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Abstract

The purpose of this study was to investigate the relationship among Turkish primary health care workers’ socio-demographic characteristics, working conditions, and anxiety. A cross-sectional study was conducted with 88 of 103 (85.4%) eligible health care workers from the city of Mugla participating. The participants’ average age was 31 years, 85.2% were university graduates, 30.7% were nurses, and 64.8% had been working between 11 and 20 years at the time of the study; 93.6% worked 8 hours each day or less. State anxiety scores for males (p = .016), health care workers age 31 or older (p = .035), nurse participants (p = .043), and individuals who had worked 11 or more years (p = .044) were significantly higher than the rest of the sample; however, trait anxiety scores for participants who did not work overtime and were not scheduled for shift work were significantly higher (p = .033 and p = .004, respectively) than the rest of the sample. According to the logistic regression analysis, risk factors for anxiety included being male and older than 31 years.

Keywords

primary health care workers working conditions anxiety

Factors causing anxiety among workers are increasing, and psychosocial causes are the most common (Bennett, Williams, Page, Hood, & Woollard, 2004; Edimansyah et al., 2008; World Health Organization [WHO], 1990). Stress, defined as the response to any non-specific request of the body, is encountered frequently in work environments (Foxall, Zimmerman, Standley, & Captain, 1990). From the perspective of work life, stress is the worker’s perception of requests in the work environment, “a negative compulsion,” “a threat to the peace and health,” or “a fear of failure” (Kaufmann, Pornschlegel, & Udris, 1982). According to an International Labour Organization (ILO) publication, stress in the workplace is the biological and psychological response of workers to their environments (Levi, 1998). Encountering stressful incidents can result in anxiety (Mahan et al., 2010; Stein & Hollander, 2002). Anxiety may be a short-term response to work-related stress (Petersen, 1999).

The word anxiety is derived from the Latin “angere,” meaning “occlusion, suffocation” (Berksun, 2003). Anxiety warns individuals of impending danger and motivates individuals to take precautions (Tukel, 2000). Freud (1894) described anxiety as a motivational condition resulting in defensive behavior. However, anxiety also plays a role in many psychiatric disorders (Nutt, Feeney, & Argyroppolous, 2002).

Anxiety may also contribute to occupational injuries and illnesses, particularly affecting physical, intellectual, and social health (Beck, Rowlins, & Williams, 1988). Symptoms of anxiety include restlessness, dyspnea, and a general state of excitement. In addition, chronic anxiety is related to burnout syndrome (Ersoy, Yıldırım, & Edirne, 2001; Turnipseed, 1998). Anxiety may result in job dissatisfaction; a nursing study showed a negative association between their work satisfaction and anxiety (Durmuş & Günay, 2007). Individuals frequently encounter both anxiety and fear. Although these two emotions are distinct, they are often related (Yuksel, 2006). Anxiety may increase fear and lead to violence (Noyes & Saric, 1998).

Anxiety may contribute to occupational accidents and resulting injuries (Galazzi, Rancati, & Milos, 2014; Walter, Bourgois, Margarita Loinaz, & Schillinger, 2002). A study of 60 adults working in the fabricated metal products sector found that 37 workers had experienced work-related accidents and 64.8% of those workers had been diagnosed with psychiatric disorders; anxiety was one of the most common psychiatric disorders identified (Spor, Akbulut, Turkbikmaz, & Akayoglu, 1988). In another study of ship builders, workers who had experienced occupational accidents were found to have higher anxiety scores compared with workers who had not reported work-related injuries (L. Onen, Issever, & Sabuncu, 1998).

Negative working conditions are associated with anxiety; 82% of employees on the night shift working in Turkey’s iron and steel industry were found to suffer from anxiety (L. Onen, 1990). The literature documents many examples of traumatic workplace events that could cause anxiety (Taino, Pezzuto, Pucci, & Imbriani, 2014; Wicker et al., 2014), or anxiety may have contributed to these work-related injuries (Galazzi et al., 2014; Walter et al., 2002).

Several studies have reported that health care workers are likely to suffer from anxiety (Bennett, Lowe, Matthews, Dourali, & Tattersall, 2001; Canbaz et al., 2008; Ding, Qu, Yu, & Wang, 2014; Donmez, Aktekin, Erengin, Dinc, & Karaman, 1996; Fiabane, Giorgi, Sguazzin, & Argentero, 2013; Gorak & Yildiz, 1992; Hayran, Cali, & Harmanci, 1994; Laranjeira, 2011; Lim, Bogossian, & Ahern, 2010; Lindsay, Hanson, Taylor, & McBurney, 2008; McEwan & Goldenberg, 1999; R. Onen, Kaptanoglu, & Aksaray, 1993; Weinberg & Creed, 2000). Health care workers practice in high stress environments. Risk factors for anxiety among health care workers should be identified.

This study examined the relationship among socio-demographic status and working conditions of Turkish primary health care workers in the city of Mugla and their state-trait anxiety levels.

Method

The governor of Mugla, Mugla S.K. University, and Mugla Provincial Directorate of Health approved this study, and primary health care workers consented verbally before the interview.

Study Population

This study was conducted in Mugla, a city of 838,324 residents located in southwestern Turkey. The city is a center for energy production and tourism (Turkey Statistical Information Services, 2014). One hundred three primary health care workers were practicing in the Mugla city center at the time of this study and comprised the study’s population (Public Health Directorate, 2014). The researchers chose to include all primary health care centers and health care workers (i.e., physicians, nurses, midwives, and laboratory assistants) working in the city center at the time of the study. Eighty-eight (85.5%) of the 103 primary health care workers agreed to participate, 6 refused to participate, and 9 could not be reached due to military service, parental leave, or annual leave. To gather data, a questionnaire was used during face-to-face 15- to 20-minute interviews with the health care workers at their offices. Data were collected between January 11, 2009, and February 15, 2009.

