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Reciprocal relations between care-related emotional burden and sleep problems in healthcare professionals: a multicentre international cohort study
  1. Boris Cheval1,2,3,
  2. Denis Mongin1,2,
  3. Stéphane Cullati1,2,3,4,
  4. Carole Winz1,
  5. Martina von Arx1,3,
  6. Ralph Erich Schmidt5,
  7. Thomas Agoritsas6,7,8,
  8. Pierre Chopard1,2,
  9. Delphine Sophie Courvoisier1,2
  1. 1 Quality of Care Service, University Hospitals of Geneva, Geneva, Switzerland
  2. 2 Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
  3. 3 Swiss NCCR ’LIVES: Overcoming Vulnerability: Life Course Perspectives', University of Geneva, Geneva, Switzerland
  4. 4 Institute of Sociological Research, University of Geneva, Geneva, Switzerland
  5. 5 Department of Psychology, University of Geneva, Geneva, Switzerland
  6. 6 Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
  7. 7 Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
  8. 8 Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Boris Cheval, Quality of Care Division, Geneva University Hospitals, Geneva 1206, Switzerland; boris.cheval{at}


Objective To determine whether there are reciprocal relations between care-related regret and insomnia severity among healthcare professionals, and whether the use of different coping strategies influences these associations.

Methods This is a multicentre international cohort study of 151 healthcare professionals working in acute care hospitals and clinics (87.4% female; mean age=30.4±8.0 years, 27.2% physicians, 48.3% nurses and 24.5% other professions) between 2014 and 2017. Weekly measures of regret intensity, number of regrets, and use of coping strategies (Regret Coping Scale) and sleep problems (Insomnia Severity Index) were assessed using a web survey.

Results The associations between regret and insomnia severity were bidirectional. In a given week, regret intensity (bregret intensity→sleep=0.26, 95% credible interval (CI) (0.14 to 0.40)) and number of regrets (bnumber of regrets→sleep=0.43, 95% CI (0.07 to 0.53)) were significantly associated with increased insomnia severity the following week. Conversely, insomnia severity in a given week was significantly associated with higher regret intensity (bsleep→regret intensity=0.14, 95% CI (0.11 to 0.30)) and more regrets (bsleep→number of regrets=0.04, 95% CI (0.02 to 0.06)) the week after. The effects of regret on insomnia severity were much stronger than those in the opposite direction. The use of coping strategies, especially if they were maladaptive, modified the strength of these cross-lagged associations.

Conclusions The present study showed that care-related regret and sleep problems are closely intertwined among healthcare professionals. Given the high prevalence of these issues, our findings call for the implementation of interventions that are specifically designed to help healthcare professionals to reduce their use of maladaptive coping strategies.

  • emotional burden
  • sleep problems
  • coping strategies
  • healthcare professionals

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  • Contributors BC, DSC designed the analyses. BC, DSC, DM analysed the data. BC, DSC drafted the manuscript. All authors critically appraised and approved the final version of the manuscript.

  • Funding This work is part of the ICARUS cohort study, funded by the Swiss National Science Foundation (grant number 166010).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The relevant local research ethics committees (ethics committee of the University Hospitals of Geneva, Switzerland) approved this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.