Shift work

Health consequences of shift work and insufficient sleep

Type of study: systematic review

Number of citations: 601

Year: 2016

Authors: G. Kecklund, John Axelsson

Journal: British Medical Journal

Journal ranking: Q1

Key takeaways: Shift work is linked to acute sleep loss, accidents, type 2 diabetes, weight gain, and various chronic diseases, with potential shared common mechanisms.

Abstract: This review summarises the literature on shift work and its relation to insufficient sleep, chronic diseases, and accidents. It is based on 38 meta-analyses and 24 systematic reviews, with additional narrative reviews and articles used for outlining possible mechanisms by which shift work may cause accidents and adverse health. Evidence shows that the effect of shift work on sleep mainly concerns acute sleep loss in connection with night shifts and early morning shifts. A link also exists between shift work and accidents, type 2 diabetes (relative risk range 1.09-1.40), weight gain, coronary heart disease (relative risk 1.23), stroke (relative risk 1.05), and cancer (relative risk range 1.01-1.32), although the original studies showed mixed results. The relations of shift work to cardiometabolic diseases and accidents mimic those with insufficient sleep. Laboratory studies indicate that cardiometabolic stress and cognitive impairments are increased by shift work, as well as by sleep loss. Given that the health and safety consequences of shift work and insufficient sleep are very similar, they are likely to share common mechanisms. However, additional research is needed to determine whether insufficient sleep is a causal pathway for the adverse health effects associated with shift work.

Shift work and disturbed sleep/wakefulness.

Type of study:

Number of citations: 1046

Year: 2003

Authors: T. Åkerstedt

Journal: Sleep medicine reviews

Journal ranking: Q1

Key takeaways: Shift work significantly disrupts sleep and alertness, leading to fatigue-related accidents and reduced productivity, with strategies like napping and recovery time not fully eliminating the effects.

Abstract: This paper reviews the effects of shift work and finds strong, acute effects on sleep and alertness in relation to night and morning work. The effects seem, however, to linger and also affect days off. The level of the disturbances is similar to that seen in clinical insomnia and may be responsible for considerable human and economical costs due to fatigue related accidents and reduced productivity. The mechanism behind the disturbances is the sleep interfering properties of the circadian system during day sleep and the corresponding sleep promoting properties during night work. Various strategies may be used to counteract the effects of shift work, such as napping, sufficient recovery time between shifts, clockwise rotation, etc. Still it does not seem possible to more eliminate the effects-only to reduce them.

Individual vulnerability to insomnia, excessive sleepiness and shift work disorder amongst healthcare shift workers. A systematic review.

Type of study: systematic review

Number of citations: 163

Year: 2018

Authors: L. Booker, Michelle Magee, S. Rajaratnam, T. Sletten, M. Howard

Journal: Sleep medicine reviews

Journal ranking: Q1

Key takeaways: Older age, morning-type, circadian flexibility, being married or having children, increased caffeine intake, neuroticism, and lower hardiness are associated with increased sleep-related impairment in healthcare shift workers.

Shift Work and Shift Work Sleep Disorder: Clinical and Organizational Perspectives

Type of study: literature review

Number of citations: 220

Year: 2017

Authors: Emerson M. Wickwire, J. Geiger-Brown, S. Scharf, C. Drake

Journal: Chest

Journal ranking: Q1

Key takeaways: Shift work is associated with negative health consequences and shift work sleep disorder, resulting in decreased quality of life and increased workplace costs for employers.

The Impact of Shift Work on Sleep, Alertness and Performance in Healthcare Workers

Type of study: non-rct observational study

Number of citations: 288

Year: 2019

Authors: Saranea Ganesan, Michelle Magee, J. Stone, Megan D Mulhall, A. Collins, M. Howard, S. Lockley, S. Rajaratnam, T. Sletten

Journal: Scientific Reports

Journal ranking: Q1

Key takeaways: Shift work impairs healthcare workers' alertness and performance due to sleep loss and circadian misalignment, with the most significant impact occurring during night shifts.

Shift work with and without night work as a risk factor for fatigue and changes in sleep length: A cohort study with linkage to records on daily working hours

Type of study: non-rct observational study

Number of citations: 75

Year: 2019

Authors: M. Härmä, K. Karhula, S. Puttonen, A. Ropponen, A. Koskinen, A. Ojajärvi, M. Kivimäki

Journal: Journal of Sleep Research

Journal ranking: Q1

Key takeaways: Shift work, especially with night shifts, increases the risk of long sleep and fatigue, indicating a higher need for recovery.

Abstract: We examined shift work with or without night work as a risk factor for fatigue and short or long sleep. In a prospective cohort study with 4‐ and 6‐year follow‐ups (the Finnish Public Sector study), we linked survey responses of 3,679 full‐time hospital employees on sleep duration and fatigue to records on daily working hours in 2008 (baseline), 2012 and 2014. We used logistic regression to estimate risk ratios and their confidence intervals to examine whether continuous exposure to shift work or changes between shift work and day work were associated with short (≤6.5 hr) or long (≥9.0 hr) sleep over 24 hr and fatigue at work and during free days. Compared with continuous day work and adjusting for age, gender, education and fatigue/sleep duration at baseline, continuous shift work with night shifts was associated with increased fatigue during free days (risk ratio = 1.38, 95% confidence interval 1.17–1.63) and long sleep (risk ratio = 8.04, 95% confidence interval 2.88–22.5, without adjustment for education) after 6‐year follow‐up. Exposure to shift work without night shifts increased only long sleep after 6 years (risk ratio = 5.87, 95% confidence interval 1.94–17.8). A change from day work to shift work with or without night shifts was associated with an increased risk for long sleep, and a change from shift work to day work with a decreased risk for long sleep and fatigue. This study suggests that irregular shift work is a modifiable risk factor for long sleep and increased fatigue, probably reflecting a higher need for recovery.

Mental Health Consequences of Shift Work: An Updated Review

Type of study: literature review

Number of citations: 145

Year: 2020

Authors: Jessica P. Brown, Destiny Martin, Z. Nagaria, A. Verceles, S. Jobe, Emerson M. Wickwire

Journal: Current Psychiatry Reports

Journal ranking: Q1

Key takeaways: Shift work can lead to poor mental health outcomes, including depressed mood, anxiety, substance use, cognitive impairments, lower quality of life, and suicidal ideation.

Abstract: Purpose of ReviewApproximately 25% of employed individuals engage in shift work, which can substantially alter opportunities for restorative sleep. Being tired on the job can lead to safety risks in professions such as healthcare, first responders, manufacturing, and numerous others. In addition to the physical stress and health consequences of shift work, recent evidence links shift work to poor mental health outcomes. The current review examines the literature from 2016 onward, emphasizing the impact of shift work on mental health.Recent FindingsShift work is associated with considerable impacts on sleep, depressed mood and anxiety, substance use, impairments in cognition, lower quality of life, and even suicidal ideation. Pronounced sleep disturbances frequently underlie the mental health consequences of shift work.SummaryShift work can have physical, mental health, and safety consequences. Future research should aim to better understand the interplay of shift work, sleep, and mental health and seek to mitigate the adverse consequences of shift work.

Shift work is associated with extensively disordered sleep, especially when working nights

Type of study:

Number of citations: 11

Year: 2023

Authors: G. Boersma, T. Mijnster, P. Vantyghem, G. A. Kerkhof, Marike Lancel, Karen Spruyt, L. Gennaro

Journal: Frontiers in Psychiatry

Journal ranking: Q1

Key takeaways: Shift work is associated with disordered sleep and a variety of sleep disorders, with young and lower educated shift workers at higher risk for sleep disorders.

Abstract: Background Shift work is generally associated with working and sleeping out of phase with the endogenous, circadian sleep–wake cycle. This exerts detrimental effects on sleep health. The present study aimed at evaluating the presence of short and long sleep as well as sleep disorders within a broad range of shift work schedules and elucidating the role of sociodemographic factors therein. Methods A large dataset containing information on sleep was collected through advertisement in a Belgium newspaper (De Standaard). Adult, working individuals were selected (n = 37,662) and categorized based on their work schedule (regular day, early morning, evening, night, and rotating shift). In this cross-sectional study, prevalence rates of short sleep (≤6 h), long sleep (≥9 h) and sleep disorders (screened with Holland Sleep Disorders Questionnaire), and associations between these sleep variables and sociodemographics (age, sex, education, living companion(s)) were analyzed using binominal logistic regression analyses. Results In the total sample all sociodemographic factors affected prevalences of short, long and disordered sleep, consistent with previous studies. Compared to day workers, shift workers more frequently reported short sleep, most prominently night workers (26 vs. 50%) (p < 0.001). Furthermore, all sleep disorders as well as sleep disorder comorbidity were more common in shift workers, again most pronounced in night workers (all p < 0.05). In night shift workers the level of education had the strongest associations with disturbed sleep with a two-fold higher prevalence of short and disordered sleep in low relative to academic educated groups (all p < 0.02). Conclusion Shift work is related not only to curtailed sleep and shift work disorder, but also to a plethora of sleep disorders, including insomnia, sleep-related breathing disorders and sleep-related movement disorders. Our findings imply that education on coping strategies may be especially important for young and/or lower educated shift workers.

