Elsevier

Journal of Professional Nursing

Volume 35, Issue 2, March–April 2019, Pages 112-119
Journal of Professional Nursing

The Relationship of Childhood Adversity on Burnout and Depression Among BSN Students

https://doi.org/10.1016/j.profnurs.2018.09.008Get rights and content

Highlights

  • Adverse childhood experiences (ACEs) impact physical and mental health outcomes during adulthood.

  • Significant relationship found between number of ACEs burnout and depression in incoming BSN students

  • Female nursing students reported higher levels of Burnout A: Exhaustion than males.

  • Female nursing students reported higher levels of Burnout B: Depersonalization than males.

  • Female nursing students reported higher level of depressive symptoms than males.

Abstract

Background

Research evidence strongly suggests that Adverse Childhood Experiences (ACEs) predispose individuals to development of an increased sensitivity to stress and negative physical and mental health outcomes in adulthood.

Purpose

To determine if there was a relationship between the number of ACEs reported by first semester BSN students and their reported level of Burnout and Depression.

Methods

211 students enrolled in the first semester of upper division courses of their BSN program completed self-report questionnaires which measured the number of ACEs, the level of Depression and the level of Burnout.

Results

The number of reported ACEs by participants had a significant relationship on the levels of burnout and severity of depressive symptoms. Female students with a higher number of ACEs were more likely to report higher levels of Burnout A (Emotional Exhaustion) and Burnout B (Depersonalization), and higher depression severity scores compared to males.

Conclusion

Nursing programs should educate faculty concerning the frequency and range of adverse experiences that students may have had prior to admission to the nursing program, and the possible relationship with Burnout and Depression. Faculty can provide early information on counseling and support services.

Introduction

Growing research evidence strongly suggests that Adverse Childhood Experiences (ACEs) increase the sensitivity to psychosocial stress later in life and possibly across the life span (McLaughlin et al., 2010; Shapero et al., 2014). ACE is a term coined to encompass the chronic, unpredictable and stress-inducing events that some individuals face during childhood and include the stress caused by poverty, abuse or neglect, parental substance abuse or mental illness, and exposure to violence (Felitti et al., 1998; Johnson, Riley, Granger, & Riis, 2013). The increased sensitivity to stress induced by ACEs has been characterized by a tendency to perceive neutral events as threatening and stressful as well as magnified physiological responses to psychosocial stressors. ACEs have been identified as being determinants for an increased susceptibility to a wide range of adverse physical and mental health outcomes. For example, individuals who have experienced ACEs during their childhood demonstrate an increased incidence of cardiovascular disease, diabetes, and depression during adulthood (CDC, 2014; Chapman et al., 2004; Felitti et al., 1998; Korkeila et al., 2010; Monnat & Chandler, 2015).

Several studies have documented factors impacting the stress level of nursing students during their nursing program. General themes noted within these studies included stress that arose from clinical aspects, academic aspects, and personal aspects associated with the nursing curriculum (Jimenez, Navia-Osorio, & Diaz, 2010; Prymachuk & Richard, 2007; Sheu, Lin, & Hwang, 2002). A study by Gibbons (2010) studied the psychological and physiological impact of stress on nursing students, and found that as nursing student's stress levels increased, reports of Burnout A, (emotional exhaustion) and Burnout B, (depersonalization), also increased and report the development of burnout. Another study conducted by Rella, Winwood, and Lushington (2009), found that up to 20% of graduates were reporting signs of serious maladaptive fatigue/stress and depression. The prevention and treatment of burnout and depression among nursing students poses an important challenge for nursing education, since these conditions can persist or worsen after graduation and they can contribute to increased rates of nurse attrition, higher healthcare costs, and ultimately lower quality of healthcare (ANA, 2014; Gibbons, 2010; Holdren, Paul III, & Coustasse, 2015).

Several studies attribute the development of burnout and depression among nursing students to the stress induced by the demanding requirements of nursing programs. However, there is a current gap in the research literature concerning the role that ACEs might play in the development of burnout and depression among nursing students. More research is needed to determine if ACEs increase the susceptibility to burnout and depression among nursing students. This is timely and critical since there is an expected national nursing shortage within the next decade, due to the increased rates of retirement among nurses in the baby boomer generation (Buerhaus, Skinner, Auerbach, & Staiger, 2017). Understating the susceptibilities of nursing students to the effects of stress and the subsequent impact of stress is vital to nursing school administrators in order to better prepare a new generation of nurses for the demands of the nursing profession.

Section snippets

Adverse Childhood Experiences Induce Stress Sensitivity

Several studies have documented the negative consequences that ACEs produce in the developing brain. When the brain of a developing child is chronically stressed by ACEs, it releases higher levels of cortisol, which leads to shrinkage of the hippocampus, an area of the brain responsible for processing emotion, memory and managing stress (Sheridan, Fox, Zeanah, McLaughlin, & Nelson, 2012; McLaughlin et al., 2010).

Recent magnetic resonance imaging (MRI) studies also suggest that the number of

Measures

This study was part of a larger prospective cohort study, and participants were required to complete a series of self-report questionnaires. The questionnaires completed by participants for this study included the ACE questionnaire, The PHQ9 questionnaire, the Maslach Burnout Inventory, and a demographic questionnaire. All questionnaires were completed in an online format, which were accessed through the study's website, using a secure password protected account. Participants were instructed to

Demographics

Of the total 211 participants recruited into this study, 72% of them were females and 28% males, with an average age of 24.7. Participants were predominantly Hispanic (89%), and 11% reported being from other racial/ethnic groups, with minimal variation observed across cohorts (see Table 1).

Childhood Adversity

Of the 211 participants, 179 completed the ACE questionnaire (see Table 2). This questionnaire was scored with each “Yes” response counted as a score of “1”. An ACE score of four or more is considered the

Discussion

Of the 211 participants, 72% reported having experienced at least one ACE. This number was higher than the rate reported by the CDC's national Behavioral Risk Factor Surveillance System ACE data, which was collected between 2009 and 2014. Also, 23% reported having experienced 4 or more ACEs during their lifetime, and this number was also significantly higher than the percentages reported in the CDC's national study, which revealed that only 16.2% of women and 12.4% of men reported having

Conclusions

This study confirmed the findings in the research literature concerning the negative impact of adverse childhood experiences on the mental health outcomes of individuals. The higher the number of ACEs reported by participants in this study, the higher the levels of burnout and depression severity reported by participants. Further research will be conducted as part of this longitudinal cohort study to determine if the levels of Burnout and Depression reported by participants in this study

Acknowledgments

This work was partially funded by the Orville Edward Egbert, M.D. endowment and support from the University of Texas at El Paso School of Nursing.

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