Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journa.
A Journal of Nursing Values.
Innovation.
Collaboration, and Global Impact Volume 12.
Issue 2.
April 2026 Published by STIKep PPNI Jawa Barat ISSN 2354-8428, e-ISSN 2598-8727 Review Article The Relationship Between Resilience and NursesAo Mental Health:
A Systematic Review Amani Istiqomah1.
Bangun Mukti Ardi2 1Poltekkes Kemenkes Jakarta I.
Indonesia 2Airlangga University Hospital Abstract Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journa.
Volume 12 .
, 231-241 https://doi.
org/10.
33755/jkk.
Article info Received Revised Accepted Published April 01, 2026 April 19, 2026 April 23, 2026 April 24, 2026 Corresponding author Amani Istiqomah* Department of nursing.
Poltekkes Kemenkes Jakarta I Jl.
Wijaya Kusuma No.
RT.
8/RW.
Pd.
Labu.
Kec.
Cilandak.
Kota Jakarta Selatan.
Daerah Khusus Ibukota Jakarta Email:
istiqomah@poltekkesjakarta1.
Citation Istiqomah.
, & Ardi.
The relationship between resilience and nursesAo mental health: A systematic Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journa.
, 12.
, 231Ae241.
https://doi.
org/10.
33755/jkk.
Website https://journal.
stikep-ppnijabar.
id/jkk This is an Open Access article distributed under the terms of the Creative Commons Attribu tion-NonCommercial 4.
International License p-ISSN : 2354 8428 e-ISSN: 2598 8727 Background: Nurses face chronic work-related stress burdens that lead to mental health problems such as depression, anxiety, stress, burnout, and sleep disorders, while suboptimal resilience levels may increase nursesAo mental health vulnerability.
Objective: This systematic review aimed to synthesize recent evidence on the relationship between resilience and mental health outcomes among nurses.
Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
A structured search was conducted in Scopus.
PubMed.
ScienceDirect, and Web of Science to identify articles published in English between 2021 and 2025.
Original quantitative studies that examined the association between resilience and mental health outcomes among nurses were Two reviewers independently screened the records, assessed eligibility, and resolved disagreements through Methodological quality was appraised using the Joanna Briggs Institute Critical Appraisal Checklist.
Due to heterogeneity in study measures and outcomes, findings were synthesized Results: A total of 1319 records were identified, of which 10 studies met the inclusion criteria.
Resilience was consistently associated with lower levels of depression, anxiety, psychological distress, burnout, and fatigue among nurses.
Higher resilience was also associated with better psychological well-being, professional quality of life, occupational adaptation, and job satisfaction.
Several studies suggested that resilience functioned as a mediating factor in the relationship between occupational stressors and mental health outcomes, while burnout also emerged as an important Conclusion: Resilience is consistently associated with more favorable mental health outcomes among nurses.
However, the available evidence is limited to cross-sectional research, preventing causal inference.
Strengthening resilience may represent a promising strategy to support nursesAo mental health, but future longitudinal and intervention studies are needed.
Keywords: Anxiety.
mental health.
systematic review factors, with a high burden of depression, anxiety, stress, burnout, sleep disturbances, and emotional exhaustion resulting from chronic work pressure, staff shortages, long shifts, and workplace violence .
These conditions not INTRODUCTION Mental health problems among nurses encompass a range of psychological disorders influenced by biological, social, and economic Jurnal Keperawatan Komprehensif.
Volume 12 Issue 2.
April 2026 Resilience and NursesAo Mental Health: A Systematic Review only adversely affect nursesAo health but also compromise patient safety and organizational performance, including reduced quality of life and job satisfaction, increased risk of chronic illness, and higher rates of absenteeism, turnover, and low workforce retention .
Ae.
Globally, numerous reviews and meta-analyses have reported a high prevalence of anxiety, depression, stress, insomnia, and burnout among nurses across various healthcare settings, including during and after the pandemic .
