Yuan Zhang, PhD, RN, Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell. Alicia Dugan, PhD, Division of Occupational and Environmental Medicine, University of Connecticut School of Medicine Sundus Siddique, MBBS, MPH, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Laura Punnett, ScD, Department of Biomedical Engineering, Francis College of Engineering, University of Massachusetts Lowell

This study seeks to: (1) describe the association between work-family conflict and depressive symptoms among healthcare workers; and (2) examine the role of one modifiable personal factor (sleep) and one modifiable organizational factor (decision latitude) in the association between work-family conflict and depressive symptoms.

Depression is the leading cause of disability worldwide and has higher rates in healthcare workers than the general public. Work-family conflict is bi-directional, including work interference with family and family interference with work. It is a significant source of stress for workers and may lead to depression and poor health. Sleep, as a significant dimension of self-care, may be impaired by work-family conflict; and, on the other hand, affect employees? mental health. Decision latitude, defined as the ability to influence job decisions, is a key psychosocial determinant of worker health and may have a transformative effect at the workplace. It is plausible that sleep and decision latitude influence or contribute directly to the association between work-family conflict and depressive symptoms.

A cross-sectional in-person survey was collected with 1,060 healthcare workers from five public sector facilities in the northeast U.S. Questions measuring socio-demographics, work-family conflict, sleep quantity and quality, depressive symptoms, and working conditions such as decision latitude, physical demands, psychological demands, social support, schedule control, job hazards, workplace safety, emotional labor, organizational support for safety, negative acts, assaults, and weekly work and overtime hours. Multivariable linear and Poisson regression models were used to examine associations among variables and to test potential mediating and moderating effects.

Nearly a quarter of the respondents reported depressive symptoms, over one-half reported short sleep duration (?6 hours per day), and nearly one-third reported sleep disturbances. There was a significant association between work-family conflict and depressive symptoms (?=2.73, p<0.001), after adjusting for multiple working conditions and sociodemographic variables. Sleep disturbances partially mediated this association by 27.5%. Decision latitude moderated the association between work family-conflict and depressive symptoms (?=-1.71, p<0.01): healthcare workers with low decision latitude had a stronger association than those with medium to high levels.

Consistent with our prior expectation, work-family conflict was significantly associated with depressive symptoms among healthcare workers. Sleep disturbances mediated the relationship, while decision latitude served as a significant moderator. The mediating role of sleep in this association has been previously reported in nursing home employees and hospital nurses. To our knowledge, this is the first study reporting decision latitude as a moderator. The findings suggest that evidence-based interventions at both the individual and organizational levels should seek to reduce work-family conflict, promote employee sleep hygiene, and improve employees? decision-making at work.

Modifiable personal factors such as sleep disturbances and modifiable organizational factors such as decision latitude play important roles in translating work-family conflict into depressive symptoms. Future longitudinal studies with a nationally representative sample are needed to verify these associations.

Tags: Empirical study, Fit; Balance; Conflict; Spillover; and Enrichment, Health care and social assistance, Organization- and Job-Level Environments and Practices, Organizational Practices, Sleep and Fatigue, Work - Life - Family, Workplace Stress; Outcomes; and Recovery