Psychosocial Risks in Spanish
Nu sing: Rela ionship Wi h S abili y
and Wo king Condi ions
Ángela Na bona-Gál ez
1
, Juan Gómez-Salgado
2
,
3
*, Ca los Ruiz-F u os
2
,
3
,
Diego Ayuso-Mu illo
4
, Guadalupe Fon án-Vinag e
4
,
5
, Ja ie Fagundo-Ri e a
6
,
Rocío Palomo-Gómez
7
, Azaha a Ruge -Na a e e
8
and Regina Allande-Cussó
9
1
School o Doc o a e, Uni e si y o Huel a, Huel a, Spain,
2
Depa men o Sociology, Social Wo k and Public Heal h, Facul y o
Labou Sciences, Uni e si y o Huel a, Huel a, Spain,
3
Escuela de Posg ado, Uni e sidad de Especialidades Espí i u San o,
Espí i u San o, Guayaquil, Guayas, Ecuado ,
4
Gene al Nu sing Council o Spain, Mad id, Spain,
5
Spanish Ins i u e o Nu sing
Resea ch, Mad id, Spain,
6
Cen o Uni e si a io de En e me ía C uz Roja, Uni e si y o Se ille, Se ille, Spain,
7
Depa men o
Obs e ics, Hospi al La Línea de la Concepción, Andusian Heal h Se ice, Cádiz, Spain,
8
Depa men o Nu sing, Facul y o Heal h
Sciences o Ceu a, Uni e si y o G anada, G anada, Spain,
9
Depa men o Nu sing, Facul y o Nu sing, Physio he apy and
Podia y, Uni e si y o Se ille, Se ille, Spain
Objec i es: Psychosocial isks significan ly a ec he physical and men al heal h o
wo ke s, especially in he heal hca e sec o . This s udy assesses psychosocial isks in
a sample o Spanish nu ses by applying he ISTAS_ENFERMERÍA ques ionnai e.
Me hods: A desc ip i e c oss-sec ional s udy was conduc ed wi h 2,765 nu ses wo king
in Spain. Sociodemog aphic, occupa ional, and psychosocial a iables we e assessed
using he ISTAS_ENFERMERÍA ques ionnai e. Da a we e collec ed h ough a digi al o m
dis ibu ed h ough social ne wo ks and p o essional channels.
Resul s: Significan di e ences we e ound in ISTAS_ENFERMERÍA sco es acco ding o
socio-demog aphic and employmen a iables. Younge age and job ins abili y we e
associa ed wi h highe le els o s ess, while s able con ac s we e co ela ed wi h
lowe pe cei ed isks.
Conclusion: The s udy highligh s he ela ionship be ween psychosocial isks and socio-
demog aphic and occupa ional ac o s. You h and job ins abili y a e linked o highe le els
o s ess, while job s abili y educes hese isks. In e en ions o imp o e wo king
condi ions and suppo younge p o essionals a e ecommended.
Keywo ds: psychosocial isk ac o s, nu ses, occupa ional s ess, occupa ional heal h, wo king condi ions
INTRODUCTION
Occupa ional sa e y and heal h (OSH) is a co e domain in occupa ional isk managemen , which
ocuses on he p e en ion, iden ifica ion, assessmen , and con ol o isks ha can a ise bo h inside
and ou side he wo kplace [1]. I has become inc easingly impo an due o he wo ying ise in he
numbe o occupa ional acciden s and diseases, wi h 2.9 million dea hs epo ed in 2019, o which
nea ly an 11% we e caused by acciden s and he es by wo k- ela ed diseases [2].
A he global le el, occupa ional isks pose a majo heal h challenge, wi h some s udies es ima ing
ha be ween 5% and 7% o dea hs wo ldwide a e linked o isks in he wo k en i onmen [3]. In
Edi ed by:
Paulo Sousa,
New Uni e si y o Lisbon, Po ugal
Re iewed by:
Ana Gama,
New Uni e si y o Lisbon, Po ugal
Flo en ino Se anhei a,
New Uni e si y o Lisbon, Po ugal
*Co espondence
Juan Gómez-Salgado,
[email p o ec ed]
Recei ed: 10 Janua y 2025
Accep ed: 06 May 2025
Published: 20 May 2025
Ci a ion:
Na bona-Gál ez Á, Gómez-Salgado J,
Ruiz-F u os C, Ayuso-Mu illo D,
Fon án-Vinag e G, Fagundo-Ri e a J,
Palomo-Gómez R, Ruge -Na a e e A
and Allande-Cussó R (2025)
Psychosocial Risks in Spanish Nu sing:
Rela ionship Wi h S abili y and
Wo king Condi ions.
In . J. Public Heal h 70:1608330.
doi: 10.3389/ijph.2025.1608330
In . J. Public Heal h | Owned by SSPH+ | Published by F on ie s May 2025 | Volume 70 | A icle 16083301
In e na ional Jou nal o Public Heal h
ORIGINAL ARTICLE
published: 20 May 2025
doi: 10.3389/ijph.2025.1608330
example, occupa ional diseases such as silicosis and asbes osis
emain common in de eloping coun ies, which emphasises he
u gen need o imp o e egula ion and labou p ac ices [4].
In his con ex , psychosocial isks ha e gained impo ance and
a e desc ibed as hose ci cums ances in he wo k en i onmen
ha can nega i ely impac he physical and men al heal h o
gene al wellbeing o wo ke s. These isks include ac o s such as
s ess, he ype o ac i i ies pe o med, he dynamics be ween
colleagues and supe io s, and he o ganisa ional en i onmen in
gene al, all o which can a ec he abili y o employees o
adequa ely cope wi h he demands o he job [5].
In he field o heal h p o essionals, wo ke s ace nume ous
occupa ional isks ha a ec hei physical and men al wellbeing,
such as musculoskele al inju ies, exposu e o haza dous
subs ances, and iolence a wo k, which a e in u n
compounded by s ess and bu nou [6]. The Wo ld Heal h
O ganiza ion (WHO) es ima es ha globally, a ound
59 million heal h p o essionals su e om wo k- ela ed
acciden s and diseases, accoun ing o app oxima ely 4% o
he global G oss Domes ic P oduc (GDP) [7].