Instruments

Socio-demographic characteristics and working conditions

The independent variables for this study included gender, age, education, marital status, number of children, income other than salary, professional status, total (annual) work time, daily work hours, overtime in the last 12 months, and shift worked in the last 12 months.

State-Trait Anxiety Inventory (STAI)

Developed by Spielberger, Gorsuch, Lushene, Vagg, and Jacobs (1983), this inventory consists of two 20-item scales to differentiate state and trait anxiety. The state portion of the instrument (SAI) assesses individuals’ “present” feelings; the trait portion of the instrument (TAI) assesses how individuals “generally” feel (Spielberg et al., 1970). The STAI has been translated into many languages, including Spanish, Turkish, Japanese, Arabic, and Dutch (Barnes, Harp, & Junk, 2002). The reliability and validity of the scale have been assessed for the Turkish version. Reliability coefficients for the SAI were measured to be between 0.26 and 0.68 (Aydemir & Koroglu, 2000), 0.73 and 0.86 (Oner, 1997), and 0.83 and 0.87 (Oner & Compte, 1983). For TAI, reliability coefficients were reported to be between 0.71 and 0.86 (Aydemir & Koroglu, 2000), 0.16 and 0.54 (Oner, 1997), 0.94 and 0.96 (Oner & Compte, 1983), and 0.87 (Yakar & Pinar, 2013). Internal consistency and homogeneity coefficients were between 0.94 and 0.96 (Aydemir & Koroglu, 2000) and 0.86 and 0.92 (Oner, 1997) for SAI, and between 0.83 and 0.87 (Aydemir & Koroglu, 2000) and 0.83 and 0.92 (Oner, 1997) for TAI. The scale has been used in many Turkish research studies (Basol, Duygu, & Gökbakan, 2014; Dastan & Buzlu, 2011; Demir & Khorshid, 2010; Fidan, Ceyhun, & Kirpınar, 2011; Gurhan, Akyuz, Atici, & Kisa, 2009; Gurkan, Gulseven, & Eren, 2013; Ilhan, Demirbas, & Dogan, 2007; Issever, Ozdilli, Altunkaynak, Onen, & Disci, 2008; Kilic et al., 2015; Kocabas, 2013; Tasci, Guleser, Tokmakci, Eroglu, & Kaplan, 2012; Yucel & Sennaroglu, 2007).

Statistical Analyses

SPSS 15.0 was used to analyze the data. The compatibility of the mean scores from the questionnaire with a normal distribution was measured by the Kolmogorov–Smirnov test and Lilliefors test. The data were analyzed using t tests, one-way ANOVA, and logistic regression; p < .05 was considered statistically significant. Logistic regression analysis was also used to distinguish between anxiety and baseline variables. State anxiety (normal, higher than normal) and trait anxiety (normal, higher than normal) were grouped and included in the logistic regression model as dependent variables. Variables with a p value of <.10 per univariate regression analyses were included in the multiple logistic regression analysis using the conventional method of maximum likelihood and variable selection using backward elimination. A p value of <.10 was used as a criterion for retaining variables in the final model.

Results

The mean age of the primary health care worker participants was 37.14 ± 6.17. More than 79% of participants were female, 85.2% were 31 years or older, 85.2% had earned university degrees, 95.5% were married, 94.3% had children, and 87.5% reported no income apart from salary (e.g., portfolio income, rental income, or income from real estate). Nearly 49% of the participants were midwives, 64.8% had worked between 11 and 20 years, 93.6% worked 8 hours or less each day, 84.1% had not worked overtime in the last 12 months, 95.5% did not work shifts, and 92% did not work the night shift (Table 1).

Table 1.

Distribution of Socio-Demographic Characteristics and Working Conditions of Health Workers

Characteristics	N = 88	%
Socio-demographic
Gender
Female	70	79.5
Age group (years)
≥31	75	85.2
Educational level
University	75	85.2
Marital status
Married	84	95.5
Children situation
Yes	83	94.3
The presence of income other than salary
No	77	87.5
Working conditions
Occupational status
Physician	17	19.3
Nurse	27	30.7
Midwives	43	48.9
Laboratory assistant	1	1.1
Total working time (year)
≤10	12	13.6
11-20	57	64.8
≥21	19	21.6
Daily working time (hours)
≤8	82	93.6
Overtime work
No	74	84.1
Shift work
No	84	95.5
Night work
No	81	92

The mean state anxiety score was 41.94 ± 5.62, the median was 41.00, and the range was 31 to 61. The mean trait anxiety score was 43.53 ± 4.43, the median was 43, and the range was 33 to 53 (Table 2). According to the STAI, trait anxiety scores were higher than “normal adult levels” in 64.8% of the participants, and 53.4% of the sample exhibited higher state anxiety scores than “normal adult levels” (Table 3).

Table 2.

Distribution of State and Trait Anxiety Levels of Health Workers

Anxiety levels	N	M	Median	SD	Minimum	Maximum
State	88	41.94	41.00	5.62	31.00	61.00
Trait	88	43.53	43.00	4.43	33.00	53.00

Table 3.

Distribution of State and Trait Anxiety Levels of Health Workers Based on the Mean of Normal Adult Levels

The mean of normal adult levels (according to inventory^a)	N = 88	%
State anxiety
≤40.03 (normal)	41	46.6
≥40.04 (higher than normal)	47	53.4
Trait anxiety
41.58 (normal)	31	35.2
41.59 (higher than normal)	57	64.8

Spielberger State-Trait Anxiety Inventory.

