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Article

Anxiety and Its Relationship with Professional Quality of Life and Meaning in Life Among Hospital Nursing Personnel: A Cross-Sectional Study

by
Vasiliki Tsoulou
,
Areti Stavropoulou
,
Angeliki Stamou
and
Maria Polikandrioti
*
Department of Nursing, University of West Attica, 12241 Athens, Greece
*
Author to whom correspondence should be addressed.
Psychiatry Int. 2026, 7(4), 180; https://doi.org/10.3390/psychiatryint7040180
Submission received: 27 June 2026 / Revised: 5 August 2026 / Accepted: 13 August 2026 / Published: 19 August 2026
(This article belongs to the Special Issue Mental Health, Well-Being and Decision-Making in First Responders and Frontline Workers)
Versions Notes

Abstract

Introduction: Nurses in hospital settings frequently experience anxiety, which may adversely affect both their psychological well-being and professional functioning. In this context, Professional Quality of Life (ProQoL) and Meaning in Life are recognized as key factors influencing nurses’ mental health outcomes. Aim: The aim of the present study was to explore the level of anxiety among nursing personnel in hospital settings and to assess its association with ProQoL and Meaning in Life. Materials and Methods: A cross-sectional study was conducted in a convenience sample of 200 nursing personnel in a public hospital. Data were collected using the Zung Self-Rating Anxiety Scale (SAS), the Professional Quality of Life Scale-5 (ProQoL-5), and the Meaning in Life Questionnaire (MLQ) which also included characteristics of nursing personnel. Results: Anxiety levels were low to mild (39.8 ± 8.7). ProQoL dimensions indicated moderate to high Compassion Satisfaction (35.5 ± 7.3) and moderate levels of Burnout (27.6 ± 5.7) and Secondary Traumatic Stress (26.5 ± 6.1). Regarding Meaning in Life, participants reported high levels of Presence of Meaning (27.1 ± 4.8) and moderate levels of Search for Meaning (21.7 ± 6.7). A statistically significant negative correlation was observed between anxiety and Compassion Satisfaction (r = −0.532, p < 0.001), as well as between anxiety and Presence of Meaning (r = −0.387, p < 0.001). In contrast, anxiety was positively correlated with Burnout (r = 0.652, p < 0.001) and Secondary Traumatic Stress (r = 0.534, p < 0.001). In the multivariable analysis, the self-rating of daily work experience score was associated with increased anxiety levels by 0.9 units for each unit increase (95% CI: 0.2 to 1.7, p < 0.011). Compassion Satisfaction was associated with a decrease in anxiety by 0.4 units (95% CI: −0.6 to −0.2, p < 0.001), while Burnout and Secondary Traumatic Stress were associated with an increase in anxiety by 0.5 (95% CI: 0.2 to 0.8, p < 0.001) and 0.4 units (95% CI: 0.2 to 0.6, p < 0.001), respectively. Conclusions: Self-rated daily work experience, Burnout, and Secondary Traumatic Stress were positively associated with anxiety, whereas Compassion Satisfaction was negatively associated with anxiety. These results illustrate the importance of targeted interventions aimed at reducing anxiety, strengthening ProQoL, and promoting Meaning in Life to support nursing personnel’s well-being.

