The role of bidirectional associations of depression, anxiety and emotional exhaustion on turnover intention among nurses: a multicenter cross-sectional study in China

Abstract

Abstract Background: A high turnover rate in nursing has become a global concern. Mental health issues may increase the turnover intention of nurses and lead to turnover behaviors. However, very little is known about the role of bidirectional associations between emotional exhaustion and depression/anxiety on turnover intention. This study aimed to examine the associations among depression, anxiety, emotional exhaustion and turnover intention, and to test the role of bidirectional associations of depression, anxiety and emotional exhaustion on turnover intention among nurses. Methods: An online multicenter cross-sectional study was conducted in Hunan Province, China, from December 2021 to February 2022. The questionnaire captured data on the Turnover Intention Scale, the Emotional Exhaustion Scale, the Patient Health Questionnaire-2 and the Generalized Anxiety Disorder Scale-2, as well as sociodemographic information. Data analysis was performed by univariate analysis, Pearson correlation analysis, multiple linear regression analysis, and structural equation modeling. Results: The average turnover intention score among Chinese nurses was 14.34±3.75. The prevalence of depression and anxiety was 25.9% and 22.3%, respectively. Depression (r = 0.378, P<0.001), anxiety (r = 0.391, P<0.001), and emotional exhaustion (r = 0.532, P<0.001) were positively associated with turnover intention. Emotional exhaustion partially mediated on the associations between depression/anxiety and turnover intention, with both mediating effects accounting for 60.7%. The mediating ratios of depression/anxiety on the associations between emotional exhaustion and turnover intentions were 17.6% and 16.5%, respectively. Conclusions: Depression, anxiety and emotional exhaustion showed significant positive effects on turnover intention among nurses. Emotional exhaustion played a partial mediation role between depression/anxiety and turnover intention, while depression/anxiety played no significant mediations between emotional exhaustion and turnover intention.