The researchers determined that state anxiety scores were not related to education, marital status, having children, source of income, daily work hours, overtime, or shift work. Compared with other groups of health care workers, state anxiety scores for males (p = .016), workers aged 31 and older (p = .035), nurses (p = .043), and workers with 11 or more years of experience were significantly higher (Table 4).

Table 4.

Distribution of State and Trait Anxiety Levels of Health Workers Based on Socio-Demographic Characteristics and Working Conditions

	State anxiety		Trait anxiety
Characteristics	M ± SD	p value^a	M ± SD	p value^a
Gender
Male (n = 18)	44.78 ± 6.04	.016	42.94 ± 4.60	.53
Female (n = 70)	41.21 ± 5.31		43.69 ± 4.40
Age group
≤30 (n = 13)	38.92 ± 5.02	.035	42.85 ± 5.38	.547
≥31(n = 75)	42.97 ± 5.58		43.65 ± 4.27
Education (University)
Graduate (yes; n = 75)	41.00 ± 5.95	.821	43.45 ± 4.37	.684
Graduate (no; n = 13)	42.62 ± 3.22		44.00 ± 4.91
Marital status
Married (n = 84)	41.95 ± 5.61	.944	43.36 ± 4.37	.086
Not married (n = 4)	41.75 ± 6.70		47.25 ± 4.64
Income other than salary
Yes (n = 11)	41.64 ± 3.17	.848	43.82 ± 5.09	.822
No (n = 77)	41.99 ± 5.90		43.49 ± 4.36
Children situation
Yes (n = 83)	41.93 ± 5.60	.917	43.42 ± 4.44	.335
No (n = 5)	42.20 ± 6.61		45.40 ± 4.27
Occupational status
Nurse (n = 21)	42.51 ± 5.95	.043	43.90 ± 4.11	.663
Other (n = 67)	40.14 ± 4.00		43.42 ± 4.55
Total working time (year)
≤10 (n = 12)	38.92 ± 5.31	.044	42.33 ± 5.29	.315
≥11(n = 76)	42.42 ± 5.55		43.72 ± 4.28
Daily working time (hours)
≤8 (n = 82)	41.84 ± 5.76	.533	43.62 ± 4.49	.495
≥9 (n = 6)	43.33 ± 2.87		42.33 ± 3.61
Overtime work
Yes (n = 14)	41.07 ± 3.54	.53	43.84 ± 4.65	.033
No (n = 74)	42.11 ± 5.93		41.93 ± 2.49
Shift work
Yes (n = 4)	41.00 ± 3.55	.733	43.64 ± 4.50	.004
No (n = 84)	41.99 ± 5.71		41.25 ± 0.95
Night work
Yes (n = 7)	41.00 ± 4.08	.646	44.00 ± 4.43	.774
No (n = 81)	42.02 ± 5.74		43.49 ± 4.45

Note. The bold values are statistically significant.

t test.

With regard to trait anxiety scores, no significant differences were found by gender, age, education, marital status, presence of children, source of income, profession, work tenure, or daily work hours. Trait anxiety scores for health care workers who worked overtime and were assigned shift work were significantly higher than other groups (Table 4).

The logistic regression analysis showed that male participants 31 years and older were most likely to report significantly higher state anxiety (odds ratio [OR] = 3.9, confidence interval [CI] [1.03, 14.74], and OR = 5.8, CI [1.13, 30.01], respectively). Participants 31 years and older were significantly more likely to experience trait anxiety (OR = 7.8, CI [1.27, 24.19]; Table 5).

Table 5.

Risk Factors Affecting Anxiety According to Logistic Regression Analyses

Risk factors	B	p value	OR	95% CI[Lower, Upper]
State anxiety
Gender (male)	1.762	.035	5.825	[1.130, 13.013]
Age (years; ≥31)	1.365	.044	3.917	[1.038, 14.742]
Constant	−1.045	.045
Trait anxiety
Age (years; ≥31)	2.065	.026	7.888	[1.279, 12.195]
Constant	−1.146	.034

Note. The bold values are statistically significant. OR = odds ratio; CI = confidence interval.

Discussion

State anxiety scores of male health care workers were found to be significantly higher than female workers’ state anxiety scores. A few studies have confirmed this finding (Baturlu & Erden, 2007; Donmez et al., 1996; Sun, Ful, Ying Chang, & Wang, 2012; Uskul, Selvi, & Melikoglu, 2006). This finding may be explained by the lower number of males participating in the study because males are more often assigned to mobile health services than females (e.g., violence and harassment are more common when providing mobile health services). Examples of anxiety-producing traumatic events that have occurred during work hours are documented in the literature (Taino et al., 2014; Wicker et al., 2014). Both stress at work and outside of work contribute to anxiety experienced by health care staff (Weinberg & Creed, 2000). However, anxiety, in general, has been more often observed in females than males (Canbaz et al., 2008; Foot & Koszycki, 2004; Olatunji & Wolitzky-Taylor, 2009; Sahin, Batigun, & Uzun, 2011; Stewart, Taylor, & Baker, 1997; Tasdemir, Erakgun, Deniz, & Certug, 2013). Women have reported higher levels of anxiety than men in studies of physician interns in Istanbul (Hayran et al., 1994), general practitioners in England (Sutherland & Cooper, 1992), and physicians in China (Gong et al., 2014). One explanation for this gender difference may be that psychiatric disorders are reported more often in women than men in the general population (American Psychiatric Association [APA], 2013).