Disturbance of the Circadian System in Shift Work and Its Health Impact

Type of study: literature review

Number of citations: 199

Year: 2021

Authors: D. Boivin, Philippe Boudreau, Anastasi Kosmadopoulos

Journal: Journal of Biological Rhythms

Journal ranking: Q1

Key takeaways: Night-shift work disrupts the circadian system, leading to misalignment with the environment and increased risk of various medical conditions.

Abstract: The various non-standard schedules required of shift workers force abrupt changes in the timing of sleep and light-dark exposure. These changes result in disturbances of the endogenous circadian system and its misalignment with the environment. Simulated night-shift experiments and field-based studies with shift workers both indicate that the circadian system is resistant to adaptation from a day- to a night-oriented schedule, as determined by a lack of substantial phase shifts over multiple days in centrally controlled rhythms, such as those of melatonin and cortisol. There is evidence that disruption of the circadian system caused by night-shift work results not only in a misalignment between the circadian system and the external light-dark cycle, but also in a state of internal desynchronization between various levels of the circadian system. This is the case between rhythms controlled by the central circadian pacemaker and clock genes expression in tissues such as peripheral blood mononuclear cells, hair follicle cells, and oral mucosa cells. The disruptive effects of atypical work schedules extend beyond the expression profile of canonical circadian clock genes and affects other transcripts of the human genome. In general, after several days of living at night, most rhythmic transcripts in the human genome remain adjusted to a day-oriented schedule, with dampened group amplitudes. In contrast to circadian clock genes and rhythmic transcripts, metabolomics studies revealed that most metabolites shift by several hours when working nights, thus leading to their misalignment with the circadian system. Altogether, these circadian and sleep-wake disturbances emphasize the all-encompassing impact of night-shift work, and can contribute to the increased risk of various medical conditions. Here, we review the latest scientific evidence regarding the effects of atypical work schedules on the circadian system, sleep and alertness of shift-working populations, and discuss their potential clinical impacts.

WORKING AROUND THE CLOCK: THE EFFECT OF SHIFT WORK AND SLEEP ON DEPRESSIVE SYMPTOMS

Type of study:

Number of citations: 1

Year: 2022

Authors: Cleothia Frazier

Journal: Innovation in Aging

Journal ranking: Q1

Key takeaways: Shift work is associated with increased depressive symptoms, but improving sleep duration and quality can help reduce these harmful effects.

Abstract: Abstract Shift work is increasingly prevalent in a 24-hour society where there is increased demand for round the clock service. However, shift work can disrupt circadian rhythms, which can negatively impact sleep. In turn, diminished sleep is associated with poor mental health. To expand prior research that reveal the independent effects of shift work and sleep on mental health, this study focuses on the interconnection between shift work, sleep, and depressive symptoms. Guided by the Stress Process Model (SPM), I examine the association between shift work and depressive symptoms and investigate whether sleep duration, sleep quality (insomnia symptoms), and sleep latency (the time it takes to fall asleep) mediate this relationship. Data was drawn from the age 50 health module of the National Longitudinal Survey of Youth 1979 cohort. The sample consisted of noninstitutionalized adults aged 51-60 (N=5,386). Findings show that shift workers had increased odds of short sleep, insomnia symptoms, and increased sleep latency compared to non-shift workers. Moreover, shift work was associated with increased depressive symptoms. However, part of the effect of shift work on depressive symptoms was indirect, operating through sleep. Specifically, short sleep during the week and on the weekend as well as insomnia symptoms mediated the relationship between shift work and depressive symptoms. The findings suggest that while engaging in shift work can negatively affect mental health, improving sleep duration and sleep quality can be effective in reducing the harmful effects of engaging in shift work during late midlife.

Shift workers' experiences and views of sleep disturbance, fatigue and healthy behaviors: a systematic review and qualitative evidence synthesis.

Type of study: systematic review

Number of citations: 1

Year: 2025

Authors: J. Benton, Charlotte L Lee, Hannah A Long, Thavapriya Sugavanam, Leah Holmes, Annie Keane, Neal Thurley, Simon D. Kyle, David Ray, David P. French

Journal: Scandinavian journal of work, environment & health

Journal ranking: Q1

Key takeaways: Shift workers need interventions that focus on self-regulation of behaviors, thoughts, and emotions to better manage sleep and fatigue, rather than solely focusing on sleep education.

Abstract: OBJECTIVE Shift work is common across most societies but poses significant risks to the health of shift workers. In part, this risk is due to the disruption of healthy sleep-wake schedules. This systematic review identified qualitative research on shift workers' experiences of sleep disturbance, fatigue and healthy behaviors. METHODS We conducted a systematic search of four databases (CINAHL, EMBASE, MEDLINE, PsycINFO) and identified 28 eligible studies involving 1519 participants. We appraised the studies using an adapted Critical Appraisal Skills Programme (CASP) checklist, and confidence in the review findings was formally assessed using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach. Data were thematically synthesized. RESULTS Three analytical themes were generated. 'Inevitability of fatigue and tiredness' outlines how shift workers experience a culture where they feel 'peer pressure to soldier through' their shifts regardless of fatigue. 'Balancing sleep needs with competing responsibilities' highlights how shift workers struggle to balance the need for daytime sleep with family, leisure, and work responsibilities, often prioritizing family needs over their own sleep. 'Obstacles to engaging in healthy behaviors' describes how shift workers often know which actions would benefit their health and reduce fatigue but find it challenging to translate this knowledge into behavior due to fatiguing and stressful work environments. For the purposes of the GRADE-CERQual assessment, short summary statements were developed to describe 22 review findings: there was moderate or high confidence in all but one of these findings. CONCLUSION This review suggests that sleep education alone is unlikely to be effective. Interventions should focus on helping shift workers self-regulate their behaviors, thoughts, and emotions to better manage sleep and fatigue.

Working Around the Clock: The Association between Shift Work, Sleep Health, and Depressive Symptoms among Midlife Adults

Type of study: non-rct observational study

Number of citations: 7

Year: 2023

Authors: Cleothia Frazier

Journal: Society and Mental Health

Journal ranking: Q1

Key takeaways: Shift work is associated with increased depressive symptoms in midlife adults, with short sleep during the week and on the weekend contributing to this relationship.

Abstract: Shift work is an integral part of living in a 24-hour society. However, shift work can disrupt circadian rhythms, negatively impacting health. Guided by the Stress Process Model (SPM), this study examines the association between shift work and depressive symptoms and investigates whether sleep health (duration, quality, and latency) mediates this relationship among midlife adults. Utilizing data from the National Longitudinal Survey of Youth 1979 cohort (N = 6,372), findings show that working evening, night, and irregular shifts is associated with increased depressive symptoms. The results also show that part of the association between shift work and depressive symptoms among night and irregular shift workers, is indirect, operating through short sleep during the week and on the weekend. Although shift work can negatively affect mental health, getting more restorative sleep may mitigate part of the harmful mental health consequences of non-standard work schedules.

The Impact of Night Work on the Sleep and Health of Medical Staff—A Review of the Latest Scientific Reports

Type of study: systematic review

Number of citations: 5

Year: 2024

Authors: Katarzyna Czyż-Szypenbejl, W. Mędrzycka-Dąbrowska

Journal: Journal of Clinical Medicine

Journal ranking: Q1

Key takeaways: Night work significantly increases the risk of sleep disorders and health disturbances, highlighting the need for healthcare workers to be aware of these risks and take preventative measures.

Abstract: Introduction: Employees working in shifts are exposed to many threats affecting their health, quality of life and safety at work. Those who perform their work only at night are particularly vulnerable. The purpose of the review is to identify risks to the health, quality of life and sleep of shift health workers. Method: A systematic review (SR) was used in the analysis. Electronic databases were searched. The search was limited to the latest studies published in the last five years: 2019–2023. Results: Finally, 36 articles were included in the review. Most authors have shown a link between sleep disturbance or its quality and shift work/night work. Moreover, a three-shift schedule was the most significant factor for poorer subjective sleep quality when compared to other work schedules. Furthermore, many authors have shown a link between shift/night work and health problems, which include cardiometabolic risk, glucose intolerance, breast cancer and immune vulnerability. Conclusions: The research results clearly show a significant impact of night work on the increased risk of sleep disorders and health disturbance. Healthcare workers should be aware of the risks associated with night work in order to take measures preventing sleep/health problems. Shift/night workers should have the opportunity to be screened for disorders linked with their work.