1. Introduction

Human resources are a fundamental cornerstone of healthcare systems, encompassing professionals engaged in activities aimed at improving population health. Effective functioning of healthcare systems largely depend on the availability and quality of the health workforce, out of whom nurses have a prominent role in providing care [1]. However, there is a remarkable shortage of nurses accounting for 5.8 million which is anticipated to further reduce to 4.1 million by 2030 if current growth trends and resource distribution are maintained [2,3].
Nurses experience emotional disturbance mainly attributed to complex work environment, including provision of continuous care, managing emergencies, and communicating with patients and families [4]. Compared with other healthcare professionals, nurses are more regularly confronted with human suffering and death, making compassionate care an integral component of their professional responsibilities [5]. For all these reasons, nursing is ranked 27th among 130 occupations for psychological strain [6].
Anxiety is a frequent condition among nurses, worldwide. For example, in the United States, about 41.5% among hospital nurses report moderate to severe anxiety, while approximately 24.2% and 29% of nurses report anxiety symptoms in Japan and China, respectively [7]. In Greece, 33.3% of nurses reported anxiety in the post-pandemic period [8]. Despite geographical variance, anxiety represents a major global health-related issue associated with diminished job satisfaction, frequent absenteeism, burnout, and lower Professional Quality of Life (ProQoL) [4,7].
The concept of ProQoL describes occupational well-being among helping professions. Particularly, in nursing, ProQoL is conceptualized through the following three dimensions: Compassion Satisfaction, Burnout, and Secondary Traumatic Stress. More specifically, Compassion Satisfaction refers to a sense of fulfilment originating from providing care and supporting patients. Burnout syndrome is a work-related issue characterized by emotional exhaustion, depersonalization, and diminished personal accomplishment. Secondary Traumatic Stress involves emotional distress resulting from indirect exposure to patients’ traumatic experiences, presenting as intrusive thoughts, sleep disturbances, and negative emotional responses. Among nursing populations, anxiety symptoms are associated with high levels of Burnout, whereas reduced likelihood of experiencing anxiety is associated with higher levels of happiness [6]. Furthermore, higher ProQoL and lower psychological burden have been associated with greater Meaning in Life [9,10].
According to Frankl’s theory, Meaning in Life derives from meaningful activities, experiences, and interpersonal relationships, even under adverse conditions [11]. Meaning in Life is a key element of well-being, and psychological growth, conceptualized through two dimensions: Presence of Meaning in Life reflects the degree to which each person considers life as purposeful while Search for Meaning in Life reflects the effort to achieve meaning [12]. Meaning in Life has been relatively underexplored from a medical perspective. Existing research has mainly focused on patients and medical students, while evidence regarding clinical nurses still remains limited. This gap is particularly relevant given that nurses are exposed to high workloads, complex interpersonal demands, frequent encounters with death, and shift work, all of which may influence their perception of Meaning in Life [13].
Anxiety measurement among nurses is important, as it poses a significant threat to the sustainability of healthcare systems globally [4,7], contributes to staff shortages [14] and impairs professional performance [5]. All these factors undermine the quality of patient care [4,7,13].
Anxiety, ProQoL, and Meaning in Life have largely been examined separately among nurses. To the best of our knowledge, limited attention has been given to associations between anxiety, ProQoL, and Meaning in Life in clinical settings. Therefore, examining their association represents an important yet underexplored area of research. On this basis, investigation of whether ProQoL and Meaning in Life are factors associated with anxiety, may provide valuable insights into nurses’ psychological well-being.
The aim of the present study was to investigate the level of anxiety among hospital nursing personnel and to examine the associations between anxiety, ProQoL, and Meaning in Life.

2. Material and Methods

2.1. Study Sample

This single-center, cross-sectional study included 200 nursing personnel working at a public general hospital in Greece. Data were collected between April and November 2025. The nursing personnel comprised registered nurses and nursing assistants. The study used a convenience sampling method.
In this study, no priori power calculation was performed. The sample size was determined according to feasibility and availability of eligible participants. Initially, 250 individuals were invited to participate; however, 200 were finally enrolled, while 50 refused to participate or had missing data (participation rate 80.0%).
Participants invited: n = 250
Enrolled: n = 200 Not enrolled: n = 50
Final analytic sample n = 200

2.2. Inclusion and Exclusion Criteria

Eligible participants were nursing personnel who (i) were employed in the hospital at the time of data collection, (ii) had at least one year of clinical experience, and (iii) reported no history of diagnosed psychiatric disorders. The third criterion was assessed based on participants’ self-reported information and was not verified by medical record or physician assessment. Nursing personnel who declined participation or provided incomplete questionnaire data were excluded from the final analysis.

2.3. Data Collection Procedure

Data were collected through self-administered questionnaires during non-clinical time to minimize disruption of clinical duties. Completion of questionaries lasted approximately 20–25 min and took place in a private office room to ensure privacy and confidentiality. Completion was implemented without the presence or assistance of a researcher.

2.4. Measurement Instruments

Data collection was carried out using a researcher-developed questionnaire to collect nursing personnel characteristics, along with the following instruments: (a) the Zung Self-Rating Anxiety Scale (SAS), (b) the Professional Quality of Life Scale (ProQoL-5), and (c) the Meaning in Life Questionnaire (MLQ).

2.4.1. Characteristics of Participants

The study collected demographic characteristics of the participants, including gender, age, marital status, educational level, and number of children. Additionally, work-related characteristics were collected, including information on the following: department, years of professional experience, desire to leave the profession, shift work (rotating schedule), weekend work and relationship with medical and nursing staff. Furthermore, participants were asked to self-report their quality of life and daily work experience within a range of score 0–10 (from poor to excellent).

2.4.2. Assessment of Anxiety

The Zung Self-Rating Anxiety Scale (SAS) which was developed by Zung [15] consists of 20 items assessing cognitive, emotional, and somatic symptoms of anxiety. Scoring is based on the sum of item scores after reversing five positively worded items. High values indicate high anxiety within a range of scores from 20 to 80. Raw scores were evaluated. More specifically, raw scores of 20–44 indicate normal anxiety, 45–59 mild to moderate anxiety, 60–74 marked anxiety and ≥75 severe anxiety [15,16]. The validated SAS Greek version had Cronbach’s alpha = 0.897, indicating high internal consistency [17].

