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Nurses face significantly higher rates of workplace incivility and suicide risk than the general population. However, the magnitude of this association remains unquantified empirically. This study aims to determine the association between nurses' experiences of workplace incivility and suicidal ideation, and to explore the independent, cumulative, and pattern-specific associations between incivility from various sources and suicidal ideation.
Cross-sectional study.
This cross-sectional study employed convenience sampling to enroll 2337 eligible nurses, who provided valid responses during July–August 2024. Suicidal ideation was assessed using two items from the National Comorbidity Survey, and the workplace incivility was assessed by the Nursing Incivility Scale. Logistic regression analysis was used to examine overall, independent, cumulative, and latent-profile-analysis-derived associations between workplace incivility experiences and suicidal ideation.
Workplace incivility experience significantly elevated risk of suicidal ideation after adjustment for confounders. Nurse-initiated workplace incivility demonstrated the strongest association with elevated suicidal ideation risk, surpassing workplace incivility from other sources including physicians and patients. A dose–response relationship was also observed between cumulative workplace incivility experience among nurses and increased risk of suicidal ideation. Nurses in the “high incivility” pattern and “patient and physician incivility” pattern exhibited a higher risk of suicidal ideation compared to nurses in the “low incivility” pattern.
Nurses experiencing workplace incivility demonstrate a heightened risk of suicidal ideation.
Workplace incivility experienced by nurses was associated with an increased risk of suicidal ideation. Medical institutions and nursing managers are encouraged to consider workplace incivility in routine screening and intervention efforts for suicide prevention.
This study aims to investigate whether higher levels of depression predict increased physical frailty over time and whether worsening physical frailty predicts higher levels of depression over time, at both the between-person and within-person levels.
A longitudinal study.
A total of 269 patients who underwent cardiac surgery were included in this study at T1 (admission). We followed up depression and physical frailty at T2 (the seventh day after surgery), T3 (the day before discharge), and T4 (the three-month follow-up). To determine the temporal order of the association between depression and physical frailty at both between-person or within-person levels, we employed the cross-lagged panel model (between-person effects), and random intercept cross-lagged panel model (within-person effects).
The cross-lagged panel model findings revealed a time-dependent shift in directionality: physical frailty initially predicted depression between T1 and T2, whereas depression subsequently emerged as a significant predictor of physical frailty from T2 to T4. These between-person effects suggest that the dominant direction of influence may vary across different perioperative stages. Notably, the random intercept cross-lagged panel model results identified a robust unidirectional within-person effect, indicating that increases in depression consistently predicted subsequent increases in physical frailty over time, while the reverse pathway was not statistically significant. This finding underscores the potential causal role of depression in driving physical frailty progression, beyond the influence of stable between-person characteristics.
This study advances understanding of the depression-physical frailty relationship in middle-aged and older cardiac surgery patients by delineating temporal precedence and disentangling within- and between-person effects. Depression emerges as a key driver of physical frailty, underscoring the need to prioritize its management in postoperative care protocols. Future research should explore mechanisms linking intraindividual depression to physical frailty progression and evaluate integrated psychosomatic interventions to optimize recovery outcomes.
We have adhered to the STROBE guideline.
This study did not include patient or public involvement in its design, conduct, or reporting.
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