, which further contributes to declining quality of care and threatens the sustainability of healthcare systems .
Ae.
This systematic review therefore aimed to synthesize recent evidence on the relationship between resilience and mental health outcomes among nurses.
Specifically, this review examined whether resilience is associated with lower levels of depression, anxiety, burnout, psychological distress, fatigue, and related adverse outcomes, as well as whether it is associated with higher well-being, professional quality of life, and job In this context, resilience is considered a key protective factor that enables nurses to adapt to work-related stress and maintain mental wellbeing.
However, nursesAo resilience levels are generally reported to be low to moderate and insufficient to counterbalance high levels of occupational stress .
Ae.
Consistent evidence indicates that resilience is negatively associated with depression, anxiety, stress, burnout, and psychological distress, and positively associated with psychological well-being, post-traumatic growth, job satisfaction, and quality of life .
,14Ae.
Nevertheless, under conditions of high workload and limited organizational support, high resilience alone may not be sufficient to fully protect nurses from mental health problems .
This systematic review was conducted in accordance with the PRISMA guidelines.
The review focused on quantitative evidence examining the relationship between resilience and mental health outcomes among nurses.
METHODS
Overview Search Strategy This systematic review followed PRISMA A structured literature search was conducted in Scopus.
PubMed.
ScienceDirect, and Web of Science.
The search strategy used Boolean operators combining key terms related to nurses, resilience, and mental health outcomes.
The keywords used were Aunurses,Ay Auresilience,Ay and Auburnout,Ay Audepression,Ay Auanxiety,Ay Aupsychological distress,Ay with the search string formulated as: (AunursesA.
AND (AuresilienceAy OR Aupsychological resilienceA.
AND (AuburnoutAy OR AudepressionAy OR AuanxietyAy OR Aupsychological distressA.
Equivalent terms were adapted for each database.
The inclusion criteria were original research articles published in English between 2021 and 2025 that examined the relationship between resilience and mental health among nurses.
All search results were imported into Mendeley Desktop to remove Study selection was conducted independently by two reviewers, and Various structured psychological interventions, such as mindfulness-based stress reduction, emotional intelligence training, and resilience training, have been shown to improve well-being and reduce psychological symptoms, although the effectiveness and sustainability of these effects remain variable .
However, previous systematic reviews and meta-analyses have primarily focused on prevalence, determinants, or intervention effectiveness, often combining multiple healthcare professions or examining only a limited range of mental health outcomes.
Consequently, these studies have not provided a comprehensive synthesis of the relationship between resilience and the full spectrum of mental health indicators, specifically among nurses .
,12,14,.
Selection Criteria Studies were selected based on predefined eligibility criteria using the PEO framework (Population.
Exposure.
Outcom.
The criteria were applied to identify relevant articles for inclusion in this review.
Jurnal Keperawatan Komprehensif.
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April 2026 Istiqomah et al.
Table 1.
Selection Criteria Criteria Inclusion Exclusion Population Studies involving nurses .
egistered nurses or nursing staf.
working in healthcare settings.
Studies professionals or mixed populations where nurse-specific data cannot be separated.
Exposure Studies resilience/psychological resilience using validated or standardized instruments.
Studies assessing coping or other psychological variables without explicit measurement of resilience.
Outcome Studies reporting the association between resilience and mental health outcomes .
, depression, anxiety, stress, burnout, psychological distress, sleep problems, well-being, quality of Studies reporting only non-psychological .
satisfaction, turnove.
without mental health indicators.
Study design Quantitative observational studies .
cross-sectional, associations between resilience and mental health.
Qualitative studies, reviews, editorials, primarily evaluating resilience programs.
Quality Assessment across the majority of studies in the same The role of resilience .
, predictor, mediator, or moderato.
was also considered in the synthesis.
Methodological quality and risk of bias of the included studies were assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for analytical cross-sectional studies.