Compared with younger workers, older workers reported higher levels of anxiety. Health workers, 31 years and older, were found to have statistically higher state anxiety scores than younger workers. In Ankara, nurses 46 years and older reported higher anxiety scores than younger nurses (Gorgulu, 1998). In Turkey, older workers in emergency units had higher anxiety scores than younger workers (Canbaz et al., 2008). As the proportion of older employees in the workforce increases, researchers have become increasingly interested in the association between age and anxiety. The curvilinear nature of this relationship has been documented in the literature with employees in their late 20s to early 40s generally reporting lower levels of anxiety than older employees (APA, 2013; Kouri, Di Giampaolo, Toto, Cerrone, & Boscolo, 2001; Zacher, Jimmieson, & Bordia, 2014). A few studies have reported that anxiety is not affected by age (Picakciefe, Ergor, Kilic, & Yemez, 2006; Uskul et al., 2006).

No significant difference was detected for mean STAI scores by health workers’ educational status (p > .05). Some studies have confirmed this finding (Sirin, Kavak, & Ertem, 2003; Tuncer & Yucel, 2014; Turhan, 2007; Uskul et al., 2006). However, health workers with the lowest mean STAI score were university graduates. Similar studies have supported the same result (Ay, 1992; Gorgulu, 1998; Picakciefe et al., 2006). In the literature, it is reported that individuals with more education better cope with the stress and anxiety of diagnosing and treating illness and injury (Pan et al., 2013; Stafford et al., 2014). Similarly, in another study, it was found that individuals with higher educational levels have better coping mechanisms, and they use these mechanisms to improve their quality of life (Malik & Kiran, 2013).

When researchers assessed primary health care workers, nurses had higher state anxiety scores compared with other workers (Taghavi, Sharifi Neiestanak, Aghajani, & Mehran, 2009; Yalcin & Ilhan, 2008). More than 80% of primary health care workers in this study had practiced for 11 years or more. Assessing anxiety levels based on senority, the longer workers had worked, the higher their anxiety levels. Similar studies have supported the same result (Durmuş & Günay, 2007; Issever, Onen, & Sabuncu, 2002; Issever, Sabuncu, & Onen, 1999; Ocaktan, Keklik, & Çol, 2002), which may be explained by the increased exposure to stress workers with longer tenure experience.

Under Article 99 of Law No. 657 on Civil Servants and the European Union’s Council Amending Working Time Directive 1993/104/EC and 2003/88/EC, every worker is entitled to work 40 hours a week and 8 hours a day (Ekici & Ozcelik, 2011); 15.9% of health care workers in this study worked overtime. Frequent overtime violates regulations regarding standard work hours and could endanger workers’ health, security, and well-being (Clerk, 1989). Trait anxiety was higher for workers who worked overtime in this study.

Few study respondents worked shifts or at night (i.e., 4.5% and 8.0%, respectively). However, trait anxiety was significantly higher for workers in this study who worked shifts. Shift work may be associated with mental health; however, limited research on this issue was found in the literature, and the results so far are inconclusive. A recent review on the topic concluded that causal relationships between shift work and mental health are not well established due to the correlational cross-sectional design of the majority of these studies (Vogel, Braungardt, Meyer, & Schneider, 2012). Some findings on this topic are nonetheless reported in the literature. Individuals working shifts have been found to report high levels of fatigue (Shen et al., 2006; Yuan et al., 2011); employee fatigue contributes to accidents and injuries and affects occupational performance, safety, and health (Yumang-Ross & Burns, 2014) In addition, shift work may negatively affect concentration and be associated with depression, anger, and anxiety (Houry, Shockley, & Markovchick, 2000). A study by Bara and Arber (2009) found that women who worked more than 2 years of shift work and men who worked more than 4 years of night work were more likely to report depression and anxiety.

Study Limitations

This study had several limitations. First, the study was conducted in a single city’s primary health care centers; hospitals and private facilities were not included. The inability to generalize may affect the findings of this study. Second, the interviews were conducted during working hours, which may have affected the number of workers who participated in the study. Third, the study was based on self-reported information, so the findings may not be completely accurate. Fourth, recall bias may have affected the accuracy of the data collected. Fifth, meaningful statistical analyses were constrained due to the small sample size and the resulting lack of statistical power. Sixth, because this is a cross-sectional study, the researchers cannot establish causality between anxiety and related risk factors. Future longitudinal studies should be conducted to confirm the conclusions from this study. Finally, because this study was conducted only in Mugla, Turkey, these results cannot be generalized to all Turkish primary care workers. Future studies are needed using larger samples in several health care centers in different regions of Turkey.

Conclusion

This study established a connection between socio-demographic characteristics, working conditions, and anxiety. Anxiety affects workers’ mental health and general well-being. Therefore, risk factors for anxiety should be identified and ameliorated to protect workers from illness and injury. Health care workers should be monitored for the effects of anxiety on worker health. Workers should learn effective ways of coping with occupational stressors, including strategic problem solving, developing a social support network, and exercising self-control, escape-avoidance, and distancing. In addition, access to an Employee Assistance Program for early identification and treatment of anxiety-related disorders should be instituted. Commitment from employers is essential to adequately measure the scope of anxiety-related disorders among health care workers. The implementation of reporting mechanisms that foster the identification of stressful events is necessary for developing targeted prevention strategies as well as testing their effectiveness. Occupational health nurses are essential members of the occupational safety and health team, which must address this serious public health issue (AAOHN, 2014).

