The Impact of Workplace Violence and Intimate Partner Violence on Depression Among Nurses: The Mediating Role of Impostor Syndrome

The Impact of Workplace Violence and Intimate Partner Violence on Depression Among Nurses: The Mediating Role of Impostor Syndrome | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Impact of Workplace Violence and Intimate Partner Violence on Depression Among Nurses: The Mediating Role of Impostor Syndrome Xia Huang, Nan Li, Jingjun Wang, Lei Huang, Yalin Huang, Tao Yang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8596940/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 14 You are reading this latest preprint version Abstract Background: Depression is a global mental health concern and demonstrates high prevalence among nurses, significantly impairing their quality of life. Previous studies have identified impostor syndrome (IS), workplace violence (WPV), and intimate partner violence (IPV) as risk factors for depression. It has been hypothesised that WPV and IPV may promote the development of IS, which in turn could lead to depression; however, these relationships have not been empirically confirmed. Aims: This study aimed to examine the mediating role of IS in the relationships between WPV, IPV, and depression among nurses. Methods: A multi-centre, cross-sectional survey was conducted with 742 enrolled nurses. The mediating effect of IS was analysed using bootstrap methods in SPSS Amos 28.0. Results: IS significantly mediated the relationship between WPV and depression (β=0.074, 95% CI 0.025 to 0.126), accounting for 35.41% of the total effect. IS also mediated the relationship between IPV and depression (β=0.074, 95% CI 0.028 to 0.123), accounting for 39.36% of the total effect. Conclusion: The findings indicate that IPV, WPV, and IS are significant predictors of depression in nurses. Exposure to IPV and WPV may exacerbate depressive symptoms by intensifying IS. For nurses who have experienced violence, early identification and intervention targeting IS are therefore crucial to mitigate the risk of depression. Impostor syndrome Workplace violence Intimate partner violence Depression Nurse Figures Figure 1 Figure 2 Figure 3 Introduction Depression is a prevalent psychiatric condition with multifactorial aetiology. Globally, it affects approximately 5% of adults, with nurses demonstrating a particularly high vulnerability compared to other professional groups. This elevated risk is attributed to distinct occupational hazards, including prolonged working hours, excessive workloads, and shift work disrupting circadian rhythms[1, 2]. The resultant impairment to nurses' quality of life and professional performance underscores the necessity for effective management strategies. Such strategies are critical not only for enhancing occupational well-being but also for improving clinical service quality and reducing medical errors, absenteeism, and turnover[3]. Consequently, early identification of modifiable risk factors and targeted preventive interventions are priorities in safeguarding this workforce from the adverse effects of depression[4]. The occurrence and development of depression are strongly influenced by socio-environmental factors[5]. Among these, the work and family environments constitute critical sources of environmental risk[6, 7]. Violence, a severe manifestation of adversity within these environments[8], is a recognised determinant of psychological well-being among nurses[9]. The World Health Organization notes that exposure to adverse life events, including violence, elevates the risk of depression. Workplace violence (WPV) and intimate partner violence (IPV), as common forms of violence experienced by nurses, are associated with an increased risk of depression[10]. Specifically, WPV, encompassing verbal abuse, threats, or physical assaults from patients or bullying among colleagues, has been shown to increase nurses' risk of depression by 2.11-fold[11]. Similarly, IPV, which involves physical, sexual, or psychological harm by an intimate partner, is closely linked to a significantly heightened risk of depression and suicidal ideation[12-14]. However, existing research has predominantly utilised cross-sectional data to establish associations between WPV, IPV, and depression. The potential mechanisms or intervening variables that explain the progression from experiencing violence to developing depression remain insufficiently explored. Investigating these mediating factors is therefore crucial to provide a theoretical foundation for targeted interventions. The development of depression is understood to result not merely from environmental stressors but also from individual cognitive and psychological processes. Negative psychological factors, such as impostor syndrome (IS) and anxiety, constitute significant risk factors for depression, whereas positive resources like self-confidence, resilience, and hope can buffer stress and reduce vulnerability[15-18]. Critically, evidence suggests that exposure to violence can trigger profound self-doubt in survivors[19], a response whose core characteristics align closely with those of IS. Consequently, we hypothesise that IS may act as a key mediating variable in the relationship between WPV, IPV, and depression. Background The relationship between IPV,WPV and depression A robust correlation exists between IPV and depression. Evidenced by global data indicating that 8.43% of major depression cases in 2019 were attributable to IPV[ 20 ]. Similarly, WPV is strongly associated with depression. Reported prevalence rates among those exposed to WPV range from 18.65% in a large Chinese sample to 32.7% in a German cohort[ 21 , 22 ]. Experiences of IPV can negatively alter self-evaluation, a significant factor in the development of depression[ 23 ]. Concurrently, Conservation of Resources theory posits that WPV depletes psychological resources; chronic exposure hinders access to critical resources like self-esteem and resilience, thereby increasing vulnerability to mental health problems including depression[ 24 ]. The relationship between IS with depression IS is a characteristic exhibited by individuals in the domain of self-perception[ 25 ], described as self-doubt of intellect, skills, or accomplishments among high-achieving individuals[ 26 ]. These individuals cannot internalize their success and apprehension of being exposed as a fraud in their work, despite verifiable and objective evidence of their successfulness. The most commonly linked groups to IS are typically comprised of high-achieving individuals and appear disproportionately prevalent in academics, particularly in the healthcare field[ 27 ]. Among nurses, reported prevalence rates range from 36% to 75%[ 28 ]. Crucially, IS demonstrates a strong association with depression. Research indicates that healthcare workers with severe IS report significantly higher depression scores than those with mild or moderate symptoms[ 29 , 30 ]. Potential mediating role of IS between IPV, WPV and depression among nurses Although existing literature has sufficiently demonstrated the associations between IPV, WPV, IS, and depression, few studies have integrated these four factors into a unified theoretical framework to explore their interactive mechanisms systematically. Previous research indicates that multiple mediating factors may exist in the pathway from experiences of violence to depression, including objective variables such as race and gender, as well as positive psychological traits like optimism, resilience, and self-efficacy. Consequently, it is hypothesised that IS may also play a significant mediating role in this process. This inference draws theoretical support from Richard Lazarus's Stress and Coping Theory. This theory emphasises that stress responses are not determined solely by external events or static individual characteristics, but rather result from dynamic transactions between individuals and their environments. Within this framework, cognitive appraisal serves as the core mediating mechanism linking stressors to subsequent stress responses[ 31 ]. Critically, multiple prior studies indicate that after experiencing violence, individuals often develop negative cognitive evaluations characterised by profound self-doubt, which aligns closely with the core features of IS. Specifically, IPV experiences are significantly correlated with individuals' doubts about their own capabilities for success[ 32 ]. Similarly, WPV has been shown to induce self-doubt among nursing populations[ 33 ]. Therefore, validating the mediating role of IS between IPV, WPV, and depression holds significant theoretical and practical implications for identifying this critical cognitive bias. This understanding can inform the development of targeted interventions to interrupt the progression from violent experiences to depression. In summary, guided by the Stress and Coping Theory framework, this study aims to explore the interrelationships among IS, IPV, WPV, and depression within the nursing population. Within this model, WPV and IPV are defined as environmental stressors, while depression is posited as a maladaptive stress response. The research specifically investigates whether the internal cognitive appraisal characteristic of IS mediates the effects between these variables. It seeks to clarify whether IS mediates the relationship between IPV and depression, and separately, whether IS mediates the association between WPV and depression. The hypotheses are as follows: H1:Positive correlation between IS, IPV, WPV and depression. H2:IS mediates between IPV, WPV and depression. The conceptual model of this study is shown in Fig. 1 . Methods Sample and settings This multicentre, cross-sectional study employed a convenience sampling method to recruit registered nurses from healthcare institutions across five Chinese provinces and municipalities (Sichuan, Shanghai, Chongqing, Tibet, and Heilongjiang). The sample was predominantly drawn from tertiary hospitals (Grade III institutions), with supplementary recruitment from community health centres and private medical facilities. Inclusion criteria were: (1) age 18 years or older; (2) current registration as a nurse; and (3) voluntary participation. All potential participants completed a demographic questionnaire. Submitted questionnaires were screened, and those from individuals not meeting all inclusion criteria were excluded from the analysis. All statistical analyses were performed using SPSS 26.0, with a threshold of p < 0.05 considered statistically significant. Measures Demographic characteristic questionnaires Data on demographic and professional characteristics were collected using a study-specific questionnaire. This instrument captured standard demographic variables, including gender, age, marital status, only-child status, and fertility status. It also recorded professional details such as years of clinical experience, level of education, department, professional title, and position. Impostor syndrome The Clance Impostor Phenomenon Scale (CIPS) was used to assess IS. Originally developed by Clance in 1985[34], the scale was subsequently translated and culturally adapted into Chinese by Jiang et al.[35]. This Chinese version has demonstrated good reliability and validity and has established utility in nursing populations. The scale comprises 18 items across three dimensions: self-doubt (8 items), external attribution of success (6 items), and passive pretence (4 items). Items are rated on a 5-point Likert scale ranging from 1 ('not at all') to 5 ('completely'), yielding a total score between 18 and 90. A higher total score indicates a more severe level of impostor phenomenon. In the present study, the scale demonstrated excellent internal consistency, with a Cronbach’s α coefficient of 0.905. Intimate partner violence Exposure to IPV was assessed using the abbreviated version of the Revised Conflict Tactics Scales (E-HITS). Originally developed by Sherin et al. as a brief IPV screening tool[36], the scale was later translated and culturally adapted for the Chinese context by Chan et al., specifically for use with emergency department staff in Hong Kong[37]. The adapted version has demonstrated good applicability and measurement properties for accurately reflecting healthcare workers' experiences of IPV. Consequently, it was employed in this study to identify nurses exposed to IPV. The scale contains 5 items rated on a 5-point Likert scale from 1 ('never') to 5 ('a lot of the time'). A higher total score indicates a greater frequency of exposure to violence within an intimate relationship. In this sample, the scale showed good internal consistency, with a Cronbach’s α coefficient of 0.819. Workplace violence WPV was measured using a scale adapted for the Chinese context by Wang[38], based on the original Workplace Violence Scale developed by Schat et al.