Metabolic and cardiovascular consequences of shift work: The role of circadian disruption and sleep disturbances

Type of study:

Number of citations: 163

Year: 2018

Authors: L. Kervezee, Anastasi Kosmadopoulos, D. Boivin

Journal: European Journal of Neuroscience

Journal ranking: Q2

Key takeaways: Shift work increases the risk of metabolic and cardiovascular health problems due to circadian disruption and sleep disturbances.

Abstract: Shift work, defined as work occurring outside typical daytime working hours, is associated with an increased risk of various non‐communicable diseases, including diabetes and cardiovascular disease. Disruption of the internal circadian timing system and concomitant sleep disturbances is thought to play a critical role in the development of these health problems. Indeed, controlled laboratory studies have shown that short‐term circadian misalignment and sleep restriction independently impair physiological processes, including insulin sensitivity, energy expenditure, immune function, blood pressure and cardiac modulation by the autonomous nervous system. If allowed to persist, these acute effects may lead to the development of cardiometabolic diseases in the long term. Here, we discuss the evidence for the contributions of circadian disruption and associated sleep disturbances to the risk of metabolic and cardiovascular health problems in shift workers. Improving the understanding of the physiological mechanisms affected by circadian misalignment and sleep disturbance will contribute to the development and implementation of strategies that prevent or mitigate the cardiometabolic impact of shift work.

Sleep, mental health and physical health in new shift workers transitioning to shift work: Systematic review and meta-analysis.

Type of study: meta-analysis

Number of citations: 12

Year: 2024

Authors: R. Harris, E. Kavaliotis, S. P. Drummond, A. Wolkow

Journal: Sleep medicine reviews

Journal ranking: Q1

Key takeaways: Shift work negatively impacts new workers' sleep and mental health early in their careers, with pre-shift work mental health, sleep, and work characteristics predicting better shift work tolerance later in their careers.

The Influence of Shift Work on the Quality of Sleep and Executive Functions

Type of study: non-rct observational study

Number of citations: 14

Year: 2020

Authors: Mojtaba Elhami Athar, M. Atef-Vahid, A. Ashouri

Journal: Journal of Circadian Rhythms

Journal ranking: Q2

Key takeaways: Shift work impairs executive functions, leading to poorer sleep quality and reduced performance in cognitive tasks compared to day workers.

Abstract: Shift work is an inconsistent and atypical work schedule. This study aimed to investigate the influence of shift work on the Quality of Sleep (QOS) and Executive Functions (EF). Thirty shift workers and thirty day workers first completed a demographic questionnaire. They then were tested using the Pittsburgh Sleep Quality Index (PSQI) and EF tests, including the Corsi Block-Tapping Task (CBTT), Berg’s Card Sorting Task (BCST), and the Continuous Performance Task (CPT). Results were subjected to non-parametric Chi-Square Tests, the Mann-Whitney U Test, and Independent T-Tests. Shift workers had significantly poorer sleep quality than day workers, which was shown in PSQI global scale (p = 0.001), sleep duration (p = 0.042), habitual sleep efficiency (p = 0.021), and sleep disturbance (p = 0.021). Concerning EF tests, shift workers performed significantly poorer on CBTT (p = 0.019) and BCST (p = 0.015, 0.047) compared with day workers. Significant differences were also observed between shift workers and day workers in terms of variables of omission errors (p = 0.037) and commission errors (p = 0.041) on CPT, but no significant difference was found between shift workers and day workers in reaction time (p = 0.561). Shift work impaired EF. These findings are related to shift workers’ poorer sleep and its detrimental effects on areas of the brain, which are critical for EF, such as the prefrontal area. Our results suggest the evaluation and implication of practices and policies to assuage the consequences of working in shifts.

The relationship between shift work, sleep, and work hours on wellbeing

Type of study: non-rct observational study

Number of citations: 0

Year: 2024

Authors: L. Di Milia, B. Bjorvatn

Journal: Industrial Health

Journal ranking: Q2

Key takeaways: Shift work negatively impacts sleep duration and wellbeing, with fewer work hours leading to a greater impact of sleep/sleepiness on wellbeing.

Abstract: We investigated the role of sleep and work hours on wellbeing among day- and shift workers. We tested a mediation-moderation hypothesis proposing that; 1) sleep would mediate the association between the work schedule and the impact of sleep/sleepiness on wellbeing; 2) work hours would moderate the link between work schedule and sleep. We made random phone calls to 1,162 participants and identified 172-d and 130 shift workers that worked ≥35 h/week. The work schedule had a positive indirect effect on the impact of sleep/sleepiness via sleep duration (β=0.0511, SE=0.0309, [0.0008, 0.3219]. The relationship between shift work and sleep duration was negative (β=−0.35, SE=0.14, p<0.01), and sleep duration was negatively associated with a greater impact of sleep/sleepiness on wellbeing (β=−0.15, SE=0.06, p<0.02). The path between the work schedule and sleep duration was moderated by work hours; fewer work hours resulted in shift workers reporting a greater impact of sleep/sleepiness on wellbeing. The results support the mediation-moderation hypothesis. Work hours and sleep duration are key characteristics in work schedule design.

Night Shift Work and Its Health Effects on Nurses

Type of study: non-rct observational study

Number of citations: 84

Year: 2017

Authors: Candie Books, L. Coody, Ryan Kauffman, S. Abraham

Journal: The Health Care Manager

Journal ranking: Q1

Key takeaways: Night shift work increases the risk of sleep deprivation, family stressors, and mood changes, with rotating shifts being a major concern and fatigue-related illnesses being a secondary issue.

Abstract: The purpose of this research was to study night shift work and its health effects on nurses. This was a quantitative study using descriptive design; it also incorporated three qualitative open-ended questions to complement the study. The data were collected using Survey Monkey, with an Internet-based confidential data collection tool. The population of relevance to this study was nurses employed in hospital settings in the United States. E-mail addresses and Facebook were used to recruit participants. Results indicated that there is an increased risk of sleep deprivation, family stressors, and mood changes because of working the night shift. Rotating shifts were mentioned as a major concern for night shift nurses. Respondents agreed that complaints about fatigue and fatigue-related illnesses in night shift workers were ignored. There was also a general perception among nurses working the night shift that sleep deprivation leads to negative health consequences including obesity; however, they were not as high a concern as rotating shifts or fatigue.

The impact of shift and night work on health.

Type of study:

Number of citations: 542

Year: 1996

Authors: G. Costa

Journal: Applied ergonomics

Journal ranking: Q1

Key takeaways: Shift and night work negatively impacts workers' health and well-being, leading to disruptions in circadian rhythms, decreased work performance, and difficulties maintaining family and social relationships.

Impact of Shift Work and Long Working Hours on Worker Cognitive Functions: Current Evidence and Future Research Needs

Type of study: systematic review

Number of citations: 59

Year: 2021

Authors: V. Leso, L. Fontana, A. Caturano, I. Vetrani, Mauro Fedele, I. Iavicoli

Journal: International Journal of Environmental Research and Public Health

Journal ranking: Q2

Key takeaways: Night work may negatively impact worker cognitive functions, particularly attention, memory, and response inhibition, with cognitive performance worsening over consecutive shifts or very long work hours.

Abstract: Particular working conditions and/or organization of working time may cause important sleep disturbances that have been proposed to be predictive of cognitive decline. In this regard, circadian rhythm misalignment induced by exposure to night work or long working hours would be responsible for cognitive impairment. Nevertheless, evidence supporting this correlation is limited and several issues still need to be elucidated. In this regard, we conducted a systematic review to evaluate the association between shift/night work and cognitive impairment and address its main determinants. Information provided by the reviewed studies suggested that night work might have serious immediate negative effects especially on cognitive domains related to attention, memory and response inhibition. Furthermore, cognitive performance would progressively worsen over consecutive night shifts or following exposure to very long work shifts. Otherwise, conflicting results emerged regarding the possible etiological role that night work chronic exposure would have on cognitive impairment. Therefore, circadian rhythm desynchronization, lack of sleep and fatigue resulting from night work may negatively impact worker’s cognitive efficiency. However, in light of the considerable methodological variability of the reviewed studies, we proposed to develop a standardized research and evaluation strategy in order to obtain a better and comprehensive understanding of this topic.

Shift Work and Poor Mental Health: A Meta-Analysis of Longitudinal Studies.

Type of study: meta-analysis

Number of citations: 236

Year: 2019

Authors: L. Torquati, G. Mielke, W. Brown, N. Burton, T. Kolbe-Alexander

Journal: American journal of public health

Journal ranking: Q1

Key takeaways: Shift work is associated with increased risk of poor mental health, particularly depressive symptoms, with women experiencing higher rates than men.