Applying Research to Practice

Health care workers should be monitored for the effects of anxiety on worker health. Workers should learn effective ways of coping with occupational stressors, including strategic problem solving, developing a social support network, and exercising self-control, escape-avoidance, and distancing. In addition, access to an Employee Assistance Program for early identification and treatment of anxiety-related disorders should be instituted. Commitment from employers is essential to adequately measure the scope of anxiety-related disorders among health care workers. The implementation of reporting mechanisms that foster the identification of stressful events is necessary for developing targeted prevention strategies as well as testing their effectiveness. Further information can be found on the OSHA website (https://www.osha.gov/).

Footnotes

Acknowledgements

The authors thank all workers who participated in this study and the reviewers for their insightful and helpful comments. Thanks to all those who cooperated in this research, including the Provincial Director of Mugla City Health and Mugla Governorship and Mugla S.K University.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Metin Picakciefe is MD, PhD, associate professor, Head of Department of Public Health, Faculty of Medicine, Mugla S.K. University, Turkey.

Aynur Turgut, RN, is a nurse, School of Health Sciences, University of Mugla S.K., Turkey.

Emel Igneci, RN, is a nurse, School of Health Sciences, University of Mugla S.K., Turkey.

Fatih Cayli, RN, is a nurse, School of Health Sciences, University of Mugla S.K., Turkey.

Artuner Deveci is MD, associate professor, Department of Psychiatry, Faculty of Medicine, Celal Bayar University, Turkey

References

AAOHN. (2014). Preventing workplace violence: The occupational and environmental health nurse role. AAOHN Journal, 62, 48-50. doi:10.3928/21650799-20140121-01

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

(1992). An investigation of “levels of state-trait anxiety” that nurses, who work at Dokuz Eylul University Practice and Research Hospital (Master thesis). Ege University, Izmir, Turkey.

Aydemir

Koroglu

(Eds.). (2000). Clinical scales used in psychiatry. State Trait Anxiety Inventory. Ankara, Turkey: Physicians Publication Union.

Bara

A. C.

Arber

(2009). Working shifts and mental health—Findings from the British Household Panel Study (1995-2005). Scandinavian Journal of Work, Environment & Health, 35, 361-367. doi:10.5271/sjweh.1344

Barnes

L. B.

Harp

Junk

(2002). Reliability generalization of scores on the Spielberger State-Trait Anxiety Inventory. Educational and Psychological Measurement, 62, 603-618.

Basol

Duygu

Gökbakan

A. M.

(2014). Anxiety experienced in the fear of disease: Tick bite and crimean-congo hemorrhagic fever. Acta Medica Mediterranea, 30, 691-696.

Baturlu

D. Z.

Erden

(2007). The relationship between foreign language anxiety and English achievement of Yıldız Technical University School of Foreign Languages preparatory students. Journal of Theory and Practice in Education, 3, 24-38.

Beck

C. K.

Rowlins

R. P.

Williams

R. S.

(1988). Mental health psychiatric nursing (2nd ed.). Toronto, Ontario, Canada: The C. V. Mosby Company.

10.

Bennett

Lowe

Matthews

Dourali

Tattersall

(2001). Stress in nurses: Coping, managerial support and work demand. Stress & Health, 17, 55-63. doi:10.1002/1532-2998

11.

Bennett

Williams

Page

Hood

Woollard

(2004). Levels of mental health problems among UK emergency ambulance workers. Emergency Medicine Journal, 21, 235-236. doi:10.1136/emj.2003.005645

12.

Berksun

O. E.

(2003). Anxiety and anxiety disorders (2nd ed.). Istanbul, Turkey: Turgut Press.

13.

Canbaz

Dundar

Dabak

Sunter

A. F.

Pekseken

Cetinoglu

E. C.

(2008). Violence towards workers in hospital emergency services and in emergency medical care units in Samsun: An epidemiological study. Ulus Travma Acil Cerrahi Derg, 14, 239-244.

14.

Clerk

J. M.

(1989). Introduction to working conditions and environment (2nd ed.). Geneva, Switzerland: International Labor Office.

15.

Dastan

N. B.

Buzlu

(2011). Depression and anxiety levels in early stage Turkish breast cancer patients and relation factors. Asian Pacific Journal of Cancer Prevention, 12, 137-141.

16.

Demir

Khorshid

(2010). The effect of cold application in combination with standard analgesic administration on pain and anxiety during chest tube removal: A single-blinded, randomized, double-controlled study. Pain Management Nursing, 11, 186-196. doi:http://dx.doi.org/10.1016/j.pmn.2009.09.002

17.

Ding

Wang

(2014). The mediating effects of burnout on the relationship between anxiety symptoms and occupational stress among community healthcare workers in China: A cross-sectional study. PLoS ONE, 9, 1-7. doi:10.1371/journal.pone.0107130

18.

Donmez

Aktekin

Erengin

Dinc

Karaman

(1996). State and trait anxiety among physicians and medical students. SP Dergisi, 4, 268-275.

19.

Durmuş

Günay

(2007). Factors affecting job satisfaction and anxiety levels in the nurses. Erciyes Medical Journal, 29, 139-146.

20.

Edimansyah

B. A.

Rusli

B. N.

Naing

Rusl

B. A. M.

Winn

Ariff

R. H. T.

(2008). Self-perceived depression, anxiety, stress and their relationships with psychosocial job factors in male automotive assembly workers. Industrial Health, 46, 90-100. doi:http://doi.org/10.2486/indhealth.46.90

21.

Ekici

Ozcelik

(2011). Physicians’ working hours, night work, overtime costs, recreation and vacation rights (1st ed.). Ankara: Turkish Medical Association. Retrieved from http://www.ttb.org.tr/kutuphane/nobet_2011.pdf

22.

