Toxic leadership behaviours of nurse managers and the co-occurrence of anxiety and depression in nurses: Propensity score matching.

OBJECTIVE

This study investigates the association between nurses' exposure to toxic leadership and the co-occurrence of anxiety and depression, applying both categorical and transdiagnostic analytical frameworks.

METHODS

A cross-sectional design was employed among 2337 nurses from 20 tertiary hospitals in China. Toxic leadership was assessed using the Toxic Leadership Behaviours of Nurse Managers scale. Anxiety and depression symptoms were measured with the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9. To minimize potential confounding, propensity score matching was performed. A dual-framework analytical approach was adopted: (1) a categorical perspective, defining co-occurrence as concurrent scores of five or higher on both symptom scales; and (2) a transdiagnostic perspective, utilizing a bifactor model to extract a general psychopathology factor. Data were analysed using binary logistic and linear regressions.

RESULTS

The prevalence of co-occurring anxiety and depression among nurses was 48.4%. Categorical analysis indicated that exposure to toxic leadership was associated with a fivefold increased odd of this co-occurrence. Although the interaction effect between gender and toxic leadership was not statistically significant, the association appeared markedly stronger in male nurses than in females. The transdiagnostic analysis corroborated these findings, showing a strong positive association between toxic leadership and the general psychopathology factor.

CONCLUSIONS

By integrating categorical and transdiagnostic perspectives, this study establishes a significant association between toxic leadership and the co-occurrence of anxiety and depression among nurses. As toxic leadership is a modifiable organizational factor, healthcare institutions should prioritize targeted interventions to safeguard the mental health and sustainability of the nursing workforce.