2.4.3. Assessment of Professional Quality of Life

The Professional Quality of Life Scale (ProQoL-5) is a widely used self-report instrument among helping professions. Developed by Beth Hudnall Stamm [18], it consists of 30 items and encompasses three subscales: (a) Compassion Satisfaction (satisfaction level derived from helping others); (b) Burnout syndrome (exhaustion and frustration at work); and (c) Secondary Traumatic Stress, (stress symptoms due to indirect exposure to others’ traumatic experiences). Scoring is conducted by summing the relevant items for each subscale after reversing specific Burnout items. Results are interpreted separately for each dimension, with no overall score. High scores on Compassion Satisfaction indicate a positive professional experience, whereas high scores on Burnout and Secondary Traumatic Stress indicate greater psychological burden. In the Greek population, Cronbach’s alpha for Compassion Satisfaction was 0.87; for Burnout, it was 0.73; and for Secondary Traumatic Stress, it was 0.83 [19].

2.4.4. Assessment of Meaning in Life

The Meaning in Life Questionnaire (MLQ) which was developed by Steger et al., [20] consists of 10 items and comprises two subscales: (a) Presence of Meaning, reflecting the extent to which individuals perceive their lives as meaningful, and (b) Search for Meaning, referring to the active pursuit of Meaning in Life. Scoring is based on the sum or mean of the items for each subscale, after reversing one negatively worded item. Results are interpreted separately for each dimension. High values indicate greater Meaning in Life. The Greek validation study reported internal consistency (Cronbach’s alpha = 0.76 for the total scale, 0.83 for Presence of Meaning, and 0.82 for Search for Meaning) [20,21].

2.5. Ethical Considerations

The research received approval from the Scientific Council of the public General Hospital Asklepieio Voulas Approval/Decision No. 36, dated 6 March 2025, and was conducted in line with the Declaration of Helsinki. Prior to enrollment, all participants received information about the objectives of the study and provided their written consent. Participation was entirely voluntary and anonymous while confidentiality of the data was strictly maintained.

2.6. Statistical Analysis

Categorical variables are presented as absolute and relative (%) frequencies, while continuous variables are presented as mean, standard deviation (±SD), median, and interquartile range (IQR). Normality was assessed using the Kolmogorov–Smirnov test and graphically with histograms and Q-Q plots. Independent samples t-test, ANOVA, Mann–Whitney, and Kruskal–Wallis tests were applied to identify differences in anxiety scores according to participants’ characteristics, depending on data distribution. Associations between questionnaire scores (anxiety, Professional Quality of Life, Meaning in Life) were assessed using Spearman’s rho correlation coefficient which ranges from −1 to +1, with values closer to ±1 indicating stronger associations and values near 0 indicating no association. Statistical significance was set at p < 0.05. All analyses were performed using SPSS version 28 (SPSS Inc., Chicago, IL, USA).
Multiple linear regression analysis was applied to estimate potential factors on anxiety levels. Results are presented as regression coefficients (b) with 95% confidence intervals (CIs). Variables which showed a statistically significant association with anxiety (p < 0.05) in the univariate analyses, together with clinically relevant variables, were entered into the multivariable linear regression model. The assumptions of linear regression were assessed before interpreting the final model. Multicollinearity among the independent variables was assessed by the use of variance inflation factors (VIFs), and model performance was assessed using the coefficient of determination (R2) and adjusted R2.

3. Results

3.1. Sample Description

The study sample consisted of 200 hospital nursing personnel. The sample description is presented in Table 1.
The majority of the sample were female, with 157 individuals (78.6%), 85 (42.5%) belonged to the age group 41–49, 126 (63.0%) were married, 83 (41.5%) of University Educational level, 140 (70.0%) had children, 90 (45%) worked in a surgical department, 119 (59.5%) had professional experience ≥20 years, 72 (36.0%) reported the desire to leave the profession, 69 (34.5%) had rotating schedule at the level of very often, 75 (37.5%) had weekend work at the level of very often, and 98 (49.0%) reported good relationships with other medical and nursing staff.
As self-reported by participants, the mean score of overall quality of life (0–10 scale) was 6.6 (SD = 1.8), with a median of 7 (IQR: 5–8). Similarly, the mean score of daily work experience was 6.1 (SD = 2.0), with a median of 6 (IQR: 5–8).

