International journal of nursing studies · 2026
Assessing trauma exposure and predicting depression risk among female nurses: Development of a trauma exposure load index and application of machine learning approaches.
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Liu Yiting, Sun Shuiju, Tian Yusheng, Li Xuting, Yu Qiang, Liao Xiaoli, Li Yamin
Аннотация
BACKGROUND: Depression among nurses is an important occupational health concern, but identifying nurses at higher risk remains challenging because work-related exposures are heterogeneous and often measured separately. Occupational trauma-related experiences, including adverse clinical events, workplace violence, bullying, threats and sexual harassment, may differ in frequency and severity, and simple event counts may not adequately capture their relevance to mental health risk.
OBJECTIVE: To derive a weighted occupational trauma exposure burden score among female nurses and examine its association with moderate-to-severe depressive symptoms.
DESIGN: Large-scale, cross-sectional analysis using baseline data from the Nurses' Mental Health Study in China.
SETTING: 67 tertiary hospitals across 31 provincial-level regions in China.
PARTICIPANTS: 90,196 registered female nurses.
METHODS: Fourteen occupational trauma exposure indicators were analysed using item response theory to derive a weighted trauma exposure load index. Depressive symptoms were assessed using the nine-item Patient Health Questionnaire, with scores of 10 or higher indicating moderate-to-severe depressive symptoms. Logistic regression and Light Gradient Boosting Machine models were developed using a stratified 7:3 training-testing split.
RESULTS: The derived trauma exposure load index summarised heterogeneous occupational trauma exposures, with workplace violence and sexual harassment emerging as highly informative indicators of the overall exposure burden. The index showed greater variation across occupational contexts than across most demographic characteristics, with higher burden observed among psychiatry and emergency nurses. In the prediction model, the trauma exposure load index was the highest-ranking predictor, and higher scores were associated with greater predicted risk of moderate-to-severe depressive symptoms. The calibrated Light Gradient Boosting Machine model showed acceptable discrimination in the independent testing set, with an area under the receiver operating characteristic curve of 0.830 (95% confidence interval 0.824-0.836).
CONCLUSIONS: The trauma exposure load index provided an empirically weighted summary of heterogeneous occupational trauma exposures among female nurses and was associated with moderate-to-severe depressive symptom status. These findings support further evaluation of weighted exposure measures to examine the relationship between complex occupational trauma exposure and nurses' mental health. Longitudinal studies are needed to assess temporal relationships and the generalisability of the index.
REGISTRATION: The Nurses' Mental Health Study was registered prospectively with the Chinese Clinical Trial Registry (ChiCTR2300072142) on 5 June 2023; participant recruitment began in December 2023.
OBJECTIVE: To derive a weighted occupational trauma exposure burden score among female nurses and examine its association with moderate-to-severe depressive symptoms.
DESIGN: Large-scale, cross-sectional analysis using baseline data from the Nurses' Mental Health Study in China.
SETTING: 67 tertiary hospitals across 31 provincial-level regions in China.
PARTICIPANTS: 90,196 registered female nurses.
METHODS: Fourteen occupational trauma exposure indicators were analysed using item response theory to derive a weighted trauma exposure load index. Depressive symptoms were assessed using the nine-item Patient Health Questionnaire, with scores of 10 or higher indicating moderate-to-severe depressive symptoms. Logistic regression and Light Gradient Boosting Machine models were developed using a stratified 7:3 training-testing split.
RESULTS: The derived trauma exposure load index summarised heterogeneous occupational trauma exposures, with workplace violence and sexual harassment emerging as highly informative indicators of the overall exposure burden. The index showed greater variation across occupational contexts than across most demographic characteristics, with higher burden observed among psychiatry and emergency nurses. In the prediction model, the trauma exposure load index was the highest-ranking predictor, and higher scores were associated with greater predicted risk of moderate-to-severe depressive symptoms. The calibrated Light Gradient Boosting Machine model showed acceptable discrimination in the independent testing set, with an area under the receiver operating characteristic curve of 0.830 (95% confidence interval 0.824-0.836).
CONCLUSIONS: The trauma exposure load index provided an empirically weighted summary of heterogeneous occupational trauma exposures among female nurses and was associated with moderate-to-severe depressive symptom status. These findings support further evaluation of weighted exposure measures to examine the relationship between complex occupational trauma exposure and nurses' mental health. Longitudinal studies are needed to assess temporal relationships and the generalisability of the index.
REGISTRATION: The Nurses' Mental Health Study was registered prospectively with the Chinese Clinical Trial Registry (ChiCTR2300072142) on 5 June 2023; participant recruitment began in December 2023.