Abstract: Background. Shift work is characterized by employees working outside the standard hours of 7:00 am to 6:00 pm. Because shift work includes night work, the normal sleep-wake cycle (circadian rhythm) is disrupted, with potential consequences for shift workers' physical and mental health.Objectives. To assess the pooled effects of shift work on mental health and to evaluate whether these differ in men and women.Search Methods. We searched PubMed, Scopus, and Web of Science databases for peer-reviewed or government reports published up to August 2018Selection Criteria. To be included, studies had to be longitudinal or case-control studies of shift work exposure associated with adverse mental health outcomes. For subanalyses, we grouped these outcomes as anxiety symptoms, depressive symptoms, or general poor mental health symptoms.Data Collection and Analysis. We followed the Meta-Analysis of Observational Studies in Epidemiology Group guidelines. We extracted adjusted risk estimates for each study to calculate pooled effect sizes (ESs) using random effect models and metaregression analysis to explore sources of heterogeneity.Main Results. We included 7 longitudinal studies, with 28 431 unique participants. Shift work was associated with increased overall risk of adverse mental health outcomes combined (ES = 1.28; 95% confidence interval [CI] = 1.02, 1.62; I2 = 70.6%) and specifically for depressive symptoms (ES = 1.33; 95% CI = 1.02, 1.74; I2 = 31.5%). Gender differences explained more than 90% of heterogeneity, with female shift workers more likely to experience depressive symptoms than female non-shift workers (odds ratio = 1.73; 95% CI = 1.39, 2.14).Authors' Conclusions. To our knowledge, this is the first meta-analysis to investigate the pooled effects of shift work on the risk of poor mental health, including subanalyses by type of poor mental health and gender. Shift workers, particularly women, are at increased risk for poor mental health, particularly depressive symptoms.Public Health Implications. Depression accounts for 4.3% of the global burden of disease and incidence, with mental disorders worldwide predicted to cost US $16.3 million by 2030. With 1 in 5 people in the United States and Europe doing shift work, and the increased risk of poor mental health among shift workers, shift work industries are a priority context for reducing this burden. Workplace health promotion programs and policies are needed to minimize shift workers' risk of poor mental health. (Am J Public Health. Published online ahead of print September 19, 2019: e1-e8. doi:10.2105/AJPH.2019.305278).

Shift work and mental health: a systematic review and meta-analysis

Type of study: meta-analysis

Number of citations: 81

Year: 2019

Authors: Yixuan Zhao, A. Richardson, Carmel Poyser, P. Butterworth, L. Strazdins, L. Leach

Journal: International Archives of Occupational and Environmental Health

Journal ranking: Q1

Key takeaways: Shift work is associated with poorer mental health, with the strongest evidence for irregular or unpredictable shift work.

Abstract: BackgroundShift work is common. However, research findings are mixed regarding the impact of shift work on mental health. This systematic review sought to provide a comprehensive summary of existing research examining the association between different types of shift work and mental health. The review included large-scale, non-occupation-specific research.MethodsFour electronic databases PubMed, PsycINFO, Web of Science and SCOPUS were searched to identify studies that reported on the statistical association between shift work and mental health and that used population-based samples. Two reviewers extracted information about study characteristics and data on the association between shift work and mental health. A meta-analysis was performed for longitudinal studies adopting a ‘broad binary’ measure of shift work.ResultsThirty-three studies were included in the final review—10 cross-sectional studies, 22 longitudinal studies, and 1 study that included both. Findings were grouped based on whether the measure of shift work focussed on: (1) night/evening work, (2) weekend work, (3) irregular/unpredictable work schedule, or (4) a broad binary measure. There was a reasonable level of evidence that overall, when a broad binary measure was adopted, shift work was associated with poorer mental health—this finding was supported by the meta-analysis results. There was also some evidence that irregular/unpredictable work was associated with poorer mental health. There was less evidence for night/evening and minimal evidence for weekend work. Inconsistencies in study methodology, limited contrasting and combining the results.ConclusionsThe association between shift work and mental health is different across types of shift work. The evidence is strongest for a broad binary, general measure of shift work and for irregular or unpredictable shift work. There is a need for continued research that adopts consistent and clear measures of shift work.

The relationship between shift work and mental health among electronics workers in South Korea: A cross-sectional study

Type of study: non-rct observational study

Number of citations: 54

Year: 2017

Authors: Mo-Yeol Kang, H. Kwon, K. Choi, C. Kang, Hyunjoo Kim

Journal: PLoS ONE

Journal ranking: Q1

Key takeaways: Shift work is associated with an increased risk of mental health problems, particularly insomnia, depression, and suicidal ideation, with sleep disturbance being a central mechanism.

Abstract: Objective To determine the relationship between shift work and mental health, particularly insomnia, depression, and suicidal ideation, among electronics production workers. Methods A survey was conducted with 14,226 workers from an electronics manufacturer in South Korea. After excluding 112 individuals with incomplete responses, 14,114 respondents were analyzed. As part of a larger project, we collected data on respondents’ general characteristics, work-related characteristics, and health status; however, in this study, we focused on the data related to shift work and mental health. Insomnia, depression, and suicidal ideation were set as dependent variables and working schedule as set as the independent variable. We performed multiple logistic regression analysis with daytime workers as the reference group. The model was adjusted for age, gender, body mass index, workplace, educational level, and marital status with or without children under 6 years of age. Results Relative to daytime workers, shift workers had 2.35, 1.23, and 1.17 greater odds of insomnia, depression, and suicidal ideation, respectively. Within the shift worker group, we found that the odds of depression and suicidal ideation increased dramatically when respondents had insomnia. The ORs for depression and suicidal ideation were 4.899 and 7.934, respectively. Conclusions Our findings suggest that shift work is related to an increased risk of mental health problems in production workers, and the sleep disturbance related with shift work is a central mechanism for this relationship. Since these results suggest that proactive management of sleep problems might attenuate their detrimental effects on shift worker’s mental health.

Shift work and its association with mental health outcomes: A Systematic Review

Type of study: systematic review

Number of citations: 0

Year: 2025

Authors: Hannah Zuraff

Journal: International Journal of Research in Human Resource Management

Journal ranking: brak

Key takeaways: Shift work is strongly associated with poor mental health outcomes, highlighting the need for improved workplace policies and support to protect workers' well-being.

Abstract: While prior research has demonstrated that long hours and shift work are associated with higher hazards to one's physical health, their effects on one's mental health have received less attention. Through an analysis of the available data, this review seeks to close this gap. A systematic review was carried out with an emphasis on articles that had the terms 'shift work' and 'mental health' in their abstracts/titles. 24 publications were found in the first searches; six articles-all published between, 2010-2021, remained after screening. The results show a strong correlation between poor mental health outcomes and shift employment. This demonstrates the necessity of improved workplace policies and support to protect workers' well-being. Further research across various sectors and demographics is essential to fully understand the impact of shift work on mental health beyond anxiety, depression, and insomnia. As shift workers constitute a vulnerable group, prioritizing their mental health is crucial.

The association between mental health and shift work: Findings from the Atlantic PATH study.

Type of study: non-rct observational study

Number of citations: 15

Year: 2021

Authors: E. Sweeney, Yunsong Cui, Z. Yu, T. Dummer, V. DeClercq, C. Forbes, S. Grandy, M. Keats, A. Adisesh

Journal: Preventive medicine

Journal ranking: Q1

Key takeaways: Shift workers are at increased risk of depression and poor self-rated health, potentially leading to increased risk of comorbidity, poor quality of life, missed work, and early retirement.

Effects of Factors Related to Shift Work on Depression and Anxiety in Nurses

Type of study: non-rct observational study

Number of citations: 36

Year: 2022

Authors: Yuxin Li, Yongchao Wang, Xiaoyan Lv, Rong Li, Xiangyun Guan, Li Li, Junli Li, Yingjuan Cao

Journal: Frontiers in Public Health

Journal ranking: Q1

Key takeaways: Reducing workload, stress during night shifts, and facilitating rest and relaxation can help reduce depression and anxiety in shift nurses.

Abstract: Background Although shift work is the foundation of the provision of 24-h continuous care in hospitals, it can negatively impact mental health in hospital workers such as nurses. Despite the connection between mental health and overall health, little is known about the effect of shift work-related factors on mental health in this population. Objectives We investigated the effect of scheduling practices, physical and psychological characteristics related to shift work, and personal habits during shift work on depression and anxiety among nurses. Methods In this multi-center cross-sectional study, 11,061 nurses from 20 hospitals in the Shandong Province of China completed an online survey between December 2020 and February 2022. Multivariate ordered logistic regression analysis was performed to examine shift-related factors associated with depression and anxiety in the study population. Results The completion rate of all nurses' questionnaires was 83.00% (n = 9,181). Among the 9,181 respondents, 66.20% (n = 6,078) were shift nurses. Depression and anxiety were found in 58.82 and 62.08% of shift nurses, respectively, and these rates were influenced by fatigue during shift work, psychological stress before/during/after night shifts, feeling of being refreshed after resting before/after night shifts, using sleep medication before/after night shifts, physical discomfort during night shifts, busyness during night shifts, food intake during shift work, working > 40 h/week during shift work, and sleep quality before/after night shifts. Conclusions Depression and anxiety in shift nurses may be addressed by reducing their workload, sources of stress during night shifts, and facilitating rest and relaxation.