[39]. This instrument assesses the frequency of WPV experienced by respondents in the preceding 12 months. It comprises five items, each rated on a four-level frequency scale. Scoring for each item is as follows: 0 points for no exposure, 1 point for a single occurrence, 2 points for 2–3 occurrences, and 3 points for 4 or more occurrences. The total score, calculated by summing all item scores, ranges from 0 to 15. Total scores are categorised to indicate exposure frequency: zero (0), low (1–5), medium (6–10), or high (11–15). In this study, the scale demonstrated acceptable internal consistency, with a Cronbach’s α of 0.782. Depression Depressive symptom severity was assessed using the depression subscale of the 21-item Depression, Anxiety and Stress Scales (DASS-21). The Chinese version of this subscale, validated by Xu et al. in 2010 [40], comprises seven items. Each item is rated on a 4-point severity scale from 0 ('did not apply to me at all') to 3 ('applied to me very much'). The total score is calculated by summing the scores for all seven items and multiplying by two, with higher scores indicating greater severity of depressive symptoms. In the current sample, this subscale demonstrated excellent internal consistency, with a Cronbach’s α coefficient of 0.905. Investigation procedures An online survey was developed and administered using the Questionnaire Star platform (www.wjx.cn). The questionnaire comprised three sections: a description of the study's purpose and procedures, an informed consent form, and the formal measurement scales. All questionnaires were distributed electronically via the social media application WeChat, with participants requested to complete them within one week. The platform was configured to require respondents to spend a minimum of 30 seconds reading the participant information sheet and to provide electronic informed consent before accessing the survey items. The required sample size was calculated using the formula for estimating a population proportion: N=(U 2 1- α /2 ×P 0 (1-P 0 ))/d 2 , where U is the standard normal deviate corresponding to the confidence level, α is the significance level, P₀ is the estimated population proportion, and d is the margin of error. Based on previous literature indicating a prevalence of IS among nurses of 36–75%[28], P₀ was set at 0.40. With a margin of error (d) of 0.04 and α of 0.05 (two-sided), the minimum required sample size was 576. Accounting for a potential 10–15% non-response rate, the target sample size was adjusted to 640–677. Between April and May 2024, 800 questionnaires were initially collected. Following the removal of incomplete submissions, 762 responses were retained. Application of the inclusion criteria, age ≥18 years, registered nurse status, and voluntary participation, yielded 704 eligible responses. To ensure data quality, several a priori measures were implemented: (1) a minimum completion time of three minutes was enforced to discourage random responding; (2) questionnaires with patterned or highly consistent responses were excluded; and (3) incomplete questionnaires were discarded. Subsequent data cleaning followed a systematic protocol: (1) Range and logic checks: Values outside plausible ranges (e.g., age < 18) or exhibiting logical inconsistencies (e.g., work experience exceeding age) were verified against original records where possible, corrected, or treated as missing. (2) Outlier handling: Statistical outliers were evaluated for clinical plausibility. Those deemed implausible data entry errors were corrected or set to missing. (3) Missing data: For continuous variables with minimal missingness, mean imputation was used. For categorical variables, a distinct 'missing' category was created. No critical variables contained missing data in the final analytic sample. Following this process, the final analytic sample comprised 649 valid responses, which met and exceeded the a priori sample size requirement. The sampling and screening procedure is summarised in Fig 2 . Statistical analysis All statistical analyses were performed using SPSS 26.0 and SPSS Amos 28.0. Categorical variables, such as demographic characteristics, are presented as frequencies and percentages. Continuous variables, including scores for impostor syndrome and depression, were standardised during preprocessing. The normality of their distributions was assessed using the Kolmogorov-Smirnov test. Variables following a normal distribution are expressed as mean ± standard deviation (SD), while non-normally distributed variables are reported as median and interquartile range (IQR). Associations between variables were examined using non-parametric tests and Spearman’s rank-order correlation. Factors associated with depression were identified using stepwise forward multiple linear regression. To model the relationships between variables and test the hypothesised mechanisms, structural equation modelling (SEM) was conducted in Amos 28.0, specifically to verify the mediating role of IS. The two-step approach proposed by Anderson and Gerbing was followed. First, confirmatory factor analysis was used to assess the measurement model, with multiple fit indices evaluating model fit, reliability, and validity. Second, the structural model was tested by examining the significance of path coefficients (β) and the coefficient of determination (R 2 ) for the dependent variable. Results Demographic features of the subjects The final analytical sample comprised 649 nurses. The cohort was predominantly female (n=580, 89.4%). The largest proportion of participants were aged 30-39 years (n=268, 41.3%). Most nurses held a bachelor’s degree or higher (n=488, 75.2%), including a small subset (n=9, 1.4%) with a master’s degree or doctoral qualification. The majority were married (n=434, 66.9%) and had one or more children (n=392, 60.4%). Full demographic and professional characteristics are detailed in Table 1. Comparison of levels of depression Depression levels did not differ significantly across demographic groups. Detailed results are presented in Table 1 . Table 1 Differences in depression among nurses by Socio-demographic characteristic of participants (N = 649) Variable s N（%） H(Z) p Age 0.718 0.869 ≤29 279(43) 30-39 268(41.3) 40-49 76(11.7) ≥50 26(4) Gender -0.906 0.365 Female 580(89.4) Male 69(10.6) Clinical experience 6.787 0.079 ＜3 84(12.9) 3-5 138(21.3) 6-10 141(21.7) ＞10 286(44.1) Education level 2.669 0.445 Senior high school and below 8(1.2) Junior college 153(23.6) Bachelor degree 479(73.8) Master degree and above 9(1.4) Department 11.641 0.234 Internal medicine ward 135(20.8) Surgery ward 121(18.6) Psychiatry 122(18.8) Emergency room 55(8.5) Outpatient 12(1.8) ICU 20(3.1) Operating room 27(4.2) Gynaecology 49(7.6) Paediatrics 8(1.2) Others 100(15.4) Professional title 0.734 0.865 Primary 392(60.4) Middle 203(31.3) Associate senior 51(7.9) Senior 3(0.5) Positions 3.801 0.284 Nurses 442(68.1) Nursing team leaders 91(14) Head nurses and above 72(11.1) Others 44(6.8) Marital status 1.601 0.659 Unmarried 198(30.5) Married 434(66.9) Divorces 13(2) Widowed 4(0.6) Only child or not -0.068 0.946 Yes 217(33.4) No 432(66.6) Fertility status 0.590 0.899 Childless 257(39.6) 1 Chlid 248(38.2) 2 Children 141(21.7) 3 Children or above 3(0.5) a. p-values derived from Mann-Whitney U (binary), Kruskal-Wallis H (multi-category). Correlations among the major variables Results of Spearman's correlation analysis showed that nurses' depression levels were positively correlated with experiences of IS, IPV as well as with WPV. At the same time, depression, IPV, WPV and IS were all interrelated with each other. This is consistent with hypothesis 1. See Table 2 for further details. Table 2 The correlations among the continuous variables by Spearman’s Correlation (N=649) Variable s Median (IQR) 1 2 3 4 Depression 2 (0-8) 1 Impostor syndrome 38 (26-54) 0 .453 ** 1 Intimate partner violence 5 (5-6) 0 .251 ** 0 .178 ** 1 Workplace Violence 0 (0-1) 0 .252 ** 0 .196 ** 0 .259 ** 1 a. Bold values indicate statistically significant associations (*p < 0.05, **p <0.01). b. Abbreviations: IQR, Inter quartile Range. Multiple linear regression Factors associated with depression were included in the stepwise multiple linear regression. Continuous variables were standardized using z-score transformation. The results revealed that IS (β=0.386, 95% CI: 0.316 to 0.456), IPV (β=0.134, 95% CI: 0.065 to 0.204), WPV (β=0.136, 95% CI: 0.066 to 0.205) was considered to be a factor that can contribute to the depression. See Table 3 for further details. Tab le 3 Multivariate linear regression analysis of depression as the dependent variable. Variable s B β t p -Value LLCI ULCI Impostor syndrome 0.386 0.386 10.888 *** 0.316 0.456 Intimate partner violence 0.134 0.134 3.789 *** 0.065 0.204 Workplace Violence 0.136 0.136 3.825 *** 0.066 0.205 a. ***p<0.001 Structural equation modeling of the association between WPV , IPV , IS , and depression Model Fit Analysis To determine the links between these factors, a path analysis was performed, including the construction of a mediation model and parameter estimation. SPSS AMOS 28.0 was used to construct a SEM model, with IPV and WPV as the independent variable, depression as the dependent variable, and IS as the mediating variable, to evaluate the indirect and direct effects among variables. The collected observation data were in alignment with the structural model, as illustrated in Fig 3 . The results indicate that all model fit indices in this study meet the criteria for good fit, specifically: χ2= 74.052, χ2/ df = 1.543, GFI = 0.982, AGFI = 0.970, CFI=0.992, TLI=0.989, RMSEA= 0.029, SRMR=0.027. Discriminant Validity Distinctiveness validity is used to examine the degree of statistical differentiation among latent variables. This study employed the Fornell-Larcker criterion, which requires the square root of the average variance extracted (AVE) for a latent variable to exceed its correlation coefficient with any other latent variable. As shown in Table 4 , the bolded values on the diagonal are all greater than the off-diagonal elements in their respective rows and columns. This result indicates that the shared variance between any latent variable and its measurement indicators is greater than the shared variance between that latent variable and any other latent variable. This confirms that the measurement model possesses good discriminant validity. Convergent validity Convergent validity assesses the degree of convergence among observed variables measuring the same latent construct. This study employed composite reliability (CR), AVE, and factor loadings for comprehensive evaluation. As shown in Table 4 , all observed variables exhibited standardized factor loadings exceeding 0.5 on their corresponding latent variables. The CR values for all latent variables exceeded the critical threshold of 0.7, indicating excellent internal consistency reliability of the measurement model. Furthermore, the AVE values for each latent variable surpassed the benchmark of 0.5, signifying that the variance explained by each latent variable exceeded the variance attributable to measurement error. This fully demonstrates the measurement model's strong convergent validity. Tab le 4 Aggregate and discrimination validity measures for models Construct Dimension Unstd S.E. t-value p Factor loadings CR AVE WPV IPV IS DP WPV WPV1 1.000 0.772 0.778 0.544 0.738 WPV2 0.995 0.071 13.980 *** 0.840 WPV3 0.347 0.027 13.006 *** 0.575 IPV IPV1 1.000 0.641 0.846 0.652 0.193 0.807 IPV2 1.739 0.104 16.721 *** 0.920 IPV3 2.021 0.118 17.128 *** 0.836 IS ZWHY 1.000 0.763 0.800 0.572 0.196 0.195 0.756 WJGY 0.612 0.040 15.358 *** 0.694 BDWZ 0.659 0.042 15.805 *** 0.808 DP DP1 1.000 0.745 0.861 0.674 0.245 0.229 0.501 0.821 DP2 1.101 0.054 20.215 *** 0.864 DP3 1.249 0.062 20.155 *** 0.849 a. The bold numbers on the diagonal represent the square roots of the corresponding variable AVE. b .Abbreviations: AVE, Average Variance Extracted, CR, Composite Reliability. c . ***p<0.001 Mediation Analysis The bias-corrected Bootstrap method was used to test the mediating effect model, and the sample was repeated 2000 times to test the significance of the mediating effect, and the 95% CI was calculated. Table 5 results show that all path coefficients do not include 0 and Z > 1.96 in the bootstrap 95% CI. Thus, IS partially mediated the relationship between IPV and depression, as well as the relationship between WPV and depression. Table 5 Bootstrap test of the mediating effect of impostor syndrome Effect β SE Z p-value Bias-Corrected 95%CI Percentile 95%CI Standardized direct effects IPV to DP 0.114 0.050 2.280 * 0.016 0.215 0.017 0.216 WPV to DP 0.135 0.055 2.455 0.012 0.025 0.239 0.025 0.241 IPV to IS 0.164 0.048 3.417 *** 0.056 0.247 0.062 0.255 WPV to IS 0.165 0.051 3.235 0.003 0.059 0.259 0.059 0.259 IS to DP 0.452 0.052 8.692 *** 0.342 0.546 0.346 0.552 Standardized indirect effects IPV to DP via IS 0.074 0.024 3.083 *** 0.030 0.125 0.028 0.123 WPV to DP