3.2. Questionnaire Scores

The description of the questionnaire scores is presented in Table 2. Anxiety levels, as measured by the Zung Self-Rating Anxiety Scale (SAS), showed a mean score of 39.8 (SD = 8.7) and a median score of 38.5 (IQR: 33–47), indicating normal to mild levels of anxiety.
Regarding ProQoL, Compassion Satisfaction showed a mean score of 35.5 (SD = 7.3) and a median of 36 (IQR: 31–41), indicating moderate to high levels. Burnout had a mean score of 27.6 (SD = 5.7) and a median of 28 (IQR: 24–31), while Secondary Traumatic Stress showed a mean score of 26.5 (SD = 6.1) and a median of 26 (IQR: 22–31), reflecting moderate levels for both dimensions. With respect to Meaning in Life, Presence of Meaning showed a mean score of 27.1 (SD = 4.8) and a median of 27 (IQR: 25–31), indicating relatively high levels, whereas Search for Meaning had a mean score of 21.7 (SD = 6.7) and a median of 21 (IQR: 16.5–26), suggesting moderate levels.
Internal consistency reliability was high for Compassion Satisfaction (Cronbach’s alpha = 0.885), Presence of Meaning (Cronbach’s alpha = 0.808), Search for Meaning (Cronbach’s alpha = 0.851), and the Zung Self-Rating Anxiety Scale (Cronbach’s alpha = 0.821), and acceptable for Burnout (Cronbach’s alpha = 0.737) and Secondary Traumatic Stress (Cronbach’s alpha = 0.766).

3.3. Factors Associated with Participants’ Anxiety

A statistically significant association with nursing personnel anxiety was identified for the desire to leave the nursing profession (p < 0.001) and for the relationship with medical and nursing staff (p < 0.001). In addition, a statistically significant negative correlation was observed with the Quality of Life score (r = −0.289, p < 0.001) and with the daily work experience score (r = −0.308, p < 0.001) as self-reported by participants (Table 3).
More specifically, participants who expressed a desire to leave the profession showed higher median anxiety scores (45) compared to those who did not (36.5). Regarding relationships with medical and nursing staff, higher anxiety levels were observed among those reporting moderate/poor relationships (47.5), whereas lower levels were recorded among those reporting good (37) or very good relationships (37.5). Furthermore, a statistically significant negative correlation was observed between self-reported quality of life score and anxiety (r = −0.289, p < 0.001), as well as between self-reported daily work experience score and anxiety (r = −0.308, p < 0.001). All measures were self-reported using numeric rating scales ranging from 0 to 10.

3.4. Correlation Between the Questionnaires

A statistically significant negative correlation was observed between anxiety and Compassion Satisfaction (r = −0.532, p < 0.001), as well as between anxiety and Presence of Meaning (r = −0.387, p < 0.001). In contrast, anxiety was positively correlated with Burnout (r = 0.652, p < 0.001) and Secondary Traumatic Stress (r = 0.534, p < 0.001). No statistically significant association was found between anxiety and Search for Meaning (p = 0.301). More specifically, anxiety levels decreased as Compassion Satisfaction and Presence of Meaning increased, while they increased in parallel with Burnout and Secondary Traumatic Stress (Table 4).

3.5. Multivariable Analysis of Factors Associated with Participants’ Anxiety

In the multivariable analysis (Table 5), the self-rating of daily work experience score was associated with increased anxiety levels by 0.9 units for each unit increase (β = 0.9, 95% CI: 0.2–1.7, p < 0.001). Compassion Satisfaction was associated with a decrease in anxiety by 0.4 units (β = −0.4, 95% CI: −0.6 to −0.2, p < 0.001), while Burnout and Secondary Traumatic Stress were associated with an increase in anxiety by 0.5 (β = 0.5, 95% CI: 0.2–0.8, p < 0.001) and 0.4 units (β = 0.24, 95% CI: 0.2–0.6, p < 0.001), respectively.
Although daily work experience was negatively correlated with anxiety in the univariate analysis, its regression coefficient became positive after adjustment for Professional Quality of Life dimensions and other covariates. Variance inflation factors ranged from 1.39 to 3.18 (mean VIF = 1.90), indicating no evidence of problematic multicollinearity. The change in direction likely reflects a suppression or conditional association arising after adjustment for correlated psychosocial variables.
The multivariable model explained 58.6% of the variance in anxiety scores (R2 = 0.586; adjusted R2 = 0.559).

4. Discussion

4.1. Principal Findings

In line with the study objectives, the results showed that nursing personnel reported: a. low to mild levels of anxiety, b. high Compassion Satisfaction, moderate Burnout and Secondary Traumatic Stress and c. a relatively high Presence of Meaning in Life, and moderate Search for Meaning. This profile suggests that nursing personnel did not experience clinically significant anxiety and demonstrated protective resources, particularly high Compassion Satisfaction and a strong sense of Meaning in Life. This dual pattern may indicate the association between better psychological well-being and Meaning in Life and Compassion Satisfaction; however, their protective effects were not explored.

