A. (2023). Anger and psychological symptoms relationship: Mediator role of maladaptive schemas. Front. Psychol., 14.","DOI":"10.3389\/fpsyg.2023.1183618"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"101775","DOI":"10.1016\/j.cpr.2019.101775","article-title":"The Computations of hostile biases (CHB) model: Grounding hostility biases in a unified cognitive framework","volume":"73","author":"Smeijers","year":"2019","journal-title":"Clin. Psychol. Rev."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"108958","DOI":"10.1016\/j.neuropsychologia.2024.108958","article-title":"The influence of social knowledge structures on hostile attribution bias in aggressive and nonaggressive individuals: An ERP study","volume":"202","author":"Gagnon","year":"2024","journal-title":"Neuropsychologia"},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Wang, Y., Cao, S., Dong, Y., and Xia, L.X. (2019). Hostile attribution bias and angry rumination: A longitudinal study of undergraduate students. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0217759"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"101975","DOI":"10.1016\/j.avb.2024.101975","article-title":"Neural correlates of hostile attribution bias\u2014A systematic review","volume":"78","author":"Wagels","year":"2024","journal-title":"Aggress. Violent Behav."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Ed\u00fa-Valsania, S., Lagu\u00eda, A., and Moriano, J.A. (2022). Burnout: A Review of Theory and Measurement. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19031780"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1080\/19012276.2016.1227939","article-title":"Depersonalization reconsidered: An empirical analysis of the relation between depersonalization and cynicism in an extended version of the Maslach Burnout Inventory","volume":"69","author":"Larsen","year":"2017","journal-title":"Nord. Psychol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1111\/psyp.12802","article-title":"Heart rate, health, and hurtful behavior","volume":"54","author":"Jennings","year":"2017","journal-title":"Psychophysiology"},{"key":"ref_78","unstructured":"Alvarenga, M., and Byrne, D. (2016). Anger, Hostility, and Cardiovascular Disease in the Context of Interpersonal Relationships. Handbook of Psychocardiology, Springer."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1002\/smi.3048","article-title":"What goes around comes around: Nightmares and daily stress are bidirectionally associated in nurses","volume":"37","author":"Garcia","year":"2021","journal-title":"Stress Health"},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Bennaroch, K., and Shochat, T. (2023). Psychobiological risk factors for insomnia and depressed mood among hospital female nurses working shifts. Front. Sleep, 2.","DOI":"10.3389\/frsle.2023.1206101"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"23779608251374232","DOI":"10.1177\/23779608251374232","article-title":"The Impact of Rotating Shift Work on Nurse Burnout: A Systematic Review of Contributing Factors and Organizational Strategies","volume":"11","author":"Qtait","year":"2025","journal-title":"Sage Open Nurs."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"101415","DOI":"10.1016\/j.aucc.2025.101415","article-title":"The association between shift scheduling and burnout, insomnia, and wellbeing in critical care nurses","volume":"38","author":"Geraghty","year":"2025","journal-title":"Aust. Crit. Care"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1111\/jpm.12450","article-title":"Systematic review of studies of mental health nurses\u2019 experience of anger and of its relationships with their attitudes and practice","volume":"25","author":"Jalil","year":"2018","journal-title":"J. Psychiatr. Ment. Health Nurs."},{"key":"ref_84","first-page":"15","article-title":"Incivility toward nurses: A systematic review and meta-analysis","volume":"14","author":"Moosavi","year":"2021","journal-title":"J. Med. Ethics Hist. Med."},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Hutchinson, M., and Jackson, D. (2013). Hostile clinician behaviours in the nursing work environment and implications for patient care: A mixed-methods systematic review. BMC Nurs., 12.","DOI":"10.1186\/1472-6955-12-25"},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Baranauskas, M., Kup\u010di\u016bnait\u0117, I., Lieponien\u0117, J., and Stukas, R. (2025). Sleep Quality and Professional Burnout in Clinical Nurses: A Cross-Sectional Study. Healthcare, 13.","DOI":"10.3390\/healthcare13212727"},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"Sikaras, C., Pachi, A., Alikanioti, S., Ilias, I., Sideri, E.P., Tselebis, A., and Panagiotou, A. (2025). Occupational Burnout and Insomnia in Relation to Psychological Resilience Among Greek Nurses in the Post-Pandemic Era. Behav. Sci., 15.","DOI":"10.3390\/bs15020126"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"e13776","DOI":"10.1111\/jsr.13776","article-title":"Symptom dynamics among nightmare sufferers: An intensive longitudinal study","volume":"32","author":"Dumser","year":"2023","journal-title":"J. Sleep Res."