via IS 0.074 0.026 2.846 0.003 0.025 0.126 0.025 0.126 Standardized total effects IPV to DP 0.188 0.047 4.000 *** 0.095 0.281 0.097 0.284 WPV to DP 0.209 0.048 4.354 *** 0.110 0.303 0.113 0.305 a. Bold values indicate statistically significant associations (***p < 0.001). b. Abbreviations: DP, Depression. c . ***p<0.001 Direct and indirect effects In this study, the total effect was decomposed into direct and indirect effects. As shown in Table 5 and Fig 3 , IS served as a mediating variable that partially mediated the relationship between IPV, WPV, and depression. Specifically, the estimated total effect of IPV on depression was β = 0.188 (95% CI: 0.097 to 0.284); the estimated direct effect of IPV on depression was β = 0.114 (95% CI: 0.017 to 0.216); and the estimated indirect effect of IPV on depression was β = 0.074 (95% CI: 0.028 to 0.123), which explained 39.36% of the total effect of IPV on depression. In addition, IS mediated the association between WPV and depression, with a total effect size estimate of β = 0.209 (95% CI: 0.113 to 0.305); a direct effect size estimate of β = 0.135 (95% CI: 0.025 to 0.241) for WPV on depression; and an indirect effect size estimate of β = 0.074 (95% CI: 0.025 to 0.126), and this indirect effect explained 35.41% of the total effect of WPV on depression. These results suggest that IS mediates the relationship between IPV, WPV, and depression, which is consistent with Hypothesis 2. Discussion This study utilised structural equation modelling to examine the mediating role of IS in the relationships between IPV, WPV, and depression. Path analysis confirmed that IPV, WPV, and IS were all significant positive predictors of depression. Moreover, IPV and WPV were found to exert both direct effects on depression and indirect effects mediated through IS. The hypothesised model demonstrated a satisfactory fit to the observed data, as indicated by standard model fit indices. The direct effect of Intimate partner violence and Workplace violence on depression Extant research demonstrates that violence is a potent predictor of depression. Women experiencing IPV face a threefold increased risk of depression[41], while nurses exposed to WPV are 2–4 times more likely to develop depressive symptoms[42]. The present findings are congruent with this established evidence. The mechanisms underlying this relationship are well elucidated: IPV often induces chronic fear, erodes self-worth, and creates persistent psychological stress that fosters depression[43].Similarly, WPV can precipitate significant psychological distress and cognitive distortions, including persistent sadness, insecurity, and diminished self-esteem, that are intrinsically linked to depressive onset[44]. The nursing profession confers specific vulnerabilities to both IPV and WPV. Professionally, nurses operate as frontline healthcare workers under considerable pressure, interacting directly with patients and families who may vent anxieties as aggression, thereby increasing WPV risk. Personally, high-intensity work and emotional exhaustion can deplete the emotional resources necessary for harmonious domestic relationships. This, compounded by irregular shift patterns that disrupt family life, can exacerbate partner conflict and elevate IPV risk[45]. Consequently, a multi-level intervention strategy is imperative. Primarily, preventive institutional measures are required to mitigate triggers. These include implementing scientifically designed shift systems to ensure rest and work-life balance, protecting nurses' rest periods from non-essential encroachments, and advancing legal and policy frameworks that explicitly prohibit WPV, thereby creating a safer structural environment. Given that some violent incidents may remain unavoidable, secondary intervention through early identification and support is equally crucial. Healthcare institutions must establish effective mechanisms to identify nurses affected by violence and provide timely support to mitigate psychological sequelae. This study highlights a critical, measurable indicator for such screening: the presence of IS. As a maladaptive cognitive state marked by self-doubt, IS can serve as an early warning signal that a nurse exposed to violence is developing the negative cognitive biases that potentiate depression. Early identification of IS thus represents a strategic point for targeted psychological intervention to disrupt the pathway from violence to depression. The partial mediating roles of impostor syndrome IS is highly prevalent among healthcare workers[28, 46]. Substantial evidence identifies IS not merely as a correlate but as a key factor in the development of psychological morbidity, including depression and anxiety[47], and it significantly elevates the risk of suicide in this population[48]. However, research specifically examining the impact of IPV and WPV on nurses' IS remains limited. This study demonstrated that IS plays a significant mediating role in the relationships between WPV, IPV, and depression. The proposed pathways through which WPV and IPV may precipitate IS are multifaceted. Firstly, violent experiences can directly instigate the negative cognitive patterns central to IS. Evidence suggests that exposure to belittling or disrespectful treatment in the workplace significantly erodes an individual's belief in their capability to complete tasks successfully, fostering professional inferiority and self-doubt[49]. Similarly, IPV is known to severely damage self-worth, acting as a potent catalyst for pervasive self-doubt[50]. This persistent internal questioning of one's competence and achievements corresponds closely with the core characteristics of IS. Secondly, violence may indirectly foster IS by undermining the foundations of positive self-evaluation. Social evaluation theory posits that external feedback is pivotal in constructing self-perception and self-esteem[51]. Positive social evaluations bolster self-esteem and group-valued identity, buffering against IS, whereas persistent negative evaluations promote negative self-schemas and lower self-esteem, thereby inducing IS[52]. For nurses, both WPV and IPV represent profound sources of negative feedback. WPV exposure is linked to loss of confidence, increased shame, and diminished self-esteem[53], while IPV severely impairs self-efficacy and self-worth[54]. These mechanisms collectively elucidate how experiences of violence become significant antecedents of IS. Furthermore, IS is a well-established predictor of depression, with several mechanisms explaining this progression within the nursing context. Individuals with pronounced IS tendencies are prone to internalising criticism, leading to chronic experiences of shame and embarrassment. The cumulative burden of these negative emotions substantially increases vulnerability to depression[55]. The nursing profession exacerbates this dynamic; perceived as an environment where error is intolerable, it imposes immense pressure for perfection. This pressure, compounded by shift-work-induced sleep disturbance and additional external demands (e.g., research obligations), creates a high-stress occupational milieu. Within such an environment, the negative self-appraisal, perfectionism, and intense fear of failure characteristic of IS not only perpetuate psychological strain but may also synergise with occupational stressors, creating a vicious cycle that markedly elevates the risk of depressive onset[56]. In synthesis, exposure to IPV or WPV heightens the likelihood of developing IS. IS, with its associated cognitive and affective burdens, significantly exacerbates an individual's risk for depression. This study therefore confirms H2, demonstrating that IS acts as a significant mediator in the pathways linking both WPV and IPV to depression. Nurses constitute the core human resource within healthcare systems, and their psychological well-being directly impacts care quality and patient safety. However, depression, WPV, IPV, and IS represent prevalent and significant occupational health challenges within this workforce. A critical complicating factor is the low rate of voluntary reporting by nurses following violent incidents[57], which impedes early identification and timely support, creating substantial barriers to effective intervention. Consequently, healthcare institutions urgently require systematic strategies to mitigate the adverse effects of these issues on workforce stability and healthcare system resilience. The present study offers important insights for safeguarding nurses’ mental health. Moving beyond the established direct association between violence and depression, it identifies IS as a crucial mediating variable. This finding provides a novel theoretical perspective for understanding the psychological mechanisms underpinning nurses’ depression and establishes an evidence-based foundation for developing targeted interventions. Specifically, the research findings reveal key entry points for addressing depression as a mental health issue. Previous research indicates that strong social support and targeted psychological interventions are central to helping nurses counteract the effects of WPV and IPV and ameliorate IS[58, 59]. Therefore, it is recommend that healthcare organisations integrate validated IS assessments into routine occupational health monitoring and psychological screening programmes to facilitate the early identification of high-risk individuals. For nurses who have experienced IPV or WPV, immediate access to professional support, such as cognitive restructuring and counselling, should be provided to disrupt the pathway from IS to depression. At an organisational level, nursing management must actively foster a culture that encourages the proactive reporting of violence, backed by efficient, confidential reporting and response mechanisms[57]. This ensures affected nurses receive institutional support and guidance promptly, thereby reducing the likelihood that violent experiences become internalised as IS. Furthermore, investment in cultivating a supportive, collaborative work environment and positive team culture is essential. Such systemic measures address the root causes of the distorted self-evaluations characteristic of IS, build psychological resilience, and ultimately enhance the holistic well-being and professional retention of the nursing workforce. Strengths and limitations: This study employed structural equation modelling and confirmed that, within the nursing population studied, IS exerts a significant mediating effect on both the WPV-depression and IPV-depression pathways. This finding clarifies a previously underexplored psychological mechanism, providing a novel theoretical perspective for understanding the development of depression among nurses. Several limitations of this study must be acknowledged. First, the cross-sectional design establishes associations but cannot determine causality or elucidate the dynamic pathways between violence exposure, IS, and depression. Longitudinal or interventional studies are needed to verify the proposed causal chain. Second, while the mediating role of IS was confirmed, the potential buffering effect of factors such as self-esteem within the violence-IS-depression pathway was not explored. Third, the sample consisted solely of registered nurses from selected provinces in China, which may limit the generalisability of the findings to other cultural contexts or healthcare systems. Multinational studies are required to validate the universality of these mechanisms. Conclusion This study confirms that IS is a key mediating factor linking both WPV and IPV to depression. The results suggest that prolonged exposure to violent environments may increase nurses' risk of depression by fostering the negative cognitive and psychological patterns characteristic of IS. Consequently, the accurate identification and targeted management of IS are crucial. It is recommend the integration of validated IS assessments into routine occupational health monitoring and psychological screening programmes. Concurrently, healthcare institutions should establish personalised support systems for nursing staff. Implementing these measures would not only help mitigate the psychological impact of violence but also directly address the detrimental effects of IS, thereby safeguarding nurses' mental health and enhancing the overall quality and reliability of healthcare delivery. Declarations Acknowledgements The authors wish to thank the study participants for their contribution to the research, as well as current and past investigators and staff. Authors' contributions XH and NL developed the statistical framework for data analysis,conducted the statistical analysis,interpreted thedata and drafted the manuscript. JJW and LH, along with others, participated in the formulation of the research design and analytical framework. YW were involved in the study design, interpreta-tion of the data, development of thestatistical framework and reviewed the manuscript.All authors read and approved the final manuscript. Funding Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate The study was approved by the Ethics Committee of west China hospital, Sichuan university (No. 1581). 