4.2. Anxiety Levels Among Nursing Personnel

The finding of low to mild levels of anxiety among nursing personnel is consistent with previous research reporting anxiety within normal or low ranges across hospital settings [22,23]. However, investigation of anxiety remains important due to its well-documented association with a wide range of adverse outcomes. Additionally, anxiety has been linked with psychological distress, including low self-esteem, fatigue, disturbances in sleep and appetite, as well as with physical health consequences such as cardiovascular disease, hypertension, reduced immune function, and chronic pain. Anxiety may also contribute to maladaptive behaviors, including smoking, disordered eating, alcohol and substance use [24].

4.3. Professional Quality of Life and Its Relationship with Anxiety

As previously articulated, the present results showed high levels of Compassion Satisfaction. Interestingly, evidence has shown that Compassion Fatigue decreases as Compassion Satisfaction increases, and vice versa. Notably, care of high-quality is closely linked to lower Compassion Fatigue and higher Compassion Satisfaction among nurses [25,26].
Also, results showed that anxiety and Compassion Satisfaction were negatively associated, meaning that as anxiety increased, Compassion Satisfaction decreased, and the reverse was also true. Higher levels of Compassion Satisfaction are related to psychological resilience and lower vulnerability to occupational stress, which may be relevant to anxiety among nurses [27,28]. Furthermore, anxiety was positively correlated with Burnout and Secondary Traumatic Stress. This finding is in line with existing hospital-based literature, suggesting that mental health and Burnout are closely interconnected. Burnout is associated with a higher risk of anxiety symptoms [13] while prolonged occupational stress is a contributor to physical and emotional exhaustion [21,22]. Demanding work conditions may increase Burnout risk whereas positive workplace factors such as job satisfaction, adaptability, patient appreciation, and organizational support have been associated with lower Burnout [21,22]. Secondary Traumatic Stress is related to intense anxiety, ineffective coping styles, and depression [29].

4.4. Meaning in Life and Its Relationship with Anxiety

Nursing personnel of this sample reported relatively high levels of Presence of Meaning but moderate levels of Search for Meaning. Possibly, participants perceived their lives as purposeful and valuable, (experienced meaningfulness) while simultaneously engaged in the pursuit of additional or deeper sources of meaning, (active pursuit of meaning) without becoming complacent [12,21]. Among nurses, work itself is often identified as a source of Meaning in Life, through caregiving roles [30], while exposure to suffering may also contribute to the development of Meaning in Life through personal growth [10,30]. Meaning in Life enables nurses to cope with adverse psychological conditions, and to deliver person-centered care [30].
A negative association was found between the Presence of Meaning and anxiety. Presence of Meaning is associated with lower levels of anxiety, depression, stress, and other negative outcomes by supporting psychological stability, adaptive coping strategies and resilience when coping with emotionally demanding situations such as exposure to suffering and death [31,32].
Burnout symptoms were negatively associated with Presence of Meaning and positively associated with Search for Meaning [31]. In front line nurses, mental health was correlated with Meaning in Life under the COVID-19 pandemic [32]. On the other side of the spectrum, positive mental health has been shown to strengthen Meaning in Life, thus suggesting that these constructs may share a bidirectional relationship [33].