Working shifts and mental health--findings from the British Household Panel Survey (1995-2005).

Type of study: non-rct observational study

Number of citations: 202

Year: 2009

Authors: A. Bara, S. Arber

Journal: Scandinavian journal of work, environment & health

Journal ranking: Q1

Key takeaways: Night work has a greater negative impact on men's mental health than varied shift patterns, while women's mental health is more negatively affected by varied shift patterns.

Abstract: OBJECTIVE Our objective was to examine the impact of shift work on mental health at the population level. We expected that this impact would depend on duration of exposure, type of shift work, and gender. METHODS We analyzed longitudinal data (1995-2005) from the British Household Panel Survey. From the 2005 wave, we selected a subsample of people aged 21-73 years who had been followed annually from 1995 to 2005. We used responses in 2005 to the General Health Questionnaire (GHQ, 12-item) and self-reported anxiety/depression as dependent variables. Controlling for age, marital status, education, number of years working in six occupational categories (1995-2005), and baseline mental health, we performed nested logistic regression models to examine the effect of the duration of night work and varied shift patterns on mental health for men and women. RESULTS Undertaking night work for > or =4 years in men was associated with an increased risk of having a GHQ score reflecting mental ill health and reporting anxiety/depression [odds ratios (OR) 2.58, 95% confidence interval (95% CI) 1.22-5.48; OR 6.08, 95% CI 2.06-17.92, respectively]. Women were significantly more likely to report anxiety/depression (OR 2.58, 95% CI 1.53-4.35 ) and to have a GHQ score reflecting mental ill health (OR 4.17, 95% CI 1.45-11.98), after working varied shift patterns for 2-3 years, and >/=4 years, respectively. CONCLUSIONS Different types of shift work had a differential impact on mental health, but this impact varied according to gender. Women's mental health was more adversely affected by varied shift patterns, while night work had a greater negative impact on men's mental health.

The Association Between Shift Work And Affective Disorders: A Systematic Review

Type of study: systematic review

Number of citations: 16

Year: 2020

Authors: T. D'Oliveira, A. Anagnostopoulos

Journal: Chronobiology International

Journal ranking: Q2

Key takeaways: Shift work is associated with increased symptoms of depression and anxiety, with some studies finding no association.

Abstract: Abstract Atypical working time patterns are known to be associated with adverse physical health consequences. The impact of chronic exposure to shift work on psychological wellbeing and mental health is also reported, but not fully appreciated. We conducted a systematic review of the literature on the association between shift work and affective disorders using the electronic databases Medline, PsycINFO, Embase, Web of Science and Google Scholar. Data extracted included detailed characteristics of shift work, the affective disorders under study, and the population targeted. Some 25 extracted articles satisfied all inclusion and exclusion criteria. Findings of these articles reveal shift work is associated with increases in depressive symptoms (12 studies), anxiety (2 studies), and depression and anxiety (7 studies). Only three studies found no association between shift work and depression. The findings of this review suggest that shift work increases the symptoms of depression and anxiety.

Working Time Society consensus statements: Evidence-based effects of shift work on physical and mental health

Type of study: systematic review

Number of citations: 141

Year: 2019

Authors: C. Moreno, E. Marqueze, C. Sargent, K. Wright, S. Ferguson, P. Tucker

Journal: Industrial Health

Journal ranking: Q2

Key takeaways: Shift work may negatively impact physical and mental health due to misalignment of light-dark cycles and social misalignment, leading to changes in behavior and increased risk of diseases.

Abstract: Potential effects of shift work on health are probably related to the misalignment between the light-dark cycle and the human activity-rest cycle. Light exposure at night mediates these effects, including social misalignment and leads to an inversion of activity and rest, which, in turn, is linked to changes in behaviours. This article reviews the epidemiological evidence on the association between shift work and health, and possible mechanisms underlying this association. First, evidence from findings of the meta-analyses and systematic reviews published in the last 10 yr is presented. In addition, it reports the larger single-occupation studies and recent large population-based studies of the general workforce. Koch’s postulates were used to evaluate the evidence related to the development of disease as a result of exposure to shift work. Finally, we discussed limitations of the multiple pathways that link shift work with specific disorders and the methodological challenges facing shift work research. We concluded that the clearest indications of shift work being the cause of a disease are given when there is a substantial body of evidence from high quality field studies showing an association and there is good evidence from laboratory studies supporting a causal explanation of the link.

The effects of shift work on physical and mental health

Type of study: literature review

Number of citations: 172

Year: 2012

Authors: M. Vogel, T. Braungardt, Wolfgang Meyer, W. Schneider

Journal: Journal of Neural Transmission

Journal ranking: Q2

Key takeaways: Shift work disrupts circadian rhythms, potentially increasing the incidence of psychological, psychosomatic, and cardiovascular disorders.

Abstract: Occupational engagement is a pre-requisite for continuous income opportunities. Among the changing social circumstances work-related conditions play an increasingly eminent role in psychological and mental well-being. The public discusses the question of a possible association between the demands of modern work life and the increases of psychological, psychosomatic and cardiovascular disorders. Given the socioeconomic implications of psychiatric and psychosomatic suffering in the general population, there is a need to further elucidate the causes of their increasing incidence. From a medical point of view, any organization of work disrupting the phased circadian rhythms for bio-psycho-social processes and functioning of the individual are interesting against the background of clock genes and certain biological functions that are organized in a circadian fashion. The authors review the influence of shift work as a form of systematic desynchronization of inner clock systems on the endocrine, the physical, and the mental level. The significance of the findings in the field is discussed along with future directions of conclusive research.

Exploring the Health and Well-being Impacts of Shift Work on Nurses: A Literature Review

Type of study: systematic review

Number of citations: 0

Year: 2024

Authors: Gaid Rashad Al Moteri, Fayez Saleh Almutairi, Mohammed Saud Almutairi, Zaid Naif, M. Alotaibi, Khalid Rashed Almutairi, Hussain Ahmed Almutawabojabra, Waleed Aqoub, Fahad Awadh Almutairi, Ahmed Abdullah Alshuwayman, Narjes Mousa, Taher Alabdullah

Journal: Power System Technology

Journal ranking: Q1

Key takeaways: Shift work significantly impacts nurses' health, leading to sleep disorders, fatigue, and increased stress, as well as mental health issues and strained family relationships.

Abstract: Aim: This literature review aims to explore and synthesize recent findings on the impact of shift work on the health and well-being of nurses, focusing on physical, psychological, and social outcomes. Given the essential role nurses play in healthcare, understanding how shift work affects their well-being is critical for developing supportive workplace policies and improving healthcare quality. Methods: A comprehensive literature search was conducted using databases such as PubMed, CINAHL, and Scopus, covering studies published from 2016 onward. Keywords included 'shift work,' 'nurse health,' 'well-being,' and 'occupational health.' Selection criteria focused on studies that addressed the physical, psychological, and social impacts of shift work on nurses, resulting in a curated collection of peer-reviewed articles. Findings: Shift work significantly affects nurses' health, leading to sleep disorders, fatigue, and a heightened risk of chronic health conditions, such as cardiovascular and gastrointestinal diseases. Psychologically, shift work is associated with increased stress, burnout, and susceptibility to mental health issues like anxiety and depression. Socially, irregular work hours challenge work-life balance, often leading to strained family relationships and social isolation. These impacts have far-reaching implications, potentially affecting job performance and patient care quality. Conclusion: The findings underscore the need for healthcare organizations to consider interventions aimed at mitigating the adverse effects of shift work on nurses. Policies that prioritize nurse well-being could improve retention, job satisfaction, and overall healthcare delivery quality. Future research should focus on longitudinal studies and effective interventions to provide clearer insights into sustainable practices that support nurse health in shift-based environments.

Shift work, clinically significant sleep disorders and mental health in a representative, cross-sectional sample of young working adults

Type of study: non-rct observational study

Number of citations: 19

Year: 2022

Authors: A. Reynolds, B. Lechat, Y. Melaku, K. Sansom, B. Brown, M. Crowther, S. Wanstall, K. Maddison, J. Walsh, L. Straker, R. Adams, N. McArdle, P. Eastwood

Journal: Scientific Reports

Journal ranking: Q1

Key takeaways: Clinical sleep disorders are common in young workers and are largely undiagnosed, leading to poorer mental health, particularly in those working evening and/or night shifts.