In nu sing, occupa ional isks a e di e se and impac bo h he
physical and men al heal h o p o essionals, ul ima ely
comp omising he quali y o pa ien ca e [8]. Among hese
isks, psychosocial ac o s s and ou , including high wo k
demands, an in ense wo k pace, and he o e lap o
p o essional and amily esponsibili ies—a si ua ion known as
double p esence. Addi ionally, he emo ional demands o
cons an in e ac ion wi h pa ien s in c i ical condi ions u he
con ibu e o hese isks [9].
These ac o s in ensi y psychological exhaus ion, inc easing
he likelihood o s ess and bu nou . As a esul , bo h he
wellbeing o heal hca e s a and he s anda d o ca e hey
p o ide a e nega i ely a ec ed [10]. Recen s udies highligh
he p e alence and impac o psychosocial isks among nu ses,
pa icula ly du ing heal h eme gencies like he COVID-19
pandemic a ound he wo ld. Nu ses ace mode a e o high
isks in mul iple dimensions, including job s ess, poo
wo king condi ions, and excessi e wo kload [11,12]. These
isks can lead o men al heal h issues such as dep ession,
bu nou synd ome, and s ess- ela ed diso de s [13]. The
COVID-19 pandemic has exace ba ed hese isks, wi h nu ses
epo ing high emo ional wo k and wo kload [14]. Howe e ,
adequa e esou ces, measu es, and in o ma ion can se e as
p o ec i e ac o s agains psychosocial isks [15]. The
economic impac o men al heal h issues among nu ses in he
EU is es ima ed a €240 billion annually [13].
In his sense, se e al scales and ques ionnai es ha e been
de eloped o assess and measu e psychosocial isks, such as
he Job Con en Ques ionnai e (JCQ) [16], he E o -Rewa d
Imbalance Ques ionnai e (ERI) [17], and he Copenhagen
Psychosocial Ques ionnai e (COPSOQ) [18]. These ools a e
enowned o hei psychome ic alidi y and hei abili y o
p o ide aluable in o ma ion on psychosocial isks in di e en
wo k se ings [19]. Among hem, he SUSESO/
ISTAS21 ques ionnai e, based on he second e sion o
COPSOQ, s ands ou as a obus and e ec i e ool o
assessing psychosocial isks a wo k. This ques ionnai e co e s
a wide ange o psychosocial ac o s, including wo k demands,
hei influence, de elopmen a wo k, social ela ionships, and
emo ional con en [18].
The adap a ion and psychome ic alida ion o he SUSESO/
ISTAS21 ques ionnai e in nu ses in Spain, known as
ISTAS_ENFERMERÍA, has esul ed in a eliable and specific
ool o assess psychosocial isks in his popula ion g oup [20].
The esul s o i s adap a ion indica e ha he
ISTAS_ENFERMERÍA has adequa e alidi y and eliabili y
indices, which allows o a mo e accu a e iden ifica ion o he
psychosocial isk ac o s a ec ing nu ses. This ea ly iden ifica ion
is also c ucial o de elop p e en i e and suppo i e in e en ions
which will con ibu e o imp o ing nu ses’wellbeing and he
quali y o ca e hey p o ide [19].
In his con ex , he p esen s udy aims o assess psychosocial
isks in a sample o nu ses in Spain.
METHODS
Design
Desc ip i e c oss-sec ional s udy based on ques ionnai es.
Popula ion and Sample
The s udy popula ion consis ed o 325,018 nu ses egis e ed in
Spain (2020 da a). The scope o he s udy was na ionwide and
included nu ses who me he ollowing inclusion c i e ia: i) nu ses
who p o ide nu sing ca e specific o hei p o ession; ii) nu ses
esiding in Spain; and iii) ac i e nu ses. Those who did no mee
he inclusion c i e ia we e excluded om he s udy, as well as he
ollowing: i) nu ses wi h a ecognised qualifica ion om ano he
coun y who a e no ye p ac ising in Spain; ii) p o essionals who
do no pe o m nu sing ca e unc ions; and iii) nu ses wo king
ou side Spain.
Da a we e collec ed om nu ses who wo ked in bo h P ima y
Ca e and Specialised Ca e o he Spanish Na ional Heal h Se ice
(NHS) o in p i a e en i ies (such as ca e homes o he aged and
p i a e clinics, among o he s).
The minimum equi ed sample was calcula ed o be
384 nu ses, using a 5% ma gin o e o , 95% confidence, and
50% he e ogenei y. Howe e , he o al sample finally ob ained
was 2,765 nu ses, a exceeding he minimum sample size
calcula ed, which inc eased he s a is ical powe o he s udy.
The sample was selec ed by non-p obabilis ic snowball
sampling, s a ing wi h nu ses who ag eed o pa icipa e and,
h ough dissemina ion, achie ing he inclusion o all said
pa icipan s. Pa icipa ion was comple ely olun a y, and
confiden iali y o he da a collec ed was gua an eed. All
pa icipan s accep ed in o med consen be o e comple ing he
ques ionnai e.
Va iables
This s udy examines socio-demog aphic, occupa ional, and
psychosocial a iables. To assess he socio-demog aphic
p ofile, ques ions on sex, age, ma i al s a us, educa ional le el
ecei ed and comple ed, and p o ince o employmen
we e included.
In . J. Public Heal h | Owned by SSPH+ | Published by F on ie s May 2025 | Volume 70 | A icle 16083302
Na bona-Gál ez e al. Psychosocial Risk in Nu sing Wo k
As o occupa ional a iables, fi s ly, aspec s such as sick lea e
( ype and equency); numbe o se ices assigned o he
p o essional; en i y and cu en posi ion held; ime a cu en
uni ; employmen ela ionship; ype o con ac ; wo king hou s
(and i s specific cha ac e is ics such as o a ions, hei equency,
and mode o no ifica ion); le el o s ess and anxie y caused by
such o a ion; le el o job compe ence and how such compe ence
a ec s job secu i y; whe he he e a e changes in he wo king day;
whe he he p o essional also wo ks in ano he place; p e ious
wo k expe iences ( ejec ion o accep ance o wo king con ac s
owing o he le el o expe ise); e ec s o lack o expe ience on
wellbeing (sleep dis u bance, anxie y, o insecu i y).
