Predictors of Psychological Distress among Nurses: The Role of Burnout, Self-Esteem, Resilience, Age and Professional Experience

Authors

  • Sidra Munir National University of Medical Sciences, Rawalpindi, Pakistan
  • Muhammad Rizwan University of Wah, Wah Cantt, Pakistan

Abstract

Psychological distress is a frequently reported occupational health issue among nurses and is linked to suboptimal health, decreased job functioning, and poorer care quality. Although burnout, self-esteem, resilience, and demographic characteristics have individually been associated with psychological distress, limited evidence has examined their relative contribution within a single predictive model, particularly in low- and middle-income countries. To determine whether burnout, self-esteem, resilience, age, and professional experience significantly predict psychological distress among nurses working in a public tertiary care hospital in Pakistan. A quantitative cross-sectional study was conducted among 140 registered nurses employed at the District Headquarters Hospital, Okara, Pakistan. Participants completed a demographic questionnaire, the Depression Anxiety Stress Scale-21 (DASS-21), Copenhagen Burnout Inventory (CBI), Rosenberg Self-Esteem Scale (RSES), and Brief Resilience Scale (BRS). Internal consistency was assessed using Cronbach’s alpha. Pearson correlation analysis examined relationships among study variables, while multiple linear regression identified independent predictors of psychological distress. Statistical significance was established at p < 0.05. The study demonstrated acceptable to excellent internal consistency. Burnout was positively correlated with psychological distress whereas resilience and self-esteem were not significantly correlated with psychological distress. The regression model was statistically significant and explained 42.7% of the variance in psychological distress. The only significant predictor of psychological distress was burnout. Resilience, self-esteem, age, and professional experience were not significant predictors. Burnout was the strongest predictor of psychological distress among nurses, while self-esteem, age, and professional experience were not independently predictive of psychological distress. The results highlight the significance of organizational strategies for minimizing occupational burnout, enhancing nurses' mental health, and fostering a healthier healthcare workforce.

Author Biography

Muhammad Rizwan, University of Wah, Wah Cantt, Pakistan

Professor at Department of Psychology, University of Wah, Wah Cantt, Pakistan

References

Acharya, A., Bhatta, P., Bhatta, D. D., Shrestha, M. M., & Sapkota, V. P. (2026). Psychological distress and its associated factors among cancer patients in Nepal: A cross-sectional study. PLOS mental health, 3(3), e0000419. https://doi.org/10.1371/journal.pmen.0000419

Akturan, A., Arslan, A., Yener, S., & Kilinç, S. (2024). Understanding career adapt abilities, career stress, work stress, career regret, job satisfaction among nursing professionals. Journal of Advanced Nursing, 81(7), 3798–3810. https://doi.org/10.1111/jan.16516

Alansari, A. N., Omri, A. E., & Singh, K. (2025). Staff shortages linked to burnout, depression, and anxiety among outpatient nurses: a cross-sectional analysis at Hamad General Hospital, Qatar. BMC nursing, 24(1), 1118. https://doi.org/10.1186/s12912-025-03758-7

AlHarbi, N. (2022). Self-esteem: a concept analysis. Nursing science quarterly, 35(3), 327-331.

Alodhialah, A. M., Almutairi, A. A., & Almutairi, M. (2024). Exploring nurses’ emotional resilience and coping strategies in palliative and End-of-Life care settings in Saudi Arabia: a qualitative study. Healthcare, 12(16), 1647. https://doi.org/10.3390/healthcare12161647

Baharum, H., Ismail, A., McKenna, L., Mohamed, Z., Ibrahim, R., & Hassan, N. H. (2023). Success factors in adaptation of newly graduated nurses: a scoping review. BMC Nursing, 22(1), 125. https://doi.org/10.1186/s12912-023-01300-1

Bamforth, K., Rae, P., Maben, J., Lloyd, H., & Pearce, S. (2023). Perceptions of healthcare professionals' psychological wellbeing at work and the link to patients' experiences of care: A scoping review. International journal of nursing studies advances, 5, 100148. https://doi.org/10.1016/j.ijnsa.2023.100148

Bibi, A., Kahliq, F., & Younus, M. (2024). Explore the level of self-esteem among undergraduate nursing students. J Xi’an Shiyou Univ Nat Sci Ed, 20(2), 285-292.