4.5. Organizational and Interpersonal Factors Associated with Anxiety

According to descriptive results, 36.1% of nursing personnel reported a desire to abandon their profession. This intention has been reported among nurses across various healthcare settings, with reported rates ranging from 4% to 56%, likely reflecting differences in healthcare systems, organizational contexts, and workforce conditions. These rates are of crucial importance in light of the ongoing global shortage of nurses [34,35].
Also, higher anxiety levels were observed among participants reporting the desire to leave the profession. Similarly, Arimon-Pagès et al. [36], in a study of 1302 hospital nurses, reported that higher levels of state and trait anxiety were associated with considerations of transferring to another unit, changing profession, and regretting career choice. Tabur et al. [37] showed the anxiety related to work burden as a predictor of turnover intention which was more intense according to the severity of anxiety. However, nurses’ intention to leave their job is a multifactorial issue. It is shaped by working conditions (salary, shift work), workload demands, professional opportunities, personal responsibilities, coping resources, and job satisfaction [34,35]. Nurses’ intention to remain in their profession and workforce sustainability strongly dependent on supportive organizational structures that promote effective teamwork, reduce occupational strain, and ensure supportive working conditions [38,39].
Higher anxiety levels were observed among participants reporting poorer relationships with medical and nursing staff. Interprofessional relationships, particularly between nurses and physicians, are determinants of psychological well-being. Additionally, disruptive behaviors, diminished communication, low job satisfaction, impending nursing workflows and lack of collegial support have been associated with increased work-related stress, emotional strain, not only within nurse–physician interactions but also within nursing teams [38,39]. Poor collaboration, combined with inadequate staffing, may strengthen nurses’ intention to leave the profession. Professional recognition may also represent an important organizational resource that underpins nurses’ psychological well-being, potentially influencing anxiety, Burnout, and turnover intention through its impact on perceived professional value and meaning of work [40].
Furthermore, a negative correlation was observed between anxiety and both self-reported quality of life and daily work experience. The way nurses perceive or rate their demanding work environment, including heavy workloads, patient pressure, and shift work, may adversely affect emotional balance and well-being [26]. This pattern became even more evident following the COVID-19 pandemic, when prolonged occupational stress was associated with poorer perceived health, emotional exhaustion, and increased symptoms of psychological distress [41]. Perceptions of limited professional autonomy may further exacerbate psychological distress [42].
Last but not least, an unexpected finding was that the direction of the association between daily work experience and anxiety differed between the univariate and multivariable analyses. Specifically, better daily work experience was associated with lower anxiety in the bivariate analysis, whereas the adjusted model showed a positive association. Because multicollinearity diagnostics did not indicate problematic collinearity (variance inflation factors (VIFs) mean = 1.90), this finding is more likely explained by a suppression effect resulting from simultaneous adjustment for multiple correlated dimensions of ProQoL. However, the precise mechanism underlying this sign reversal cannot be definitively established from the present data. Therefore, this adjusted association should be interpreted cautiously and warrants confirmation in future studies.

4.6. Confounding Factors

Resilience and coping strategies may represent important influencing factors that could have shaped the observed results; however, they were not assessed in the present study. Resilience is associated with improved well-being, higher job satisfaction and Compassion Satisfaction, and lower levels of Burnout and Secondary Traumatic Stress. This may be explained by its role in enhancing individuals’ ability to regulate emotional responses to demanding clinical experiences. Similarly, adaptive coping strategies are linked to reduced Burnout and Secondary Traumatic Stress, whereas avoidance-based coping is associated with higher Compassion Fatigue and lower Compassion Satisfaction [5].

4.7. Strengths and Limitations of the Study

Interpretation of the present findings should be made with caution due to several limitations. First, the cross-sectional design precludes any inference of causal relationships between anxiety, ProQoL and Meaning in Life. Second, the use of convenience sampling from a single hospital in Attica limits the generalizability of the findings to the broader population of nursing personnel in Greece, while a potential center effect may also have influenced the results. Also, one more limitation is that undiagnosed or unreported psychiatric conditions cannot be completely excluded since the absence of psychiatric conditions was not verified either by medical history or by physician assessment but based on participants’ self-report. A further limitation is the reversal in the direction of the association between daily work experience and anxiety across the bivariate and multivariable analyses. Although this may reflect a suppression effect (addition of another variable to the statistical model can change the relationship between two variables, even reversing the direction of the association), the underlying mechanism remains unclear and warrants cautious interpretation. The present sample was predominantly female (n = 157, 78.6%), which may limit the generalizability of the findings to more gender-balanced nursing populations. In addition, several relevant confounding factors were not assessed, which may have influenced levels of anxiety, ProQoL and Meaning in Life. Furthermore, the reliance on self-report measures may introduce response bias, including recall bias and subjective interpretation of psychological states. Finally, the relatively small sample size should also be acknowledged as a limitation, although statistically significant associations were observed.

5. Clinical Implications and Future Perspectives

From a clinical perspective, reducing anxiety, fostering Meaning in Life, and improving ProQoL among healthcare professionals may enhance psychological well-being in demanding clinical environments.
Understanding the factors associated with nursing personnel’s anxiety, as well as the associations with Pro-QoL and Meaning in Life, may support the development of effective strategies for anxiety management. In addition, healthcare organizations and leaders should address these challenges to support high-quality patient care, increase cohesion and improve working conditions.
Future research should further explore anxiety, ProQoL and Meaning in Life among nurses, using larger, more diverse, and cross-cultural samples to improve generalizability. Longitudinal studies may better exhibit the dynamics of these constructs. Moreover, future studies should incorporate objective assessments in addition to self-report measures to reduce bias and strengthen the validity of findings.