Ersoy

Yıldırım

Edirne

(2001). Staff burnout syndrom. STED, 10, 46-47.

23.

Fiabane

Giorgi

Sguazzin

Argentero

(2013). Work engagement and occupational stress in nurses and other healthcare workers: The role of organizational and personal factors. Journal of Clinical Nursing, 22, 2614-2624. doi:10.1111/jocn.12084

24.

Fidan

Ceyhun

Kirpınar

(2011). Coping strategies and family functionality in youths with or without suicide attempts. Archives of Neuropsychiatry, 48, 195-200. doi:10.4274/Npa.Y5785

25.

Foot

Koszycki

(2004). Gender differences in anxiety-related traits in patients with panic disorder. Depress Anxiety, 20, 123-130.

26.

Foxall

M. J.

Zimmerman

Standley

Captain

B. B.

(1990). A comparison of frequency and sources of nursing job stress perceived by intensive care, hospice and medical-surgical nurses. Journal of Advanced Nursing, 15, 577-584.

27.

Freud

(1894). On the grounds for detaching a particular syndrome from neurasthenia under the description anxiety neurosis. In Strachey

(Ed.), The standard ed. of the complete psychological works of Sigmund Freud (Vol. 3, pp. 85-117). London, England: Hogarth.

28.

Galazzi

Rancati

Milos

(2014). A survey of accidents during the clinical rotation of students in a nursing degree program. Giornale italiano di medicina del lavoro ed ergonomia, 36, 25-31.

29.

Gong

Han

Chen

Dib

H. H.

Yang

Zhuang

. . . Lu

(2014). Prevalence of anxiety and depressive symptoms and related risk factors among physicians in China: A cross-sectional study. PLoS ONE, 9, 1-7. doi:10.1371/journal.pone.0103242

30.

Gorak

Yildiz

(1992). The effect of nursing experience, to the level of anxiety. IV (Books of Abstracts, pp. 488-493). Sivas, Turkey: National Nursing Congress.

31.

Gorgulu

R. S.

(1998). Determination of the level of anxiety of nurses and nurses identify stressors that affect the business environment (Doctoral thesis). Hacettepe University, Ankara, Turkey.

32.

Gurhan

Akyuz

Atici

Kisa

(2009). Association of depression and anxiety with oocyte and sperm numbers and pregnancy outcomes during in vitro fertilization treatment. Psychological Reports, 104, 796-806. doi:10.2466/PR0.104.3.796-806

33.

Gurkan

Gulseven

Eren

(2013). Yoga after coronary artery bypass graft surgery: Its effect on anxiety and self-care agency. HealthMED, 7, 211-216.

34.

Hayran

Cali

Harmanci

H. G.

(1994). Specialization in medicine as a source of anxiety. IV (Books of Abstracts, pp. 1-3). Didim, Turkey: Congress on Public Health.

35.

Houry

D. E.

Shockley

L. W.

Markovchick

(2000). Wellness issues and the emergency medicine resident. Annals of Emergency Medicine, 35, 394-397. doi:10.1016/S0196-0644(00)70060-6

36.

Ilhan

I. O.

Demirbas

Dogan

Y. B.

(2007). Psychosocial factors in alcohol use-related problems of working youth. Substance Use & Misuse, 10, 1537-1544. doi:10.1080/10826080701212444

37.

Issever

Onen

Sabuncu

(2002). Personality characteristics, psychological symptoms and anxiety level of drivers in charge of urban transportation in Istanbul. Occupational Medicine, 52, 297-303.

38.

Issever

Ozdilli

Altunkaynak

Onen

Disci

(2008). Depression in tax office workers in Istanbul and its affecting factors. Indoor and Built Environment, 17, 414-420. doi:10.1177/1420326X08096609

39.

Issever

Sabuncu

Onen

(1999). The state and trait anxiety levels of fire employees. The Medical Journal of Goztepe Training and Research Hospital, 14, 79-81.

40.

Kaufmann

Pornschlegel

Udris

(1982). Workload and stress. In Zimmermann

(Ed.), Stress and strain at the work (pp. 13–48). Reinbek, Germany: Rowohlt.

41.

Kilic

S. P.

Karadag

Oyucu

Kale

Zengin

Ozdemir

Korhan

E. A.

(2015). Effect of music on pain, anxiety, and patient satisfaction in patients who present to the emergency department in Turkey. Japan Journal of Nursing Science, 12, 44-53. doi:10.1111/jjns.12047

42.

Kocabas

(2013). The effects of cooperative learning on continual and state anxiety and musical performance in teaching music. International Journal of New Trends in Arts, Sports & Science Education, 2, 28-35.

43.

Kouri

Di Giampaolo

Toto

Cerrone

Boscolo

(2001). Anxiety, life style and obstetric history of women working in a high-fashion clothing industry. Giornale italiano di medicina del lavoro ed ergonomia, 23, 438-441.

44.

Laranjeira

C. A.

(2011). The effects of perceived stress and ways of coping in a sample of Portuguese health workers. Journal of Clinical Nursing, 21, 1755-1762. doi:10.1111/j.1365-2702.2011.03948.x

45.

Levi

(1998). Stress. Encylopedia of occupational safety and health. Geneva, Switzerland: International Labour Organization.

46.

Lim

Bogossian

Ahern

(2010). Stress and coping in Australian nurses: A systematic review. International Nursing Review, 57, 22-31.

47.