This tool evaluates key domains including sampling bias, measurement validity, confounding factors, response bias, and the adequacy of statistical The results of the quality appraisal were used to inform the interpretation of findings, with greater emphasis placed on studies with higher methodological quality.
RESULTS
Searching results Based on the literature search, a total of 1.
records were identified from four databases:
Scopus .
= .
ScienceDirect .
= .
PubMed .
= .
, and Web of Science .
= .
After removing 650 duplicate records, 669 records remained for screening.
Title screening was conducted on these 669 records, resulting in the exclusion of 418 records that were not relevant or not classified as research articles.
The remaining 251 records were then sought for Of these, 144 records could not be retrieved due to irrelevant titles and abstracts or inaccessibility of the full text, leaving 107 reports to be assessed for eligibility.
During the full-text review, 97 articles were excluded because they did not focus on nurses .
= .
or did not discuss mental health .
= .
Finally, 10 studies met the inclusion criteria and were included in this systematic review.
The article selection process is illustrated in the PRISMA flow diagram.
Data analysis Data were analyzed using a structured narrative synthesis approach, as meta-analysis was not feasible due to heterogeneity in outcome measures and study designs.
Extracted data were organized into mental health outcome domains, psychological distress, sleep problems, and job Studies were grouped and compared within each outcome domain to identify patterns and relationships between resilience and mental health outcomes.
The direction .
ositive or negativ.
and consistency of associations were assessed across studies.
Consistency was determined by the recurrence of similar findings Jurnal Keperawatan Komprehensif.
Volume 12 Issue 2.
April 2026 Resilience and NursesAo Mental Health: A Systematic Review Screening Identification Records identified from*:
Databases .
= .
Records removed before screening:
Scopus .
= 305 ) Duplicate records removed Science Direct .
= .
Records screened Records excluded** .
= .
Not a research journal Reports sought for retrieval Reports not retrieved due to irrelevant titles/abstracts or inaccessible full texts .
= 251 ) .
= .
Reports assessed for eligibility Reports excluded:
= .
Not focus on nurse .
= .
Included Does not address mental health Studies included in review .
= 10 ) Reports of included studies Figure 1.
PRISMA Flow Diagram Study characteristics Resilience Scale, and Brief Resilience Scale.
Mental health outcomes were assessed using standardized tools such as DASS-21.
PHQ-2.
GAD2.
PASS-4.
GHQ-12.
WHO-5 Well-Being Index.
PROMIS Global Health.
Maslach Burnout Inventory (MBI).
ProQOL, and pandemic fatigue The The methodological heterogeneity, which may limit direct comparability across studies.
A total of 10 cross-sectional studies from 8 countries were included: China .
Spain .
Saudi Arabia .
Greece .
Taiwan .
Peru .
, and the Philippines .
All studies examined psychological resilience among nurses and its association with mental health outcomes, including depression, anxiety, psychological distress, burnout, sleep problems, and psychological well-being, as well as selected occupational outcomes such as job satisfaction, professional quality of life, and pandemic fatigue.
Resilience was measured using validated instruments, including the ConnorAeDavidson Resilience Scale (CD-RISC, including CD-RISC.
Resilience Scale-14 (RS-.
Mental Respondent characteristics Participants were predominantly hospital-based nurses, mostly female, aged 20Ae40 years, with varying levels of clinical experience.
Most held a bachelorAos degree in nursing.
Studies were largely Jurnal Keperawatan Komprehensif.
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April 2026 Istiqomah et al.
conducted during or shortly after the COVID-19 pandemic .
1Ae2.
Several focused on psychiatric/mental health nurses, while others included newly graduated nurses or general clinical nurses.
Variations in clinical settings, career stages, and pandemic-related contexts contributed to heterogeneity across studies.
Burnout and emotional exhaustion were commonly reported, particularly among nurses in high-demand clinical settings.
More than 60% of nurses in one study reported moderate-to-high burnout levels .
Higher resilience was consistently associated with lower burnout and better professional quality of life.
