Stress begets stress: The moderating role of childhood adversity in the relationship between job stress and sleep quality among nurses

Nurses exhibit considerable variations in sleep quality and experience high job stress levels. Distal factors, such as childhood adversity, and proximal factors, both influence sleep quality. We investigated the moderating role of childhood adversity with job stress and sleep quality, and whether this aligns with the stress-sensitization or stress-amplification models. The impact of job stressors' total score on sleep quality was analyzed using traditional linear regression models and the extreme gradient boosting machine learning algorithm. Hierarchical regression models examined the moderating role of childhood adversity in the relationship between job stress and sleep quality. An interactive tool was used to visualize the results. Among the dimensions of job stress, “time allocation and workload” strongly correlated with sleep quality, followed by “nursing profession and work problems,” “patient care issues,” “management and interpersonal problems,” and “working environment and equipment problems.” The moderating role of childhood adversity in the relationship between different dimensions of job stressors (except working environment and equipment problems) and sleep quality aligns with the stress-sensitization model. This study was susceptible to recall bias and objective sleep data were unavailable. Cross-sectional study design was used, thus limiting causal inferences. Finally, the moderating effect of childhood adversity on subsequent stress among nurses remains unclear. Childhood adversity and job stress were integrated into a stress-sensitization model, providing a nuanced and specific examination of sleep quality. Healthcare policymakers should focus on job stress and childhood adversity, improve nurses' sleep quality, and ultimately benefit patient care and outcomes.