The le el o psychosocial isk was assessed using he
ISTAS_En e me ía scale. This ool measu es psychosocial
ac o s in nu sing wo k pe o mance, such as wo k s ess
and quali y o li e a wo k. The alida ion o he ool in he
nu sing popula ion ob ained a C onbach’s alpha alue o 0.7.
The scale p esen s a ac o ial s uc u e o 5 dimensions wi h
15 i ems, which explain 63.6% o he a iance, and i showed
an op imal fi in he pa ame e s calcula ed by confi ma o y
ac o analysis ( alues highe han 0.90 o he TLI, NFI, and
CFI, lowe han 0.08 o he SRMR, and lowe han 0.08 o
he RMSEA [20].
The scale includes 15 i ems dis ibu ed in fi e dimensions,
whose sco es a y depending on he dimension: in “Suppo a
wo k”and “Job sa is ac ion,”i ems a e a ed om 0 (Always) o 4
(Ne e ), while in “Wellbeing a wo k,”“Job insecu i y”and
“‘Double p esence,”i ems a e a ed om 4 (Always) o 0
(Ne e ). The o al sco e is ob ained by adding he alues o all
i ems, anging om 0 (mos a ou able) o 60 (leas a ou able),
whe e lowe sco es indica e be e psychosocial condi ions and
highe sco es indica e g ea e psychosocial isk.
P ocedu e
Da a collec ion was conduc ed o e a 3-mon h pe iod, be ween
1 Augus and 31 Oc obe 2023, based on a digi al ques ionnai e
c ea ed using Google Fo ms
©
wi h ques ions ela ed o he s udy
a iables and dis ibu ed h ough social ne wo ks and specific
nu sing p o essional g oups. All pa icipan s we e equi ed o
p o ide in o med consen and explici ly confi m hei
p o essional ole as nu ses be o e being able o access he
ques ionnai e.
The dissemina ion o he ques ionnai e was ca ied ou by he
esea ch eam, ensu ing i s dis ibu ion in specific nu sing
communi ies. Addi ionally, he Spanish Gene al Council o
Nu sing suppo ed he dissemina ion o he ques ionnai e on
hei o ficial social media channels and among hose egis e ed
nu ses in Spain who wished o be con ac ed by email o
esea ch pu poses.
Da a Analysis
Uni a ia e and bi a ia e desc ip i e analyses we e pe o med
using SPSS S a is ics
©
26 so wa e [21]. To assess he
no mali y o he da a, he Kolmogo o -Smi no es was
applied, which yielded a alue o p <0.05, indica ing non-
no mali y. Consequen ly, non-pa ame ic es s, i.e., he Mann-
Whi ney U es and he K uskal-Wallis H es , we e used o
compa e g oups, and Kendall’s Tau-B coe ficien was applied o
analyse co ela ions be ween a iables.
To explo e he ela ionship be ween he le el o pe cei ed
psychosocial isk and he es o he a iables, a ca ego ical
eg ession analysis (CATREG) adap ed o he quali a i e
na u e o he a iables was used [22]. The ca ego ical
eg ession analysis was pe o med o examine he associa ion
be ween psychosocial isk sco es (dependen a iable) and
independen a iables such as age, gende , ma i al s a us,
educa ional le el, and wo kload. The eg ession model
included adjus men s o po en ial con ounde s, and esul s
we e epo ed as eg ession coe ficien s (β) wi h 95%
confidence in e als (ci). S a is ical significance was se a p <
0.05. This analysis included elemen s o classical eg ession, such
as he coe ficien o de e mina ion (R
2
), he analysis o a iance in
eg ession, and he significance o he model pa ame e s. The
a iables included in he eg ession model we e hose ha showed
significan di e ences in he bi a ia e analysis. The op imal
scaling op ion in SPSS
©
[23] was used o gua an ee an
adequa e adap a ion o he a iables o he model.
E hical Conside a ions
This s udy was app o ed by he P o incial Resea ch E hics
Commi ee o Huel a, Spain, wi h code 1520-N-23. I also
complies wi h he guidelines es ablished in he Decla a ion o
Helsinki [24] and complies wi h he p o isions o Regula ion
(EU) 2016/679 o he Eu opean Pa liamen and o he Council on
he p o ec ion o indi iduals wi h ega d o he p ocessing o
pe sonal da a and he ee mo emen o such da a [25], as well as
wi h O ganic Law 3/2018, o 5 Decembe , on he P o ec ion o
Pe sonal Da a and gua an ee o digi al igh s [26].
Da a collec ion was ca ied ou o e a pe iod o 3 mon hs
(01 Aug - 31 Oc , 2023), using a digi al ques ionnai e c ea ed wi h
Google Fo ms
©
and dis ibu ed h ough social ne wo ks and
specific p o essional nu sing g oups, wi h he suppo o he
Gene al Council o Nu sing o Spain o dissemina ion
h ough i s o ficial channels and by email o egis e ed nu ses
in e es ed in pa icipa ing in esea ch. This ques ionnai e
included ques ions ela ed o he s udy a iables, and all
pa icipan s we e equi ed o p o ide in o med consen ,
explici ly confi m hei p o essional ole as nu ses, and ick
he app op ia e box a e eading he in o ma ion p o ided
abou he s udy and he in o med consen documen . Rigo ous
measu es we e implemen ed o ensu e he p i acy and
confiden iali y o he pa icipan s, in acco dance wi h he
p o isions o he O ganic Law on Da a P o ec ion and
Gua an ee o Digi al Righ s [26], wi h da a being s o ed in a
p o ec ed da abase accessible only o he esea ch eam.