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Prevalence and correlates of imposter syndrome and self-esteem among medical students at Jazan University, Saudi Arabia: A cross-sectional study. PLoS ONE. 2024;19(5):e0303445. Kaur A, Ahamed F, Sengupta P, Majhi J, Ghosh T. Pattern of workplace violence against doctors practising modern medicine and the subsequent impact on patient care, in India. PLoS ONE. 2020;15(9):e0239193. Matheson FI, Daoud N, Hamilton-Wright S, Borenstein H, Pedersen C, O'Campo P. Where Did She Go? The Transformation of Self-Esteem, Self-Identity, and Mental Well-Being among Women Who Have Experienced Intimate Partner Violence. Women's health issues: official publication Jacobs Inst Women's Health. 2015;25(5):561–9. Hu KS, Chibnall JT, Slavin SJ. Maladaptive Perfectionism, Impostorism, and Cognitive Distortions: Threats to the Mental Health of Pre-clinical Medical Students. Acad psychiatry: J Am Association Dir Psychiatric Resid Train Association Acad Psychiatry. 2019;43(4):381–5. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8596940","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":589911659,"identity":"d5447e46-1ccb-4c05-9d13-c93c2ea392fd","order_by":0,"name":"Xia Huang","email":"","orcid":"","institution":"Mental Health Center, National Center for Mental Disorders, West China Hospital, Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Xia","middleName":"","lastName":"Huang","suffix":""},{"id":589911662,"identity":"bf8769e8-3da6-4b4c-b04e-a27b8a993f71","order_by":1,"name":"Nan Li","email":"","orcid":"","institution":"West China Tianfu Hospital, Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Nan","middleName":"","lastName":"Li","suffix":""},{"id":589911667,"identity":"22300ac0-def5-489b-80ec-7ed202070707","order_by":2,"name":"Jingjun Wang","email":"","orcid":"","institution":"West China Hospital of Stomatology, Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Jingjun","middleName":"","lastName":"Wang","suffix":""},{"id":589911668,"identity":"e48aa42b-ba73-40d1-8beb-b741307f4f28","order_by":3,"name":"Lei Huang","email":"","orcid":"","institution":"School of Nursing, Henan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Lei","middleName":"","lastName":"Huang","suffix":""},{"id":589911669,"identity":"91366cea-05ea-4824-bf04-a8ea4243dc10","order_by":4,"name":"Yalin Huang","email":"","orcid":"","institution":"Mental Health Center, National Center for Mental Disorders, West China Hospital, Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Yalin","middleName":"","lastName":"Huang","suffix":""},{"id":589911670,"identity":"d6a5561b-a87f-4d46-87b4-66082e017365","order_by":5,"name":"Tao Yang","email":"","orcid":"","institution":"Mental Health Center, National Center for Mental Disorders, West China Hospital, Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Tao","middleName":"","lastName":"Yang","suffix":""},{"id":589911672,"identity":"8f22ea71-8531-417f-a010-a65ee03a8cd9","order_by":6,"name":"Ya Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIiWNgGAWjYHACxgcJFWw8/OyNjUCGDVFamA0+nOGTk+w5fNjgwZk0orSwSc5skzM2uJGWJvmw7RBh9QbnzxhI87CZJW44kGNWkcB2gIG/vTsBv5YDZwyMeXjSEmceOGN2I4HnDoPEmbMb8GoxO9hjkMwjcSyx72APUIvEMwYDiVwCWg7zGADR/8SGwzxmBQkGh4nQcozHsHFGApuxwDG2NIaEBCK02J9hK2b4cIANGMjMhyUSDqTxEPSLZP/h7T8S/wGjUv5h48ef/2zk+Nt78WthYOAwQOHyEFAOAuwPiFA0CkbBKBgFIxoAAP0AUFtHr+qoAAAAAElFTkSuQmCC","orcid":"","institution":"Department of Nursing, West China Hospital, Sichuan University","correspondingAuthor":true,"prefix":"","firstName":"Ya","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2026-01-14 03:23:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8596940/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8596940/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102755333,"identity":"d66b81eb-cb3d-4c38-8fe7-21adc56aa5f2","added_by":"auto","created_at":"2026-02-16 09:43:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":75884,"visible":true,"origin":"","legend":"\u003cp\u003eConcept model of this study\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea.\u003c/sup\u003eAbbreviations: DP, Depression.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8596940/v1/b18f90da37970df7fcd7f391.png"},{"id":102755286,"identity":"a67e8c66-c57f-429a-9c9a-02cdded73b63","added_by":"auto","created_at":"2026-02-16 09:42:58","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":365529,"visible":true,"origin":"","legend":"\u003cp\u003eThe process of sampling\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8596940/v1/959ce0cc5494ad86ae4f6c57.png"},{"id":102755298,"identity":"122ef8aa-77d9-47f5-a009-555ebcf5830f","added_by":"auto","created_at":"2026-02-16 09:43:00","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":228387,"visible":true,"origin":"","legend":"\u003cp\u003eMediation model of this study\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea.\u003c/sup\u003eStructural equation model analysis of the impact of IS on WPV, IPV and depression. All the coefficients in this figure have been standardized.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb.\u003c/sup\u003eAbbreviations: DP, Depression.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8596940/v1/9413230144188a6221c30d71.png"},{"id":103056454,"identity":"a74d45a8-7347-4abd-94d8-8804a5163749","added_by":"auto","created_at":"2026-02-20 09:10:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1986315,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8596940/v1/8cefd27e-f7bc-404d-8622-843786a8b8ec.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Impact of Workplace Violence and Intimate Partner Violence on Depression Among Nurses: The Mediating Role of Impostor Syndrome","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDepression is a prevalent psychiatric condition with multifactorial aetiology. Globally, it affects approximately 5% of adults, with nurses demonstrating a particularly high vulnerability compared to other professional groups. This elevated risk is attributed to distinct occupational hazards, including prolonged working hours, excessive workloads, and shift work disrupting circadian rhythms[1, 2]. The resultant impairment to nurses\u0026apos; quality of life and professional performance underscores the necessity for effective management strategies. Such strategies are critical not only for enhancing occupational well-being but also for improving clinical service quality and reducing medical errors, absenteeism, and turnover[3]. Consequently, early identification of modifiable risk factors and targeted preventive interventions are priorities in safeguarding this workforce from the adverse effects of depression[4].\u003c/p\u003e\n\u003cp\u003eThe occurrence and development of depression are strongly influenced by socio-environmental factors[5]. Among these, the work and family environments constitute critical sources of environmental risk[6, 7]. Violence, a severe manifestation of adversity within these environments[8], is a recognised determinant of psychological well-being among nurses[9]. The World Health Organization notes that exposure to adverse life events, including violence, elevates the risk of depression. Workplace violence (WPV) and intimate partner violence (IPV), as common forms of violence experienced by nurses, are associated with an increased risk of depression[10]. Specifically, WPV,\u0026nbsp;encompassing verbal abuse, threats, or physical assaults from patients or bullying among colleagues,\u0026nbsp;has been shown to increase nurses\u0026apos; risk of depression by 2.11-fold[11]. Similarly, IPV, which involves physical, sexual, or psychological harm by an intimate partner, is closely linked to a significantly heightened risk of depression and suicidal ideation[12-14].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, existing research has predominantly utilised cross-sectional data to establish associations between WPV, IPV, and depression. The potential mechanisms or intervening variables that explain the progression from experiencing violence to developing depression remain insufficiently explored. Investigating these mediating factors is therefore crucial to provide a theoretical foundation for targeted interventions. The development of depression is understood to result not merely from environmental stressors but also from individual cognitive and psychological processes. Negative psychological factors, such as impostor syndrome (IS) and anxiety, constitute significant risk factors for depression, whereas positive resources like self-confidence, resilience, and hope can buffer stress and reduce vulnerability[15-18]. Critically, evidence suggests that exposure to violence can trigger profound self-doubt in survivors[19], a response whose core characteristics align closely with those of IS. Consequently, we hypothesise that IS may act as a key mediating variable in the relationship between WPV, IPV, and depression.\u003c/p\u003e\n"},{"header":"Background","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eThe relationship between IPV,WPV and depression\u003c/h2\u003e \u003cp\u003eA robust correlation exists between IPV and depression. Evidenced by global data indicating that 8.43% of major depression cases in 2019 were attributable to IPV[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Similarly, WPV is strongly associated with depression. Reported prevalence rates among those exposed to WPV range from 18.65% in a large Chinese sample to 32.7% in a German cohort[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Experiences of IPV can negatively alter self-evaluation, a significant factor in the development of depression[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Concurrently, Conservation of Resources theory posits that WPV depletes psychological resources; chronic exposure hinders access to critical resources like self-esteem and resilience, thereby increasing vulnerability to mental health problems including depression[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eThe relationship between IS with depression\u003c/h2\u003e \u003cp\u003eIS is a characteristic exhibited by individuals in the domain of self-perception[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], described as self-doubt of intellect, skills, or accomplishments among high-achieving individuals[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. These individuals cannot internalize their success and apprehension of being exposed as a fraud in their work, despite verifiable and objective evidence of their successfulness. The most commonly linked groups to IS are typically comprised of high-achieving individuals and appear disproportionately prevalent in academics, particularly in the healthcare field[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Among nurses, reported prevalence rates range from 36% to 75%[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Crucially, IS demonstrates a strong association with depression. Research indicates that healthcare workers with severe IS report significantly higher depression scores than those with mild or moderate symptoms[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePotential mediating role of IS between IPV, WPV and depression among nurses\u003c/h3\u003e\n\u003cp\u003eAlthough existing literature has sufficiently demonstrated the associations between IPV, WPV, IS, and depression, few studies have integrated these four factors into a unified theoretical framework to explore their interactive mechanisms systematically. Previous research indicates that multiple mediating factors may exist in the pathway from experiences of violence to depression, including objective variables such as race and gender, as well as positive psychological traits like optimism, resilience, and self-efficacy. Consequently, it is hypothesised that IS may also play a significant mediating role in this process. This inference draws theoretical support from Richard Lazarus's Stress and Coping Theory. This theory emphasises that stress responses are not determined solely by external events or static individual characteristics, but rather result from dynamic transactions between individuals and their environments. Within this framework, cognitive appraisal serves as the core mediating mechanism linking stressors to subsequent stress responses[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCritically, multiple prior studies indicate that after experiencing violence, individuals often develop negative cognitive evaluations characterised by profound self-doubt, which aligns closely with the core features of IS. Specifically, IPV experiences are significantly correlated with individuals' doubts about their own capabilities for success[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Similarly, WPV has been shown to induce self-doubt among nursing populations[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Therefore, validating the mediating role of IS between IPV, WPV, and depression holds significant theoretical and practical implications for identifying this critical cognitive bias. This understanding can inform the development of targeted interventions to interrupt the progression from violent experiences to depression.