Several studies identified burnout as a mediator in the relationship between resilience and mental health outcomes.
For example, in China, burnout partially mediated the effect of resilience on psychological outcomes, indicating that lower resilience increases emotional exhaustion, which in turn worsens mental health .
Similar patterns were observed in psychiatric nurses .
Quality Appraisal The methodological quality of the included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist.
Overall, 90% of the studies .
were rated as high quality with a low risk of bias, while one study was rated as moderate quality.
Despite its limitations, the moderate-quality study showed findings consistent in direction with the higherquality studies.
No studies were excluded based on quality assessment.
however, study quality was considered in the interpretation of findings.
Positive Well-Being Outcomes Resilience demonstrated a consistently positive association with psychological well-being and professional quality of life.
In Saudi Arabia, 58% of psychiatric nurses were classified as flourishing, with moderate-to-high resilience levels despite high emotional demands .
Other studies reported positive associations between resilience and well-being measures (WHO-5.
PROMIS) as well as compassion satisfaction, alongside negative associations with burnout and fatigue .
These findings suggest that resilience functions not only as a protective factor against negative outcomes but also as a resource that enhances positive psychological Outcome Domains Negative Psychological Symptoms (Depression.
Anxiety.
Psychological Distres.
Across all studies assessing these outcomes, resilience showed a consistently negative association with depression, anxiety, and psychological distress.
In China, approximately 38Ae40% of nurses reported poor mental health (GHQ-.
, with higher depression levels observed among those with high work stress and low resilience .
Similar findings were reported in Spain and Peru, where resilience remained a significant independent predictor of lower depressive symptoms after controlling for confounders .
Occupational-Related Outcomes Satisfaction and Pandemic Fatigu.
Occupational outcomes were analyzed separately due to their conceptual distinction from core mental health indicators.
Resilience was positively associated with job satisfaction and adaptation, particularly among newly graduated nurses, where it supported early career adjustment and coping with professional stress .
Pandemic fatigue was associated with lower resilience, high workload, and insufficient organizational support.
Although closely related to mental health, it was conceptualized as a context-specific influenced by pandemic-related stressors.
Anxiety was also prevalent, particularly among younger and female nurses and those working in high-intensity settings .
In Taiwan, 36.
of nurses reported anxiety symptoms during COVID-19 .
Across studies, higher resilience was consistently associated with lower anxiety and distress levels, despite variations in measurement tools and effect sizes.
Occupational Mental (Burnout and Fatigu.
Health (Job Outcomes Jurnal Keperawatan Komprehensif.
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April 2026 Resilience and NursesAo Mental Health: A Systematic Review Table 2.
Article Review Summary Title Design Research Findings Relationships between emotional intelligence, mental resilience, and adjustment disorder in novice nurses: a crosectional study in China D: Cross-sectional S: 445 new nurses V: resilience, emotional intelligence, adjustment I: Mental Resilience Scale.
CDRISC-10.
EI scale A: Chi-square, logistic Higher emotional intelligence is associated with greater resilience and lower psychological symptoms in nurses.
Resilience and EI are psychological stress.
Mediating Role of Resilience and Its Impact on Psychological WellBeing and Mental Distress among Mental Health Nurses .
D: Cross-sectional S: 250 mental health nurses V: resilience, psychological well-being, mental distress I: DASS-21.
RyffAos PWB.
CDRISC
A: Descriptive, t-test.
ANOVA.
Resilience.
Burnout and Mental Health in Nurses: A Latent Mediation Model D: Cross-sectional S: 1165 Spanish nurses V: resilience, burnout, mental health issues I: RS-14.
Maslach Burnout Inventory.
GHQ-28 A: SEM, latent mediation The research results report that the level of moderate-extreme stress is 66%, moderate-extreme anxiety is 56%, and depression is 25%.
Resilience relationship between psychological distress and PWB.
Higher distress is associated with lower resilience, and higher resilience is associated with higher PWB.
