Work

Transition shock and depression-anxiety-stress symptoms among nursing interns in China: the indirect roles of self-efficacy and burnout in a cross-sectional mediation and network analysis study

Year: 2026

Type: article

Abstract: Background Clinical internship is a high-risk period for psychological distress among nursing interns. Grounded in Conservation of Resources theory's resource loss spiral proposition, this study examined serial associational pathways via self-efficacy and burnout linking transition shock to depression-anxiety-stress symptoms and explored their symptom-level network structure. Methods 663 mid internship nursing interns from western China completed the Transition-Shock Scale, the General Self-Efficacy Scale, the Maslach Burnout Inventory and the Depression Anxiety Stress Scale 21 (DASS-21). Pearson correlation and multiple linear regression examined factors associated with DASS-21 scores. A serial mediation model (5,000 bootstraps) estimated direct and indirect statistical associations along the theorized sequence. A Gaussian graphical model estimated the DASS-21 symptom network, including node and bridge expected influence. Results All main variables intercorrelated significantly (all p < 0.01); transition shock, self-efficacy and burnout were independently associated with DASS-21 scores. The mediation model fit acceptably; the direct association accounted for 44.53% of the total effect and three indirect pathways for 55.47%. In the DASS-21 symptom network, S6 (I was intolerant of anything that kept me from getting on with what I was doing), A6 (I was aware of the action of my heart in the absence of physical exertion) and S4 (I found myself getting agitated) had the highest expected influence, while A6, S2 (I tended to over-react to situations) and D2 (I found it difficult to work up the initiative to do things) showed the highest bridge expected influence. Both centrality indices demonstrated adequate stability (CS-coefficients = 0.750 for expected influence and 0.673 for bridge expected influence, respectively). Conclusion Among nursing interns in western China, higher transition shock was associated with more severe depression-anxiety-stress symptoms both directly and indirectly, along sequential associational pathways involving self-efficacy and burnout. Several structurally central symptoms (S6, A6 and S4) and bridge symptoms (A6, S2 and D2) were identified as potentially important nodes for further clinical investigation, rather than confirmed intervention targets. These findings generate hypotheses for targeted mental health support in clinical nursing education. Given the cross-sectional design, causal or temporal ordering cannot be established; findings should be interpreted within this population and setting.

Source: Frontiers in Medicine

DOI: 10.3389/fmed.2026.1982612

Authors: Qiulan Zheng, Juan Li, Xingfeng Yu, Yuying Chen, Jie Liu

Institutions: Second Affiliated Hospital of Chongqing Medical University, The Affiliated Yongchuan Hospital of Chongqing Medical University, Shaanxi Provincial People's Hospital

Language: English

Topic: Healthcare professionals’ stress and burnout

Subfield: General Health Professions

Field: Health Professions

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801