RESULTS
Desc ip i e Analysis
The sample consis ed o 2,765 nu ses om all o e Spain, wi h a
mean age o 40.87 yea s. O he o al sample, 87.3% we e women,
while only 12.3% we e men and a small pe cen age iden ified
hemsel es as non-bina y o p e e ed no o s a e hei sex. The
In . J. Public Heal h | Owned by SSPH+ | Published by F on ie s May 2025 | Volume 70 | A icle 16083303
Na bona-Gál ez e al. Psychosocial Risk in Nu sing Wo k
mean ISTAS21 sco e was 1.78 (SD = 0.503), wi h no significan
di e ences be ween sexes (p = 0.503). Tables 1,2desc ibe he
main esul s o he desc ip i e bi a ia e analysis o socio-
demog aphic and occupa ional a iables.
The esul s show significan di e ences o he ma i al s a us,
educa ional le el, and p o ince o wo k a iables conce ning he
ISTAS_En e me ía sco es and he di e en ca ego ies o he
a iable. Ma ied people and hose wi h a doc o a e o deg ee
had lowe sco es (indica ing be e psychosocial condi ions) han
hose wi h a mas e ’s deg ee.
Age e eals a nega i e and significan ela ionship wi h he
sco es (Tau b = −0.12, P <0.001), sugges ing a lowe pe cep ion o
isk wi h inc easing age. On he o he hand, no significan
di e ences we e ound based on sex (P = 0.503), al hough
he e was a g ea e p opo ion o women in he sample (87.3%).
The mean ISTAS_En e me ía sco e showed significan
di e ences acco ding o employmen ela ionship, numbe o
se ices, wo k a ea, cu en posi ion, ime a cu en uni , and sick
lea e (p = 0.001). Highe alues we e ound in esponden s who
we e wo king wi hou a con ac (mean = 2.164), we e
unemployed (mean = 2.143), o had had wo o mo e sick
lea es in he p e ious yea (mean = 2.027), while he lowes
sco es we e associa ed wi h ci il se an s/s a u o y employees
(mean = 1.640), manage s (mean = 1.155), and hose who had
been in he same uni o mo e han 10 yea s (mean = 1.662).
The e we e no significan di e ences acco ding o he ype o
con ac o he eason o sick lea e.
Mul i a ia e Reg ession Analysis
A ca ego ical eg ession analysis was ca ied ou using he
ISTAS_En e me ía scale o al sco e as he dependen a iable
and he ollowing a iables as p edic o s: age; ma i al s a us;
educa ional le el; employmen ela ionship; numbe o
se ices; cu en posi ion; ime a cu en uni ; and sick
lea e. The model showed a coe ficien o de e mina ion o
R
2
=0.095(adjus edR
2
= 0.089) and an o e all significance o
p<0.001, indica ing ha he model was o low bu significan
explana o y powe .
The a iables ha con ibu ed significan ly o he model we e:
age; educa ion comple ed; employmen ela ionship; numbe o
se ices; ime a cu en uni ; and sick lea e (Table 3). In
addi ion, he esul s indica e ha o each addi ional yea ,
p o essionals pe cei e 0.12 imes lowe le els o psychosocial
isk (β=−0.124), sugges ing ha younge nu ses a e mo e
suscep ible o s ess. Meanwhile, p o essionals wi hou a
con ac expe ience 0.063 imes highe le els o psychosocial
isk han ci il se an s (β= 0.063), while hose who a e
assigned o mo e han en o a ing se ices pe cei e
0.095 imes highe le els o psychosocial isk han hose wi h
less o a ion (β=−0.095). In he same way, nu ses engaged in
nu sing ca e epo ed isk le els 0.065 imes highe han
supe iso s and manage s (β=−0.065), who ace less di ec
exposu e o s esso s. Finally, p o essionals wi h wo o mo e sick
lea es in he p e ious yea epo ed 0.16 imes highe le els o
psychosocial isk han hose wi h no sick lea es (β=−0.162).
TABLE 1 | Socio-demog aphic a iables (Da a om he ISTAS_En e me ía S udy, Spain, 2023).
Va iables To al sample (n = 2,765) ISTAS21 mean sco e (δ/SD) Con as o hypo heses
Sex
Male 341 (12.3%) 1.792 (SD = 0.562) P = 0.503
a
Female 2,414 (87.3%) 1.779 (SD = 0.494)
Non-bina y 1 (0.0%) 1.200 (SD = 0)
Ra he no say 9 (0.3%) 1.874 (SD = 0.590)
Age
Mean 40.87 yea s 1.78 (SD = 0.5) Tau b
b
= -0.12 (p 0.001)
Ma i al s a us
Ma ied 1,186 (42.9%) 1.722 (SD = 0.494) 0.001
a
Di o ced 117 (4.2%) 1.751 (SD = 0.500)
Wi h a pa ne (cohabi ing) 748 (27.1%) 1.840 (SD = 0.517)
Wi h a pa ne (non-cohabi ing) 242 (8.8%) 1.828 (SD = 0.484)
Sepa a ed 41 (1.5%) 1.824 (SD = 0.561)
Single 422 (15.3%) 1.819 (SD = 0.492)
Widowed 9 (0.3%) 1.814 (SD = 0.546)
Educa ional le el
Deg ee 588 (21.3%) 1.809 (SD = 0.480) 0.007
a
Fo me Highe deg ee 42 (1.5%) 1.820 (SD = 0.550)
Fo me Lowe deg ee 704 (25.5%) 1.722 (SD = 0.464)
Doc o a e 59 (2.1%) 1.714 (SD = 0.641)
Special y 397 (14.4%) 1.751 (SD = 0.532)
Mas e ’s deg ee 664 (24%) 1.831 (SD = 0.522)
Expe 298 (10.8%) 1.803 (SD = 0.504)
Voca ional aining 13 (0.5%) 1.764 (SD = 0.493)
δMean sco e.
SD, s anda d de ia ion.
a
K uskal Wallis H es .
b
Kendall’s Tau-B.
In . J. Public Heal h | Owned by SSPH+ | Published by F on ie s May 2025 | Volume 70 | A icle 16083304
Na bona-Gál ez e al. Psychosocial Risk in Nu sing Wo k
TABLE 2 | Occupa ional a iables (Da a om he ISTAS_En e me ía S udy, Spain, 2023).