\u003c/p\u003e \u003cp\u003eIn summary, guided by the Stress and Coping Theory framework, this study aims to explore the interrelationships among IS, IPV, WPV, and depression within the nursing population. Within this model, WPV and IPV are defined as environmental stressors, while depression is posited as a maladaptive stress response. The research specifically investigates whether the internal cognitive appraisal characteristic of IS mediates the effects between these variables. It seeks to clarify whether IS mediates the relationship between IPV and depression, and separately, whether IS mediates the association between WPV and depression. The hypotheses are as follows:\u003c/p\u003e \u003cp\u003eH1:Positive correlation between IS, IPV, WPV and depression.\u003c/p\u003e \u003cp\u003eH2:IS mediates between IPV, WPV and depression.\u003c/p\u003e \u003cp\u003eThe conceptual model of this study is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eSample and settings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis multicentre, cross-sectional study employed a convenience sampling method to recruit registered nurses from healthcare institutions across five Chinese provinces and municipalities (Sichuan, Shanghai, Chongqing, Tibet, and Heilongjiang). The sample was predominantly drawn from tertiary hospitals (Grade III institutions), with supplementary recruitment from community health centres and private medical facilities. Inclusion criteria were: (1) age 18 years or older; (2) current registration as a nurse; and (3) voluntary participation. All potential participants completed a demographic questionnaire. Submitted questionnaires were screened, and those from individuals not meeting all inclusion criteria were excluded from the analysis. All statistical analyses were performed using SPSS 26.0, with a threshold of p \u0026lt; 0.05 considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDemographic characteristic questionnaires\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData on demographic and professional characteristics were collected using a study-specific questionnaire. This instrument captured standard demographic variables, including gender, age, marital status, only-child status, and fertility status. It also recorded professional details such as years of clinical experience, level of education, department, professional title, and position.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImpostor\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003esyndrome\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Clance Impostor Phenomenon Scale (CIPS) was used to assess IS. Originally developed by Clance in 1985[34], the scale was subsequently translated and culturally adapted into Chinese by Jiang et al.[35]. This Chinese version has demonstrated good reliability and validity and has established utility in nursing populations. The scale comprises 18 items across three dimensions: self-doubt (8 items), external attribution of success (6 items), and passive pretence (4 items). Items are rated on a 5-point Likert scale ranging from 1 ('not at all') to 5 ('completely'), yielding a total score between 18 and 90. A higher total score indicates a more severe level of impostor phenomenon. In the present study, the scale demonstrated excellent internal consistency, with a Cronbach’s α coefficient of 0.905.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntimate partner violence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExposure to IPV was assessed using the abbreviated version of the Revised Conflict Tactics Scales (E-HITS). Originally developed by Sherin et al. as a brief IPV screening tool[36], the scale was later translated and culturally adapted for the Chinese context by Chan et al., specifically for use with emergency department staff in Hong Kong[37]. The adapted version has demonstrated good applicability and measurement properties for accurately reflecting healthcare workers' experiences of IPV. Consequently, it was employed in this study to identify nurses exposed to IPV. The scale contains 5 items rated on a 5-point Likert scale from 1 ('never') to 5 ('a lot of the time'). A higher total score indicates a greater frequency of exposure to violence within an intimate relationship. In this sample, the scale showed good internal consistency, with a Cronbach’s α coefficient of 0.819.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWorkplace violence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWPV was measured using a scale adapted for the Chinese context by Wang[38], based on the original Workplace Violence Scale developed by Schat et al.[39]. This instrument assesses the frequency of WPV experienced by respondents in the preceding 12 months. It comprises five items, each rated on a four-level frequency scale. Scoring for each item is as follows: 0 points for no exposure, 1 point for a single occurrence, 2 points for 2–3 occurrences, and 3 points for 4 or more occurrences. The total score, calculated by summing all item scores, ranges from 0 to 15. Total scores are categorised to indicate exposure frequency: zero (0), low (1–5), medium (6–10), or high (11–15). In this study, the scale demonstrated acceptable internal consistency, with a Cronbach’s α of 0.782.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepressive symptom severity was assessed using the depression subscale of the 21-item Depression, Anxiety and Stress Scales (DASS-21). The Chinese version of this subscale, validated by Xu et al. in 2010 [40], comprises seven items. Each item is rated on a 4-point severity scale from 0 ('did not apply to me at all') to 3 ('applied to me very much'). The total score is calculated by summing the scores for all seven items and multiplying by two, with higher scores indicating greater severity of depressive symptoms. In the current sample, this subscale demonstrated excellent internal consistency, with a Cronbach’s α coefficient of 0.905.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInvestigation procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn online survey was developed and administered using the Questionnaire Star platform (www.wjx.cn). The questionnaire comprised three sections: a description of the study's purpose and procedures, an informed consent form, and the formal measurement scales. All questionnaires were distributed electronically via the social media application WeChat, with participants requested to complete them within one week. The platform was configured to require respondents to spend a minimum of 30 seconds reading the participant information sheet and to provide electronic informed consent before accessing the survey items.\u003c/p\u003e\n\u003cp\u003eThe required sample size was calculated using the formula for estimating a population proportion: N=(U\u003csup\u003e2\u003c/sup\u003e\u003csub\u003e1-\u003c/sub\u003e\u003csub\u003eα\u003c/sub\u003e\u003csub\u003e/2\u003c/sub\u003e×P\u003csub\u003e0\u003c/sub\u003e(1-P\u003csub\u003e0\u003c/sub\u003e))/d\u003csup\u003e2\u003c/sup\u003e, where U is the standard normal deviate corresponding to the confidence level, α is the significance level, P₀ is the estimated population proportion, and d is the margin of error. Based on previous literature indicating a prevalence of IS among nurses of 36–75%[28], P₀ was set at 0.40. With a margin of error (d) of 0.04 and α of 0.05 (two-sided), the minimum required sample size was 576. Accounting for a potential 10–15% non-response rate, the target sample size was adjusted to 640–677.\u003c/p\u003e\n\u003cp\u003eBetween April and May 2024, 800 questionnaires were initially collected. Following the removal of incomplete submissions, 762 responses were retained. Application of the inclusion criteria, age ≥18 years, registered nurse status, and voluntary participation, yielded 704 eligible responses. To ensure data quality, several a priori measures were implemented: (1) a minimum completion time of three minutes was enforced to discourage random responding; (2) questionnaires with patterned or highly consistent responses were excluded; and (3) incomplete questionnaires were discarded.\u003c/p\u003e\n\u003cp\u003eSubsequent data cleaning followed a systematic protocol: (1) Range and logic checks: Values outside plausible ranges (e.g., age \u0026lt; 18) or exhibiting logical inconsistencies (e.g., work experience exceeding age) were verified against original records where possible, corrected, or treated as missing. (2) Outlier handling: Statistical outliers were evaluated for clinical plausibility. Those deemed implausible data entry errors were corrected or set to missing. (3) Missing data: For continuous variables with minimal missingness, mean imputation was used. For categorical variables, a distinct 'missing' category was created. No critical variables contained missing data in the final analytic sample. Following this process, the final analytic sample comprised 649 valid responses, which met and exceeded the a priori sample size requirement. The sampling and screening procedure is summarised in \u003cstrong\u003eFig 2\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll statistical analyses were performed using SPSS 26.0 and SPSS Amos 28.0. Categorical variables, such as demographic characteristics, are presented as frequencies and percentages. Continuous variables, including scores for impostor syndrome and depression, were standardised during preprocessing. The normality of their distributions was assessed using the Kolmogorov-Smirnov test. Variables following a normal distribution are expressed as mean ± standard deviation (SD), while non-normally distributed variables are reported as median and interquartile range (IQR). Associations between variables were examined using non-parametric tests and Spearman’s rank-order correlation. Factors associated with depression were identified using stepwise forward multiple linear regression.\u003c/p\u003e\n\u003cp\u003eTo model the relationships between variables and test the hypothesised mechanisms, structural equation modelling (SEM) was conducted in Amos 28.0, specifically to verify the mediating role of IS. The two-step approach proposed by Anderson and Gerbing was followed. First, confirmatory factor analysis was used to assess the measurement model, with multiple fit indices evaluating model fit, reliability, and validity. Second, the structural model was tested by examining the significance of path coefficients (β) and the coefficient of determination (R\u003csup\u003e2\u003c/sup\u003e) for the dependent variable.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDemographic features of the subjects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe final analytical sample comprised 649 nurses. The cohort was predominantly female (n=580, 89.4%). The largest proportion of participants were aged 30-39 years (n=268, 41.3%). Most nurses held a bachelor’s degree or higher (n=488, 75.2%), including a small subset (n=9, 1.4%) with a master’s degree or doctoral qualification. The majority were married (n=434, 66.9%) and had one or more children (n=392, 60.4%). Full demographic and professional characteristics are detailed in \u003cstrong\u003eTable 1.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of levels of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003edepression\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepression levels did not differ significantly across demographic groups. Detailed results are presented in \u003cstrong\u003eTable 1\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e Differences in depression among nurses by Socio-demographic characteristic of participants (N = 649)\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003cstrong\u003es\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eN（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eH(Z)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.718\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.869\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e≤29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e279(43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e30-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e268(41.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e40-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e76(11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e≥50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.906\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.365\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e580(89.