Increased resilience can reduce the negative impact of distress on nurses' wellbeing.
Resilience is negatively correlated with burnout and mental health 6 Ae 87% of the effect of resilience on mental health issues is mediated by burnout.
Burnout has proven to be a strong mediator between resilience and mental health, meaning that high resilience reduces burnout, which in turn improves nurses' mental health.
Psychological distress, well-being, resilience, posttraumatic growth, and turnover intention of mental health nurses during COVID-19: A crosectional study .
D: Cross-sectional S: 144 Australian mental health nurses V: Psychological distress, wellbeing, resilience, posttraumatic growth, turnover intention I: CD-RISC.
PROMIS Global Health A: T-test, linear regression About 30-50% experienced moderate to high distress during the pandemic.
High distress is associated with low resilience and well-being.
half of the nurses remained "flourishing.
The relationship between psychological resilience and professional quality of life among mental health nurses: a cross-sectional .
D: Cross-sectional S: 179 mental health nurses V: resilience, compassion satisfaction, burnout, secondary traumatic stress I: CD-RISC.
ProQOL A: correlation, regression Resilience is positively related to compassion satisfaction, negatively related to burnout and secondary traumatic stress.
Nurses with higher resilience tend to find positive meaning in their work and are better protected from emotional Jurnal Keperawatan Komprehensif.
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Title Design Relationship between nursesAo resilience and depression, anxiety and stress during COVID-19 in Taiwan .
Predictors of Depression in Nurses During COVID-19 Health Emergency The Mediating Role of Resilience .
Research Findings D: Cross-sectional S: 600 nurses V: resilience, depression, anxiety, stress I: standards DASS resilience A: correlation D: Cross-sectional S: 286 Peru nurses V: fear, stress, resilience.
I: Self-report questionnaire A: SEM, correlation The mediating and moderating role of psychological resilience between occupational stress and mental health of psychiatric nurses .
D: Cross-sectional S: 413 psychiatric nurses V: work stress, resilience, mental health I: Chinese NursesAo Stress Scale.
CD-RISC.
WEMWBS.
GHQ
A: Descriptive.
Spearmen mediation/moderation (SmartPLS) Pandemic fatigue and clinical nursesAo mental health, sleep quality, and job contentment during the COVID-19 pandemic: The mediating role of resilience .
D: Cross-sectional S: 225 clinical nurses V: pandemic fatigue, resilience, mental health, sleep quality, job satisfaction I: Pandemic Fatigue Questionnaire.
Brief Resilience Scale.
Job Contentment Scale.
Sleep Quality Scale A: Correlation, mediation The Mediating Role of Resilience in the Relationship between Perceived Stress and Mental Health D: Cross-sectional S: 214 Spanish nurses V: stress, resilience, wellbeing, anxiety, depression I: PSS-4.
RS-14.
WHO-5.
PHQ2.
GAD-2 A: correlation, mediation Regression analysis shows resilience as a strong ProQOL 33Ae40% of nurses experience depression, anxiety, or stress.
Higher resilience is associated with lower mental health problems.
The model shows that fear and stress predict depression.
mediates the effects of fear and stress on depression.
The research results show that 5% fall into the "positive mental health" category and 16.
7% into the "completely troubled" category.
Resilience has been shown to mediate the relationship between work stress and mental health, but not to moderate it.
High work stress reduces resilience, and low resilience is associated with more psychological symptoms and less well-being.
Pandemic fatigue is associated with worse mental health, lower sleep Resilience has been shown to partially mediate that relationship, so nurses with high resilience do not experience a decline in mental health and job satisfaction as severely as nurses with low resilience.
Resilience relationship between stress and various negative mental health High stress levels decrease resilience, which in turn increases depression, anxiety, and These findings confirm that interventions aimed at enhancing resilience have the psychological impacts of pandemic stress on nurses.
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Resilience and NursesAo Mental Health: A Systematic Review
DISCUSSION