Va iables To al sample
(n = 2,765)
ISTAS21 mean sco e
(δ/SD)
Con as o
hypo heses
Employmen ela ionship
I am a ci il se an , s a u o y employee 911 (32.9%) 1.640 (SD = 0.466) 0.001
a
I am an in e im 713 (25.8%) 1.859 (SD = 0.496)
I am a pe manen employee (I ha e a pe manen con ac , ...) 466 (16.9%) 1.740 (SD = 0.486)
I ha e a pe manen discon inuous con ac 43 (1.6%) 1.965 (SD = 0.605)
I am a empo a y employee wi h a aining con ac ( empo a y con ac unde aining) 41 (1.5%) 1.660 (SD = 0.576)
I am empo a y employee (con ac o limi ed wo k and se ices, ci cums ances o p oduc ion, ...) 561 (20.3%) 1.920 (SD = 0.499)
Wi hou a con ac 30 (1.1%) 2.164 (SD = 0.512)
Type o con ac
Full- ime 2,403 (86.9%) 1.777 (SD = 0.508) 0.614
a
Full- ime wi h educed wo king hou s (ma e ni y/pa e ni y, s udies, disabili y) 193 (7.0%) 1.806 (SD = 0.454)
Pa - ime 113 (4.1%) 1.788 (SD = 0.500)
Pa - ime wi h educed wo king hou s (ma e ni y/pa e ni y, s udies, disabili y) 56 (2.0%) 1.839 (SD = 0.429)
Numbe o se ices
Less han 5 di e en se ices 564 (23.7%) 1.672 (SD = 0.489) 0.001
a
Be ween 5 and 10 di e en se ices 1,025 (37.1%) 1.750 (SD = 0.495)
Mo e han 10 di e en se ices 1,084 (39.2%) 1.876 (SD = 0.502)
Wo k a ea
U gen and eme gency ca e 21 (0.8%) 1.920 (SD = 0.437) 0.001
a
Managemen 3 (0.1%) 1.155 (SD = 0.443)
Gene al managemen , go e ning, and adminis a ion 7 (0.3%) 1.714 (SD = 0.707)
Educa ional field 18 (0.7%) 1.844 (SD = 0.698)
P ima y Ca e 570 (20.8%) 1.729 (SD = 0.534)
Teaching and esea ch 12 (0.4%) 1.522 (SD = 0.620)
Public hospi al 1710 (62.3%) 1.785 (SD = 0.481)
P i a e hospi al 199 (7.3%) 1.764 (SD = 0.497)
Va ious en i ies 135 (4.9%) 1.923 (SD = 0.530)
Subsidised hospi al 20 (0.7%) 1.730 (SD = 0.397)
O he en i ies no ela ed o nu sing 5 (0.2%) 2.053 (SD = 0.536)
Public bodies 8 (0.3%) 1.675 (SD = 0.560)
No cu en ly wo king 36 (1.3%) 2.085 (SD = 0.557)
Cu en posi ion
Assis an Nu se 2,287 (82.7%) 1.804 (SD = 0.493) 0.001
a
Residen Nu se 37 (1.3%) 1.690 (SD = 0.551)
Nu se in cha ge o uni o se ice wi hou ecognised managemen posi ion 139 (5%) 1.711 (SD = 0.477)
Uni o a ea supe iso wi h managemen unc ions only 93 (3.4%) 1.465 (SD = 0.455)
Uni supe iso wi h di ec pa ien ca e as well as managemen unc ions 84 (3%) 1.590 (SD = 0.517)
Specialis nu se 29 (1%) 1.671 (SD = 0.602)
School nu se 11 (0.4%) 1.636 (SD = 0.598)
Teaching and esea ch 9 (0.3%) 1.837 (SD = 0.501)
Time a cu en uni
Unemployed 32 (1.2%) 2.143 (SD = 0.498) 0.001
a
Less han 30 days 193 (7.0%) 1.969 (SD = 0.501)
1–6 mon hs inclusi e 446 (16.1%) 1.848 (SD = 0.528)
6 mon hs o 2 yea s inclusi e 570 (20.6%) 1.803 (SD = 0.505)
Be ween 2 and 5 yea s inclusi e 615 (22.2%) 1.765 (SD = 0.496)
Be ween 5 and up o 10 yea s inclusi e 337 (12.2%) 1.744 (SD = 0.486)
Mo e han 10 yea s 572 (20.7%) 1.662 (SD = 0.461)
Sick lea e
I ha e no had any sick lea e in he las yea 1,444 (52.3%) 1.689 (SD = 0.494) 0.001
a
I ha e had ONE sick lea e in he las yea 1,028 (37.2%) 1.842 (SD = 0.484)
I ha e had TWO OR MORE sick lea es in he las yea 280 (10.1%) 2.027 (SD = 0.507)
P olonged/long- e m sick lea e (mo e han 1 yea ) 9 (0.3%) 1.837 (SD = 0.433)
Lea e o absence 2 (0.1%) 1.766 (SD = 0.141)
Type o sick lea e
Sick lea e due o an acciden a wo k 46 (3.9%) 1.891 (SD = 0.551) 0.991
a
Sick lea e due o occupa ional disease 102 (8.6%) 1.883 (SD = 0.481)
Pa e ni y/ma e ni y lea e 97 (8.2%) 1.854 (SD = 0.483)
Sick lea e due o common illness 940 (79.3%) 1.895 (SD = 0.496)
δMean sco e.
SD, s anda d de ia ion.
a
K uskal Wallis H es .
In . J. Public Heal h | Owned by SSPH+ | Published by F on ie s May 2025 | Volume 70 | A icle 16083305
Na bona-Gál ez e al. Psychosocial Risk in Nu sing Wo k

Despi e he low explana o y powe o he model, he esul s
e eal significan ela ionships be ween se e al independen
a iables and he ISTAS_En e me ía scale sco e. This
highligh s he ele ance o socio-demog aphic and
occupa ional ac o s in he assessmen .