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e69(10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical experience\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.787\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.079\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e84(12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e3-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e138(21.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e6-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e141(21.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e＞10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e286(44.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.669\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.445\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSenior high school and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eJunior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e153(23.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBachelor degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e479(73.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMaster degree and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepartment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.641\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.234\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eInternal medicine ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e135(20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSurgery ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e121(18.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePsychiatry\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e122(18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eEmergency room\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55(8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOutpatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12(1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20(3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOperating room\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27(4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGynaecology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49(7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePaediatrics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100(15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfessional title\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.734\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.865\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e392(60.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e203(31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAssociate senior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51(7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSenior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3(0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.801\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.284\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e442(68.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNursing team leaders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91(14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHead nurses and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e72(11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44(6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.601\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.659\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e198(30.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e434(66.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDivorces\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOnly child or not\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.946\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e217(33.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e432(66.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFertility status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.590\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.899\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eChildless\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e257(39.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e1 Chlid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e248(38.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2 Children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e141(21.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e3 Children or above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3(0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003csup\u003ea.\u003c/sup\u003ep-values derived from Mann-Whitney U (binary), Kruskal-Wallis H (multi-category).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelations among the major variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResults of Spearman's correlation analysis showed that nurses' depression levels were positively correlated with experiences of IS, IPV as well as with WPV. At the same time, depression, IPV, WPV and IS were all interrelated with each other. This is consistent with hypothesis 1. See \u003cstrong\u003eTable 2\u003c/strong\u003e for further details.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e The correlations among the continuous variables by Spearman’s Correlation (N=649)\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003cstrong\u003es\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMedian\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 (0-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eImpostor syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38 (26-54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003cstrong\u003e.453\u003c/strong\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIntimate partner violence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5 (5-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003cstrong\u003e.251\u003c/strong\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003cstrong\u003e.178\u003c/strong\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWorkplace\u0026nbsp;Violence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0-1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003cstrong\u003e.252\u003c/strong\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003cstrong\u003e.196\u003c/strong\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003cstrong\u003e.259\u003c/strong\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003csup\u003ea.\u003c/sup\u003eBold values indicate statistically significant associations (*p \u0026lt; 0.05, **p \u0026lt;0.01).\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb.\u003c/sup\u003eAbbreviations: IQR, Inter quartile Range.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMultiple linear regression\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFactors associated with depression were included in the stepwise multiple linear regression. Continuous variables were standardized using z-score transformation. The results revealed that IS (β=0.386, 95% CI: 0.316 to 0.456), IPV (β=0.134, 95% CI: 0.065 to 0.204), WPV (β=0.136, 95% CI: 0.066 to 0.205) was considered to be a factor that can contribute to the depression. See \u003cstrong\u003eTable 3\u003c/strong\u003e for further details.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTab\u003c/strong\u003e\u003cstrong\u003ele 3\u003c/strong\u003e Multivariate linear regression analysis of depression as the dependent variable.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"565\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003cstrong\u003es\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eβ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003et\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003cstrong\u003e-Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eLLCI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eULCI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eImpostor syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.386\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.386\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.888\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.456\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIntimate partner violence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.789\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.204\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWorkplace\u0026nbsp;Violence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.825\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.205\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003csup\u003ea.\u003c/sup\u003e***p\u0026lt;0.001\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStructural equation modeling of the association between\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eWPV\u003c/strong\u003e\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eIPV\u003c/strong\u003e\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eIS\u003c/strong\u003e\u003cstrong\u003e, and depression\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eModel Fit Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo determine the links between these factors, a path analysis was performed, including the construction of a mediation model and parameter estimation. SPSS AMOS 28.0 was used to construct a SEM model, with IPV and WPV as the independent variable, depression as the dependent variable, and IS as the mediating variable, to evaluate the indirect and direct effects among variables. The collected observation data were in alignment with the structural model, as illustrated in \u003cstrong\u003eFig 3\u003c/strong\u003e. The results indicate that all model fit indices in this study meet the criteria for good fit, specifically: χ2= 74.052, χ2/ df = 1.543, GFI = 0.982, AGFI = 0.970, CFI=0.992, TLI=0.989, RMSEA= 0.029, SRMR=0.027.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscriminant Validity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDistinctiveness validity is used to examine the degree of statistical differentiation among latent variables. This study employed the Fornell-Larcker criterion, which requires the square root of the average variance extracted (AVE) for a latent variable to exceed its correlation coefficient with any other latent variable. As shown in\u0026nbsp;\u003cstrong\u003eTable 4\u003c/strong\u003e, the bolded values on the diagonal are all greater than the off-diagonal elements in their respective rows and columns. This result indicates that the shared variance between any latent variable and its measurement indicators is greater than the shared variance between that latent variable and any other latent variable. This confirms that the measurement model possesses good discriminant validity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConvergent validity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConvergent validity assesses the degree of convergence among observed variables measuring the same latent construct. This study employed composite reliability (CR), AVE, and factor loadings for comprehensive evaluation. As shown in\u0026nbsp;\u003cstrong\u003eTable 4\u003c/strong\u003e, all observed variables exhibited standardized factor loadings exceeding 0.5 on their corresponding latent variables. The CR values for all latent variables exceeded the critical threshold of 0.7, indicating excellent internal consistency reliability of the measurement model. Furthermore, the AVE values for each latent variable surpassed the benchmark of 0.5, signifying that the variance explained by each latent variable exceeded the variance attributable to measurement error. This fully demonstrates the measurement model's strong convergent validity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTab\u003c/strong\u003e\u003cstrong\u003ele\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e4\u003c/strong\u003e Aggregate and discrimination validity measures for models\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eConstruct\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDimension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eUnstd\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eS.E.