6. Conclusions

Nursing personnel reported low to mild levels of anxiety. ProQoL dimensions indicated moderate to high Compassion Satisfaction and moderate levels of Burnout and Secondary Traumatic Stress. Regarding Meaning in Life, participants reported high Presence of Meaning and moderate Search for Meaning.
A statistically significant negative correlation was observed between anxiety and Compassion Satisfaction as well as between anxiety and Presence of Meaning. Furthermore, anxiety was positively correlated with Burnout and Secondary Traumatic Stress.
Higher anxiety levels were observed among nursing personnel who reported the desire to leave the profession and among those reporting moderate to poor relationships with medical and nursing staff. Anxiety levels decreased as both Quality of Life and daily work experience increased, as self-reported by participants.
However, intention to leave the profession, relationships with nursing and medical staff, self-reported quality of life, and Presence of Meaning were not statistically significant after adjustment.
In the multivariable analysis, Compassion Satisfaction was associated with a decrease in anxiety, while Burnout and Secondary Traumatic Stress were associated with an increase in anxiety.
Although the self-rating of daily work experience was negatively correlated with anxiety in the univariate analysis, its regression coefficient became positive after adjustment for ProQoL dimensions and other covariates.

Author Contributions

Conceptualization, M.P.; Methodology, M.P.; Software, M.P.; Validation, V.T., A.S. (Areti Stavropoulou) and A.S. (Angeliki Stamou); Formal Analysis, V.T., A.S. (Areti Stavropoulou) and A.S. (Angeliki Stamou); Investigation, V.T. and A.S. (Areti Stavropoulou); Resources, A.S. (Angeliki Stamou); Data Curation, V.T., A.S. (Areti Stavropoulou) and A.S. (Angeliki Stamou); Writing—Original Draft, M.P.; Writing—Review and Editing, M.P.; Supervision, M.P. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Scientific Council of the public General Hospital Asklepieio Voulas (protocol code No.36 and date of approval 6 March 2025).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author upon reasonable request.

Conflicts of Interest

The authors declare no conflicts of interest.