},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Riemann, D., Dressle, R.J., Benz, F., Palagini, L., and Feige, B. (2023). The Psychoneurobiology of Insomnia: Hyperarousal and REM Sleep Instability. Clin. Transl. Neurosci., 7.","DOI":"10.3390\/ctn7040030"},{"key":"ref_90","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_91","doi-asserted-by":"crossref","unstructured":"Akram, U., Barclay, N.L., and Milkins, B. (2018). Sleep-Related Attentional Bias in Insomnia: Time to Examine Moderating Factors?. Front. Psychol., 9.","DOI":"10.3389\/fpsyg.2018.02573"},{"key":"ref_92","doi-asserted-by":"crossref","unstructured":"Cellini, N., and Lombardo, C. (2020). Editorial: The Interplay Between Sleep and Emotion: What Role Do Cognitive Processes Play?. Front. Psychol., 11.","DOI":"10.3389\/fpsyg.2020.612498"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1007\/s11013-009-9136-4","article-title":"Nightmares, neurophenomenology and the cultural logic of trauma","volume":"33","author":"Kirmayer","year":"2009","journal-title":"Cult. Med. Psychiatry"},{"key":"ref_94","first-page":"150","article-title":"Insomnia and burnout in Greek Nurses","volume":"18","author":"Kousloglou","year":"2014","journal-title":"Hippokratia"},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Van Nguyen, T., and Liu, H.E. (2022). A cross-sectional study on sleep disturbances and associated factors among nurses. BMC Psychiatry, 22.","DOI":"10.1186\/s12888-022-03748-y"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"A285","DOI":"10.1093\/sleep\/zsab072.728","article-title":"731 Who is most at risk for nightmares? Demographic and psychosocial differences in nightmare prevalence among nurses","volume":"44","author":"Martinez","year":"2021","journal-title":"Sleep"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1111\/jan.16290","article-title":"Psychological distress symptoms in nurses and their intention to leave: A cross-sectional secondary data analysis","volume":"81","author":"Edwin","year":"2025","journal-title":"J. Adv. Nurs."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"e70106","DOI":"10.1111\/nhs.70106","article-title":"The Effect of Anger Management Training on Nurses\u2019 Anger, Psychological Resilience, and Quality of Care: A Randomized Controlled Trial","volume":"27","author":"Mert","year":"2025","journal-title":"Nurs. Health Sci."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1007\/s40675-024-00287-8","article-title":"Therapeutic Management of Nightmares: Practice Guide for Imagery Rehearsal Therapy (IRT)","volume":"10","author":"Romier","year":"2024","journal-title":"Curr. Sleep Med. Rep."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"e14193","DOI":"10.1111\/jsr.14193","article-title":"Digital cognitive behavioural therapy for insomnia reduces insomnia in nurses suffering from shift work disorder: A randomised-controlled pilot trial","volume":"33","author":"Ell","year":"2024","journal-title":"J. Sleep Res."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"00469580231178528","DOI":"10.1177\/00469580231178528","article-title":"Impact of nurse leaders behaviors on nursing staff performance: A systematic literature review","volume":"60","author":"Alsadaan","year":"2023","journal-title":"INQUIRY J. Health Care Organ. Provis. Financ."},{"key":"ref_102","first-page":"5090276","article-title":"Impact of Nurse Manager Leadership styles on Work Engagement: A systematic literature review","volume":"2023","author":"Alluhaybi","year":"2023","journal-title":"J. Nurs. Adm. Manag."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"8883236","DOI":"10.1155\/jonm\/8883236","article-title":"Effects of Organizational Cynicism and Socialization on Nurses\u2019 Job Burnout: A Career-Stage-Based Analysis","volume":"2025","author":"Kim","year":"2025","journal-title":"J. Nurs. Manag."},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Ahmed, A.K., Atta, M.H.R., El-Monshed, A.H., and Mohamed, A.I. (2024). The effect of toxic leadership on workplace deviance: The mediating effect of emotional exhaustion, and the moderating effect of organizational cynicism. BMC Nurs., 23.","DOI":"10.1186\/s12912-024-02308-x"},{"key":"ref_105","doi-asserted-by":"crossref","unstructured":"Abdelaliem, S.M.F., and Abou Zeid, M.A.G. (2023). The relationship between toxic leadership and organizational performance: The mediating effect of nurses\u2019 silence. BMC Nurs., 22.","DOI":"10.1186\/s12912-022-01167-8"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3837\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T13:00:43Z","timestamp":1779109243000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3837"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,15]]},"references-count":105,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15103837"],"URL":"https:\/\/doi.org\/10.3390\/jcm15103837","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,15]]}}}