Butler, S. (2025). Understanding burnout in nurses: identification and coping strategies. British Journal of Nursing, 34(4), 220-224.

Caldiroli, C. L., Sarandacchi, S., Tomasuolo, M., Diso, D., Castiglioni, M., & Procaccia, R. (2025). Resilience as a mediator of quality of life in cancer patients in healthcare services. Scientific Reports, 15(1), 8599. https://doi.org/10.1038/s41598-025-93008-2

Chirico, F., Afolabi, A. A., Ilesanmi, O. S., Nucera, G., Ferrari, G., Sacco, A., ... & Leiter, M. (2021). Prevalence, risk factors and prevention of burnout syndrome among healthcare workers: an umbrella review of systematic reviews and meta-analyses. Journal of Health and Social Sciences, 6(4), 465-491.

Delgado, C., Evans, A., Roche, M., & Foster, K. (2022). Mental health nurses’ resilience in the context of emotional labour: An interpretive qualitative study. International Journal of Mental Health Nursing, 31(5), 1260–1275. https://doi.org/10.1111/inm.13037

Friedberg, A., & Malefakis, D. (2022). Resilience, trauma, and coping. Psychodynamic psychiatry, 50(2), 382-409.

Getie, A., Ayenew, T., Amlak, B. T., Gedfew, M., Edmealem, A., & Kebede, W. M. (2025). Global prevalence and contributing factors of nurse burnout: an umbrella review of systematic review and meta-analysis. BMC Nursing, 24(1), 596. https://doi.org/10.1186/s12912-025-03266-8

Hasan, A., & Alsulami, A. (2024). Mediating Role of Resilience and its Impact on Psychological Well-Being, and Mental Distress among Mental health Nurses. SAGE Open Nursing, 10, 23779608231219140. https://doi.org/10.1177/23779608231219140

Herrman, H., Stewart, D. E., Diaz-Granados, N., Berger, E. L., Jackson, B., & Yuen, T. (2011). What is resilience?. The Canadian Journal of Psychiatry, 56(5), 258-265.

Hussain, A., Xia, X., Jameel, A., Sadiq, S., Kanwel, S., & Saleem, S. (2026). Integrating support, trust, and self-efficacy to enhance work engagement: the moderating role of basic psychological needs among nurses. BMC Psychology, 14(1). https://doi.org/10.1186/s40359-026-04189-y

Hussein, A. H. M., Abou Hashish, E. A., & Younes, B. M. (2024). The Relationship Between Nurses' Psychological Well-Being and Their Work Productivity Loss: A Descriptive Correlational Study. SAGE open nursing, 10, 23779608241285400. https://doi.org/10.1177/23779608241285400

Izdebski, Z., Kozakiewicz, A., Białorudzki, M., Dec-Pietrowska, J., & Mazur, J. (2023). Occupational Burnout in Healthcare Workers, Stress and Other Symptoms of Work Overload during the COVID-19 Pandemic in Poland. International journal of environmental research and public health, 20(3), 2428. https://doi.org/10.3390/ijerph20032428

Khan, D. A., Khan, M. T., Masih, A. G., Siddiqui, D. A., Parvez, A., Ali, F. M., & Bibi, A. (2024). Anxiety, depressive symptoms and socio-demographic factors associated with self-esteem among male nursing students: Self-esteem among male nursing students. Pakistan Journal of Health Sciences, 15-20.

Komariah, M., Eriyani, T., Rahayuwati, L., Agustina, H. R., Nurhakim, F., Somantri, I., Qadous, S. G., Janmanee, A., & Gartika, N. (2025). Quality of Life, Self-Esteem, and Stress among First-Semester Student Nurses in Indonesia: A Cross-Sectional Study. SAGE Open Nursing, 11, 23779608251317805. https://doi.org/10.1177/23779608251317805

Leary, M. R. (1999). The social and psychological importance of self-esteem.