The mediating role of unhealthy behavior in the relationship between shift work and perceived health

Type of study: non-rct observational study

Number of citations: 6

Year: 2021

Authors: K. Proper, Eva A. Jaarsma, S. Robroek, Jolinda L D Schram, H. Boshuizen, H. Picavet, W. Verschuren, S. V. van Oostrom

Journal: BMC Public Health

Journal ranking: Q1

Key takeaways: Shift work is not significantly related to mental or physical health, but unhealthy behaviors like smoking and physical inactivity may mediate this relationship.

Abstract: Abstract Background Little is known about the relationship between shift work and perceived health, including potential underlying mechanisms such as unhealthy behaviors. The aim of this study was to investigate whether unhealthy behaviors mediate the relationship between shift work and perceived mental and physical health, taking into account potential differences by level of education. Methods Data from 1633 workers participating in the Doetinchem Cohort Study during 1995–2016 were used. Being engaged in shift work was determined at 1 year preceding the assessment of health behaviors. Mental and physical health were assessed after 5 years of follow-up by the 5-item Mental Health Inventory and the physical functioning scale of the 36-item Short Form Health Survey. Smoking, physical inactivity, alcohol consumption, and overweight were considered as potential mediators and education was treated as moderator. Moderated mediation analyses using generalized estimated equations were performed. Results Shift work was not statistically significantly related to either mental or physical health. Despite this, statistically significant mediation effects of smoking (Beta − 0.09; 95% Confidence Interval − 0.20 - -0.01, respectively B -0.09; 95%CI -0.21 - -0.01) and physical inactivity (B 0.11; 95%CI 0.03–0.23, respectively B 0.08; 95%CI 0.01–0.18) were found in the relationship between shift work and mental or physical health. Direct and indirect effects outweighed each other in the relationship between shift work and mental health, since the direction of these effects was opposite. The relationship between shift work, unhealthy behavior, and health was not different by educational level. Conclusion Shift workers did not report lower mental or physical health than non-shift workers. Though mediation effects of unhealthy behavior were observed in the relationship between shift work and perceived health, these small effects had minor public health relevance.

More than sleep problems? Testing five key health behaviors as reasons for quality of life issues among shift workers

Type of study: non-rct observational study

Number of citations: 0

Year: 2024

Authors: Yuxin Chen, Kaiyi Deng, Ian M. Hughes, Claire E Smith, Hongdao Meng, Minh Quan Le, Min Sun, Xianyan Zhang, Danping Liu

Journal: Health and Quality of Life Outcomes

Journal ranking: Q1

Key takeaways: Shift work negatively impacts quality of life for Chinese petroleum workers due to less frequent healthy eating and physical exercise, potentially affecting their physical and mental health more than sleep and substance use.

Abstract: Abstract Background The shift work schedule is a common work arrangement that can disrupt typical sleep-wake rhythms and lead to negative health consequences. The present study aims to examine the effect of shift work on health-related quality of life (QoL) and explore potential behaviorial mediators (i.e., sleep, eating, exercise, smoking, drinking). Methods A cross-sectional survey was conducted among 4,449 petroleum workers in southwest China. Data on shift work status, health behaviors, and physical and mental health QoL were collected. We tested our model using path analysis and the Monte Carlo approach among 2,129 included participants. Results After adjusting for covariates, shift work did not exhibit a significant direct association with QoL. However, shift work indirectly related to poorer physical health quality of life via less frequent healthy food consumption; shift work also indirectly related to poorer mental health QoL via both less frequent healthy food consumption and physical exercise. No significant indirect effects were found via sleeping, smoking, or drinking. Conclusions Results suggest that shift work presents a challenge for QoL among Chinese petroleum workers due to their lesser engagement in two specific health behaviors: healthy eating and physical exercise. Healthy eating and exercise may present an even more prominent threat to shift workers’ QoL than sleep and substance use. Strategies targeting shift work schedule as well as eating and exercise behaviors may help protect against poor QoL and adverse physical and mental health outcomes in this vulnerable group.

A qualitative exploration of the shift work experience: the perceived effect on eating habits, lifestyle behaviours and psychosocial wellbeing

Type of study: non-rct observational study

Number of citations: 45

Year: 2018

Authors: F. Nea, L. K. Pourshahidi, John M. Kearney, M. Livingstone, C. Bassul, Clare A. Corish

Journal: Journal of Public Health

Journal ranking: Q1

Key takeaways: Shift work negatively impacts workers' eating, lifestyle behaviors, and psychosocial health, with internal motivation playing a significant role in lifestyle choices.

Abstract: Background Approximately 17% of the European workforce is engaged in shift work. How the experience of shift work impacts on the dietary and lifestyle practices of workers is unclear. Methods Overall, 15 focus groups were conducted by two researchers, with 109 participants. The initial focus group was carried out with both researchers present, to ensure consistency in facilitation. Both researchers thematically analysed all data collected. Results Shift work was described as affecting many areas of workers' lives. Three overarching themes were identified: (i) impact on eating behaviour; (ii) impact on other lifestyle behaviours including physical activity, sleep, alcohol consumption, smoking; and (iii) impact on psychosocial health and wellbeing. There appeared to be overlap between the effect of shift work and the effect of individual internal factors in influencing workers' decision-making with regard to lifestyle practices. Conclusions Shift work affects many areas of workers' lives, negatively impacting on eating and lifestyle behaviours and psychosocial health. This study augments the current literature as it highlights the role internal motivation plays in workers' lifestyle choices. The research should help inform the development of public health strategies to minimize the impact of shift work, such as specialist behavioural change interventions specific to this group.

The Relationship Between Shift Work and Men's Health.

Type of study: literature review

Number of citations: 68

Year: 2018

Authors: Nanfu Deng, T. Kohn, L. Lipshultz, A. Pastuszak

Journal: Sexual medicine reviews

Journal ranking: Q1

Key takeaways: Non-standard shift work is associated with increased negative health outcomes and urologic complications, particularly with shift work sleep disorder (SWSD).

Physical and mental fatigue in shift work and mitigation strategies: an integrative review

Type of study: systematic review

Number of citations: 0

Year: 2025

Authors: Amanda Sorce Moreira, Sérgio Roberto de Lucca

Journal: Revista Brasileira de Medicina do Trabalho

Journal ranking: Q4

Key takeaways: Shift work increases physical and mental fatigue, and strategies like work schedule adjustments, rest, phototherapy, monitoring, and staff education can help mitigate these effects.

Abstract: The new configurations of society have fragmented working hours into shifts, resulting in greater fatigue which affects worker health. Our aim was to identify the relationship between physical and mental fatigue and shift work and the main strategies for mitigating these effects. This review study was conducted between March and May 2023 using the Biblioteca Virtual em Saúde (Virtual Health Library). Twenty seven of the 1,176 identified articles were selected, with health professionals (doctors and nursing professionals), drivers, and aircraft pilots being the most studied populations. The following strategies for mitigating fatigue in shift work stood out: work schedule adjustments, interand intra-workday rest associated with phototherapy, monitoring and evaluating early signs of fatigue, supervised prescription of stimulants (such as caffeine) and sedatives, use of monitoring equipment, and staff education and training.

Fatigue and recovery in shiftworking nurses: A scoping literature review.

Type of study: systematic review

Number of citations: 45

Year: 2020

Authors: Jess Gifkins, A. Johnston, R. Loudoun, A. Troth

Journal: International journal of nursing studies

Journal ranking: Q1

Key takeaways: Shiftwork scheduling, high work demands, and work control can hinder recovery from fatigue in shiftworking nurses, while work control, break opportunities, age, and family structure can enhance recovery.

Fatigue and shift work

Type of study: non-rct observational study

Number of citations: 151

Year: 2006

Authors: Jianhua Shen, L. Botly, Sharon A. Chung, A. Gibbs, Skender Sabanadzovic, C. Shapiro

Journal: Journal of Sleep Research

Journal ranking: Q1

Key takeaways: Frequency of shift work significantly affects subjective fatigue, but not sleepiness, supporting the concept of fatigue and sleepiness as distinct and independent phenomena.

Abstract: Shift work is a ubiquitous phenomenon and its adverse effects on workers’ physical and mental health have been documented. In the sleep literature, differentiating between the symptoms of fatigue and sleepiness, and developing appropriate objective and subjective measures, have become very important endeavors. From such research, fatigue and sleepiness have been shown to be distinct and independent phenomena. However, it is not known whether shift work differentially affects fatigue and sleepiness. In an attempt to answer this question, 489 workers from a major Ontario employer completed a series of subjective, self‐report questionnaires, including the Fatigue Severity Scale (FSS) and the Epworth Sleepiness Scale. Workers were separated into four groups based on the frequency with which they are engaged in shift work (never, fewer than four times per month, 1–2 days per week, 3 days or more per week). The frequency of shift work was found to have a significant effect on subjective fatigue, but not on subjective sleepiness. Compared with the subjects who never had a shift schedule, those who worked in a shift for 3 days or more had significantly higher mean score of the FSS. In agreement with previous results, a low correlation was found between workers’ subjective fatigue and sleepiness scores, providing further support for the concept of fatigue and sleepiness as distinct and independent phenomena. Future research should address the possibility of using the FSS as an indicator when the frequency of shift work has become high enough to adversely affect work performance or cause health problems.

