Working hours indirectly affect anxiety symptoms through sleep and stress in dentists, physicians, and psychotherapists

Descriptive parameters for sleep timings (hh:mm) and durations (decimal hours) on workdays, free days and across week in our sample of helping workers (N=172)

	Workdays				Free days
	M	SD	Min	Max	M	SD	Min	Max	P
Bedtime	23:19	00:51	21:00	01:30	23:52	01:10	21:00	05:00	<0.001
Sleep onset	23:34	00:54	21:01	01:45	24:08	01:13	21:15	05:15	<0.001
Wake-up time	06:16	00:43	03:00	08:00	7:57	01:19	4:00	13:00	<0.001
Duration of main sleep	6.70	1.00	3.00	9.50	7.83	1.20	3.98	11.50	<0.001
Nap duration^#	0.23	0.43	0.00	2.00	0.39	0.64	0.00	3.00	<0.001
Across week / past month						M	SD	Min	Max
Duration of main sleep (5workdays, 2free days)						7.02	0.90	3.71	9.50
Subjective sleep quality (1=very bad; 5=excellent)						3.68	0.90	1	5
Total nap duration^#						0.62	0.90	0.00	4.25
Estimated sleep need						7.27	0.80	5.00	10.00
Mid-sleep on free days corrected for sleep debt						3:37	1:02	24:20	8:35

# Median=0

Table 2

Correlation coefficients for all variables in path analysis models examining the relationship between working hours and anxiety (N=172)

	AS	WH	SD_w	SSQ	PSS	Gender	PR	WE	SWork	SNeed	SD_f	Nap	SAid	MSFsc
WH	−0.090
SD_w	−0.154^*	−0.229^**
SSQ	−0.434^***	−0.056	0.239^**
PSS	0.619^***	−0.071	−0.238^**	−0.353^***
Gender (1=male, 2=female)	0.179^*	−0.193^*	0.201^**	0.044	0.177^*
PR (0=dentists/doctors, 1=psychotherapists)	−0.135	−0.105	0.295^***	0.042	−0.182^*	0.137
WE (years)	−0.120	−0.129	−0.030	0.010	−0.165^*	−0.047	0.243^**
SWork (0=no, 1=yes)	−0.018	−0.136	0.178^*	0.138	−0.048	0.132	0.165^*	−0.016
SNeed (decimal hours)	0.051	−0.104	0.322^***	0.041	0.010	0.256^***	0.121	−0.108	0.141
SD_f (decimal hours)	−0.050	−0.036	0.447^***	0.127	−0.018	0.257^***	0.089	−0.124	0.058	0.438^***
Nap (decimal hours)	0.089	0.051	−0.256^***	−0.033	0.060	−0.268^***	−0.217^**	−0.036	−0.148	−0.153^*	−0.174^*
SAid (0=no, 1=yes)	0.223^**	−0.018	−0.109	−0.271^***	0.216^**	−0.035	0.103	0.078	−0.047	−0.005	−0.178^*	−0.053
MSFsc	−0.047	0.013	−0.150^*	−0.002	−0.013	−0.086	0.047	−0.162^*	0.029	0.026	−0.125	0.098	0.138
HE (0=no, 1=yes)	−0.080	0.096	−0.059	0.008	0.033	−0.186^*	−0.119	−0.020	0.209^**	−0.086	−0.202^**	0.005	0.026	0.013

* P<0.05;

** P<0.01;

*** P<0.001.

AS – anxiety symptoms; HE – hand eczema; MSFsc – mid-sleep on free days corrected for sleep debt; Nap – total weekly nap time; PR – profession; PSS – perceived stress scale; SAid – sleeping aids; SD_f – sleep duration on free days; SD_w – sleep duration on workdays; SNeed – sleep need; SSQ – subjective sleep quality; SWork – shift work; WE – work experience; WH – working hours

Table 3

Fit statistics of tested models of the (indirect) relationship between working hours and anxiety symptoms

Model	χ	P_χ²	CFI	TLI	RMSEA (90% CI)	P_RMSEA	SRMR	AIC	BIC^$
0: parallel mediators	6.331 (10)	0.7867	1.000	1.000	0.000 (0.000, 0.055)	0.935	0.022	4315.777	4314.638
A: stress → sleep	66.160 (14)	<0.001	0.765	0.000	0.147 (0.113, 0.184)	<0.001	0.054	4367.606	4366.542
B: sleep → stress	24.445 (14)	0.0405	0.953	0.798	0.066 (0.014, 0.108)	0.246	0.036	4325.891	4324.827
B1: sleep → stress → sleep	9.956 (14)	0.7654	1.000	1.000	0.000 (0.000, 0.052)	0.944	0.027	4311.402	4310.338
B2: SD_w → PSS	10.345 (14)	0.7366	1.000	1.000	0.000 (0.000, 0.054)	0.934	0.028	3853.865	3853.029

