Neuro-circadian Disruption and Occupational Health Resilience in Psychiatric Nursing: A Systematic Review of Sleep–Emotion–Stress Interconnections and Evidence-Based Interventions

Abstract

Psychiatric nursing is distinctively demanding, requiring high-intensity emotional labor, crisis intervention, and ethical decision-making amidst unpredictable clinical environments. The intersection of shift work, circadian misalignment, and occupational stress creates specific neurobiological and psychosocial vulnerabilities that threaten nurse well-being. This systematic review synthesizes evidence regarding the reciprocal relationships between sleep disturbance, emotional dysregulation, and occupational stress in psychiatric nurses and evaluates interventions designed to foster resilience. Following PRISMA 2020 guidelines, we searched PubMed, Scopus, Web of Science, CINAHL, PsycINFO, and Google Scholar for studies published between January 2020 and March 2025. Eligibility criteria included peer-reviewed studies involving psychiatric or mental health nurses that addressed sleep, emotional regulation, or occupational stress. Quality was appraised using AMSTAR 2, Cochrane RoB 2, the Newcastle–Ottawa Scale, and CASP tools. The review included 89 studies representing over 45,000 nurses across 28 countries. Results indicated that 38.6% of participants suffered from poor sleep quality, while moderate burnout and secondary traumatic stress scores averaged 24.99 and 21.99, respectively. Data revealed a bidirectional relationship between sleep quality and emotion regulation, mediated significantly by occupational stress. Notably, night-shift work increased sleep disorder risk by 1.6-fold. Interventions such as bright-light therapy and mindfulness training improved sleep efficiency, whereas organizational-level programs demonstrated sustained burnout reduction. Neuro-circadian disruption, emotional dysregulation, and occupational stress constitute a reinforcing triad that degrades professional resilience. To sustain the psychiatric nursing workforce, it is critical to integrate circadian-informed scheduling with psychosocial support and mindfulness-based strategies.

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