DISCUSSION
Psychosocial isks in he wo k en i onmen ep esen a majo
challenge o he heal h and wellbeing o wo ke s. Pa icula ly in
highly demanding p o essions such as nu sing, hese isks
become mo e p ominen due o ac o s such as emo ional
bu den, con inuous s ess, and in e ac ion wi h pa ien s unde
high-p essu e condi ions. A s udy on he men al heal h o
heal hca e wo ke s du ing he COVID-19 pandemic ound
high le els o emo ional exhaus ion, s ess, and anxie y among
nu ses, highligh ing he p e alence o psychosocial isks linked o
hei wo k en i onmen . The nu sing en i onmen is
cha ac e ised by high emo ional demands and cons an
p essu e o espond e ec i ely in di ficul si ua ions [27]. In
he same line, ano he a icle had no ed ha he cha ac e is ics
o he nu sing job, such as p olonged exposu e o human
su e ing, in ense emo ional bu den, and high wo k demands,
significan ly inc ease psychosocial isks [15]. This con ex
unde lines he need o implemen e ec i e in e en ions o
e ec i ely add ess hese ac o s and p o ec he men al and
physical heal h o heal h p o essionals.
The p esen analysis add esses he esul s ob ained in he
assessmen o psychosocial isks using he ISTAS_En e me ía
scale in his popula ion g oup. The main findings e ealed a mean
sco e o 1.78 on he scale, eflec ing a low o mode a e le el o isk.
Howe e , his sco e o e looks significan di e ences linked o
ac o s such as employmen ela ionship, ma i al s a us,
educa ional le el, numbe o se ices assigned o he
p o essional, ime in he uni , and sick lea e. All his indica es
ha specific job cha ac e is ics, such as he di e si y o assigned
a eas and job s abili y, a e de e minan s o unde s anding he
pe cep ion o he wo king en i onmen beyond socio-
demog aphic a iables.
Al hough he analysis iden ified significan ela ionships
be ween ce ain socio-demog aphic a iables and psychosocial
isks, he explana o y model showed a low p edic i e capaci y
(R
2
= 0.095). This sugges s ha , while ac o s such as age, ma i al
s a us, and educa ional le el seem o influence he sco es
ob ained, he e a e o he elemen s ha ha e no been
conside ed and ha could be playing a significan ole in he
a ia ions obse ed. Acco ding o he li e a u e, despi e socio-
demog aphic a iables being significan , o he s uc u al and
con ex ual ac o s such as wo kload, o ganisa ional cul u e,
and pe cei ed social suppo also ha e a c i ical impac on he
expe ience o psychosocial isks [28]. Fo example, a iables such
as leade ship quali y, pe cei ed ai ness a wo k, and eam
cohesion ha e p o en pa icula ly influen ial, sugges ing ha
explana o y models need o inco po a e hese dimensions o
ully unde s and how psychosocial isks a e shaped [29].
Among he mos no able findings is he nega i e ela ionship
be ween age and he pe cep ion o psychosocial isks. This esul ,
consis en wi h p e ious esea ch, sugges s ha younge wo ke s ace
g ea e di ficul ies in adap ing o wo k demands, possibly owing o a
lack o p o essional expe ience o s abili y, in con as o hei mo e
expe ienced coun e pa s. Acco ding o Hsu [30], young wo ke s
epo highe le els o wo k- ela ed s ess and emo ional exhaus ion
han hei mo e expe ienced pee s, who end o benefi omg ea e
esilience and esou ces accumula ed h oughou hei ca ee s.
In e en ions o imp o e coping skills and esilience in younge
wo ke s, such as men o ing and skill de elopmen p og ammes, can
be ins umen al in educing his ulne abili y.
Rega ding he sex o he pa icipan s, no significan di e ences
we e ound in ela ion o he pe cep ion o psychosocial isks.
This finding is consis en wi h esea ch such as he one by
Méndez-Ri e o e al. [31], who ound ha , in homogeneous
wo k en i onmen s in e ms o wo king condi ions, di e ences
be ween men and women in he pe cep ion o psychosocial isks
we e ound o be minimal, sugges ing ha isks can equally a ec
bo h sexes when wo king condi ions a e simila . Howe e , his
s udy also sugges s ha occupa ional seg ega ion and specific
wo k dynamics may influence how hese isks a e expe ienced,
especially in con ex s o job insecu i y, unde lining he need o
conside b oade o ganisa ional and con ex ual ac o s.
In addi ion, Ca ani and Rizza [32] explo ed how occupa ional
oles influenced by sex may modi y exposu e o psychosocial
isks, highligh ing ha he ep esen a ion o women is o en
g ea e in sec o s wi h high emo ional demands, such as
educa ion and heal h. While no always ansla ing in o
significan di e ences in e ms o pe cep ion, his ac o could
add ele an nuances in ce ain wo k se ings [32]. The e o e,
al hough he da a om his analysis did no e eal significan
TABLE 3 | Model fi and significance o eg ession analysis (Da a om he ISTAS_En e me ía S udy, Spain, 2023).
R
2
= 0.095
a
Fishe ’s F = 32.13 p <0.001
Va iable Coe ficien (β) Deg ees o eedom F-s a is ic p alue
Age −0.124 2 28.915 <0.001
Educa ional le el 0.064 2 7.448 <0.001
Employmen ela ionship 0.063 1 4.179 0.041
Numbe o se ices −0.095 1 9.185 0.002
Cu en posi ion −0.065 2 10.857 <0.001
Time a cu en uni 0.053 3 3.656 0.012
Sick lea e −0.162 2 72.631 <0.001
a
Reg ession coe ficien .
In . J. Public Heal h | Owned by SSPH+ | Published by F on ie s May 2025 | Volume 70 | A icle 16083306
Na bona-Gál ez e al. Psychosocial Risk in Nu sing Wo k
di e ences by sex, p e ious esea ch indica es ha he e a e
con ex s whe e such di e ences may be appa en depending
on he occupa ional s uc u e and he esponsibili ies assigned.
