Association of Endocrine-Metabolic Disorders with Depression and Anxiety in Nurses: A Prospective Cohort Study

Background The association between various endocrine-metabolic disorders and symptoms of depression and anxiety has been established in the general population. However, longitudinal evidence regarding these associations within nurse populations remains limited. Objective Aimed to identify specific endocrine and metabolic diseases associated with an increased risk of depression and anxiety, and to delineate relevant occupational, behavioral, and physiological susceptibility factors within the nursing population. Methods We conducted a prospective cohort study among registered nurses from a tertiary hospital in Hubei Province. Eligible participants were those without depressive or anxiety symptoms at baseline (January 2024). Baseline data on sociodemographic characteristics, lifestyle factors, disease history, and psychological scale scores were collected via questionnaires. The primary exposures were predefined endocrine-metabolic disorders (thyroid disease, polycystic ovary syndrome(POCS), gastric/duodenal ulcer, and diabetes), ascertained through a self-reported disease history questionnaire. The primary outcomes were the 12-month incidence of depressive symptoms and anxiety symptoms, assessed at follow-up using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) scale, respectively. Logistic regression models were used to analyze the longitudinal associations between endocrine-metabolic disorders and the incidence of depressive or anxiety symptoms. Stratified analyses were performed to evaluate potential effect modification by selected covariates. Results A total of 2,888 participants contributed complete data at both baseline and follow-up. At baseline, depressive symptoms were present in 1577 nurses (54.61%) and anxiety symptoms in 940 (34.42%). In adjusted analyses, hypothyroidism was significantly associated with an increased risk of incident depressive symptoms (adjusted odds ratio [aOR] = 2.004,95%CI: 1.159 ~ 3.463). For incident anxiety symptoms, hypothyroidism, gastric/duodenal ulcer, and PCOS were significant independent predictors. The corresponding aORs were1.631(95%CI:1.012 ~ 2.629) for hypothyroidism, 1.707(95%CI:1.085 ~ 2.685) for gastric/duodenal ulcer, and 2.058(95%CI:1.350 ~ 3.136) for PCOS. A sleep duration of ≤ 7 hours per day was associated with a higher risk of incident depressive symptoms, while sleep duration ≤ 6 hours and night shift work were associated with an increased risk of incident anxiety symptoms (all P  < 0.05). Furthermore, stratified analyses indicated that the risk of anxiety associated with hypothyroidism was significantly higher among nurses who did not engage in regular exercise compared to those who did ( P for interaction = 0.010). In contrast, no significant effect modification was observed for gender, age, night shift work, smoking status, alcohol use, or sleep duration on the associations between endocrine-metabolic disorders and either depressive or anxiety outcomes (all P for interaction > 0.05). Conclusion This prospective cohort study identified hypothyroidism as a significant longitudinal risk factor for both incident depressive and anxiety symptoms. Gastric/duodenal ulcer and PCOS were also independently associated with an increased risk of incident anxiety symptoms. Furthermore, night shift work and insufficient sleep duration were confirmed as independent risk factors for these mental health outcomes.