Characteristics of shift work and their impact on employee performance and wellbeing: A literature review.

Type of study: systematic review

Number of citations: 215

Year: 2016

Authors: C. Dall'ora, J. Ball, A. Recio-Saucedo, P. Griffiths

Journal: International journal of nursing studies

Journal ranking: Q1

Key takeaways: Shift work characteristics, such as 12-hour shifts and working more than 40 hours per week, negatively impact employee performance and wellbeing across various sectors, including healthcare.

Does work-induced fatigue accumulate across three compressed 12 hour shifts in hospital nurses and aides?

Type of study: non-rct experimental

Number of citations: 59

Year: 2019

Authors: B. Thompson

Journal: PLoS ONE

Journal ranking: Q1

Key takeaways: Working three compressed 12-hour shifts in a 72-hour period leads to increased fatigue-related impairments in nurses and aides, affecting vigilance, attention, and muscle function.

Abstract: Fatigue-related impairments in the nursing workforce contribute to a multitude of health, safety, and economic consequences at the individual, organizational and societal levels. Long and compressed work schedules are commonly worked in the healthcare industry, but more research is needed to understand the cumulative effects of multiple work shifts on physiology-based performance outcomes in nurses. The purpose of this study was to compare the effects of a single nursing work shift versus three compressed (one every 24 hours) 12 hour shifts on performance-based fatigue in nurses and aides. Twenty-six fulltime hospital working nurses and aides (age = 36.1 ± 13.3 years) reported to the lab for testing before, immediately after working a single 12 hour shift, and after working three 12 hour shifts in a 72 hour period. Outcome measures included vigilance-based reaction time, lapses of attention, and muscle function assessments (lower and upper body muscle strength, explosive strength and vertical jump performance). All variables except hand grip strength showed a significant decline following the three work shifts. The psychomotor vigilance reaction time and lapses of attention variables also generally showed a significant decline from the end of shift one to the end of shift three, indicting an accumulation of fatigue in these metrics with increasing number of shifts worked. Muscle function variables responded early in the duty cycle, showing a significant decline after a single work shift, but did no further decline by the end of the third shift. These findings use objective measures to substantiate that fatigue impairments occur from working a single 12 hour shift, and in several instances, increase further with more successive work shifts. Caution should be employed by personnel and administrators with work schedules involving multiple compressed 12 hour shifts. Fatigue management strategies may be used to improve risks and consequences from fatigue-related mishaps, and this study reports several variables that appear sensitive to identifying and tracking fatigue in this population.

Does work shift affect workers' sleep quality? a systematic review

Type of study: systematic review

Number of citations: 0

Year: 2024

Authors: P. H. D. A. Silva, D. A. Pires-Oliveira, Kercya de Almeida Silva Sales, Giovanna de Oli-veira Fernandes, Filipe Moreira Gomides Sardinha Carvalhedo, Ayse Suzel Martins Cosme, Marcos Filipe da Silva Mello, Viviane Soares

Journal: Cuadernos de Educación y Desarrollo

Journal ranking: brak

Key takeaways: Shift work may worsen sleep quality in industrial workers, but the results are inconclusive.

Abstract: Shift work in industry negatively affects the circadian cycle, resulting in impaired sleep quality (SQ), increased fatigue, attention deficits, and consequently reduced productivity and work performance. The aim of this study was to determine whether shift work affects the SQ of industrial workers, using the Pittsburg Scale as an assessment tool. This is a systematic review conducted according to the PRISMA guideline. It included studies that used the Pittsburgh scale to assess SQ, stratified the sample by work shift, written in English, original, and published in the last five years.  A total of 276 studies were found, but three studies (Germany, India, and Australia) made up the review. Two of the studies reported worsening SQ in workers. The workers were aged between 18 and 41 years, and the daytime Pittsburgh scale scores ranged from 5.7 to 8.8 points, and the nighttime worker scores ranged from 3.6 to 7.8 points. The results were inconclusive, although two studies showed worse SQ in workers who perform their duties on different shifts.

Fatigue and somatization in shift-workers: Effects of depression and sleep.

Type of study: non-rct observational study

Number of citations: 4

Year: 2023

Authors: Jin Won Seo, Jooyoung Lee, Sehyun Jeon, Yunjee Hwang, Jichul Kim, Somi Lee, Seog-Ju Kim

Journal: Journal of psychosomatic research

Journal ranking: Q1

Key takeaways: Shift workers experience higher fatigue and somatization levels than non-shift workers, with this difference being associated with disturbed sleep and depressed mood.

Prevention of fatigue and insomnia in shift workers—a review of non-pharmacological measures

Type of study: systematic review

Number of citations: 97

Year: 2016

Authors: K. Richter, J. Acker, Sophia Adam, G. Niklewski

Journal: The EPMA Journal

Journal ranking: Q1

Key takeaways: Non-pharmacological preventive measures, such as scheduling, bright light exposure, napping, and cognitive-behavioral measures, can improve sleep quality and reduce fatigue in shift workers.

Abstract: Excessive fatigue and insomnia are common among shift workers and can lead to negative effects such as reduced work performance, processing errors, accidents at work, absenteeism, reduced quality of life, and symptoms of depression. Moreover, work in rotating shifts can be a risk factor for different somatic and psychiatric diseases and may contribute to poor health, especially in elder adults and women. This review aims to show non-pharmacological preventive measures against fatigue and insomnia in shift workers.Computerized literature searches in MedLine and in the Cochrane Library were performed with the following key words: shift work disorder, fatigue, insomnia, shift work, measures, treatment, therapy, strategies and coping. The search was limited to non-pharmacological studies that were conducted on human subjects and published as English-language articles in peer-reviewed journals since 1970. Additional studies were identified through the reference sections of relevant articles. Eighteen articles on fatigue in shift workers, including six original research articles with a total sample size of 3504 probands consisting of industrial workers, office employees, aircraft maintenance engineers, and non-shift workers working in simulated shifts, were analyzed, as well as seven articles on insomnia, including an original research article with a sample size of 26 media workers. Also, 4 reviews on shift work disorder were analyzed.The occurrence of fatigue and insomnia in shift workers associated with a working period is described as shift work disorder. Estimations on the prevalence of shift work disorder in shift workers vary between 5 % and about 20 %; about one in three shift workers is affected by insomnia and up to 90 % of shift workers report regular fatigue and sleepiness at the workplace. We concluded that there is a necessity for treatments to improve the sleep quality of the shift working population. The most common non-pharmacological recommendations to improve sleep quality and to reduce insomnia and fatigue were scheduling, bright light exposure, napping, psychoeducation for sleep hygiene, and cognitive-behavioral measures.Some important preventive coping strategies for fatigue associated with shift work such as napping and exposure to bright light have already been investigated and are generally approved. A few studies also provide good evidence for the efficacy of cognitive-behavioral techniques in the treatment of chronic primary and comorbid insomnia. These coping strategies summarized in this paper should be considered in the workplace health promotion programs of each work environment to improve working conditions for shift workers and to save money.

The relation between shift work and chronic fatigue among educational hospital nurses in Yazd

Type of study:

Number of citations: 1

Year: 2020

Authors: Mehrzad Ebrahemzadih, S. jam Barsang, H. Ashrafzadeh, R. Soltanigerdfaramarzi, G. Halvani, M. Ebrahimzadeh

Journal: Occupational Medicine

Journal ranking: Q2

Key takeaways: Shift work is significantly associated with chronic fatigue, with constant shifts having a lower prevalence than non-constant shifts.

Abstract: Introduction: Shift work is one of the threatening factors on Health. The important effects of shift work can be noted chronic fatigue. This study aimed to determine the association between Shift Work and chronic Fatigue among Educational Hospital Nurses. Materials and Methods: This cross-sectional study was carried out in Educational Hospital in Yazd. Using Stratified sampling technique, 200 Nurses were selected. The data was collected by using questionnaires of Demographic and chronic Fatigue. The data was analyzed using SPSS20 software and applying chi-square and Pearson correlation coefficients. Result: 57 nurse’s man and 143 nurse’s women Participated in this study. There wasn’t a significant relation between the Gender, marital status, work experience and education level with chronic Fatigue. Because Between the age group with chronic fatigue there was a significant difference. Analysis of the results of this study showed that significant relation between Shift Work and chronic Fatigue. Conclusion: Shift work can be affected on chronic fatigue that causes the difference in constant and non-constant shifts. So, chronic fatigue in people with constant shifts less than non-constant shifts.