Lindsay

Hanson

Taylor

McBurney

(2008). Workplace stressors experienced by physiotherapists working in regional public hospitals. Australian Journal of Rural Health, 16, 194-200. doi:10.1111/j.1440-1584.2008.00980.x

48.

Mahan

Park

Shelton

Brown

Weaver

(2010). Work environment stressors, social support, anxiety, and depression among secondary school teachers. AAOHN Journal, 58, 197-205. doi:10.1177/216507991005800504

49.

Malik

A. A.

Kiran

(2013). Psychological problems in breast cancer patients: A review. Chemotherapy, 2, 2-6. doi:10.4172/2167-7700.1000115

50.

McEwan

Goldenberg

(1999). Achievement motivation, anxiety and academic success in first year master of nursing students. Nurse Education Today, 19, 419-430. doi:10.1054/nedt.1999.0327

51.

Noyes

R. J. R.

Saric

R. H.

(1998). Anxiety disorders. Istanbul, Turkey: Medikal Press.

52.

Nutt

Feeney

Argyroppolous

(2002). Anxiety disorders comorbid with depression: Panic disorders and agoraphobia. London, England: Martin Dunitz.

53.

Ocaktan

M. E.

Keklik

Çol

(2002). The level of Spielberger State and trait anxiety of health workers in Abidinpasa Health Care. Ankara University. Faculty of Medicine Publications, 1, 21-28.

54.

Olatunji

B. O.

Wolitzky-Taylor

K. B.

(2009). Anxiety sensitivity and the anxiety disorders: A meta-analytic review and synthesis. Psychological Bulletin, 135, 974-999. doi:http://dx.doi.org/10.1037/a0017428

55.

Onen

(1990). The structure of the social and psychological impact of the employee’s perception of warning signs workplace (5th National Psychology Congress). Journal of Psychology and Seminar, 5, 411-419.

56.

Onen

Issever

Sabuncu

(1998). Evaluation of anxiety and attention to workers in the shipbuilding branch (3rd National Occupational Congress). Ankara: Turkish Medical Association.

57.

Onen

Kaptanoglu

Aksaray

(1993). The distribution of general physicians working in emergency departments and psychiatric symptoms assessment of the degree of stress. Community and Physician, 1, 15-19.

58.

Oner

(1997). Psychological tests used in Turkey (3rd ed.). Istanbul, Turkey: Bogazici University, Faculty of Education.

59.

Oner

Compte

A. L.

(1983). Manual of State-Trait Anxiety Inventory (Bogazici University Press No. 333). Istanbul, Turkey. Bogazici University.

60.

Pan

X. F.

Fei

M. D.

Zhang

K. Y.

Fan

Z. L.

F. H.

Fan

J. H.

(2013). Psychopathological profile of women with breast cancer based on the symptom checklist-90-R. Asian Pacific Journal of Cancer Prevention, 4, 6579-6584. doi:10.7314/APJCP.2013.14.11.6579

61.

Petersen

C. L.

(1999). Stress at work. New York, NY: Baywood.

62.

Picakciefe

Ergor

Kilic

Yemez

(2006). The relationship between the components of working life and anxiety (X. Congress on Public Health. Van. Books of Abstracts, 173). Van, Turkey: Yuzuncu Yil University.

63.

Public Health Directorate. (2014). Mugla. Retrieved from http://www.muglahsm.gov.tr/

64.

Sahin

N. H.

Batigun

A. D.

Uzun

(2011). Anxiety disorder: A study on interpersonal style, self perception, and anger. Anadolu Psikiyatri Derg, 12, 107-113.

65.

Shen

Botly

L. C.

Chung

S. A.

Gibbs

A. L.

Sabanadzovic

Shapiro

C. M.

(2006). Fatigue and shift work. Journal of Sleep Research, 15, 1-5.

66.

Sirin

Kavak

Ertem

(2003). Determination of state-trait anxiety levels of the students in the internship Maternity. Journal of Cumhuriyet University School of Nursing, 7, 27-32.

67.

Spielberger

C. D.

Gorsuch

R. L.

Lushene

Vagg

P. R.

Jacobs

G. A.

(1983). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press. Retrieved from http://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/trait-state.aspx

68.

Spor

Akbulut

Turkbikmaz

Akayoglu

(1988). Investigation of metal manufacture of articles of psychological factors in industrial accidents in business (2nd National Occupational Congress). Turkish Medical Association.

69.

Stafford

Judd

Gibson

Komiti

Quinn

Mann

G. B.

(2014). Comparison of the hospital anxiety and depression scale and the center for epidemiological studies depression scale for detecting depression in women with breast or gynecologic cancer. General Hospital Psychiatry, 36, 74-80. doi:10.1016/j.genhosppsych.2013.08.010

70.

Stein

D. J.

Hollander

(2002). Anxiety disorders comorbid with depression: Social anxiety disorder, post traumatic stress disorder, generalized anxiety disorder and obsessive-compulsive disorder. London, England: Martin Dunitz.

71.

Stewart

S. H.

Taylor

Baker

J. M.

(1997). Gender differences in dimensions of anxiety sensitivity. Journal of Anxiety Disorders, 11, 179-200. doi:10.1016/S0887-6185(97)00005-4

72.

Sun

Ful

Ying Chang

Wang

(2012). Epidemiological study on risk factors for anxiety disorder among Chinese doctors. Occupational Health, 54, 1-8. doi:http://doi.org/10.1539/joh.11-0169-OA

73.

Sutherland

V. J.

Cooper

C. L.

(1992). Job stress, satisfaction and mental health among general practitioners before and after introduction of new contract. British Medical Journal, 304, 1545-1548. doi:http://dx.doi.org/10.1136/bmj.304.6841.1545

74.