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Table 1. Description of the sample.
Table 1. Description of the sample.
n (%)
Gender
Male43 (21.4%)
Female157 (78.6%)
Age
<4035 (17.5%)
41–4985 (42.5%)
≥5080 (40.0%)
Marital status
Married126 (63.0%)
Single52 (26.0%)
Divorced22 (11.0%)
Educational level
University 83 (41.5%)
MSc & PhD54 (27.0%)
Nursing assistant diploma63 (31.5%)
Have children (Yes)140 (70.0%)
Department
ICU30 (15%)
Medical80 (40%)
Surgical90 (45%)
Years of professional experience
<1032 (16.0%)
10–1949 (24.5%)
≥20119 (59.5%)
Desire to leave nursing profession (Yes)72 (36.0%)
Shift work (rotating schedule)
Never29 (14.5%)
Rarely24 (12.0%)
Sometimes30 (15.0%)
Often48 (24.0%)
Very often69 (34.5%)
Weekend work
Never10 (5.0%)
Rarely19 (9.5%)
Sometimes47 (23.5%)
Often49 (24.5%)
Very often75 (37.5%)
Relationship with medical and nursing staff
Very good65 (32.5%)
Good98 (49.0%)
Moderate30 (15.0%)
Poor7 (3.5%)
Quality of life score (0–10)
Mean (SD)6.6 (1.8)
Median (IQR)7 (5–8)
Daily work experience score (0–10)
Mean (SD)6.1 (2.0)
Median (IQR)6 (5–8)
Table 2. Description of questionnaire scores.
Table 2. Description of questionnaire scores.
Mean (SD)Median (IQR)Cronbach’s Alpha
Anxiety Zung (Range 20–80)39.8 (8.7)38.5 (33–47)0.821
Professional Quality of Life
Compassion Satisfaction (Range 10–50)35.5 (7.3)36 (31–41)0.885
Burnout (Range 10–50)27.6 (5.7)28 (24–31)0.737
Secondary Traumatic Stress (Range 10–50)26.5 (6.1)26 (22–31)0.766
Meaning of Life
Presence of Meaning (Range 5–35)27.1 (4.8)27 (25–31)0.808
Search for Meaning (Range 5–35)21.7 (6.7)21 (16.5–26)0.851
Table 3. Factors associated with participants’ anxiety.
Table 3. Factors associated with participants’ anxiety.
Anxiety (Zung)
Mean (SD)Median (IQR)p-Value
Gender 0.711
Male40.4 (7.8)38.5 (35–47)
Female40.1 (9.5)39 (33–47)
Age 0.779
<4038.6 (8.3)38 (34–42)
41–4939.9 (7.9)39 (34–46)
≥5040.6 (9.0)39 (34–47)
Marital status 0.531
Married39.9 (8.9)39.5 (34–47)
Single39.0 (8.5)36 (33–45)
Divorced41.6 (8.9)40 (34–49)
Educational level 0.472
University 40.5 (8.4)38 (35–47)
MSc/PhD38.6 (8.3)37 (33–44)
Nursing assistant diploma40.0 (9.6)39 (35–47)
Have children 0.562
Yes40.0 (8.9)39 (33–47)
No39.6 (8.5)36.5 (34–45.5)
Department 0.092
ICU43.2 (9.7)40.5 (37–50)
Medical37.8 (8.1)37 (33–44)
Surgical40.3 (8.7)38 (34–47)
Years of nursing experience 0.419
<1037.8 (6.5)37 (34–42)
10–1941.2 (8.7)39 (34–50)
≥2040.0 (9.2)39 (33–47)
Desire to leave nursing profession <0.001
Yes44.3 (8.1)45 (37–50)
No37.5 (8.3)36.5 (32–43)
Shift work (rotating schedule) 0.506
Never37.6 (7.8)37 (32–40)
Rarely/Sometimes40.4 (8.5)38 (34–47)
Often40.8 (8.7)40 (34.5–47)
Very often39.8 (9.4)38 (33–47)
Weekend work 0.821
Never/Rarely40.2 (8.4)39 (34–47)
Sometimes40.4 (9.0)39 (34–47)
Often38.2 (9.2)38 (33–45)
Very often40.4 (8.5)38.5 (33.5–47.5)
Relations with nursing/medical staff <0.001
Very good37.2 (8.1)37.5 (32–43.5)
Good39.2 (7.4)37 (34–45)
Moderate/Poor46.5 (10.2)47.5 (39–53.5)
Spearman’s Rhop-value
Quality of life score (0–10)−0.289<0.001
Daily work experience score (0–10)−0.308<0.001
Table 4. Correlation between the questionnaires.
Table 4. Correlation between the questionnaires.
Anxiety (Zung)
Spearman’s Rhop-Value
Professional Quality of Life
Compassion Satisfaction −0.532<0.001
Burnout 0.652<0.001
Secondary Traumatic Stress 0.534<0.001
Meaning of Life
Presence of Meaning −0.387<0.001
Search for Meaning 0.0830.301
Table 5. Multivariable analysis of factors associated with participants’ anxiety.
Table 5. Multivariable analysis of factors associated with participants’ anxiety.
Anxiety (Zung)
b Coef (95% CI)p-Value
Desire to leave nursing profession
YesRef.Cat.
No−0.8 (−3.4–1.8)0.548
Relations with medical and nursing staff
Very goodRef.Cat.
Good−1.2 (−3.5–1.1)0.317
Moderate/Poor1.3 (−1.9–4.6)0.409
Quality of life score (0–10)−0.6 (−1.2–0.0)0.069
Daily work experience score (0–10)0.9 (0.2–1.7)<0.011
Professional Quality of Life
Compassion Satisfaction −0.4 (−0.6–−0.2)<0.001
Burnout 0.5 (0.2–0.8)<0.001
Secondary Traumatic Stress 0.4 (0.2–0.6)<0.001
Meaning of Life
Presence of Meaning 0.0 (−0.3–0.2)0.861
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Tsoulou, V.; Stavropoulou, A.; Stamou, A.; Polikandrioti, M. Anxiety and Its Relationship with Professional Quality of Life and Meaning in Life Among Hospital Nursing Personnel: A Cross-Sectional Study. Psychiatry Int. 2026, 7, 180. https://doi.org/10.3390/psychiatryint7040180

AMA Style

Tsoulou V, Stavropoulou A, Stamou A, Polikandrioti M. Anxiety and Its Relationship with Professional Quality of Life and Meaning in Life Among Hospital Nursing Personnel: A Cross-Sectional Study. Psychiatry International. 2026; 7(4):180. https://doi.org/10.3390/psychiatryint7040180

Chicago/Turabian Style

Tsoulou, Vasiliki, Areti Stavropoulou, Angeliki Stamou, and Maria Polikandrioti. 2026. "Anxiety and Its Relationship with Professional Quality of Life and Meaning in Life Among Hospital Nursing Personnel: A Cross-Sectional Study" Psychiatry International 7, no. 4: 180. https://doi.org/10.3390/psychiatryint7040180

APA Style

Tsoulou, V., Stavropoulou, A., Stamou, A., & Polikandrioti, M. (2026). Anxiety and Its Relationship with Professional Quality of Life and Meaning in Life Among Hospital Nursing Personnel: A Cross-Sectional Study. Psychiatry International, 7(4), 180. https://doi.org/10.3390/psychiatryint7040180

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