Fatigue, alcohol and performance impairment

Type of study:

Number of citations: 1164

Year: 1997

Authors: D. Dawson, K. Reid

Journal: Nature

Journal ranking: Q1

Key takeaways: Moderate levels of fatigue cause higher performance impairment than alcohol intoxication, highlighting the need for better sleep and recovery strategies for shift-workers.

Neurobehavioral, health, and safety consequences associated with shift work in safety-sensitive professions

Type of study: literature review

Number of citations: 183

Year: 2009

Authors: L. Barger, S. Lockley, S. Rajaratnam, C. Landrigan

Journal: Current Neurology and Neuroscience Reports

Journal ranking: Q1

Key takeaways: Shift work in safety-sensitive professions can lead to negative neurobehavioral, health, and safety consequences, requiring comprehensive fatigue management programs.

Abstract: Almost 15% of the full-time workers in the United States are shift workers. We review the physiologic challenges inherent not only in traditional night or rotating shifts but also in extended-duration shifts and other nonstandard hours. The challenging schedules of those in particularly safety-sensitive professions such as police officers, firefighters, and health care providers are highlighted. Recent findings describing the neurobehavioral, health, and safety outcomes associated with shift work also are reviewed. Comprehensive fatigue management programs that include education, screening for common sleep disorders, and appropriate interventions need to be developed to minimize these negative consequences associated with shift work.

Effect of shift work on fatigue, reaction time and accuracy of nurses in the department of neurology: A cross-sectional observational study.

Type of study: non-rct observational study

Number of citations: 6

Year: 2022

Authors: Ran An, Cheng Li, Shaolong Ai, Yuanfeng Wu, Xi Luo, Xin Li, Yan-ming Xu, Chengqi He

Journal: Journal of nursing management

Journal ranking: Q1

Key takeaways: Shift work increases nurses' fatigue, but they maintain a high level of attention and maintain a high sense of responsibility across all three working shifts.

Abstract: AIMS The purpose of our study was mainly to explore the effect of different shift work on cognitive and executive performance in a real clinical environment among nurses from China. BACKGROUND Working in shifts can disrupt circadian rhythm, resulting in reduced sleep duration, which can have a detrimental effect on cognitive function. To provide continuous service for patient care, shift work is often a special requirement for nurses. The Stroop test can be used to measure selective attention and reaction time during executive function. However, there have been limited studies about the effect of shift work on the cognitive performance of nurses by Stroop tests. Additionally, no study has been conducted in nurses working in shifts from China. METHODS Registered nurses in general ward, Department of Neurology, from West China Hospital of Sichuan University, were eligible and consecutively included if they were simultaneously responsible for the day, evening and night shifts on the shift work schedule. A fatigue questionnaire and Stroop tests were performed for each subject separately before and after three working shifts (morning, evening and night shift) to measure changes in fatigue, reaction time and accuracy. RESULTS Eighteen registered nurses (4 males and 14 females) were included in our study, with a median age of 25 years old. The fatigue degree was significantly increased after day and evening shifts (p=0.015 and <0.001, respectively). Compared with those in the preshifts, the reaction time in the neutral task and incongruent task was significantly quicker after the day shift (p=0.001, p<0.001) and night shift (p=0.008, 0.019). In contrast, the reaction time after the evening shift was mildly increased, although without significance. There was no significant difference in accuracy among the three different working shifts. In addition, there was a negative correlation between the fatigue score and reaction time on the incongruent task in the Stroop test before the day shift (r=-0.542, p=0.020). The fatigue score in the postday shift was found to be inversely related to working hours in the daytime (r=-0.500, p=0.034). CONCLUSIONS Our study showed that increased fatigue was found in nurses after day and evening shifts, and shift work can affect the reaction time after the evening shift. However, there was no significant difference in accuracy and a high level of attention could be maintained among the three working shifts, suggesting a highly developed sense of responsibility in our nurses. IMPLICATIONS FOR NURSING MANAGEMENT In addition to focusing on the common adverse effects of evening or night shifts on nurses, fatigue in the day shift should be paid special attention to by the leadership in the nursing management. Also, nurse managers can implement specific strategies to reduce fatigue after the day shift by shortening the working hours in the daytime appropriately, setting rest periods in the day shift or dividing nurses into morning and afternoon shifts.

Breaking the Fatigue Cycle: Investigating the Effect of Work-Rest Schedules on Muscle Fatigue in Material Handling Jobs

Type of study: non-rct experimental

Number of citations: 4

Year: 2023

Authors: Karla Beltran Martinez, Milad Nazarahari, H. Rouhani

Journal: Sensors (Basel, Switzerland)

Journal ranking: Q1

Key takeaways: Taking small breaks during a work shift can significantly reduce muscle fatigue and potentially reduce the risk of work-related musculoskeletal disorders without negatively affecting productivity.

Abstract: Muscle fatigue has proven to be a main factor in developing work-related musculoskeletal disorders. Taking small breaks or performing stretching routines during a work shift might reduce workers’ fatigue. Therefore, our objective was to explore how breaks and/or a stretching routine during a work shift could impact muscle fatigue and body kinematics that might subsequently impact the risk of work-related musculoskeletal disorder (WMSD) risk during material handling jobs. We investigated muscle fatigue during a repetitive task performed without breaks, with breaks, and with a stretching routine during breaks. Muscle fatigue was detected using muscle activity (electromyography) and a validated kinematic score measured by wearable sensors. We observed a significant reduction in muscle fatigue between the different work–rest schedules (p < 0.01). Also, no significant difference was observed between the productivity of the three schedules. Based on these objective kinematic assessments, we concluded that taking small breaks during a work shift can significantly reduce muscle fatigue and potentially reduce its consequent risk of work-related musculoskeletal disorders without negatively affecting productivity.

Comparing the acute effects of shiftwork on mothers and fathers

Type of study: non-rct observational study

Number of citations: 9

Year: 2021

Authors: P. Tucker, C. Leineweber, G. Kecklund

Journal: Occupational Medicine (Oxford, England)

Journal ranking: Q2

Key takeaways: Shift work negatively impacts sleep, fatigue, and work-family conflict, but having young children does not exacerbate these negative effects, possibly due to high levels of gender equality and childcare provision in Sweden.

Abstract: Abstract Background Shift work may impact women more negatively than men due to the increased burden of coping with demanding work schedules while also undertaking more of the domestic chores, including childcare. Aims To examine whether the combination of shift working and caring for children affects the sleep, fatigue and work–family conflict experienced by women more than it affects men. Methods Using data from a survey of the Swedish working population, mixed linear regression models examined work schedule (daywork, shift work with nights, shift work without nights), gender and presence of children <13 years at home as predictors of sleep insufficiency, sleep disturbance, fatigue and work–family conflict, over up to three successive measurement occasions. Adjustments were made for age, education, full/part-time working and baseline year. Results In fully adjusted models (N = 8938), shift work was associated with insufficient sleep (P < 0.01), disturbed sleep (P < 0.01), fatigue (P < 0.05) and work–family conflict (P < 0.001). Interactions in the analyses of sleep disturbance (P < 0.001) and work–family interference (P < 0.05) indicated that among participants with no children, females reported more disturbed sleep and more work–family conflict than their male counterparts, irrespective of schedule; while among participants with children, female dayworkers reported more disturbed sleep than their male counterparts, and females working shifts without nights reported more work–family interference. Conclusions Having young children did not exacerbate negative effects of shift work, in either men or women. This may reflect high levels of gender equality and childcare provision in Sweden.

Relationship between Fatigue, Sleep, Subjective Health Status, and Job Involvement in Shift-working Production Workers

Type of study:

Number of citations: 1

Year: 2023

Authors: Yeojoo Chae, Sein Ryu

Journal: Journal of Health Informatics and Statistics

Journal ranking: brak

Key takeaways: Job involvement positively correlates with perceived health in shift workers, while fatigue negatively impacts this relationship.

Abstract: Objectives: The purpose of this study was to examine of fatigue, sleep quality, and perceived health for shift workers and to identify variables that influence job involvement in order to develop an intervention program for shift workers to enhance their job involvement.Methods: Data was collected from 124 workers who worked in 3 manufacturing companies with more than 300 manufacturing companies in G-city. Data were analyzed using t-test, ANOVA, Pearson’s correlation and multiple regression analysis with SPSS statistics 27.0 program.Results: Job involvement is related to perceived health was found to have a significant positive correlation and fatigue have a significant negative correlation. Factors affecting job involvement were found to be a significant influencing factor on perceived health. It showed an explanatory power of 32.1%.Conclusions: Therefore, it is necessary to develop and verify job involvement improvement programs that take into account various variables to promote the job involvement of shift workers.