Taghavi

L. T.

Sharifi Neiestanak

N. D.

Aghajani

Mehran

(2009). Assertiveness and anxiety in midwifery and nursing students. Hayat Journal of Faculty of Nursing and Midwifery, 15, 92. Retrieved from https://doaj.org/article/4072d169c6ef41918ca1debf8932c52f

75.

Taino

Pezzuto

Pucci

Imbriani

(2014). Reactive anxiety crisis and chronic adjustment disorder: A unique case of work injury and suspected occupational disease. Giornale italiano di medicina del lavoro ed ergonomia, 36, 118-123.

76.

Tasci

Guleser

Tokmakci

Eroglu

Kaplan

(2012). Anxiety levels of women who receive radiation therapy for breast cancer. European Journal of Oncology Nursing, 16, 37. Retrieved from http://www.ejoncologynursing.com/article/S1462-3889(12)70115-1/abstract

77.

Tasdemir

Erakgun

Deniz

M. N. D.

Certug

(2013). Comparison of preoperative and postoperative anxiety levels with State-Trait Anxiety Inventory Test in preoperatively in formed patients. Turkish Journal of the Anaesthesiology and Reanimation, 41, 44-49. doi:10.5152/TJAR.2013.11

78.

Tukel

(2000). Anxiety disorders. Ankara, Turkey: Cizgi Medical Press.

79.

Tuncer

Yucel

S. C.

(2014). Comfort and anxiety levels of women with early stage breast cancer who receive radiotherapy. Asian Pacific Journal of Cancer Prevention, 15, 2109-2114.

80.

Turhan

(2007). The relationship between patient satisfaction, with preoperative and postoperative anxiety and who is undergoing ive surgery (Specialty thesis). Cukurova University, Adana, Turkey. Retrieved from http://library.cu.edu.tr/tezler/6510.pdf

81.

Turkey Statistical Information Services. (2014). Mugla, 2013. Ankara, Turkey: Turkey Statistical Information Services Press.

82.

Turnipseed

D. L.

(1998). Anxiety and burnout in the health care work environment. Psychological Reports, 82, 627-642. doi:10.2466/pr0.1998.82.2.627

83.

Uskul

Selvi

Melikoglu

(2006). Relationships between anxiety and depression levels and socio-demographical factors and diagnoses of the patients admitted in the department of chest diseases. Turkiye Klinikleri Arch Lung, 7, 11-15.

84.

Vogel

Braungardt

Meyer

Schneider

(2012). The effects of shift work on physical and mental health. Journal of Neural Transmission, 119, 1121-1132. doi:10.1007/s00702-012-0800-4

85.

Walter

Bourgois

Margarita Loinaz

Schillinger

(2002). Social context of work injury among undocumented day laborers in San Francisco. Journal of General Internal Medicine, 17, 221-229. doi:10.1046/j.1525-1497.2002.10501.x

86.

Weinberg

Creed

(2000). Stress and psychiatric disorder in healthcare professionals and hospital staff. The Lancet, 355, 533-537. doi:10.1016/S0140-6736(99)07366-3

87.

Wicker

Stirn

A. V.

Rabenau

H. F.

von Gierke

Wutzler

Stephan

(2014). Needlestick injuries: Causes, preventability and psychological impact. Infection, 42, 549-552. doi:10.1007/s15010-014-0598-0

88.

World Health Organization. (1990). Occupational health in the 1990s: A framework for change (European Occupational Health Series No. 1). København, Denmark: WHO Regional Office for Europe.

89.

Yakar

H. Y.

Pinar

(2013). Reliability and validity of Turkish version of The Caregiver Quality of Life Index Cancer Scale. Asian Pacific Journal of Cancer Prevention, 14, 4415-4419. doi:10.7314/APJCP.2013.14.7.4415

90.

Yalcin

Ilhan

S. E.

(2008). Awareness and self evaluation in nursing and midwifery students and its relationship with academic success. Education and Sciences, 33, 51-61.

91.

Yuan

S. C.

Chou

M. C.

Chen

C. J.

Lin

Y. J.

Chen

M. C.

Liu

H. H.

Kuo

H. W.

(2011). Influences of shift work on fatigue among nurses. Journal of Nursing Management, 19, 339-345.

92.

Yucel

Sennaroglu

(2007). Is psychological status a determinant of speech perception outcomes in highly selected good adolescent cochlear implant users? International Journal of Pediatric, 9, 1415-1422. doi:10.1016/j.ijporl.2007.05.015

93.

Yuksel

(2006). Mental disorders. Ankara, Turkey: Medikal and Nobel.

94.

Yumang-Ross

D. J.

Burns

(2014). Shift work and employee fatigue: Implications for occupational health nursing. AAOHN Journal, 62, 256-261. doi:10.1177/216507991406200606

95.

Zacher

Jimmieson

N. L.

Bordia

(2014). Time pressure and coworker support mediate the curvilinear relationship between age and occupational well-being. Journal of Occupational Health Psychology, 19, 462-475. doi:http://dx.doi.org/10.1037/a0036995

Relationship Between Socio-Demographic Features,Work-Related Conditions,and Level of Anxiety Among Turkish Primary Health Care Workers

Abstract

Keywords

Method

Study Population

Instruments

Socio-demographic characteristics and working conditions

State-Trait Anxiety Inventory (STAI)

Statistical Analyses

Results

Discussion

Study Limitations

Conclusion

Applying Research to Practice

Footnotes

Acknowledgements

Declaration of Conflicting Interests

Funding

Author Biographies

References