Ma i al s a us also eme ged as a significan ac o in his
analysis, wi h ma ied people sco ing lowe on psychosocial
isk. This pa e n is consis en wi h p e ious esea ch
indica ing ha pe sonal s abili y and social suppo a home
bo h ha e a p o ec i e e ec in he ace o wo k demands.
Ano he s udy has al eady highligh ed ha he emo ional and
p ac ical suppo o e ed by a pa ne o suppo ne wo k could
educe s ess le els and lead o mo e e ec i e coping s a egies,
especially in highly demanding p o essions such as nu sing [33].
Con e sely, educa ional le el exhibi ed an in e se end, as a
highe numbe o nu ses wi h ad anced deg ees, such as mas e ’s
deg ees, epo ed inc eased le els o psychosocial isk, as eflec ed
in hei highe sco es. This sugges s ha despi e hei educa ional
a ainmen , hese indi iduals may expe ience g ea e wo k-
ela ed psychosocial demands o s esso s. These findings align
wi h s udies indica ing ha he g ea e esponsibili ies and
expec a ions associa ed wi h highly qualified p ofiles heigh en
he pe cep ion o wo k p essu e and wo kload [34].
O e all, he esul s show ha socio-demog aphic a iables
p o ide ele an in o ma ion on psychosocial isks in he nu sing
p o ession, bu a e insu ficien o ully explain a iances. In his
ega d, i is c ucial o add ess wo k, o ganisa ional, and g oup
ac o s, gi en ha indi idual cha ac e is ics mus be analysed in
conjunc ion wi h he wo k con ex .
Job s abili y plays a key ole in he pe cep ion o psychosocial isks.
Wo ke s wi h empo a y con ac s o no con ac epo ed highe
le els o s ess and psychosocial isks compa ed o hose wi h s able o
pe manen jobs, such as ci il se an s [35]. This is in line wi h s udies
indica ing ha job insecu i y inc eases anxie y, nega i ely a ec ing
employees’men al and emo ional heal h. Besides, he pe cep ion o
job s abili y imp o es economic secu i y and con ibu es o g ea e
o ganisa ional iden ifica ion, which ein o ces esilience in he ace o
wo k demands [36]. These esul s unde sco e ha job insecu i y
exace ba es psychosocial isks by educing he sense o con ol and
p edic abili y o e one’s u u e a wo k, which cons i u e undamen al
aspec s o good occupa ional heal h. The numbe o se ices
p o essionals we e assigned o showed a significan ela ionship
wi h isk sco es, being highe among hose assigned o mul iple
se ices. Se e al s udies ha e explo ed he ela ionship be ween
wo kload and s ess in nu sing p o essionals, highligh ing how
mul i-se ice esponsibili ies can in ensi y hese isks. I has been
obse ed ha a significan pe cen age o nu ses expe ience high le els
o wo kload and s ess associa ed wi h he di e si y o wo k a eas and
he lack o con inui y in du ies [37]. Recen esea ch has also shown
ha inc eased wo kload, especially in e ms o men al demands,
gene a es di ficul ies in es ablishing s able ou ines and inc eases
s ess le els among ca e and adminis a i e s a [38]. These esul s
unde line he impo ance o conside ing he impac o mul i-se ice
assignmen on he occu ence o psychosocial isks and on he men al
heal h o p o essionals.
High-p essu e wo k a eas, such as eme gency depa men s,
a e associa ed wi h high le els o psychosocial isk due o he
in ensi y o demands and cons an exposu e o c i ical si ua ions.
These en i onmen s gene a e high le els o s ess due o ac o s
such as emo ional o e load, he need o make quick and accu a e
decisions, and he p essu e o mee s ic deadlines [5,39]. Such a
combina ion o cogni i e and emo ional demands in a high-
demand con ex can lead o significan psychosocial ulne abili y,
a ec ing wo ke s’men al heal h. Also, una ailabili y o adequa e
esou ces and limi ed suppo in hese en i onmen s inc ease
s ess, which may in u n esul in wo k- ela ed heal h p oblems
such as bu nou and anxie y [5,40].
Sick lea e is significan ly associa ed wi h high le els o psychosocial
isk, which can be in e p e ed in wo ways: as a di ec consequence o
exposu e oad e sewo ken i onmen so asanea lyindica o o
p e-lea e s ess and bu nou . Resea ch sugges s ha ch onic s ess,
especially in high-demand se ings such as heal hca e, can lead o
physical and emo ional o e load, esul ing in absences om wo k
[41]. Mo eo e , he e o - ewa d model ein o ces he idea ha lack
o esou ces in he ace o high wo k demands con ibu es o wo ke s’
bu nou , which can hen ansla e in o sick lea e [42]. This unde lines
he need o add ess psychosocial ac o s a an ea ly s age o p e en
mo e se ious nega i e e ec s.
O e all, he assessmen o hese wo k- ela ed a iables eflec s
how specific wo k condi ions can exace ba e o mi iga e
psychosocial isks. This finding unde sco es he impo ance o
o ganisa ional in e en ions ha p omo e mo e s able and
sus ainable en i onmen s o nu sing p o essionals.
This s udy has se e al s eng hs ha highligh i s con ibu ion
o he field o psychosocial isk esea ch in nu sing. These include
he use o a significan ly la ge sample (n = 2,765), which allows o
a obus analysis and imp o es he gene alisabili y o he esul s.
Fu he mo e, he adap a ion and psychome ic alida ion o he
ISTAS_En e me ía ques ionnai e specifically o nu ses in Spain
is a key me hodological s eng h, as i p o ides a eliable ool o
measu ing psychosocial isks in his con ex . Ano he s eng h is
ha he sample comp ises 2,765 nu ses, o whom 85.5% iden i y
as emale and 14.5% as male. This dis ibu ion mi o s na ional
s a is ics, which indica e ha 85.5% o nu ses in Spain a e emale
and 14.5% a e male [43]. Fu he mo e, a ailable da a show ha
53.3% o nu ses in Spain a e unde 45 yea s old [43]. Al hough he
s udy did no collec specific age da a, he epo ed le els o
p o essional expe ience among ou pa icipan s sugges a simila
age dis ibu ion. These simila i ies in gende and in e ed age
p ofile indica e ha he sample p o ides a ep esen a i e c oss-
sec ion o he Spanish nu sing wo k o ce. Consequen ly, he
esul s o ou s udy can be easonably ex apola ed o he
b oade nu sing popula ion in Spain.