Lyu, X., Huang, S., Ye, X., Zhang, L., Zhang, P., & Wang, Y. (2024). What influences newly graduated registered nurses’ intention to leave the nursing profession? An integrative review. BMC Nursing, 23(1), 57. https://doi.org/10.1186/s12912-023-01685-z

Márquez, G. M. (2022). Burnout syndrome. International Journal of Psychology and Neuroscience, 8(1), 19-30.

Pahwa, S., & Khan, N. (2022). Factors affecting emotional resilience in adults. Management and Labour Studies, 47(2), 216–232. https://doi.org/10.1177/0258042x211072935

Quesada-Puga, C., Izquierdo-Espin, F. J., Membrive-Jimenez, M. J., Aguayo-Estremera, R., Cañadas-De La Fuente, G. A., Romero-Bejar, J. L., & Gomez-Urquiza, J. L. (2024). Job satisfaction and burnout syndrome among intensive-care unit nurses: A systematic review and meta-analysis. Intensive and Critical Care Nursing, 82, 103660.

Raun, M., Lassen, A., & Østervang, C. (2024). Psychological Well-Being among Nursing staff in an Emergency Department: A Mixed-Methods Study. Journal of Emergency Nursing, 51(2), 238–248. https://doi.org/10.1016/j.jen.2024.10.021

Søvold LE, Naslund JA, Kousoulis AA, Saxena S, Qoronfleh MW, Grobler C and Münter L (2021) Prioritizing the Mental Health and Well-Being of Healthcare Workers: An Urgent Global Public Health Priority. Front. Public Health 9:679397. doi: 10.3389/fpubh.2021.679397

Tabakakis, C., Bradshaw, J., McAllister, M., & Sahay, A. (2024). Psychological distress in registered nurses and the role of the workplace: A cross-sectional study. The Australian Journal of Advanced Nursing, 41(3), 29–39. https://search.informit.org/doi/10.3316/informit.T2024102200008201951474193

Valaine, L., Grēve, M., Zolovs, M., Ancāne, G., Utināns, A., & Briģis, Ģ. (2024). Self-Esteem and Occupational Factors as Predictors of the Incidence of Anxiety and Depression among Healthcare Workers during the COVID-19 Pandemic in Latvia. International Journal of Environmental Research and Public Health, 21(1), 65. https://doi.org/10.3390/ijerph21010065

Watson, M. F. (2023). The relationship between psychological distress of nursing faculty with burnout. SAGE Open Nursing, 9, 23779608231181203. https://doi.org/10.1177/23779608231181203

Woo, T., Ho, R., Tang, A., & Tam, W. (2020). Global prevalence of burnout symptoms among nurses: A systematic review and meta-analysis. Journal of Psychiatric Research, 123, 9–20. https://doi.org/10.1016/j.jpsychires.2019.12.015

Wu, Y., Lin, T., Lam, J., Wang, S. S. C., & Lo, H. H. M. (2025). Resilience, coping strategies, and disaster experience: a path analysis of preparedness and avoidance in Taiwan. BMC Public Health, 25(1), 200. https://doi.org/10.1186/s12889-025-21361-y

Yi, E., & Lee, S. (2024). Psychological Well-Being of Nurses with One to Five Years of Clinical Experience. SAGE open nursing, 10, 23779608241255300. https://doi.org/10.1177/23779608241255300

Zakaria, N., Zakaria, N. H., Rassip, M. N. a. B. A., & Lee, K. Y. (2022). Burnout and coping strategies among nurses in Malaysia: a national-level cross-sectional study. BMJ Open, 12(10), e064687. https://doi.org/10.1136/bmjopen-2022-064687

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Published

2026-07-17

How to Cite

Sidra Munir, & Muhammad Rizwan. (2026). Predictors of Psychological Distress among Nurses: The Role of Burnout, Self-Esteem, Resilience, Age and Professional Experience. Pakistan Journal of Positive Psychology, 3(2), 61–69. Retrieved from https://pjpp.org/index.php/pjpp/article/view/106