ArticleBMC nursing2026
Development of a visualized calculation nomogram for comorbid depression and anxiety symptoms among nurses based on second victim experience and support-A cross-sectional study.
Article in BMC nursing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThis cross-sectional study aimed to explore factors associated with comorbid depression and anxiety symptoms (CADS) among nurses who had experienced adverse medical events, and to develop a visualized calculation nomogram for estimating the probability of CADS in individuals.
methodsA total of 2,457 nurses from the Northeastern Three Provinces China were enrolled based on Wenjuanxing from March to July 2024. Depression and anxiety were evaluated using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), and CADS was defined using prespecified clinical thresholds (PHQ-9 ≥ 10 and GAD-7 ≥ 7). Latent class analysis (LCA) was conducted to identify subgroups of second victim experience and support (SVES). Multivariate logistic regression was performed to screen independent associated factors, and a visualized calculation nomogram was constructed and internally validated using a 70/30 split sample and bootstrap resampling.
results40% of the nurses exhibited CADS. Four classes were identified: "Low SVE and Low Support" (21.6%), "Low SVE and High Support" (10.2%), "Moderate SVE and Moderate Support" (50.4%), and "High SVE and Low Support" (17.8%). Independent risk factors for CADS included Moderate/High SVE with corresponding Support, age 30 ~ 40 years and >40 years, ≥3 weekly coffee drinks, weekly working hours 45 ~ 50 and >50 hours, and ≥6 monthly night shifts. Protective factors included psychological detachment, psychological empowerment, weekly physical exercise, and monthly income ≥ 8001 CNY. Internal evaluation of the nomogram showed good discriminative ability (AUC = 0.734), calibration, and clinical applicability, and the validation cohort confirmed robust performance (AUC = 0.938) with excellent calibration and clinical value.
conclusionsCADS is prevalent among nurses. This study provides a user-friendly visualized calculation nomogram to help non-specialists quickly estimate individual probabilities of CADS in a cross-sectional sample. CLINICAL TRIAL NUMBER: Not applicable.
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