Howe e , his s udy has ce ain limi a ions ha should be
conside ed. Fi s ly, he c oss-sec ional design limi s he abili y o
es ablish causal ela ionships be ween he examined a iables,
es ic ing in e p e a ion o he obse ed associa ions. Secondly,
al hough he o al sample g ea ly exceeded he minimum sample
size calcula ed, he non-p obabilis ic snowball sampling may ha e
in oduced selec ion biases, which could a ec he
ep esen a i eness o he esul s and limi hei gene alisabili y a
he na ional le el. Also, al hough he applied ques ionnai e had
been p e iously alida ed, he use o sel - epo ins umen s may
in ol e subjec i i y and possible social desi abili y bias in he
pa icipan s’ esponses. I should also be no ed ha he
p edominance o women in he sample (87.3%) could lead o a
In . J. Public Heal h | Owned by SSPH+ | Published by F on ie s May 2025 | Volume 70 | A icle 16083307
Na bona-Gál ez e al. Psychosocial Risk in Nu sing Wo k
bias in he in e p e a ion o possible sex di e ences, al hough he
size o he sub-samples was su ficien o s a is ically obus
analyses.Finally,i wouldbeimpo an ocomplemen hese
findings wi h u he quali a i e s udies ha explo e pa icipan s’
expe iences and pe spec i es in g ea e dep h, as well as longi udinal
esea ch ha allows o analysis o changes o e ime.
To u he elabo a e on he esul s, he findings o his s udy
may ha e implica ions o he managemen o psychosocial isks in
he field o nu sing. The iden ifica ion o occupa ional and socio-
demog aphic ac o s associa ed wi h highe le els o psychosocial
isks p o ides a solid basis o designing specific and ailo ed
in e en ions aimed a imp o ing wo king condi ions. Fo
example, he esul s highligh he need o add ess job insecu i y
and sick lea e as p io i ies in he managemen o nu ses’wellbeing.
Addi ionally, he da a ob ained can se e o in o m ins i u ional
policies ha p omo e job s abili y, p o essional de elopmen , and
s a egies o mi iga e s ess and anxie y in his popula ion
g oup. On a p ac ical le el, he esul s s ess he impo ance o
implemen ing p e en i e and suppo i e p og ammes ha no
only benefi he heal h o nu ses, bu also imp o e he quali y o
ca e hey p o ide o pa ien s, hus con ibu ing o he
s eng hening o he heal hca e sys em in gene al.
Conclusion
The findings indica e ha highe educa ional le els and g ea e
wo kload a e linked o highe psychosocial isk, while ma iage
and olde age seem o ha e a p o ec i e e ec . These esul s
highligh he need o a ge ed in e en ions o mi iga e wo k-
ela ed psychosocial s esso s. O ganisa ional s a egies such as
educing wo kload, imp o ing wo k-li e balance, and p o iding
adequa e suppo o employees wi h highe educa ion le els
could help alle ia e hese isks. Fu u e s udies should ocus on
iden i ying specific mechanisms h ough which educa ional le el
influences psychosocial isk and de eloping e idence-based
in e en ions ailo ed o di e en p o essional g oups.
ETHICS STATEMENT
This s udy was app o ed by he P o incial Resea ch E hics
Commi ee o Huel a, Spain, wi h code 1520-N-23. The
s udies we e conduc ed in acco dance wi h he local legisla ion
and ins i u ional equi emen s. The pa icipan s p o ided hei
w i en in o med consen o pa icipa e in his s udy.
AUTHOR CONTRIBUTIONS
Concep ualiza ion: AN-G, JG-S, CR-F, DA-M, GF-V, JF-R, RP-
G, AR-N, RA-C. Da a cu a ion: AN-G, JG-S, CR-F, DA-M, GF-V,
JF-R, RP-G, AR-N, RA-C. Fo mal analysis: AN-G, JG-S, CR-F,
DA-M, GF-V, JF-R, RP-G, AR-N, RA-C. In es iga ion: AN-G,
JG-S, CR-F, DA-M, GF-V, JF-R, RP-G, AR-N, RA-C.
Me hodology: AN-G, JG-S, CR-F, DA-M, GF-V, JF-R, RP-G,
AR-N, RA-C. P ojec adminis a ion: AN-G, JG-S, RA-C.
Resou ces: AN-G, JG-S, CR-F, DA-M, GF-V, JF-R, RP-G, AR-
N, RA-C. So wa e: AN-G, JG-S, CR-F, DA-M, GF-V, JF-R, RP-
G, AR-N, RA-C. Supe ision: AN-G, JG-S, CR-F, DA-M, GF-V,
JF-R, RP-G, AR-N, RA-C. Valida ion: AN-G, JG-S, CR-F, DA-M,
GF-V, JF-R, RP-G, AR-N, RA-C. Visualiza ion: AN-G, JG-S, CR-
F, DA-M, GF-V, JF-R, RP-G, AR-N, RA-C. W i ing –o iginal
d a : AN-G, JG-S, CR-F, DA-M, GF-V, JF-R, RP-G, AR-N, RA-
C. W i ing – e iew and edi ing: AN-G, JG-S, CR-F, DA-M, GF-
V, JF-R, RP-G, AR-N, RA-C. All au ho s con ibu ed o he a icle
and app o ed he submi ed e sion.
FUNDING
The au ho (s) decla e ha no financial suppo was ecei ed o
he esea ch and/o publica ion o his a icle.
CONFLICT OF INTEREST
The au ho s decla e ha hey do no ha e any conflic s o in e es .
GENERATIVE AI STATEMENT
The au ho s decla e ha no Gene a i e AI was used in he
c ea ion o his manusc ip .
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