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003et-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFactor loadings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAVE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eWPV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIPV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWPV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWPV1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.772\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.778\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.738\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWPV2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.995\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.980\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.840\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWPV3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.347\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.575\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIPV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIPV1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.641\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.846\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.652\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.807\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIPV2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.739\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16.721\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.920\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIPV3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.836\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eZWHY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.763\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.800\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.572\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.756\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWJGY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.612\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.358\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.694\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBDWZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.659\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.805\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.808\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDP1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.745\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.861\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.674\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.245\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.501\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.821\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDP2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20.215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.864\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDP3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20.155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.849\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003ea.\u003c/sup\u003eThe bold numbers on the diagonal represent the square roots of the corresponding variable AVE.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e.Abbreviations: AVE, Average Variance Extracted, CR, Composite Reliability.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ec\u003c/sup\u003e\u003csup\u003e.\u003c/sup\u003e***p\u0026lt;0.001\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMediation Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe bias-corrected Bootstrap method was used to test the mediating effect model, and the sample was repeated 2000 times to test the significance of the mediating effect, and the 95% CI was calculated. \u003cstrong\u003eTable 5\u003c/strong\u003e results show that all path coefficients do not include 0 and Z \u0026gt; 1.96 in the bootstrap 95% CI. Thus, IS partially mediated the relationship between IPV and depression, as well as the relationship between WPV and depression.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eBootstrap test of the mediating effect of impostor syndrome\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEffect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eβ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eZ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eBias-Corrected\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e95%CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentile\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e95%CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eStandardized direct effects\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIPV to DP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.216\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWPV to DP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.455\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.241\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIPV to IS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.417\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.255\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWPV to IS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.259\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIS to DP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.452\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.692\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.552\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eStandardized indirect effects\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIPV to DP via IS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWPV to DP via IS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.846\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eStandardized total effects\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIPV to DP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.281\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.284\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWPV to DP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.354\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.305\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003ea.\u003c/sup\u003eBold values indicate statistically significant associations (***p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb.\u003c/sup\u003eAbbreviations: DP, Depression.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ec\u003c/sup\u003e\u003csup\u003e.\u003c/sup\u003e***p\u0026lt;0.001\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDirect and indirect effects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, the total effect was decomposed into direct and indirect effects. As shown in \u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e5\u003c/strong\u003e and\u003cstrong\u003e\u0026nbsp;Fig 3\u003c/strong\u003e, IS served as a mediating variable that partially mediated the relationship between IPV, WPV, and depression. Specifically, the estimated total effect of IPV on depression was β = 0.188 (95% CI: 0.097 to 0.284); the estimated direct effect of IPV on depression was β = 0.114 (95% CI: 0.017 to 0.216); and the estimated indirect effect of IPV on depression was β = 0.074 (95% CI: 0.028 to 0.123), which explained 39.36% of the total effect of IPV on depression. In addition, IS mediated the association between WPV and depression, with a total effect size estimate of β = 0.209 (95% CI: 0.113 to 0.305); a direct effect size estimate of β = 0.135 (95% CI: 0.025 to 0.241) for WPV on depression; and an indirect effect size estimate of β = 0.074 (95% CI: 0.025 to 0.126), and this indirect effect explained 35.41% of the total effect of WPV on depression. These results suggest that IS mediates the relationship between IPV, WPV, and depression, which is consistent with Hypothesis 2.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study utilised structural equation modelling to examine the mediating role of IS in the relationships between IPV, WPV, and depression. Path analysis confirmed that IPV, WPV, and IS were all significant positive predictors of depression. Moreover, IPV and WPV were found to exert both direct effects on depression and indirect effects mediated through IS. The hypothesised model demonstrated a satisfactory fit to the observed data, as indicated by standard model fit indices.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eThe direct effect of Intimate partner violence and Workplace violence on depression\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExtant research demonstrates that violence is a potent predictor of depression. Women experiencing IPV face a threefold increased risk of depression[41], while nurses exposed to WPV are 2\u0026ndash;4 times more likely to develop depressive symptoms[42]. The present findings are congruent with this established evidence. The mechanisms underlying this relationship are well elucidated: IPV often induces chronic fear, erodes self-worth, and creates persistent psychological stress that fosters depression[43].Similarly, WPV can precipitate significant psychological distress and cognitive distortions, including persistent sadness, insecurity, and diminished self-esteem, that are intrinsically linked to depressive onset[44].\u003c/p\u003e\n\u003cp\u003eThe nursing profession confers specific vulnerabilities to both IPV and WPV. Professionally, nurses operate as frontline healthcare workers under considerable pressure, interacting directly with patients and families who may vent anxieties as aggression, thereby increasing WPV risk. Personally, high-intensity work and emotional exhaustion can deplete the emotional resources necessary for harmonious domestic relationships. This, compounded by irregular shift patterns that disrupt family life, can exacerbate partner conflict and elevate IPV risk[45].\u003c/p\u003e\n\u003cp\u003eConsequently, a multi-level intervention strategy is imperative. Primarily, preventive institutional measures are required to mitigate triggers. These include implementing scientifically designed shift systems to ensure rest and work-life balance, protecting nurses\u0026apos; rest periods from non-essential encroachments, and advancing legal and policy frameworks that explicitly prohibit WPV, thereby creating a safer structural environment.\u003c/p\u003e\n\u003cp\u003eGiven that some violent incidents may remain unavoidable, secondary intervention through early identification and support is equally crucial. Healthcare institutions must establish effective mechanisms to identify nurses affected by violence and provide timely support to mitigate psychological sequelae. This study highlights a critical, measurable indicator for such screening: the presence of IS. As a maladaptive cognitive state marked by self-doubt, IS can serve as an early warning signal that a nurse exposed to violence is developing the negative cognitive biases that potentiate depression. Early identification of IS thus represents a strategic point for targeted psychological intervention to disrupt the pathway from violence to depression.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eThe partial mediating roles of impostor syndrome\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIS is highly prevalent among healthcare workers[28, 46]. Substantial evidence identifies IS not merely as a correlate but as a key factor in the development of psychological morbidity, including depression and anxiety[47], and it significantly elevates the risk of suicide in this population[48]. However, research specifically examining the impact of IPV and WPV on nurses\u0026apos; IS remains limited. This study demonstrated that IS plays a significant mediating role in the relationships between WPV, IPV, and depression.\u003c/p\u003e\n\u003cp\u003eThe proposed pathways through which WPV and IPV may precipitate IS are multifaceted. Firstly, violent experiences can directly instigate the negative cognitive patterns central to IS. Evidence suggests that exposure to belittling or disrespectful treatment in the workplace significantly erodes an individual\u0026apos;s belief in their capability to complete tasks successfully, fostering professional inferiority and self-doubt[49]. Similarly, IPV is known to severely damage self-worth, acting as a potent catalyst for pervasive self-doubt[50]. This persistent internal questioning of one\u0026apos;s competence and achievements corresponds closely with the core characteristics of IS. Secondly, violence may indirectly foster IS by undermining the foundations of positive self-evaluation. Social evaluation theory posits that external feedback is pivotal in constructing self-perception and self-esteem[51]. Positive social evaluations bolster self-esteem and group-valued identity, buffering against IS, whereas persistent negative evaluations promote negative self-schemas and lower self-esteem, thereby inducing IS[52]. For nurses, both WPV and IPV represent profound sources of negative feedback. WPV exposure is linked to loss of confidence, increased shame, and diminished self-esteem[53], while IPV severely impairs self-efficacy and self-worth[54]. These mechanisms collectively elucidate how experiences of violence become significant antecedents of IS.