# Adverse childhood experiences and personality traits associate with excessive fatigue in Norwegian nurses

## TL;DR

Norwegian nurses with adverse childhood experiences and certain personality traits are more likely to suffer from excessive fatigue.

## Contribution

The study identifies non-modifiable factors like adverse childhood experiences and personality traits as significant contributors to nurse fatigue.

## Key findings

- Nurses with adverse childhood experiences had over four times higher odds of excessive fatigue.
- Personality traits like high neuroticism and low conscientiousness were linked to increased fatigue risk.
- Workaholism and eveningness increased the likelihood of excessive fatigue.

## Abstract

Nurse fatigue may cause medical errors, absence and turnover. Prior research has largely emphasized modifiable factors like work schedules. This focus may overlook non‑modifiable individual factors that also meaningfully contribute to fatigue risk. This study therefore aimed to investigate the relationship between potentially non-modifiable factors and excessive fatigue in nurses.

This longitudinal cohort study investigated adverse childhood experiences and personality traits in relation to excessive fatigue in nurses. Adverse childhood experiences were assessed with four questions previously used in the Norwegian context. Personality traits included the Big Five traits (Mini-IPIP), morningness-eveningness (Horne and Östberg Morningness-Eveningness Questionnaire reduced scale), circadian type (flexibility and languidity, Circadian Type Inventory), and workaholism (Bergen Work Addiction Scale). Questionnaire data was collected at various time points from an ongoing cohort study known as the Survey of Shift work, Sleep, and Health (REK VEST, no. 088.88). Fatigue was assessed using the Chalder Fatigue Questionnaire and excessive fatigue was considered as scores of ≥4. The study sample included 741 non-pregnant Norwegian nurses. Logistic regression analyses were used to investigate associations between adverse childhood experiences, personality traits, and excessive fatigue.

Nurses who lacked a trusted adult in childhood (adjusted odds ratios (aOR) = 4.68, 95% CI = 1.97–11.11), reported bad memories (aOR = 4.94, CI = 2.70–9.03), or perceived their childhood as difficult (aOR = 4.53, CI = 2.40–8.57) had >4x the odds of excessive fatigue. High neuroticism (aOR = 2.37, CI = 1.56–3.59), low conscientiousness (aOR = 2.02, CI = 1.30–3.12), and high languidity (aOR = 5.01 CI = 2.98–8.39) increased odds of excessive fatigue. Morning types had lower (aOR = 0.65 CI = 0.45–0.93), while evening types had higher odds (aOR = 1.55 CI = 1.02–2.34) of excessive fatigue compared to intermediate types. Lastly, workaholism increased odds of excessive fatigue (aOR = 2.70 CI = 1.21–6.04).

In past literature, nurse fatigue has been studied in the context of pain, (shift)work, mental-health and other modifiable factors. This study indicates factors that are less modifiable and potentially difficult to address within the working environment, including adverse childhood experiences and personality traits, may nonetheless play important roles in excessive fatigue in nurses.