[i] PSS – perceived stress scale; SD_w – sleep duration on workdays; $ – sample-size adjusted BIC (n*=(n+2)/24). Note: In all models the effects of potential confounders were controlled for as described in the Methods section. In Model B2, sleep quality was added to the confounders’ list for mediators and the outcome

Results of the path analysis for model with parallel mediators and direct effect (Model 0; N=168). The confounding effects of gender, profession, work experience, shift work, sleep need, sleep duration on free days, total weekly nap duration, mid-sleep time point, using sleep aid, and presence of hand eczema symptoms (not shown) were controlled for as described in Methods section. Unstandardised coefficients and significances are shown (*P<0.05; **P<0.01; ***P<0.001)

Results of the path analyses for the two models with the best fit (Models B1 and B2; N=168). The confounding effects of gender, profession, work experience, shift work, sleep need, sleep duration on free days, total weekly nap duration, mid-sleep time point, using sleep aid, and presence of hand eczema symptoms (not shown) were controlled for as described in Methods section. Unstandardised coefficients and significances are shown (*P<0.05; **P<0.01; ***P<0.001)

Table 4

Direct, indirect, and total effects in the two models with the best fit (N=168)

Model and effects	β	S.E.	P-value	Bootstrap 95% CI
Model B1: sleep→stress→sleep
Direct effects
WH→SD_w	−0.186	0.070	0.007	[−0.321, −0.045]
SD_w→SSQ	0.145	0.098	0.138	[−0.047, 0.325]
PSS→SSQ	−0.298	0.072	<0.001	[−0.444, −0.159]
SD_w→PSS	−0.270	0.074	<0.001	[−0.418, −0.133]
PSS→AS	0.488	0.074	<0.001	[0.332, 0.630]
SSQ→AS	−0.243	0.063	<0.001	[−0.373, −0.123]
Indirect effects
WH→SD_w→SSQ→AS	0.007	0.005	0.214	[−0.002, 0.018]
WH→SD_w→PSS→AS	0.025	0.011	0.024	[0.006, 0.048]
WH→SD_w→PSS→SSQ→AS	0.004	0.002	0.103	[0.001, 0.009]
Total indirect effects	0.035	0.014	0.015	[0.008, 0.065]
Model B2: sleep duration→stress
Direct effects
WH→SD_w	−0.180	0.069	0.009	[−0.313, −0.047]
SD_w→PSS	−0.211	0.072	0.003	[−0.352, −0.072]
PSS→AS	0.489	0.074	<0.001	[0.332, 0.630]
Indirect (total indirect) effect
WH→SD_w→PSS→AS	0.019	0.009	0.047	[0.004, 0.040]

[i] AS – anxiety symptoms; CI – confidence interval; PSS – perceived stress scale; SD_w – sleep duration on workdays; SE – standard error; SQ – subjective sleep quality; WH – working hours. Note: In both models the effects of potential confounders were controlled for as described in the Methods section. Additionally, in Model B2, sleep quality was added to the confounder list for SD_w, PSS, and the outcome

References

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Articles in this issue

DOI: https://doi.org/10.2478/aiht-2025-76-3954 | Journal eISSN: 1848-6312 (formerly 0004-1254) | Journal ISSN: 0004-1254

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Language: English, Croatian

Page range: 102 - 112

Submitted on: Feb 1, 2025

Accepted on: May 1, 2025

Published on: Jun 30, 2025

Published by: Institute for Medical Research and Occupational Health

In partnership with: Paradigm Publishing Services

Keywords:

Cohen’s Perceived Stress Scale,

Zung Self-Rating Anxiety Scale

Related subjects:

Medicine,

Basic medical science,

Basic medical science, other

© 2025 Patricia Tomac, Iva Japundžić Rapić, Liborija Lugović-Mihić, Jelena Macan, Adrijana Košćec Bjelajac, published by Institute for Medical Research and Occupational Health
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 76 (2025): Issue 2 (June 2025)

Working hours indirectly affect anxiety symptoms through sleep and stress in dentists, physicians, and psychotherapists

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