Psychosocial Risks in Spanish Nursing: Relationship With Stability and Working Conditions

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 . REFERENCES 1. Haida a y S, Apni AA, Sa izal HBA. Occupa ional Sa e y and Heal h: A Sys ema ic Li e a u e Re iew (SLR). 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A ailable online a : h ps://www.sanidad.gob.es/gabine e/no asP ensa.do? id=6597#:~: ex =%2D%20En%20Espa%C3%B1a%2C%20seg%C3%BAn%20los% 20da os, iene%20menos%20de%2044%20a%C3%B1os. (Accessed Ap il 1, 2025). Copy igh © 2025 Na bona-Gál ez, Gómez-Salgado, Ruiz-F u os, Ayuso-Mu illo, Fon án-Vinag e, Fagundo-Ri e a, Palomo-Gómez, Ruge -Na a e e and Allande- Cussó. This is an open-access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion License (CC BY). The use, dis ibu ion o ep oduc ion in o he o ums is pe mi ed, p o ided he o iginal au ho (s) and he copy igh owne (s) a e c edi ed and ha he o iginal publica ion in his jou nal is ci ed, in acco dance wi h accep ed academic p ac ice. No use, dis ibu ion o ep oduc ion is pe mi ed which does no comply wi h hese e ms. In . J. Public Heal h | Owned by SSPH+ | Published by F on ie s May 2025 | Volume 70 | A icle 16083309 Na bona-Gál ez e al. Psychosocial Risk in Nu sing Wo k