\u003c/p\u003e\n\u003cp\u003eFurthermore, IS is a well-established predictor of depression, with several mechanisms explaining this progression within the nursing context. Individuals with pronounced IS tendencies are prone to internalising criticism, leading to chronic experiences of shame and embarrassment. The cumulative burden of these negative emotions substantially increases vulnerability to depression[55]. The nursing profession exacerbates this dynamic; perceived as an environment where error is intolerable, it imposes immense pressure for perfection. This pressure, compounded by shift-work-induced sleep disturbance and additional external demands (e.g., research obligations), creates a high-stress occupational milieu. Within such an environment, the negative self-appraisal, perfectionism, and intense fear of failure characteristic of IS not only perpetuate psychological strain but may also synergise with occupational stressors, creating a vicious cycle that markedly elevates the risk of depressive onset[56].\u003c/p\u003e\n\u003cp\u003eIn synthesis, exposure to IPV or WPV heightens the likelihood of developing IS. IS, with its associated cognitive and affective burdens, significantly exacerbates an individual\u0026apos;s risk for depression. This study therefore confirms H2, demonstrating that IS acts as a significant mediator in the pathways linking both WPV and IPV to depression.\u003c/p\u003e\n\u003cp\u003eNurses constitute the core human resource within healthcare systems, and their psychological well-being directly impacts care quality and patient safety. However, depression, WPV, IPV, and IS represent prevalent and significant occupational health challenges within this workforce. A critical complicating factor is the low rate of voluntary reporting by nurses following violent incidents[57], which impedes early identification and timely support, creating substantial barriers to effective intervention. Consequently, healthcare institutions urgently require systematic strategies to mitigate the adverse effects of these issues on workforce stability and healthcare system resilience.\u003c/p\u003e\n\u003cp\u003eThe present study offers important insights for safeguarding nurses\u0026rsquo; mental health. Moving beyond the established direct association between violence and depression, it identifies IS as a crucial mediating variable. This finding provides a novel theoretical perspective for understanding the psychological mechanisms underpinning nurses\u0026rsquo; depression and establishes an evidence-based foundation for developing targeted interventions.\u003c/p\u003e\n\u003cp\u003eSpecifically, the research findings reveal key entry points for addressing depression as a mental health issue. Previous research indicates that strong social support and targeted psychological interventions are central to helping nurses counteract the effects of WPV and IPV and ameliorate IS[58, 59]. Therefore, it is recommend that healthcare organisations integrate validated IS assessments into routine occupational health monitoring and psychological screening programmes to facilitate the early identification of high-risk individuals.\u003c/p\u003e\n\u003cp\u003eFor nurses who have experienced IPV or WPV, immediate access to professional support, such as cognitive restructuring and counselling, should be provided to disrupt the pathway from IS to depression. At an organisational level, nursing management must actively foster a culture that encourages the proactive reporting of violence, backed by efficient, confidential reporting and response mechanisms[57]. This ensures affected nurses receive institutional support and guidance promptly, thereby reducing the likelihood that violent experiences become internalised as IS.\u003c/p\u003e\n\u003cp\u003eFurthermore, investment in cultivating a supportive, collaborative work environment and positive team culture is essential. Such systemic measures address the root causes of the distorted self-evaluations characteristic of IS, build psychological resilience, and ultimately enhance the holistic well-being and professional retention of the nursing workforce.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eStrengths and limitations:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employed structural equation modelling and confirmed that, within the nursing population studied, IS exerts a significant mediating effect on both the WPV-depression and IPV-depression pathways. This finding clarifies a previously underexplored psychological mechanism, providing a novel theoretical perspective for understanding the development of depression among nurses.\u003c/p\u003e\n\u003cp\u003eSeveral limitations of this study must be acknowledged. First, the cross-sectional design establishes associations but cannot determine causality or elucidate the dynamic pathways between violence exposure, IS, and depression. Longitudinal or interventional studies are needed to verify the proposed causal chain. Second, while the mediating role of IS was confirmed, the potential buffering effect of factors such as self-esteem within the violence-IS-depression pathway was not explored. Third, the sample consisted solely of registered nurses from selected provinces in China, which may limit the generalisability of the findings to other cultural contexts or healthcare systems. Multinational studies are required to validate the universality of these mechanisms.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study confirms that IS is a key mediating factor linking both WPV and IPV to depression. The results suggest that prolonged exposure to violent environments may increase nurses\u0026apos; risk of depression by fostering the negative cognitive and psychological patterns characteristic of IS. Consequently, the accurate identification and targeted management of IS are crucial. It is recommend the integration of validated IS assessments into routine occupational health monitoring and psychological screening programmes. Concurrently, healthcare institutions should establish personalised support systems for nursing staff. Implementing these measures would not only help mitigate the psychological impact of violence but also directly address the detrimental effects of IS, thereby safeguarding nurses\u0026apos; mental health and enhancing the overall quality and reliability of healthcare delivery.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to thank the study participants for their contribution to the research, as well as current and past investigators and staff.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003econtributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXH and NL developed the statistical framework for data analysis,conducted the statistical analysis,interpreted thedata and drafted the manuscript. JJW and LH, along with others, participated in the formulation of the research design and analytical framework. YW were involved in the study design, interpreta-tion of the data, development of thestatistical framework and reviewed the manuscript.All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ethics Committee of west China hospital, Sichuan university (No. 1581). All participants were informed about all the details of this study and agreed to participate in this survey. Informed consent of all the participants were obtained.All methods were carried out in accord-ance with Declaration of Healsinki.\u003c/p\u003e\n\u003cp\u003eConsent for publication Not applicable. Competing interests\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMeng X, Wang Y, Jiang Y, Li T, Duan Y. Mental health survey among front-line medical workers after 2 years of supporting COVID-19 efforts in Hubei Province. PLoS ONE. 2023;18(10):e0287154.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParthasarathy R, Ts J, K T, Murthy P. Mental health issues among health care workers during the COVID-19 pandemic - A study from India. 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Acad psychiatry: J Am Association Dir Psychiatric Resid Train Association Acad Psychiatry. 2019;43(4):381\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl-Ashry AM, Taha SM, Elhay ESA, Hammad HA, Khedr MA, El-Sayed MM. Prevalence of imposter syndrome and its association with depression, stress, and anxiety among nursing students: a multi-center cross-sectional study. BMC Nurs. 2024;23(1):862.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang L, Chang H, Peng X, Zhang F, Mo B, Liu Y. Formally reporting incidents of workplace violence among nurses: A scoping review. J Nurs Adm Manag. 2022;30(6):1677\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDias NG, Costa D, Soares J, Hatzidimitriadou E, Ioannidi-Kapolou E, Lindert J, Sundin \u0026Ouml;, Toth O, Barros H, Fraga S. Social support and the intimate partner violence victimization among adults from six European countries. Fam Pract. 2019;36(2):117\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhalil AI, Alharbi R, Al Qtame H, Al Bena R, Khan MA. Investigating the association between resilience and impostor syndrome in undergraduate nursing and medical students: a cross-sectional study. J Med Life. 2024;17(9):868\u0026ndash;79.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Impostor syndrome, Workplace violence, Intimate partner violence, Depression, Nurse","lastPublishedDoi":"10.21203/rs.3.rs-8596940/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8596940/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eDepression is a global mental health concern and demonstrates high prevalence among nurses, significantly impairing their quality of life. Previous studies have identified impostor syndrome (IS), workplace violence (WPV), and intimate partner violence (IPV) as risk factors for depression. It has been hypothesised that WPV and IPV may promote the development of IS, which in turn could lead to depression; however, these relationships have not been empirically confirmed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAims: \u003c/strong\u003eThis study aimed to examine the mediating role of IS in the relationships between WPV, IPV, and depression among nurses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA multi-centre, cross-sectional survey was conducted with 742 enrolled nurses. The mediating effect of IS was analysed using bootstrap methods in SPSS Amos 28.0.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eIS significantly mediated the relationship between WPV and depression (β=0.074, 95% CI 0.025 to 0.126), accounting for 35.41% of the total effect. IS also mediated the relationship between IPV and depression (β=0.074, 95% CI 0.028 to 0.123), accounting for 39.36% of the total effect.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe findings indicate that IPV, WPV, and IS are significant predictors of depression in nurses. Exposure to IPV and WPV may exacerbate depressive symptoms by intensifying IS. For nurses who have experienced violence, early identification and intervention targeting IS are therefore crucial to mitigate the risk of depression.\u003c/p\u003e","manuscriptTitle":"The Impact of Workplace Violence and Intimate Partner Violence on Depression Among Nurses: The Mediating Role of Impostor Syndrome","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-16 09:38:33","doi":"10.21203/rs.3.rs-8596940/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-09T11:00:07+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-02T19:32:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"255730859462856004557907034142837358365","date":"2026-03-19T12:38:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"212703354390033583436936070672518843951","date":"2026-03-17T11:32:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"172207048211895074169154283451007086749","date":"2026-03-17T11:12:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-17T06:41:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-16T10:04:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"194200134082429226161480671448346687408","date":"2026-02-11T11:44:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"54393529940983978371598164634200890946","date":"2026-02-11T11:24:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-11T10:52:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-19T13:51:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-16T10:59:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-16T10:56:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2026-01-14T03:16:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"45b77e77-9afa-4ca5-ac8c-24411e248dce","owner":[],"postedDate":"February 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-22T07:38:21+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-16 09:38:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8596940","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8596940","identity":"rs-8596940","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}